Scleritis

What is scleritis?

Scleritis is the inflammation of your sclera, normally the white part of your eye. When you have scleritis, the white part of your eye becomes red.

Scleritis often involves piercing pain in your eye that gets worse with eye movement. It can cause permanent damage and vision loss. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. It may be caused by an underlying inflammatory disease, fungus or injury.

Scleritis should be treated. Don’t try to wait for it to go away on its own.

What are the types of scleritis?

There are two main types of scleritis: anterior (referring to the front of your sclera) and posterior (referring to the back of your sclera). Both anterior and posterior scleritis can also be diffuse, nodular or necrotizing.

• Diffuse scleritis: Diffuse scleritis is scattered all across your sclera. It’s the most common type.
• Nodular scleritis: Nodular scleritis is concentrated in one spot of the sclera. You can usually see the lump (nodule).
• Necrotizing scleritis: This most severe form of scleritis. It causes the most damage. It can destroy eye tissue and even result in the loss of your entire eye. There’s a form of necrotizing scleritis called scleromalacia perforans. It may not be painful but it can cause perforations (holes). This type accounts for 4% of scleritis.

Anterior scleritis, occurring at the front of the sclera, is the most common type of scleritis. Posterior scleritis, which affects the back of the sclera, represents about 10% of all cases of scleritis.

Who does scleritis affect?

Scleritis usually affects people who are 47 to 60 years old. But people who are younger or older can get it, too. The condition is more common in women and people assigned female at birth (AFAB) than in men and people assigned male at birth (AMAB), in part due to the association of scleritis with autoimmune conditions. But males tend to have higher rates of scleritis caused by an infection.

How common is scleritis?

Each year, healthcare providers diagnose about 10,500 cases of scleritis in the United States. This works out to about 4-6 cases per 100,000 people.

What are the signs and symptoms of scleritis?

The signs and symptoms of scleritis include:

• Redness and swelling of your sclera.
• Pain and tenderness in your eye, often severe enough to wake you up at night. It can also spread to other parts of your face.
• Watering (tearing) eyes.
• Sensitivity to light (photophobia).

What causes scleritis?

Sometimes, scleritis has no known cause. Healthcare providers call this “idiopathic.” In many other cases, you may get scleritis if you have another type of medical condition, like an autoimmune illness. Other symptoms or conditions in this category include:

• Rheumatoid arthritis. This condition affects the joints on both sides of your body. Rheumatoid arthritis is the immune system condition most often associated with scleritis.
• Connective tissue diseases like systemic lupus erythematosus. Lupus and its chronic inflammation disrupt many parts of your body, which may include your joints, your skin and organs — like your lungs, brain, kidneys and heart.
• Inflammatory bowel disease (IBD). This term describes a group of disorders that cause chronic inflammation in your intestines.
• Sjögren’s syndrome. This autoimmune disorder restricts the amount of moisture provided by glands in your eyes and mouth.
• Scleroderma. In this disorder, normal tissue is replaced with dense, thick fibrous tissue.
• Granulomatosis with polyangiitis. This disease is the result of inflammation within your tissues (granulomatous inflammation) and blood vessels (vasculitis), which can damage organ systems.

Scleritis can also be associated with:

• Infections. Certain infections cause infectious scleritis. These can be bacterial, fungal or viral. Fungal infections usually have a less positive outlook than bacterial or viral infections. Lyme disease may also cause scleritis (Lyme scleritis).
• Trauma or injury to your eye, including surgical procedures. This type of injury often gives rise to infectious scleritis. In fact, one example of this is something called surgically induced necrotizing scleritis (SINS).
• Medications used to treat or prevent bone disease. These types of drugs include bisphosphonates and are known to cause inflammatory eye reactions.

What tests will be done to diagnose scleritis?

Your provider may be able to determine if you have scleritis by giving you an eye exam, which may include a slit lamp exam.

If you have posterior scleritis, your provider may order a computed tomography (CT) scan or an ultrasound.
If your scleritis is caused by an infection, your provider may take a smear of eye discharge to send to the lab. In very few cases, your provider might order a biopsy.

How is scleritis treated?

If you have a very mild case of scleritis, your provider may recommend using nonsteroidal anti-inflammatory drugs (NSAIDS). But your provider is more likely to prescribe a systemic corticosteroid, like prednisone, for a longer period of time (seven to 10 days).

If you get inflammation again, you may need intravenous corticosteroids.

If you have an infectious version of scleritis, you may need an antibiotic, antifungal or antiviral.

For necrotizing scleritis, your provider may work with a rheumatologist to prescribe other medications, including immunotherapeutic drugs like cyclophosphamide, methotrexate, mycophenolate mofetil, or biologic agents like rituximab and adalimumab.

Other treatments may include scleral patching or grafts, which use other types of tissue as implants.

How can I reduce my risk of developing scleritis?

In many cases, you can’t prevent scleritis. But you can take good care of your eyes.

You can reduce your risk of damaging your eyes by wearing the required eye protection when you’re at work or participating in certain contact sports.

You can reduce your risk of eye infections by always making sure your hands are clean if you have to touch your eyes. Also, make sure you clean your contact lenses if you wear them.

What can I expect if I have scleritis?

Scleritis can — and should — be treated. Untreated scleritis can result in vision loss. Posterior necrotizing scleritis can be the most damaging. Your provider will also work with you to treat any other autoimmune conditions you may have.

When should I see my healthcare provider about scleritis?

You should see your healthcare provider any time you have pain, redness or swelling in one or both eyes. This is especially true if you have some type of immune system disorder.

What’s the difference between scleritis and episcleritis?

Scleritis affects your sclera. Episcleritis affects your episclera, or the outermost layer of tissue in your sclera. Episcleritis usually resolves on its own.

What’s the difference between scleritis and uveitis?

The uvea is the layer of the eye that lies underneath the sclera (the white of the eye). Inflammation of your uvea is called uveitis. Your uvea and sclera can both be inflamed at the same time, but they’re two different parts of your eye.

What’s the difference between scleritis and conjunctivitis?

Scleritis involves your sclera, while conjunctivitis (pink eye) involves the inflammation of your conjunctiva. Your conjunctiva covers your sclera and the inside of your eyelid. Both conditions may cause eye redness, but pink eye isn’t as serious and doesn’t cause the pain that scleritis does.

A note from Cleveland Clinic

Your eyes are important to you, so you’re responsible for keeping them healthy. Contact your eye care provider or healthcare provider immediately if your eyes are red and painful. It’s best to catch any type of condition early, whether it affects your eyes or other parts of your body.