Scleritis
Inflammation - sclera
The sclera is the white outer wall of the eye. Scleritis is present when this area becomes swollen or inflamed.
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.
Causes
Scleritis is often linked to autoimmune diseases. These diseases occur when the body's immune system attacks and destroys healthy body tissue by mistake. Rheumatoid arthritis and systemic lupus erythematosus are examples of autoimmune diseases that can be associated with scleritis. Sometimes the cause is unknown.
Scleritis occurs most often in people between the ages of 30 and 60. It is rare in children.
Symptoms
Symptoms of scleritis include:
- Blurred vision
- Eye pain and tenderness -- severe
- Red patches on the normally white part of the eye
- Sensitivity to light -- very painful
- Tearing of the eye
A rare form of this disease causes no eye pain or redness.
Exams and Tests
Your health care provider will perform the following tests:
- Eye exam
- Physical exam and blood tests to look for conditions that may be causing the problem
It is important for your provider to determine if your symptoms are due to scleritis. The same symptoms can also be a less severe form of inflammation, such as episcleritis.
Treatment
Treatments for scleritis may include:
- Corticosteroid eye drops to help reduce the inflammation
- Corticosteroid pills
- Newer, nonsteroid anti-inflammatory drugs (NSAIDs) in some cases
- Certain anticancer drugs (immune-suppressants) to help reduce the inflammation in severe cases
If scleritis is caused by an underlying disease, treatment of that disease may be needed.
Outlook (Prognosis)
In most cases, the condition goes away with treatment. But it may come back.
The disorder causing scleritis may be serious. However, it may not be discovered the first time you have the problem. The outcome will depend on the specific disorder.
Possible Complications
Complications may include:
- Return of scleritis
- Side effects of long-term corticosteroid therapy
- Perforation of the eyeball, leading to vision loss if the condition is left untreated
When to Contact a Medical Professional
Contact your provider or ophthalmologist if you have symptoms of scleritis.
Prevention
Most cases cannot be prevented.
People with autoimmune diseases, may need to have regular check-ups with an ophthalmologist familiar with the condition.
References
Barry RJ, Denniston AK, Rhodes B, et al. Rheumatic disease. In: Sadda SVR, Sarraf D, Freund KB, et al, eds. Ryan's Retina. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 81.
Cioffi GA, Liebmann JM. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 395.
Freund KB, Sarraf D, Mieler WF, Yannuzzzi LA. Inflammation. In: Freund KB, Sarraf D, Mieler WF, Yannuzzi LA, eds. The Retinal Atlas. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 4.
Patel SS, Goldstein DA. Episcleritis and scleritis. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.11.
Salmon JF. Episclera and sclera. In: Salmon JF, ed. Kanski's Clinical Ophthalmology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 9.
Version Info
Last reviewed on: 8/22/2022
Reviewed by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
