Scleritis: Causes, Symptoms, and Treatment 

Scleritis is an uncommon eye condition that cause redness, swelling and pain to the sclera, the white part of the eye.

Some types of scleritis, while painful, resolve on their own. Others require immediate treatment.

If your sclera grows inflamed or sore, visit your eye doctor immediately. Early treatment is important.

What Is Scleritis?

Scleritis is an eye condition in which sclera, the white part of the eye, swells, reddens and grows tender to the point that simple eye movement causes pain.

It is an uncommon condition that primarily affects adults, especially seniors. Left untreated, scleritis can lead to vision loss and other serious eye conditions.

People who are most susceptible to scleritis are those who have an autoimmune disease such as arthritis. Often, though, scleritis has no identifiable cause.

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Types

There are two categories of scleritis: posterior scleritis and anterior scleritis.

• Posterior scleritis is a rare form of scleritis that affects the back of your eye.
• Anterior scleritis is the most common and treatable type of scleritis. It refers to inflammation of the sclera found on the front part of the eye.

Specialists put anterior scleritis into three categories:

• Nodular anterior scleritis
• Diffuse anterior scleritis
• Necrotizing anterior scleritis

Nodular Anterior Scleritis

Nodular anterior scleritis causes abnormal growth of tissue called a nodule, visible on the sclera covering the front part of the eye. It can also cause dilation of blood vessels underlying your eyes and can lead to chemosis (eye irritation).

Diffuse Anterior Scleritis

Diffuse anterior scleritis is the most common type of anterior scleritis. It is widespread inflammation of the sclera covering the front part of the eye.

Necrotizing Anterior Scleritis

Necrotizing anterior sclerosis is the rarest of the three types and one of the most severe. It causes blindness if it is not managed and treated early.

Once it affects your eyes, necrotizing anterior scleritis progresses rapidly, causing tissue death around your eye (necrosis). It also thins the sclera, consequently exposing the inner structure of the eye. It also causes eye-swelling in some people. 

Symptoms of Scleritis

The first and the most common symptom you are like to experience is the throbbing pain when you move your eyes. Other symptoms include:

• The white part of the eye (sclera) swells and reddens
• Eyes grow watery
• Blurry vision
• Eye sensitivity to light

Causes of Scleritis

Scleritis at times arises without an identifiable cause. But common causes include having an autoimmune disease such as arthritis or having a post-surgical reaction.

Arthritis

Arthritis is an autoimmune infection, meaning that it causes your body’s immune system to attack its tissues. When arthritis manifests, it can cause inflammatory diseases such as scleritis.

Research has shown that 15 percent of cases of scleritis are linked to arthritis. This is more prevalent with necrotizing anterior scleritis.

Surgery

Some surgical procedures, such as pterygium surgery, can interfere with scleral tissues, causing inflammation and tissue death, leading to scleritis.

Risk factors

You are at high risk of contracting scleritis if you have autoimmune diseases like arthritis. The condition also typically affects women more than men. 

Patients who have had multiple eye surgeries are also at high risk of getting scleritis. Research also shows that eye injuries can make you susceptible to scleritis.

Using certain medications can also predispose you to scleritis. An example of such a drug is bisphosphonates, a cure for osteoporosis. 

Diagnosis

When diagnosing scleritis, the doctor or the nurse takes your medical history. The eye doctor will then do a physical examination, such as a slit-lamp examination, and order blood tests to show the cause of the disease.

Lastly, the doctors will perform a differential diagnosis, like episcleritis diagnosis, to ascertain scleritis caused the eye inflammation.

Treatment

Treatments of scleritis aim to reduce inflammation and pain. Among the suggested treatments are topical steroids, oral NSAIDs and corticosteroids.

Topical Steroids

These drugs reduce inflammation. These steroids help treat mild scleritis, causing less severe side effects. You may need additional eye therapy when using these as they are less effective when used on their own.

Oral NSAIDs

Non-steroidal anti-inflammatory drugs are the standard regimen doctors use to get rid of both types of scleritis. It is relatively cheaper with fewer side effects. NSAIDs work by inhibiting enzyme actions causing inflammation.

Corticosteroids

Medications that fit into this category, such as prednisone, are specifically designed to reduce inflammation. Doctors predominantly prescribe them to their patients who are living with arthritis.

Scleritis vs. Episcleritis

Although scleritis and episcleritis each cause inflammation of the eyes and present with almost the same symptoms, they are two entirely different diseases. 

While scleritis is a severe form of eye inflammation associated with a high risk of vision loss, episcleritis is more benign (less serious and dangerous). It is also self-limiting, resolving without treatment.

Scleritis vs. Conjunctivitis

Both scleritis and conjunctivitis cause redness of the eye. Their difference arises from the pain you will feel in each instance.

Conjunctivitis causes itching and burning but is not associated with pain. Scleritis causes eye redness accompanied by a lot of pain.

Scleritis vs. Uveitis

Uveitis is an inflammation of the uvea, the middle part of the eye, which lies just behind the sclera. Progression of scleritis can result in uveitis.

References

1. Scleritis. (November 2021). American Academy of Ophthalmology.

2. Uveitis. (November 2021). National Eye Institute.

3. Scleritis. (October 2021). StatPearls.

4. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. (May 2021). Journal of Clinical Medicine.

5. More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis. (May 2020). Cureus.

6. Scleritis and episcleritis. (October 2017). Journal Francais d’ophtalmologie.

7. Postoperative Necrotizing Scleritis: A Report of Four Cases. (December 2014). Middle East African Journal of Ophthalmology.

8. Pharmacotherapy of Scleritis: Current Paradigms and Future Directions. (March 2013). Expert Opinion on Pharmacotherapy.

9. Ocular side effects of bisphosphonates. (October 2010). Canadian Family Physician.

10. Infectious Scleritis After Use of Immunomodulators. (August 2002). JAMA Ophthalmology. 

11. Treatment of Scleritis With Combined Oral Prednisone and Indomethacin Therapy. (October 1998). America Journal of Ophthalmology.

12. Nodular anterior scleritis. The University of Iowa.

13. Ocular Examination. American Academy of Ophthalmology.

14. Treatment. American Academy of Ophthalmology.