Scleritis: What It Is, Causes, Symptoms & Treatment
Scleritis impacts the sclera, the white outer layer of your eye. It often results in inflammation, potentially causing severe pain and vision impairment if not properly managed. It is a serious condition that requires prompt medical attention.
If you suspect that you might be experiencing signs of scleritis, it’s essential to seek medical attention. A healthcare professional can offer an accurate diagnosis and suggest a personalized treatment strategy for your specific needs.
This article aims to provide comprehensive insights into scleritis, helping you recognize the symptoms and its impact on eye health.
Understanding the Sclera
The sclera, a durable and fibrous exterior layer, extends and covers the eye from the front section, where the cornea sits, to the posterior end, connecting to the optic nerve.
This rugged, protective shell has several vital functions: it maintains the eyeball’s shape, provides a sturdy attachment site for the eye’s muscles, and helps shield the eye’s internal structures from injury or infection.
Scleritis can lead to permanent vision loss if not treated appropriately. The fear of vision loss and intense pain associated with scleritis significantly impair an individual’s independence, emotional well-being, and quality of life.
Causes of Scleritis
The exact cause of scleritis is often unknown, but it can be associated with several risk factors. Awareness of scleritis is crucial due to its potential to significantly impact vision and overall eye health.
Eye Infections
Scleritis can also be caused by infections, as a result of bacteria, viruses, fungi, or parasites. These pathogens can directly invade the scleral tissue, leading to inflammation as your immune system responds to the infection.
Specific infectious agents like the herpes zoster virus, the bacterium responsible for syphilis, and the tuberculosis bacterium can directly infect the sclera, leading to severe inflammation, pain, and potential damage to the eye’s structure.
Trauma and Injury
Physical injury to the eye, such as blunt or penetrating trauma or through introduction of a foreign body, can result in this condition. The inflammation can occur immediately after the injury or develop as a delayed response.
Activities linked to increased eye injury risk include contact sports, specific occupational hazards, or accidents involving high-speed particles. Trauma-induced scleritis is your body’s way of responding to injury, involving inflammation that can complicate healing.
Surgical Complications
Scleritis can sometimes develop as complications following eye surgery, such as cataract removal, glaucoma surgeries, or refractive surgery.
The manipulation of ocular tissues, the introduction of surgical instruments, or the presence of sutures can inadvertently trigger an inflammatory response in the sclera. This post-surgical scleritis is a rare but important consideration if you experience eye pain or inflammation after undergoing eye surgery.
Chemical Exposure
Direct contact with corrosive substances or irritants significantly endangers the sclera, which can result in chemical-induced scleritis. This condition arises when harmful chemicals, such as acids, alkalis, or other toxic substances, come into contact with the eye, leading to immediate tissue damage and a robust inflammatory reaction.
The severity of the inflammation and the extent of the damage is influenced by the type of chemical involved, its concentration, and the duration of exposure. Alkali burns typically cause more damage than acidic burns due to their ability to penetrate the ocular tissues.
Autoimmune Disorders
Scleritis may often be linked to underlying autoimmune conditions where your immune system erroneously targets healthy tissues in your body, including the sclera.
Autoimmune conditions are usually associated with scleritis, including systemic lupus erythematosus, rheumatoid arthritis, and granulomatosis with polyangiitis. In these cases, your body’s immune response is not limited to the joints or specific organs but can extend to various body parts, including your eyes.
Symptoms of Scleritis
If you’re suffering from scleritis, you’ll likely encounter a range of symptoms that impact your eye health and general comfort. Recognizing the need for medical attention can lead to timely intervention, preventing long-term ocular damage.
Redness
Scleritis triggers scleral inflammation, causing eye blood vessels to dilate, leading to a noticeable redness in the affected eyes. This sign typically presents as a vivid, often bright red hue, concentrated around the cornea but can spread across the entire visible part of the eye.
This symptom depends on the extent of the sclera’s involvement and is often among the initial signs of onset.This is a hallmark symptom and helps in differentiating it from other, less severe, symptoms.
Pain and Tenderness
Due to the inflammation of the sclera, you might experience constant, intense eye pain, described as a deep, gnawing ache extending to the face, jaw, or head.
This discomfort can worsen with eye movements or when pressure is applied, making the eye tender to the touch. This severe, deep-seated discomfort distinguishes scleritis from conditions like conjunctivitis.
Increased Tear Production
In response to irritation and inflammation caused by scleritis, your eyes might produce more tears than usual to lubricate and try to soothe the affected eyes.
This excessive tear production, called epiphora, can cause your eyes to appear watery or tearful. This can lead to challenges with focus, such as blurred vision and the annoyance of constant watery eyes.
Light Sensitivity and Vision Problems
Light sensitivity or photophobia, caused by scleritis inflammation, makes bright lights or sunlight particularly discomforting, leading to squinting difficulty in well-lit areas. This discomfort and sensitivity can also impair focus in bright environments.
In the advanced stages of this condition, it may damage the cornea or retina, affecting visual acuity. If left untreated, scleritis can result in permanent vision loss, emphasizing the importance of early diagnosis and treatment.
Headaches
The severe pain associated with scleritis isn’t limited to the eye itself. It can radiate to the forehead and temples or spread to a larger portion of the head, causing severe headaches and facial pain.
This pain can be exacerbated by eye movement, visual impairments, or pressing on the eye, and it might become progressively worse over time. The intensity of these headaches can be bothersome and interfere with your daily activities and productivity.
Diagnostic Procedures
Diagnostic procedures are essential for accurately identifying scleritis and planning treatment. They enable healthcare providers to distinguish it from other eye conditions and accurately assess its severity for targeted intervention.
Clinical Examination
The diagnosis of this condition hinges on a clinical examination and a review of the patient’s medical history, emphasizing past events, autoimmune diseases, infections, or eye conditions that indicate possible scleritis.
This examination includes a comprehensive evaluation of the eye’s appearance, focusing on signs such as pronounced redness, noticeable swelling, and areas of tenderness that could indicate the presence of scleritis.
Eye Examination
The slit-lamp examination is a critical diagnostic tool for assessing scleritis, offering a detailed view of the eye’s external and internal structures. This procedure allows healthcare providers to observe signs of inflammation, scleral thinning, or vascular changes indicative of scleritis.
By utilizing the slit-lamp, doctors can evaluate the depth and severity of scleral involvement and identify any factors that lead to the redness or associated complications, such as corneal or anterior uveitis.
Eye Imaging Procedures
Ocular ultrasound and advanced imaging scans like MRI or CT play an essential role in diagnosing scleritis by offering detailed views of the eye’s internal structures.
The Ultrasound B-scan, in particular, is adept at assessing the sclera’s thickness and detecting any abnormalities or inflammation deep within the eye. These imaging techniques can reveal the presence of fluid or inflammatory cells in the sclera, which is crucial in the diagnosis of active scleritis.
Blood Tests
Blood tests are an integral component of the diagnostic toolkit for scleritis, offering critical insights into the underlying causes of the inflammation.
By measuring levels of specific indicators like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), healthcare providers can gauge the extent of systemic inflammation, which may be contributing to scleritis.
Treatment Options for Scleritis
Treatment for scleritis aims to reduce inflammation, alleviate discomfort, and tackle the root cause of the issue once identified. Prompt and appropriate treatment alleviates the immediate pain associated with this condition and is pivotal in preserving eye health in the long term.
Nonsteroidal Anti-Inflammatory Drugs
If you’re diagnosed with scleritis, your doctor may initially recommend over-the-counter Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) to manage mild inflammation and discomfort. However, in most cases, stronger prescription NSAIDs are prescribed to address inflammation and pain.
Despite their effectiveness, doctors will consider potential side effects, including gastrointestinal irritation, renal impairment, and cardiovascular risks with prolonged use. Remember to take the medication as prescribed by your doctor to avoid unintended side effects.
Corticosteroids
As part of the medical management of scleritis, doctors will prescribe corticosteroid eye drops as an alternative to or to help NSAIDs address ocular inflammation and discomfort directly.
Should your scleritis be more severe, your doctor might prescribe oral corticosteroids. They work by suppressing your overall immune response and can effectively reduce inflammation.
Immune Suppression
If your scleritis is related to an autoimmune condition or doesn’t respond adequately to other treatments, your doctor may prescribe immunosuppressive drugs.
These medications can help regulate the immune system and regulate its overactive response, potentially easing the scleritis along with the symptoms of an autoimmune disorder.
Antibiotics and Antiviral Medications
If an infection is the cause of your scleritis, specific antibiotics or antiviral treatments may be required. These medications will target the specific infectious agent to address symptoms associated with this condition.
This targeted approach is essential for addressing the underlying cause, halting the progression of inflammation, and preventing the potential for severe ocular damage, which could lead to complications of overall eye health.
Biologic Therapy
Biologic drugs are medications derived from living cells that target specific proteins or cell components of your immune system, offering a more targeted approach to reducing inflammation and the other symptoms of scleritis.
For severe cases or particularly for patients who have not responded adequately to standard therapies such as corticosteroids or immunosuppressive medications, biologic drugs could be an option. However, there is a risk of serious side effects and the potential to not work for some patients.
Eye Surgery
In specific cases, if other treatments are unsuccessful and the scleritis causes significant impairments to your vision, scleral thinning or other structural integrity issues, surgical intervention may be necessary.
This approach is usually considered a last resort used only in severe cases where other treatments fail to adequately relieve or control the condition.
Prevention Strategies
Preventing scleritis primarily involves managing underlying health conditions and adopting protective eye health practices. Recognizing the significance of these measures is crucial for maintaining overall ocular health.
Healthy Lifestyle Choices
Leading a healthy lifestyle is beneficial to prevent scleritis. Regular physical activity, maintaining a balanced diet, avoiding smoking, and limiting your alcohol consumption can support your overall health, including the health of your eyes.
Similarly, stress can exacerbate inflammation, so effective stress reduction techniques and avoiding triggers can further protect against scleritis. Participating in consistent exercise, securing sufficient rest, and practicing relaxation can all contribute to a healthier lifestyle, minimizing the risk of this condition and enhancing overall well-being.
Regular Eye and Medical Checkups
Routine consultations with your doctor are vital for preserving general well-being and reducing the risk of scleritis. These checkups often include comprehensive evaluations of the patient’s overall health, including blood tests and other diagnostics, to screen for markers of inflammation or autoimmune activity.
You can catch these underlying illnesses early by regularly visiting your healthcare provider and undergoing annual eye tests. Ophthalmologists can assess for subtle changes in the sclera and other eye components, providing an opportunity to address this condition in its initial stages.
Eye Health and Protection
Maintaining sound eye hygiene is another essential preventive measure. Good hygiene and protective eyewear at home, outdoors, and at work also mitigate risks from environmental factors or injuries.
Managing underlying conditions that contribute to scleritis, as well as incorporating Omega-3 and Vitamin D supplements under medical guidance, can help modulate the immune response and potentially reduce the incidence of scleritis. Effective control of these diseases can significantly reduce the risk of developing scleritis.
Frequently Asked Questions
What are the symptoms of scleritis?
You might notice a significant redness in one or both eyes if you have scleritis. This is often accompanied by intense, potentially severe eye pain, which may worsen with eye movement.
Light can appear harsher than usual, increasing sensitivity and discomfort in bright conditions.
You may also experience severe headaches and facial pain due to the inflammation, and tear production could increase. In severe cases, seeing or focusing might be more challenging.
How is scleritis treated?
Scleritis treatment aims to alleviate inflammation and pain, plus address any known underlying causes. Initially, your doctor might recommend over-the-counter NSAIDs for mild inflammation, but stronger prescription NSAIDs might be needed.
You may be prescribed oral corticosteroids or corticosteroid eye drops, depending on the severity of your condition. If your condition doesn’t respond well to these, or if it’s linked to an autoimmune disorder, your doctor might prescribe immunosuppressive drugs.
Antibiotics or antiviral medication might be used if an infection causes your scleritis. In severe situations, surgical intervention might be necessary to address underlying conditions that affect eye structures and cause scleritis.
What kind of underlying conditions can cause scleritis?
Scleritis can stem from a variety of sources. Often, it’s linked to systemic autoimmune disorders such as rheumatoid arthritis or lupus, where your body’s immune system attacks healthy tissues, including those in your eyes.
Additionally, infections from pathogens like tuberculosis can cause scleritis. Direct exposure to corrosive chemicals or irritants, eye injury, or surgical procedures on the eye might also trigger scleritis.
How can I prevent scleritis?
Preventing scleritis often involves controlling underlying conditions that could lead to it. Regularly seeing your doctor for checkups can help catch and manage systemic or autoimmune diseases that might trigger scleritis.
If you’re already diagnosed with a disease that puts you at risk, actively managing it reduces your chance of developing scleritis. Good eye hygiene and care, healthy lifestyle choices, and promptly treating eye infections contribute to its prevention.
