Often misdiagnosed as conjunctivitis, both episcleritis and scleritis are inflammatory disorders of the white coating of the eye that cause redness and pain. Any redness of the eye associated with discomfort should be seen by your ophthalmologist, so that the correct diagnosis can be made and the most appropriate treatment commenced. Scleritis is more common in patients that have an underlying autoimmune disease (e.g. rheumatoid arthritis) or other disease process. Scleritis typically occurs in patients 30-60 years of age and is rare in children. Scleritis must be differentiated from episcleritis, a much less severe inflammation that affects the episclera.
Causes of Scleritis
In 50% of patients, scleritis is associated with an underlying systemic disease process. Common associated systemic diseases include autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel syndrome, etc), herpes zoster (shingles), syphilis and gout. Scleritis is very frequently idiopathic (have an unknown cause).
Signs and Symptoms of Scleritis
Common symptoms of scleritis include:
- Gradual onset of eye pain, which can become progressively more severe and which may spread to the surrounding head (eye brow, ear, jaw, etc)
- Light sensitivity
- Redness on the white part of the eye, which can involve just a small sector or the entire white of the eye
- Decrease in vision
- If the posterior part of the eye is involved, it can be associated with inflammation of the socket and produce double vision and/or pain upon eye movement
- Recurrent/chronic symptoms in patients with underlying systemic disease
Common signs of scleritis include:
- Inflammation (redness and swelling) of the sclera, episclera, and overlying conjunctiva
- Commonly, dilated blood vessels can be seen
- Thinning of the sclera can be seen after severe disease and leaves a darker area where the inflammation occurred (white layer appears blue because underlying tissue, the choroid, becomes visible)
Treatment/Prognosis of Scleritis
If these symptoms are experienced, the patient should have a complete eye exam, including dilation of the pupil, to rule out other disorders. Treatment may include oral non-steroidal anti-inflammatory (NSAIDs), oral corticosteroids, and/or oral immunosuppressive therapy. If the scleritis and underlying disease are not treated promptly, the inflammation can spread to other parts of the eye. Also, symptoms can recur, and more serious complications can develop (vision loss). The length of treatment and follow-up will depend on the severity of the signs and symptoms.
Scleritis can worsen and progress to ischemia and necrosis, which may lead to scleral thinning and, in extreme cases, perforation of the globe and possibly lead to blindness.
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