Overview

Scleritis is a serious inflammatory condition affecting the sclera, which is the white, outer protective layer of the eye. This condition results in significant eye redness, pain, and potential vision problems. Scleritis is often associated with autoimmune diseases and can affect one or both eyes. If left untreated, it can lead to severe complications, including vision loss. Prompt diagnosis and treatment are essential to prevent long-term damage and alleviate discomfort.

Causes

The primary cause of scleritis is inflammation, which is frequently linked to underlying systemic health conditions. Common causes include:

• Autoimmune diseases: Rheumatoid arthritis, systemic lupus erythematosus, granulomatosis with polyangiitis, and other connective tissue diseases are common contributors.
• Infectious causes: Rarely, bacterial, fungal, or viral infections can trigger scleritis, particularly after eye surgery or trauma.
• Idiopathic: In some cases, no specific cause is identified despite thorough testing.
• Trauma: Previous eye injuries or surgeries can occasionally lead to scleritis.
• Medications: Certain medications, especially those altering immune function, may contribute to inflammation in rare instances.

Symptoms

Scleritis presents with distinctive symptoms that help differentiate it from other, less severe eye conditions:

• Severe eye pain: Deep, boring pain that often radiates to the face, temple, or jaw and may worsen at night or with eye movement.
• Redness: Pronounced redness that typically involves the entire sclera and does not improve with lubricating drops.
• Blurred vision: Vision disturbances, including blurriness or decreased visual acuity.
• Light sensitivity: Increased sensitivity to light (photophobia).
• Tearing: Increased watery discharge without pus.
• Swelling: In some cases, swelling of the sclera or surrounding tissues may be noticeable.

Diagnosis

Accurate diagnosis of scleritis involves a comprehensive eye examination and additional tests to identify the underlying cause:

• Detailed eye examination: An ophthalmologist examines the sclera using a slit lamp to identify the type and severity of inflammation.
• Differentiation from episcleritis: Scleritis causes deeper pain and redness, while episcleritis is usually milder and self-limiting.
• Imaging tests: Ultrasound of the eye or MRI may be used in complex cases to assess scleral thickness and rule out posterior scleritis.
• Blood tests: Tests for rheumatoid factor, antinuclear antibodies (ANA), and other autoimmune markers can help identify underlying systemic disease.
• Infectious workup: If infection is suspected, relevant cultures or serological tests are performed.

Treatment

Treatment of scleritis focuses on controlling inflammation, alleviating symptoms, and addressing the underlying cause:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Used for mild cases, especially anterior scleritis.
• Corticosteroids: Oral or topical steroids are often prescribed for moderate to severe inflammation.
• Immunosuppressive therapy: Medications like methotrexate, azathioprine, or cyclophosphamide are used in autoimmune-related scleritis.
• Biologic agents: In refractory cases, biologic drugs such as rituximab or infliximab may be employed.
• Antibiotics or antivirals: In infectious scleritis, targeted antimicrobial therapy is necessary.
• Monitoring: Regular follow-ups with an ophthalmologist are crucial to assess response to treatment and prevent complications.

Prognosis

The prognosis of scleritis depends on the underlying cause, severity, and timeliness of treatment:

• Favorable outcomes with early treatment: Prompt intervention often results in symptom control and prevention of vision loss.
• Risk of complications: Untreated or severe scleritis can lead to complications like scleral thinning, perforation, glaucoma, cataracts, or permanent vision impairment.
• Chronic or recurrent disease: Some individuals experience recurring episodes, particularly in autoimmune-related scleritis.
• Importance of treating underlying disease: Managing systemic autoimmune conditions improves overall prognosis and reduces scleritis recurrence.

With appropriate medical care, many people with scleritis can achieve good symptom control and preserve their vision, highlighting the importance of early diagnosis and specialist care.