Scleritis is a disorder characterized by inflammation of the sclera. The sclera is the white section of the eye. It is the firm, fibrous, whitish top layer of the eye and a class of connective tissue. It gives the eye its white color and also plays a role in the preservation of the shape of eye. The sclera is the area extending from the corneal border to the end of the optic nerve situated at the back end of the eye.

Symptoms of scleritis

The signs and symptoms of scleritis are listed below:

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  • A majority of scleritis cases, cause pain and are often accompanied by elevated eye tenderness to touch. The pain can also affect the deeper parts of the eye, and usually end up waking the patient from sleep. This pain is what differentiates scleritis from other ocular disorders, such as episcleritis or conjunctivitis, that cause redness of the eyes
  • The eyes may experience some tearing. However, excessive discharge normally does not occur
  • The redness of the blood vessels may appear near the sclera, along with a bluish or violent tone to it. Persistent and recurrent instances of scleritis can cause the sclera to thin, causing the brownish choroid occurring below it to become visible
  • There may be reduction in visual acuity due to secondary clouding of the cornea or the ocular lens. The accumulation of blood vessels, which perform the function of removing the aqueous fluid from the eye, can elevate the intraocular pressure. Secondary inflammation affecting the ciliary body that is present deeper than sclera can however reduce the intraocular stress. Lowered visual acuity caused due to migration of scleritis to the surrounding tissues can lead to inflammation of the anterior part of the eye, cataract, corneal swelling, abnormalities of the retina, or glaucoma
  • The disturbances in the eye color may be restricted to a specific part, or may occur in the full white section of the eye
  • Scleritis may elicit a bumpy look featuring many globular or oval elevations in the sclera. Those sections of the sclera that do not show reddening may have undergone necrosis or demise of the inflamed blood vessels
  • When the condition is examined by a doctor, he/she may observe scleritis to affect either the back or the front part of the eye
  • Some cases of scleritis may also lead to photosensitivity or elevated sensitivity to light
  • The advent of extraocular muscles into the sclera may cause irritation of that particular region, resulting in interruptions in the motion of the eye. This may ultimately lead to double vision

Causes of scleritis

  • Scleritis is an uncommon condition that is different from episcleritis, an eye disorder which is widely occurring. In episcleritis, the superficial tissue which occurs between the blood-filled layers of the sclera and the conjunctiva is the only area affected by inflammation
  • About 50 percent of the cases of scleritis are linked with the occurrence of underlying disorders affecting the internal organs of the body. Autoimmune anomalies, generalized vasculitic conditions and connective tissue disorders may at first cause development of scleritis as a symptom before advancing into serious medical complications.
  • About thirty percent of scleritis cases do not have any definite cause
  • Contact with certain chemicals, eye injuries, or post surgical inflammation can also cause scleritis
  • Scleritis may also result from infections by various bacteria and other pathogens such as fungi, viruses or parasites
  • Scleritis may affect one eye or both of them. Scleritis affecting both eyes is almost always caused by an underlying systemic condition
  • The existence of a known autoimmune or connective tissue disease increases the risk to developing scleritis
  • People aged between forty and fifty years are most commonly affected by scleritis
  • Women are more vulnerable to developing the condition as opposed to men

Scleritis Treatment

  • Scleritis which results due to the presence of a preexisting systemic disease is cured by treating that underlying cause. This eventually results in scleritis resolution
  • In addition to treating the underlying conditions, doctors may also prescribe topical eye drops therapy. These eye drops usually comprise of topical steroids or topical NSAIDs
  • Cases of scleritis which are infectious may also need additional treatment with topical antibiotics
  • Scleritis cases that do not have an underlying disease as the prominent cause are treated with different types of medications available over the counter, which help in alleviation of ocular inflammation. In case such topical prove to be insufficient in resolving the disorder or containing the swelling, then doctors may prescribe topical corticosteroids, anti-TNF agents and non-steroidal anti-inflammatory drugs.
  • If the above listed prescription medications result in serious side effects, then the doctor may suggest the use of sub-conjunctival steroid injections to reduce the pain
  • Rare cases of scleritis that elicit elevated thinning of the sclera may need to be corrected via surgery. In order to preserve the integrity of the eye, physicians may employ sclera grafts accessible from eye banks to carry out the surgery. Severe thinning or tearing in the limbal area because of scleritis may necessitate the use of corneal tissue.

Scleritis Pictures

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