Scleritis

Scleritis

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.

Causes

Scleritis is often linked with an autoimmune disease. Sometimes there is no known cause. Scleritis may be linked to:

• joint swelling and stiffness (arthritis)
• lupus, or other connective tissue disease
• eye infection
• inflammatory bowel disease (IBD)
• Sjogren’s syndrome (causes very dry eyes and other symptoms)
• granulomatosis
• scleroderma
• Scleritis may be caused by trauma (injury) to the eye. Rarely, it is caused by a fungus or a parasite.

Symptoms

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:

• excessive tearing, or lacrimation
• decreased vision
• blurry vision
• sensitivity to light, or photophobia
• redness of the sclera, or white portion of your eye

The symptoms of posterior scleritis are not as evident because it does not cause the severe pain as other types. Symptoms include:

• deep-seated headaches
• pain caused by eye movement
• eye irritation
• double vision

Some people experience little to no pain from scleritis. This may be because they have:

• a milder case
• scleromalacia perforans, which is a rare complication of advanced rheumatoid arthritis (RA)
• a history of using immunosuppressive medications (they prevent activity in the immune system) before symptoms began

Diagnosis

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.

The following tests can help your doctor make a diagnosis:

• ultrasonography to look for changes occurring in or around the sclera
• complete blood count to check for signs of infection and immune system activity
• a biopsy of your sclera, which involves removing tissue of the sclera so that it can be examined under a microscope