Scleritis

It is considerably more dangerous to have scleritis which is an uncommon inflammatory condition of the sclera. Imagine the white part of your eye having different layers like an onion. Called the sclera this tough fibrous tissue maintains the round shape of the eye and serves to protect the eyeball from damage. Covering the sclera is the episclera a thin membrane that adds an extra layer of protection. Both the sclera and episclera are susceptible to inflammation. An inflamed episclera is called episcleritis which is generally non-threatening to vision and overall health. It is considerably more dangerous to have scleritis which is an uncommon inflammatory condition of the sclera.

About 50 per cent of patients who have scleritis will have an associated systemic disease. The most common causes are:

• rheumatoid arthritis (the most frequent cause)
• lupus
• ankylosing spondylitis
• herpes zoster
• syphilis
• tuberculosis
• gout
• lyme disease

With the 50 per cent of those who do not have an autoimmune disorder the cause of scleritis is generally not known. It occurs most often between the ages of 30 and 60 and is very rare in children.

Those with scleritis usually have severe symptoms including a red eye light sensitivity tearing and sometimes reduced or poor vision. The most distinctive symptom of the condition is severe boring pain in the eye which may spread to the forehead behind the eye or to the cheek. The affected eye often has a bluish hue.

The type of treatment administered depends on the subtype of scleritis of which there are four. Generally the underlying disorder needs to be treated first to halt progression. It usually requires steroids during acute phases and immunosuppressive agents for the long-term. Eyedrops are not effective for this condition though they are somewhat helpful in treating episcleritis (this helps differentiate between the two). If scleritis is not treated immediately it poses the risk of eventually impairing vision in the form of cataracts secondary glaucoma retinal detachment or optic atrophy.

Diffuse Scleritis

This is the most common type of scleritis. It involves large areas or perhaps all or the sclera. Fortunately this is also the most benign form of scleritis and is the most responsive to therapy.

Nodular Scleritis

This type is characterized by immoveable inflamed nodule(s) of a specific area of the eye (hence the name “nodular”). It is very tender and sensitive to touch.

Necrotizing Scleritis

This is the worst form of the disease as it is associated with severe systemic diseases. Often it involves multiple organs as well. An associated type of vascular disease called vasculitis may actually threaten the lives of those afflicted.

This form of scleritis may also occur without inflammation (called scleromalacia perforans) and cause severe thinning of the sclera. The eye is otherwise white and there is no pain. In severe cases and often associated with rheumatoid arthritis it may cause perforation of the globe and the loss of the eye may ensue.

Posterior Scleritis

Approximately four to eight per cent of people with scleritis have this sub-type. Symptoms include poor or double vision severe pain proptosis (“bulging” eye) uveitis and limited eye movement. A most severe side-effect of this subtype is the possibility of an exudative retinal detachment (fluid under the eye) which may cause substantial visual loss.

Until proven otherwise all cases of scleritis should always be considered secondary to systemic disease. Patients suffering from scleritis should be referred for a comprehensive medical evaluation including blood tests and radiology studies where appropriate.