Scleritis is an inflammation of the sclera (the white outer wall of the eye).A.D.A.M.

Causes, incidence, and risk factors

Inflammation of the sclera is usually associated with autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Sometimes the cause is unknown.

Scleritis occurs most often in people between the ages of 30 and 60 and is rare in children.

Symptoms

• Blurred vision
• Eye pain and tenderness - severe
• Red patches on the normally white part of the eye
• Sensitivity to light - very painful
• Tearing of the eye

A rare form of this disease causes no eye pain or redness.

Signs and tests

• Eye examination
• Physical examination and blood tests to look for or rule out underlying causes

Treatment

Corticosteroid eye drops help reduce the inflammation. Sometimes corticosteroids pills are taken by mouth. Newer, nonsteroid anti-inflammatory (NSAID) drugs may be used in some cases.

If scleritis is caused by an underlying disease, treatment of that disease may be necessary.

Expectations (prognosis)

The condition may recur but usually responds to treatment. Scleritis must be distinguished from other forms of inflammation that are less severe, such as episcleritis.

The underlying disorder associated with scleritis may be serious, and may be undiagnosed at the time of the first episode. The outcome depends upon the specific disorder.

Complications

• Scleritis returns
• Side effects of long-term corticosteroid therapy
• Untreated, perforation of the eyeball may occur, leading to vision loss

Calling your health care provider

Call for an appointment with your health care provider or ophthalmologist if you have symptoms of scleritis.

Prevention

There is no preventive treatment for most cases.

Patients with autoimmune diseases such as rheumatoid arthritis may need careful monitoring by an ophthalmologist with experience treating ocular inflammatory diseases.

References

1. Watson P. Diseases of the sclera and episclera. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 23.
2. Yanoff M, Cameron D. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 431.

Review Date: 9/3/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.