Scleritis

Overview, Causes, & Risk Factors

The sclera is the white, outer coat of the eye. When this area becomes inflamed, the condition is called scleritis.

What is going on in the body?

The sclera, which is made up of protein and connective tissue, becomes inflamed and irritated. If untreated, the disease may last a long time. Even with proper treatment, it is likely to recur. Complications from the disease can cause serious eye damage or loss of the eye.

What are the causes and risks of the disease?

Once in a while the sclera may become infected with bacteria or other organisms, such as those that cause Treponema pallidum\ bacteria. Less often, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as \congenital syphilis.\ ',CAPTION,'Syphilis');" onmouseout="return nd();">syphilis. However, most cases are linked to some form of autoimmune disorder. An autoimmune disorder is one in which the body produces antibodies against its own tissues. Rheumatoid arthritis and systemic lupus erythematosus are autoimmune disorders that may cause scleritis.

Symptoms & Signs

What are the signs and symptoms of the disease?

Symptoms of scleritis include the following:

  • blurred vision
  • engorgement of blood vessels in the eye
  • eye pain and tenderness
  • redness and puffiness of the eye
  • sensitivity to light
  • tearing

    • Diagnosis & Tests

    How is the disease diagnosed?

    Diagnosis of scleritis begins with a history and physical exam. The healthcare provider will observe the eye under a special microscope.

    Prevention & Expectations

    What can be done to prevent the disease?

    There are no known ways to prevent scleritis.

    What are the long-term effects of the condition?

    Complications may occur as scleritis progresses. These vary with the amount of inflammation. Over time, the disease alters the sclera. It becomes more transparent, letting the underlying pigment show through. This gives the eye a darker appearance. Some other complications are as follows:

  • glaucoma, or increased pressure within the eyeball that may lead to vision loss
  • retinal detachment, or separation of the retina from the back of the eyeball
  • swelling of the optic nerve, which carries messages from the eye to the brain
  • uveitis, or inflammation of the colored structures in the eye

    • Unfortunately, as many as 25% of individuals with scleritis lose a significant portion of their vision within a year of getting the condition. This occurs despite active therapy.

    What are the risks to others?

    Scleritis is not contagious, and poses no risk to others.

    Treatment & Monitoring

    What are the treatments for the disease?

    The primary goal of treatment for scleritis is to prevent the loss of vision. Local corticosteroid therapy can be used to ease the person's discomfort. However, this is usually not enough to eliminate the condition. Most cases require nonsteroidal anti-inflammatory drugs. Oral corticosteroids may also be used.

    Once the condition is under control, the dose of corticosteroids may be reduced. It may be necessary for the individual to continue on a low level of the medication until the condition resolves naturally. Rarely, intravenous hydrocortisone may be required.

    What are the side effects of the treatments?

    High doses of corticosteroids may cause a cataract, which is a clouding of the lens of the eye that causes vision problems. Corticosteroids may also cause diabetes and osteoporosis.

    What happens after treatment for the disease?

    The severity of the disease varies. It can appear as a mild inflammation. A more serious form of the condition is known as nodular scleritis, which involves clusters of cells. The most severe type is necrotizing scleritis, which causes tissue death. People with necrotizing scleritis often do not live longer than 5 years.

    How is the condition monitored?

    Someone with scleritis will have regular visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.

    Attribution

    Author:William Stevens, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:06/01/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:06/01/01