Definition of Scleritis

Scleritis is an inflammation of the sclera, the white outer layer of the eyeball, which can manifest as a painful, red eye and, in some cases, may lead to vision impairment. This condition is serious, as the inflammation can extend to involve the cornea, episclera, and uvea, thereby posing a threat to vision. Women, particularly those in their 30s to 50s, are more commonly affected. The sclera’s unique structure, with its dense network of connective tissues and limited blood supply, makes it susceptible to inflammation, especially in the presence of systemic autoimmune diseases like rheumatoid arthritis, lupus, or granulomatosis.

Scleritis: Symptoms, Pain, and Complications

Scleritis is a serious eye condition that can cause pain, redness, swelling, and visual issues. Timely diagnosis and treatment are essential to prevent lasting damage.

Common Symptoms and Pain Characteristics

• Severe, Deep Pain: Patients often experience intense, piercing pain that may spread to nearby areas like the forehead, jaw, or scalp.
  • Pain can worsen with eye movement and often disrupts sleep, particularly worsening at night.
• Redness and Swelling: Characterized by a deep red or violet hue and swelling in the sclera (white part of the eye), different from more common conditions like conjunctivitis.
  • Redness originates from deeper blood vessels and can lead to connective tissue damage if untreated.

Visual Disturbances

• Blurred or Cloudy Vision: Inflammation can interfere with vision clarity and make daily visual tasks challenging.
• Light Sensitivity: Increased photophobia (light sensitivity) can add discomfort, and untreated cases may risk permanent vision impairment.

Ocular Complications

• Approximately 35% of scleritis patients experience complications, including:
  • Anterior Uveitis (13%): Inflammation of the uvea, the middle layer of the eye.
  • Ocular Hypertension (11.7%): Increased eye pressure.
  • Vision Loss (7.8%): Loss of two or more lines of Snellen visual acuity.
  • Corneal Involvement (3.9%), Retinal Detachment (3.9%), and Macular Edema (2.6%).

Long-Term Vision Outcomes

• At diagnosis, 94% of affected eyes had 20/40 vision or better.
• After at least one year, 90% maintained or improved this level of vision.
• Only 7.7% experienced a loss of two or more lines of vision.

Incidence and Demographics

Scleritis, a rare inflammatory eye condition, affects about 10,500 individuals each year in the United States, with an incidence rate of four to six cases per 100,000 people. Studies in both the United States and Australia reveal key demographic patterns and associations with systemic health conditions.

Age and Gender:

• Primarily affects middle-aged adults, commonly between 47 and 60 years.
• Women are disproportionately affected, accounting for 60% to 74% of cases.
• While rare in children, isolated case reports indicate it does occur.

Prevalence 

• United States (Olmsted County, MN):
  • Incidence rate: 5.54 per 100,000 per year.
  • Systemic disease was present in 23.4% of cases, with a trend towards higher recurrence among patients with systemic conditions.

Outcomes and Visual Prognosis:

• Scleritis is more severe than episcleritis, with a higher rate of ocular complications.
• Despite its severity, most patients retained good visual outcomes:
  • Over 90% of patients in Olmsted County had stable or improved vision, with 90.4% achieving 20/40 vision or better at the last follow-up.

Scleritis Overview: Causes, Types, and Immune System Involvement

Scleritis is a painful inflammation of the sclera (white part of the eye) that can impact vision and quality of life. It’s often linked to autoimmune diseases, infections, or trauma.

Causes of Scleritis

• Autoimmune Diseases: Commonly associated with conditions like rheumatoid arthritis and lupus, where the immune system attacks its own tissues, including the sclera.
• Infections: Rarely, bacteria or fungi can cause scleritis, especially following eye trauma or surgery. This type requires antibiotics or antifungal treatments.
• Trauma and Risk Factors: Eye injuries, surgeries, or chronic exposure to certain medications or toxins can trigger scleritis.

Immune Response

• Granulomatous Inflammation: Forms small immune cell clusters (granulomas) and is linked to diseases like tuberculosis.
• Nongranulomatous Inflammation: A simpler immune response, seen in cases where the exact cause is unknown (idiopathic).

Types of Scleritis

• Anterior Scleritis (Front of the Eye):
  • Diffuse: Widespread inflammation causing redness and discomfort.
  • Nodular: Painful, localized nodules on the sclera.
  • Necrotizing: Severe, often linked to systemic diseases, with potential for tissue damage and vision loss.
• Posterior Scleritis (Back of the Eye):
  • Harder to detect and requires imaging; symptoms include deep eye pain and possible complications like retinal detachment.

Key Differences Between Scleritis and Episcleritis

• Episcleritis:
  • Mild, affects the outer layer, bright red, less painful, usually self-resolving.
• Scleritis:
  • Deeper layer, intense pain, purplish-red, risk of vision loss, often linked to systemic issues.

Impact of Scleritis on Daily Life

Scleritis can significantly impact patients’ lives, affecting their daily activities and placing additional demands on caregivers.

• Challenges for Patients:
  • Pain: Persistent eye pain, often radiating to the face or jaw, can disrupt daily tasks like reading, working, or resting.
  • Light Sensitivity: Bright lights may become intolerable, complicating navigation in well-lit environments.
  • Work and Focus: Difficulty maintaining concentration affects performance at work or school.

Treatment

• Basic Pain Relief:
  • Over-the-counter anti-inflammatory drugs like ibuprofen can help with pain and swelling.
• Corticosteroids:
  • Prescribed if basic pain relief is insufficient, available as pills or injections. Requires monitoring for side effects.
• Advanced Medications:
  • For severe or chronic cases, helps control immune response and requires regular check-ups.
• Surgery(Rare and Last Resort):
  • Only considered for severe complications, such as high risk of scleral perforation or significant scleral thinning.
  • Scleral Reinforcement: Uses donor tissue to strengthen weak areas.
  • Keratoplasty: Replaces damaged tissue if the cornea is affected.
  • Corneal Bandage: Contact lens or glue for minor perforations.
  • Post-Surgery Care: Regular follow-ups, medication adjustments, and collaborative care with other specialists to manage the condition.

Complications and Long-Term Consequences

Associated Systemic Complications

Scleritis is intricately linked to systemic health issues, particularly autoimmune disorders. For healthcare professionals, it serves as a vital indication of systemic maladies that might require attention. Conditions frequently associated with scleritis include:

• Rheumatoid Arthritis: Often, scleritis accompanies this notorious autoimmune disorder, indicating the potential for systemic, body-wide inflammation.
• Granulomatosis with Polyangiitis (GPA): Around 10% of individuals with GPA also experience scleritis, signaling a possible systemic flare-up that could impact the kidneys and lungs.
• Systemic Lupus Erythematosus and Other Vasculitides: These systemic inflammatory diseases frequently coincide with scleritis, highlighting the critical need for comprehensive patient management.

Prognosis for Patients with Scleritis

The prognosis for scleritis varies significantly based on subtype, severity, and the presence of systemic conditions. However, with appropriate treatment, many patients maintain good vision and manage to prevent further complications.

• Mild to Moderate Scleritis: Most patients can expect to preserve excellent vision. Yet, vigilance is key as the disease can have long episodes before remission.
• Necrotizing Scleritis: This form poses a higher risk for visual impairment and an increased mortality rate due to systemic associations.

Emergency Eye Care Services in Costa Mesa

Insight Vision Center Optometry in Costa Mesa is the go-to destination for emergency eye care in Orange County. Patients from Irvine, Huntington Beach, Santa Ana, and beyond trust our expert team for fast and accurate diagnoses and treatment. Our clinic combines modern technology with compassionate care, ensuring that every emergency—from injuries to sudden vision problems—is handled efficiently and effectively. Don’t hesitate to reach out if you experience an eye emergency, and we’ll provide the urgent care you need.