What is Scleritis?
This is an inflammatory disease which is serious and which affects the white outer coating of the eye, known as the sclera – normally referred to as the whites of the eye. This is the tough, white tissue which gives the eye its shape and which protects the eye. This is a chronic and painful disease and approximately 50% of cases are contracted along with the association of other disease including granulomatosis or rheumatoid arthritis. It can also be attained thru disorders of menstruation and is fairly common among young women. This is a potentially blinding inflammatory illness that is categorized by swelling as well as cellular intrusion of the scleral as well as the episcleral tissues.
The disorder occurs most frequently in individuals who are 30 to 60 years of age – it is very rare to occur in children. If scleritis is left untreated it can spread to the surrounding features in the eye and damage the eye itself, causing problems in vision.
Scleritis Symptoms
The major symptoms of scleritis are redness in the whites of the eye as well as pain. These symptoms normally gradually develop but eventually become severe. The redness can become a very intense purple. The pain radiates from the eye to adjacent areas of the face and head. Less commonly, the eye can become teary as well as very sensitive to light and the individual can lose some vision.
Symptoms 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
The symptoms of scleritis may affect only one or both eyes. A rare form of this disease causes no eye pain or redness. If not diagnosed and treated fairly promptly, complications can develop which are serious. These include puncture of the eyeball, loss of vision as well as loss of the eyeball.
Scleritis Causes
There are many causes of scleritis. The causes of this disorder which are most common are listed below. These causes affect more than approximately one million individuals in the United States:
- Rheumatoid arthritis
- SLE
The following causes of scleritis are conditions or diseases that affect more than 200,000 people but less than 1 million individuals in the United States:
- HIV
- Inflammatory bowel disease
- Wegnener’s granulomatosis – scleritis
The following causes of scleritis are considered very rare and appear in the population at a rate of substantially less than 200,000 individuals in the United States.
- Syphilis
- Sarcoidosis
- Varicella-zoster virus
- Tuberculosis
The following causes have no stats on the number of individuals in the United States who are affected:
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- Polyarthritis nodosa
- Herpes simplex
- Polychondritis
- Rheumatoid arthritis
- Relapsing polychondritis
- Rheumatoid disease
- SLE
- Vasculitis
- Urate crystal arthropathy
Scleritis Diagnosis
When you visit the eye doctor with symptoms suggesting scleritis, he/she will ask you about your medical history as well as conduct a thorough exam. Additionally, because of the association between scleritis and other medical diseases, the doctor may suggest a very comprehensive medical exam, including blood test and other tests and evaluations. Computed tomography or CT scanning, ultrasound, magnetic resonance imaging MRI as well as a biopsy can be used to eliminate other causes for the symptoms.
Scleritis Treatment
Topical Anti-inflammatory medications
Individuals with scleritis usually do not respond to topical medications such as NSAIDs or corticosteroids. But there are a minority of individuals who are persuaded that an eye drop for example prednisolone acetate 1% is helpful and this allows them to reduce or stop all together any oral medications.
Oral NSAIDS
Many individuals with scleritis do well on an oral NSAID, and these are generally the first treatment for this condition.
Oral corticosteroids
These medications are widely used in the management of scleritis and are the first treatment for necrotizing inflammation. Dosages are individualized on the basis of tolerance as well as response. Individuals on corticosteroids need to be carefully watched with regards to blood sugar, mood, weight and bone density.
Immunosuppressive drugs
Approximately 25% of individuals with scleritis require treatment with corticosteroid-sparing immunosuppressive medications to achieve any long-term control of this disease. Drugs under this classification include:
- Methotrexate
- Mycophenolate
- Azathioprine
- Ciclosporin
- Mofetil
The choice of agent depends on the presence of any underlying disease as well as alcohol intake, liver function as well as blood pressure.
Surgical management
Surgical management in a small number of individuals with necrotizing scleritis, it may be necessary for surgery to preserve the integrity of the eye globe. In these cases, the outcome can be improved by controlling rapidly inflammation with aggressive immunosuppressive therapy.
Scleritis Pictures
