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INFLAMMATION of the sclera, the white fibrous outer layer of the EYE. The inflammation develops gradually, involving the connective tissue structure of the sclera. The scleritis may involve a small portion of the sclera (sectoral scleritis) or the entire globe of the eye (diffuse scleritis). Some people develop nodules that may become necrotic (cause tissue death). Necrotizing scleritis, with or without nodules, results in severe damage to the eye (including perforation) and often loss of vision. More than half of the people who develop scleritis also have connective tissue disorders, the most common associations being with RHEUMATOID ARTHRITIS and VASCULITIS.
Conditions often Associated with Scleritis
|Conditions often Associated with Scleritis|
|ANKYLOSING SPONDYLITIS||RHEUMATOID ARTHRITIS|
|SARCOIDOSIS||SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)|
Symptoms of Scleritis
Deep, aching PAIN characterizes scleritis, often severe enough to disrupt sleep. Referred pain sometimes affects the jaw or cranial bones around the eye. The affected area of the sclera is erythematous (“bloodshot”), and the eye typically tears in response to light (PHOTOPHOBIA). The eye may protrude from the front of the orbit when scleritis involves the back of the eye. The diagnostic path typically includes SLIT LAMP EXAMINATION and OPHTHALMOSCOPY, and possibly ultrasound to determine whether the inflammation involves the back of the eye.
Treatment is topical CORTICOSTEROID MEDICATIONS and oral NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), which suppress inflammation as well as relieve pain. Eye drops to constrict the blood vessels in the eye reduce swelling and redness. Diffuse or severe inflammation may require a therapeutic course of systemic corticosteroid medication such as prednisone. Prompt diagnosis and treatment can preserve the eye and vision. However, permanent structural damage to the eye with resulting loss of vision is a significant risk even with treatment. Scleritis may recur when it is a manifestation of an underlying connective tissue or AUTOIMMUNE DISORDER.