Scleritis is an inflammatory disease that affects the conjunctiva, sclera, and episclera (the connective tissue between the conjunctiva and sclera). It is associated with underlying systemic disease in about half of the cases. The diagnosis of scleritis may lead to the detection of underlying systemic disease. Rarely, scleritis is associated with an infectious problem.

The affected area of the sclera may be confined to small nodules, or it may cause generalized inflammation. Necrotizing scleritis, a more rare, serious type, causes thinning of the sclera. Severe cases of scleritis may also involve inflammation of other ocular tissues.

Scleritis affects women more frequently then men. It most frequently occurs in those who are in their 40's and 50's. The problem is usually confined to one eye, but may affect both.

Signs and Symptoms

• Severe, boring pain that can awaken the patient
• Local or general redness of the sclera and conjunctiva
• Extreme tenderness
• Light sensitivity and tearing (in some cases)
• Decreased vision (if other ocular tissues are involved)

Detection and Diagnosis

Along with visual acuity testing, measurement of intraocular pressure, slit lamp examination, and ophthalmoscopy, the eye care practitioner may request a physician to order blood tests to rule out diseases affecting the body. If involvement of the back of the eye is suspected, the physician may order imaging tests such as CT Scan, MRI, or ultrasonography of the eye.

Treatment

Scleritis is treated with oral steroid and non-steroidal anti-inflammatory medication to reduce inflammation. Eye drops alone do not provide adequate treatment. In very severe cases of necrotizing scleritis, surgery may be required to graft scleral or corneal tissue over the area of thinned sclera.

Illustrations by Mark Erickson
With acknowledgement to St. Lukes Eye Hospital.