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Scleritis

Published by Bupa's health information team, April 2009.

This factsheet is for people who have scleritis, or who would like information about it.

Scleritis is an inflammation of the white, outer layer of your eyeball (sclera). It can affect one or both of your eyes.

Scleritis affects more women than men, and most commonly occurs between the ages of 40 and 60.

• About scleritis
• Symptoms of scleritis
• Complications of scleritis
• Causes of scleritis
• Diagnosis of scleritis
• Treatment for scleritis
• Questions and answers
• Related topics
• Sources

About scleritis

Scleritis is an inflammation of the sclera of your eye. The sclera is the tough, white outer layer of your eyeball, often referred to as the white of your eye. It's made up of connective tissues that form a protective coating around your eye. The front part of the sclera is covered by a thin layer of tissue called the episclera and then a transparent layer called the conjunctiva.

Scleritis can affect the front of your eyeball (anterior scleritis) or the back part of your eyeball (posterior scleritis).

There are four types of anterior scleritis.

• Diffuse anterior scleritis. This is when the front part of the sclera has widespread inflammation. It's the most common type of scleritis and the least damaging.
• Nodular anterior scleritis. This is when very small, red, tender swellings (nodules) form on the front part of the sclera. It develops into more serious forms of scleritis in one in five people.
• Necrotising scleritis. This is the most severe form of scleritis. It's also referred to as brawny scleritis. It causes severe inflammation and pain in either one area or over the entire front part of the sclera. It can cause the sclera to thin which puts the eyeball at risk of serious damage. It's commonly associated with disorders that affect the connective tissues of the body, such as rheumatoid arthritis.
• Necrotising scleritis without inflammation or scleromalacia perforans. This is similar to necrotising scleritis, but doesn't cause any pain or inflammation. It's a rare condition. It can cause the sclera to become thinner which may cause bulges to form and can put the eyeball at risk of puncturing. This type of scleritis is most common in people with rheumatoid arthritis.

Posterior scleritis is rare. It usually only occurs in one eye and is most often happens in people who have disorders that affect the connective tissues in their body, such as rheumatoid arthritis. It can cause the sclera to become thinner which may result in bulges forming and can put the eyeball at risk of serious damage.

Symptoms of scleritis

Symptoms of scleritis usually start quite slowly, and can affect one or both of your eyes.

You may notice that you have redness or red blood vessels on the surface of your eye. This may be in only one small area or it may cover the entire front part of your eye. This is usually accompanied by a constant, severe, deep boring or pulsating pain in your eyeball. The pain is often worse when you move your eye and may cause you to wake at night.

Other symptoms can include:

• watering eyes
• loss of vision
• sensitivity to light
• pain in your eyebrow, temple or jaw

Complications of scleritis

The most serious complication of scleritis is thinning of the sclera, this can lead to your eyeball being punctured.

Other complications can include:

• loss of vision
• damage to your cornea, such as inflammation of the cornea (keratitis), inflammation of the middle layer of your eye (uveitis), glaucoma and cataracts
• damage to the back of your eye, including inflammation of the optic nerve, retinal detachment, swelling of the optic disc and swelling of the macula

Causes of scleritis

Scleritis is usually related to an underlying health condition. This is often a connective tissue disorder or autoimmune disease, and can include the following.

• Rheumatoid arthritis. One in five cases of scleritis is related to rheumatoid arthritis. This is an autoimmune disease in which your body's immune system attacks the lining of your joints causing inflammation of the sheaths around your tendons and can eventually lead to severe damage to the ends of your bones. It can also affect the organs of your body.
• Ankylosing spondylitis. This is when all or some of the bones and joints in your spine fuse together. Just over one in 10 people with scleritis have ankylosing spondylitis.
• Lupus (systemic lupus erythematosus). This is a rare auto-immune disease that can affect your skin, joints and organs.
• Psoriatic arthritis. This is arthritis that is related to the skin condition psoriasis.
• Reactive arthritis. This is inflammation in your joints as a result of having a bacterial or viral infection in your body.
• Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis.

Other conditions that can be associated with scleritis include:

• syphilis
• shingles
• tuberculosis
• gout
• Lyme disease
• high blood pressure

Diagnosis of scleritis

Scleritis can lead to permanent damage to your vision. Prompt diagnosis and treatment can reduce the chance of this happening.

Your GP or optometrist (a healthcare professional who examines eyes, tests sight and dispenses glasses and contact lenses) will examine your eye and refer you to an ophthalmologist if he or she suspects you have scleritis. An ophthalmologist is a doctor who specialises in eye health.

Your GP may also carry out further tests, such as a blood test, to find out if your scleritis is related to any other underlying health conditions.

Treatment for scleritis

Treatment for scleritis is usually with non-steroidal anti-inflammatory drugs (NSAIDs), such as indometacin or ibuprofen. These help to relieve pain and reduce inflammation in your eye. You will be advised to keep taking them until your symptoms have gone. Always read the patient information leaflet that comes with your medicine.

Occasionally, if your condition is severe, oral steroids or immunosuppressive medicines will be prescribed by your ophthalmologist.

If there is a suspected puncture or hole in your eyeball, an eye guard or shield will be put over your eye to protect it. This is normally done at the accident and emergency department of a hospital. The eye guard will remain in place until emergency treatment from an ophthalmologist can be given.

Any underlying conditions that have been found as a result of having scleritis will also require treatment and may require referral to another specialist such as a rheumatologist. A rheumatologist is a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues.

Scleritis can linger for several months, or even years, it may be necessary to try a variety of treatments before the inflammation is brought under control.

Related topics

• Crohn's disease
• Episcleritis
• Gout
• High blood pressure
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Psoriatic arthritis
• Rheumatoid arthritis
• Shingles
• Syphilis
• Systemic lupus erythematosus
• Tuberculosis
• Ulcerative colitis

Sources

• Scleritis. GP Notebook. www.gpnotebook.co.uk, accessed 4 November 2008
• Scleritis. eMedicine. www.emedicine.com, accessed 4 November 2008
• Collier J, Longmore M, Scally P. Oxford handbook of clinical specialities. 6th ed. Oxford: Oxford University Press, 2003:496
• Khaw PT, Elkington AR. ABC of eyes. London: BMJ Publishing Group, 2002:8
• Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:937

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009