Scleritis is an inflammation of the sclera, the white outer layer of the eye. This painful condition causes redness, swelling, and in some cases, vision problems. Scleritis is serious because the inflammation can spread to other parts of the eye, including the cornea (the clear front surface of the eye) and uvea (the middle layer of the eye). Early diagnosis and treatment are important to protect your vision.
The sclera is the tough, white outer coating of the eye. It gives the eye its shape and protects the delicate structures inside. The sclera has a dense network of connective tissues and limited blood flow. This structure makes it vulnerable to inflammation, especially in people with certain immune system disorders.
Scleritis affects about 10,500 people each year in the United States. The condition is more common in middle-aged adults, typically between 47 and 60 years old. Women account for 60% to 74% of cases. While rare in children, it can occur at any age.
Episcleritis affects the outer layer of the eye and is usually mild. It causes bright red color with little pain and often goes away on its own. Scleritis affects a deeper layer of the eye and causes intense pain. The color is often purplish red rather than bright red. Scleritis carries a risk of vision loss and is often connected to other health conditions throughout the body.
Scleritis often causes severe, deep pain that feels like a piercing ache. The pain may spread to nearby areas like the forehead, jaw, or scalp. Eye movement can make the pain worse. Many patients find that the pain disrupts sleep and may feel worse at night.
The eye develops a deep red or violet color, different from the bright red of common conditions like pink eye. The redness comes from deeper blood vessels in the eye. Swelling in the sclera is also common. Without treatment, this inflammation can damage the connective tissue of the eye.
Inflammation can interfere with vision clarity, causing blurred or cloudy vision. Daily visual tasks like reading or driving may become difficult. Many patients also experience increased sensitivity to light, which can add to their discomfort.
Scleritis is commonly linked to conditions where the immune system attacks the body's own tissues. Rheumatoid arthritis is one of the most frequent connections. Lupus and granulomatosis with polyangiitis (GPA) are also associated with scleritis. About one in four patients with scleritis has an underlying systemic disease.
In rare cases, bacteria or fungi can cause scleritis. This is more likely after eye trauma or surgery. Infectious scleritis requires treatment with antibiotics or antifungal medications to address the underlying cause.
Eye injuries and surgeries can sometimes trigger scleritis. Long-term exposure to certain medications or toxins may also play a role. In some cases, the exact cause cannot be identified.
Anterior scleritis affects the front portion of the eye. This is the most common form. It has three subtypes:
Posterior scleritis affects the back of the eye. It is harder to detect because the inflammation is not visible on the surface. Special imaging tests are needed for diagnosis. Symptoms include deep eye pain and possible complications like retinal detachment (separation of the retina from the back of the eye) or fluid buildup behind the retina.
About 35% of patients with scleritis experience complications. These may include:
Scleritis can be a sign of inflammation elsewhere in the body. When scleritis occurs alongside rheumatoid arthritis, it may signal a body-wide flare of the disease. In patients with GPA, scleritis may indicate that the condition is affecting other organs like the kidneys or lungs. This is why a thorough medical evaluation is important for anyone diagnosed with scleritis.
Despite the serious nature of scleritis, most patients maintain good vision with proper treatment. Studies show that over 90% of patients have stable or improved vision with appropriate care. At diagnosis, 94% of affected eyes have 20/40 vision or better. After at least one year, about 90% maintain or improve this level of vision.
Treatment often starts with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. These medications help reduce pain and swelling. For many patients with mild scleritis, NSAIDs provide enough relief.
When basic pain relief is not enough, corticosteroids may be prescribed. These stronger anti-inflammatory medications are available as pills or injections. They require careful monitoring because of potential side effects with long-term use.
For severe or chronic cases, medications that calm the immune system may be needed. These drugs help control the underlying inflammation and reduce flare-ups. Patients on these medications need regular check-ups to monitor their health.
Surgery is rare and only considered when severe complications occur. Options may include scleral reinforcement using donor tissue to strengthen weak areas, corneal procedures if the cornea is affected, or special bandage contact lenses for minor perforations. Post-surgical care involves regular follow-ups and medication adjustments.
Scleritis can affect many aspects of daily life. Persistent eye pain may disrupt tasks like reading, working, or resting. Some patients find that the pain spreads to the face or jaw. Light sensitivity can make it uncomfortable to be in bright environments or spend time outdoors.
Contact our optometrists promptly if you experience severe eye pain, deep redness in the white of your eye, or vision changes. Early treatment can help prevent complications and protect your vision. If you have an autoimmune condition and develop new eye symptoms, let us know right away.
We will examine your eye and ask about your symptoms and medical history. The deep red or purple color and severe pain help distinguish scleritis from milder conditions. Imaging tests may be needed to check for posterior scleritis. Blood tests can help identify underlying autoimmune conditions.
Yes, scleritis can recur, especially in patients with underlying systemic diseases. Ongoing monitoring and managing any related health conditions can help reduce the chance of flare-ups. Some patients experience several episodes before achieving long-term remission.
No, scleritis is not contagious. It is an inflammatory condition, not an infection that can spread from person to person. Even in the rare cases caused by bacteria or fungi, the infection is not transmitted to others through casual contact.
The duration varies depending on the type and severity. Mild cases may improve within a few weeks with treatment. More severe forms, especially necrotizing scleritis, may require months of therapy. Some patients have chronic or recurring episodes.
If an underlying systemic condition is suspected or diagnosed, you may need care from other doctors. Rheumatologists often help manage autoimmune diseases associated with scleritis. This team approach helps address both the eye condition and any related health issues.
During active scleritis, contact lens wear is generally not recommended. The inflammation and tenderness make lens wear uncomfortable, and lenses could irritate the eye further. Once the condition is under control, we can advise when it is safe to resume contact lens use.
