The sclera is the white part of the eye. When the sclera is swollen, red, tender, or painful (called inflammation), it is called scleritis.
It is common for people with scleritis to have another disease, like rheumatoid arthritis or other autoimmune disease. This underlying disease causes many of the symptoms of scleritis.
There are two main types of scleritis:
- anterior scleritis (occurs at the front of the eye)
- posterior uveitis (occurs at the back of the eye)
Anterior scleritis, is more common than posterior scleritis. There are three types of anterior scleritis. The most common type can inflame the whole sclera or a section of it and is the most treatable. Another type causes tender nodules (bumps) to appear on the sclera, and the most severe can be very painful and destroy the sclera.
Posterior scleritis is the rarer of the two types. People with this type of scleritis may have pain and tenderness. This form can cause problems resulting in retinal detachment and angle-closure glaucoma.
Most people only have one type of scleritis, but others can have it at both the front and back of the eye.
What Causes Scleritis?
Scleritis is often linked with an autoimmune disease. Sometimes there is no known cause. Scleritis may be linked to:
- joint swelling and stiffness (arthritis)
- lupus, or other connective tissue disease
- eye infection
- inflammatory bowel disease (IBD)
- Sjogren’s syndrome (causes very dry eyes and other symptoms)
Scleritis may be caused by trauma (injury) to the eye. Rarely, it is caused by a fungus or a parasite.
What Are Symptoms of Scleritis?
Scleritis symptoms include:
There also can be pain of the jaw, face, or head. In some cases, people lose some or all of their vision.
If you have symptoms of scleritis, you should see an ophthalmologist as soon as possible. Without treatment, scleritis can lead to vision loss.
During your exam, your ophthalmologist will:
Your ophthalmologist may work with your primary care doctor or a rheumatologist (doctor that treats autoimmune diseases) to help diagnose you. Blood, imaging or other testing may be needed.
How Is Scleritis Treated?
Scleritis needs to be treated as soon as you notice symptoms to save your vision.
Treatment varies depending on the type of scleritis. Treatment can include:
- steroid eye drops
- corticosteroid pills (medicine to control inflammation)
- nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen for pain and inflammation
- oral antibiotic or antiviral drugs
- drugs that weaken or modify the response of the immune system may be used with severe scleritis (immunosuppressive and immunomodulatory drugs)
In severe cases, surgery may be needed. This can help repair the eye and stop further loss of vision.
When scleritis is caused by another disease, that disease also needs treatment to control symptoms. Keep in mind that despite treatment, scleritis may come back. It’s important to see your ophthalmologist and other doctors regularly for the most effective treatment.