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The sclera is the protective outer layer of the eye, which is also the white part of the eye. It’s connected to muscles that help the eye move. About 83 percent of the eye surface is the sclera.
Scleritis is a disorder in which the sclera becomes severely inflamed and red. It can be very painful. Scleritis is believed to be the result of the body’s immune system overreacting. The type of scleritis you have depends on the location of the inflammation. Most people feel severe pain with the condition, but there are exceptions.
Early treatment with medication is necessary to prevent scleritis from progressing. Serious, untreated cases can lead to partial or complete vision loss.
Doctors use what’s called the Watson and Hayreh classification to distinguish the different types of scleritis. Classification is based upon whether the disease is affecting the anterior (front) or posterior (back) of the sclera. The anterior forms are most likely to have an underlying illness as part of their cause.
The subtypes of anterior scleritis include:
Each type of scleritis has similar symptoms, and they can worsen if the condition isn’t treated. Severe eye pain that responds poorly to painkillers is the main symptom of scleritis. Eye movements are likely to make the pain worse. The pain may spread throughout the entire face, particularly on the side of the affected eye.
Other symptoms may include:
The symptoms of posterior scleritis are not as evident because it does not cause the severe pain as other types. Symptoms include:
Some people experience little to no pain from scleritis. This may be because they have:
There are theories that the immune system’s T cells cause scleritis. The immune system is a network of organs, tissues, and circulating cells that work together to stop bacteria and viruses from causing illness. T cells work to destroy incoming pathogens, which are organisms that can cause disease or illness. In scleritis, they’re believed to begin attacking the eye’s own scleral cells. Doctors still aren’t sure why this happens.
Scleritis may occur at any age. Women are more likely to develop it than men. There’s no specific race or area of the world where this condition is more common.
You have an increased chance of developing scleritis if you have:
Your doctor will review a detailed medical history and perform an examination and laboratory evaluations to diagnose scleritis.
Your doctor may ask questions about your history of systemic conditions, such as whether you’ve had RA, Wegener’s granulomatosis, or IBD. They may also ask if you’ve had a history of trauma or surgery to the eye.
Other conditions that have symptoms similar to scleritis include:
The following tests can help your doctor make a diagnosis:
Treatment of scleritis focuses on fighting the inflammation before it can cause permanent damage. Pain from scleritis is also related to inflammation, so reducing the swelling will decrease symptoms.
The treatment follows a stepladder approach. If the first step in medication fails, then the second is used.
Medications used to treat scleritis include the following:
Surgery may also be necessary for severe cases of scleritis. The process involves the repair of tissues in the sclera to improve muscle function and prevent vision loss.
Sclera treatment may also be contingent on treating the underlying causes. For example, if you have an autoimmune disorder, then effectively treating it will help prevent recurring cases of scleritis.
Scleritis can cause significant eye damage, including partial to complete vision loss. When vision loss does occur, it’s usually the result of necrotizing scleritis. There’s a risk that scleritis will come back despite treatment.
Scleritis is a serious eye condition that requires prompt treatment, as soon as symptoms are noticed. Even if your symptoms improve, it’s important to follow up with an ophthalmologist on a regular basis to make sure it doesn’t return. Treating underlying autoimmune conditions that might cause scleritis is also important in preventing future problems with the sclera.
Written by: Lydia Krause and Kristeen Cherney
Medically reviewed on: Dec 20, 2016: Elaine Luo, MD
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