Scleritis
- Reviewed by Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
What is scleritis?
Scleritis is a potentially serious inflammation of the sclera, commonly called the white of the eye. It is the tough, white tissue that gives the eye its shape and protects the eye. More than 50% of cases of scleritis are associated with another disease that affects the whole body, such as rheumatoid arthritis, or are caused by infection or injury. Scleritis occurs most often in people ages 30 to 60 and is rare in children. If left untreated, the condition can spread to parts of other parts of the eye. Some visual loss could then occur.
Symptoms of scleritis
The main symptoms of scleritis are pain and redness in the white part of the eye. These symptoms usually develop gradually and eventually become severe. The redness may become an intense purple. Many people with scleritis have pain radiating from the eye to adjacent areas of the head and face. Commonly, the eye becomes teary and very sensitive to light. You may lose some vision.
Diagnosing scleritis
Your eye doctor will ask you about your medical history and conduct a thorough examination. In addition, because of the association between scleritis and other general medical conditions, your doctor may suggest a comprehensive medical examination, including blood counts and other tests and evaluations. Ultrasound, computed tomography (CT) scanning, magnetic resonance imaging (MRI), or a biopsy may be used to rule out other causes of symptoms.
Expected duration of scleritis
Depending on its cause, scleritis should begin to clear up fairly quickly once treatment begins.
Preventing scleritis
Scleritis may be prevented by avoiding eye injuries (for example, by wearing protective eyewear) or by having an associated condition (such as rheumatoid arthritis) well treated.
Treating scleritis
Scleritis should be treated promptly to help avoid complications and vision loss. When related to an underlying disease, treatment of the disease may control the inflammation of the eye. Drugs used to treat scleritis include a corticosteroid solution that you apply directly to your eye, an oral corticosteroid (prednisone), and a nonsteroidal anti-inflammatory drug (NSAID). Additional immune suppressing medications (such as cyclosporine, mycophenolate mofetil, methotrexate, rituximab, or cyclophosphamide) may be needed for severe cases not responding to corticosteroids, or when the required doses of corticosteroids are high. In severe cases, surgery may be required to repair injured areas of the eyeball.
When to call a professional
You should call your doctor immediately if your eye is painful and red.
Prognosis
Mild scleritis that is promptly diagnosed and treated has an excellent prognosis. Complications are common with more severe scleritis. These include glaucoma, damage to the cornea, cataracts, retinal detachment, and, rarely, perforation of the globe (eyeball). Vision loss may accompany any these complications.
Additional info
American Academy of Ophthalmology
https://www.aao.org/news/eyenet/
National Eye Institute
https://nei.nih.gov/
About the Reviewer
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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