The sclera is the white, outer coat of the eye. When this area becomes inflamed, the condition is called scleritis.
What is going on in the body?
The sclera, which is made up of protein and connective tissue, becomes inflamed and irritated. If untreated, the disease may last a long time. Even with proper treatment, it is likely to recur. Complications from the disease can cause serious eye damage or loss of the eye.
What are the causes and risks of the disease?
Scleritis is an unusual condition. Occasionally the sclera may become infected with bacteria or other organisms, such as those that cause syphilis. However, most cases are linked to some form of autoimmune disorder. An autoimmune disorder is one in which the body produces antibodies against its own tissues. Rheumatoid arthritis and systemic lupus erythematosus are autoimmune disorders that may cause scleritis.
What can be done to prevent the disease?
There are no known ways to prevent scleritis.
How is the disease diagnosed?
Diagnosis of scleritis begins with a history and physical exam. The healthcare professional can observe the eye under a special microscope.
Long Term Effects
What are the long-term effects of the condition?
Complications may occur as scleritis progresses. These vary with the amount of inflammation. Over time, the disease alters the sclera. It becomes more transparent, letting the underlying pigment show through. This gives the eye a darker appearance.
Some other complications are as follows:
glaucoma, that is, increased pressure within the eyeball that may lead to vision loss
retinal detachment, the separation of the retina from the back of the eyeball
swelling of the optic nerve, which carries messages from the eye to the brain
- uveitis, an inflammation of the colored structures in the eye
Unfortunately, as many as 25% of individuals with scleritis lose a significant portion of their vision within a year of getting the condition. This occurs despite active therapy.
What are the risks to others?
Scleritis is not contagious, and poses no risk to others.
What are the treatments for the disease?
The primary goal of treatment for scleritis is to prevent the loss of vision. Local corticosteroid therapy can be used to ease the person's discomfort. However, this is usually not enough to eliminate the condition. Most cases require nonsteroidal anti-inflammatory drugs. Oral corticosteroids may also be used.
Once the condition is under control, the dose of corticosteroids may be reduced. It may be necessary for the individual to continue on a low level of the medication until the condition resolves naturally. Rarely, intravenous hydrocortisone may be required.
What are the side effects of the treatments?
High doses of corticosteroids may cause a cataract, which is a clouding of the lens of the eye that causes vision problems. Corticosteroids may also cause diabetes and osteoporosis.
What happens after treatment for the disease?
The severity of the disease varies. A common seasonal inflammation of the sclera is not serious and not related to autoimmune disease. This is called episcleritis. It can be differentiated from true scleritis during an exam by an eye care professional.
A more serious form of the condition is known as nodular scleritis, which involves clusters of cells. The most severe type is necrotizing scleritis, which causes tissue death. People with necrotizing scleritis often do not live longer than 5 years.
How is the condition monitored?
Someone with scleritis needs to make regular visits to the healthcare professional and report any new or worsening symptoms.