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    Scleritis

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    Pangala Nita
    Scleritis is inflammation of the sclera, the white outer layer of the eyeball. It can be caused by infection, autoimmune conditions like rheumatoid arthritis, or unknown factors. Symptoms include eye redness, pain, blurred vision, and lid swelling. Scleritis is concerning because it can indicate serious underlying systemic diseases. It is diagnosed through eye examination and testing for infectious or autoimmune causes. Treatment involves antibiotics, antivirals, corticosteroids, or immunomodulatory drugs to reduce inflammation and prevent complications like scleral thinning and perforation which can cause vision loss.

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    Scleritis

    Uploaded by

    Pangala Nita
    68 views3 pages
    Scleritis is inflammation of the sclera, the white outer layer of the eyeball. It can be caused by infection, autoimmune conditions like rheumatoid arthritis, or unknown factors. Symptoms include eye redness, pain, blurred vision, and lid swelling. Scleritis is concerning because it can indicate serious underlying systemic diseases. It is diagnosed through eye examination and testing for infectious or autoimmune causes. Treatment involves antibiotics, antivirals, corticosteroids, or immunomodulatory drugs to reduce inflammation and prevent complications like scleral thinning and perforation which can cause vision loss.

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    Scleritis is inflammation of the sclera, the white outer layer of the eyeball. It can be caused by infection, autoimmune conditions like rheumatoid arthritis, or unknown factors. Symptoms include eye redness, pain, blurred vision, and lid swelling. Scleritis is concerning because it can indicate serious underlying systemic diseases. It is diagnosed through eye examination and testing for infectious or autoimmune causes. Treatment involves antibiotics, antivirals, corticosteroids, or immunomodulatory drugs to reduce inflammation and prevent complications like scleral thinning and perforation which can cause vision loss.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    68 views3 pages

    Scleritis

    Uploaded by

    Pangala Nita
    Scleritis is inflammation of the sclera, the white outer layer of the eyeball. It can be caused by infection, autoimmune conditions like rheumatoid arthritis, or unknown factors. Symptoms include eye redness, pain, blurred vision, and lid swelling. Scleritis is concerning because it can indicate serious underlying systemic diseases. It is diagnosed through eye examination and testing for infectious or autoimmune causes. Treatment involves antibiotics, antivirals, corticosteroids, or immunomodulatory drugs to reduce inflammation and prevent complications like scleral thinning and perforation which can cause vision loss.

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    © All Rights Reserved
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    of 3

    Scleritis

    What is scleritis?

    Scleritis is inflammation of the tough, white structural wall of the eyeball, the sclera. The sclera is made
    of collagen and is continuous with the cornea, the clear window through which we see that makes up
    the front wall of the eye. Blood vessels run along and sometimes through the sclera, and can contribute
    to inflammation. The thin outside layer of the sclera, the episclera, can also be inflamed, but episcleritis
    is typically neither as severe nor symptomatic as scleritis. Swelling and severe inflammation of sclera can
    occur in one or both eyes, can affect surrounding tissues, and be quite dramatic and dangerous to
    vision. The distinction between episcleritis and scleritis is of particular concern to the ophthalmologist –
    episcleritis is a benign condition where as scleritis can sometimes be a presenting sign of dangerous, and
    potentially fatal, underlying systemic disease.

    Are there different types of scleritis?

    There are several types of scleritis:

     Anterior
     Sectoral or Diffuse
     Nodular
     Necrotizing
     Posterior

    Scleritis can be either anterior, in the front of the eye and visible during exam, or posterior, behind the
    eye and not visible during exam. Anterior scleritis can be sectoral or diffuse, depending on how much of
    the visible sclera is affected. It can also be nodular, presenting as a focal mound or elevation of inflamed
    tissue. Necrotizing scleritis, or scleromalacia perforans, is considered the most severe form of scleritis,
    and can cause dangerous thinning, potentially leading to perforation and loss of the eye. Even more
    alarming is the fact that necrotizing scleritis can at times present with voracious inflammation and be
    obvious and symptomatic, but at other times can be asymptomatic without obvious inflammation, with
    progression unknown to the patient until seen by the ophthalmologist. Scleritis can also occur in
    conjunction with inflammation of uvea, cornea, or other parts of the eye.

    Causes of scleritis

    Scleritis is most often idiopathic, or of unknown cause to the ophthalmologist, despite diagnostic
    measures. Autoimmune inflammation and infection are the two main causes, though trauma can be an
    inciting factor. Deposition of immune-complexes, or particles comprised of antibodies bound to another
    molecule (antigen), drive inflammation in a given area or sclera. Scleritis may occur as a result of various
    stimuli, the most famous of which is rheumatoid arthritis. But many of the so called connective tissue
    diseases or collagen vascular diseases may have scleritis as part of their disease spectrum. Indeed,
    inflammation of the sclera can sometimes be a presenting manifestation of a potentially very serious
    systemic disease. Sometimes inflammation in the eye will precede extraocular (outside the eye)
    manifestations of a serious systemic disease by many months or even a few years. This is but one of the
    many reasons why it is so critical for patients to regularly visit with a physician trained in ophthalmology:
    an ophthalmologist. Serologic evaluation is typically performed to search for possible autoimmune or
    infectious causes. Lastly, scleral biopsy with microscopic evaluation of prepared tissue can give
    important information on specific patterns of inflammation seen and the presence or absence of certain
    infectious organisms.

    Symptoms of scleritis

     Redness
     Pain
     Blurry vision
     Lid swelling

    Redness may be isolated to a particular area of the eye, or diffuse. Pain can be excruciating and made
    worse with eye movement. Vision can be affected if swelling from inflammation affects surrounding
    tissues such as lens, cornea, choroid, retina, or optic nerve. Light sensitivity is not usually a symptom
    unless cornea (keratitis) is also involved.

    What other medical conditions are associated with scleritis?

    As stated above, scleritis can be a sign of more ominous systemic diseases. Non-infectious causes
    include:

     Rheumatoid Arthritis
     Systemic Lupus Erythematosus
     Inflammatory Bowel Disease
     Relapsing Polychondritis
     Ankylosing Spondylitis
     Gout
     Reactive Psoriatic Arthritis
     Granulomatosis with Polyangiitis (formerly Wegener’s Granulomatosis)
     Microscopic Polyarteritis
     Churg-Strauss Syndrome

    Infectious causes include:

     Herpes simplex
     Syphilis
     Bacteria
     Tuberculosis
     Fungi

    How is scleritis diagnosed?

    As with all ocular inflammation, a careful history and review of systems is done. Note is taken of
    potential systemic issues which have symptoms revealed on review of systems, i.e. joint swelling, rash,
    abdominal pain. Examination reveals inflammation of deep scleral vessels, or areas of necrosis (cell
    death) and scleral thinning, which can be photographed for the record. Eye drops may be able to more
    easily distinguish between inflammation of sclera and episclera when it is unclear. Posterior
    inflammation is usually not visible on exam, and the ophthalmologist can use ultrasound, looking for
    signs of inflammation behind the eye. Occasionally changes in retina or optic nerve appear from
    posterior inflammation.

    What are complications from scleritis?

    The most dreaded complication of scleritis is perforation, which can lead to dramatic vision loss,
    infection, and loss of the eye. Damage to other inflamed areas, such as cornea or retina, may leave
    permanent scarring and cause blurring. Chronic pain can be debilitating if not treated. Patients may
    suffer complications from treatment more often than disease itself, with development of cataract or
    secondary glaucoma from chronic corticosteroid use.

    How do you treat scleritis?

    First line treatment should be aimed at quieting inflammation quickly. Antibiotic or antiviral therapy can
    be used when an infectious cause is shown or even highly suspected, along with topical corticosteroids
    for some infections (never fungus). For non-infectious causes, oral or topical corticosteroids can be used,
    as well as oral or topical non-steroidal anti-inflammatory drugs (NSAIDs). Periocular corticosteroid
    injection is a debated subject, as some fear that areas of necrosis are at higher risk for melt and
    perforation, though evidence suggests that treatment of non-necrotizing scleritis with injections is
    effective. Intravenous steroids can also be used. Of course, dependence on steroid therapy should be
    avoided due to complications of long term steroid use.

    Systemic therapy, by mouth, injection, or intravenous infusion, is necessary to treat chronic or recurrent
    scleritis. Immunomodulatory therapy, utilizing a step-ladder approach, can be used effectively for non-
    infectious scleritis, with regular monitoring for blood work and side effects. Surgery to repair perforated
    sclera, or bolster dangerously thinned sclera, can be done with prepared scleral grafts, or other similar
    available sterile tissue.

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