Scleritis – causes, symptoms, diagnosis and treatment

Proven content

Scleritis is a condition characterized by inflammation of the protective layer that surrounds the eyeball. As a result of the disease, the sclera may lose its function and the shape and stiffness of the eyeball may be compromised. We distinguish front and rear scleritis, depending on its location. Treatment of ailments is based on the administration of antibiotics according to the recommendations of an ophthalmologist.

What is scleritis?

Scleritis is a disease characterized by inflammation in the wall of the eye (sclera). The sclera is made up of an anterior opening surrounding the cornea and a posterior opening surrounding the optic nerve canal to protect the structure inside the eyeball.

The sclera is an organ that consists of several layers:

1. superficial epidural,
2. sclera stroma,
3. the brown plaque adjacent to the uveal lining inside the eyeball.

Scleritis is a rare condition, but there is no specific information available. The fact is that many cases are mild and patients do not refer the problem to a specialist, which unfortunately makes epidemiological research difficult.

The causes of scleritis

Inflammation can occur in the epidural and is fairly mild in nature, with no specific cause found in most patients. Episcleritis can affect us:

1. in particularly stressful situations (1/3 cases),
2. as a result of migraines,
3. as a result of rosacea,
4. in patients with AD (atopic dermatitis),
5. in the case of syphilis and Lyme disease,
6. as a result of connective tissue and vascular ailments.

Also, various toxic agents can influence the occurrence of episcleritis.

In turn, scleritis, which is the main part of the eyeball, can have serious consequences and indicate other general conditions. The eye may be damaged and, consequently, your eyesight. Inflammation of the sclera stroma can also surround the epidural. Scleritis, especially necrotic, with tissue necrosis is associated with ailments of connective tissue and vessels. Diseases play an important role:

1. systemic lupus erythematosus,
2. RA – rheumatoid arthritis,
3. Reiter’s syndrome,
4. ankylosing spondylitis,
5. recurrent cartilage inflammation,
6. polyarteritis nodosa,
7. arthritis of a psoriatic nature,
8. giant cell arteritis,
9. Wegener’s granuloma.

Scleritis – symptoms

1. Episcleritis is a condition that attacks suddenly and leads to a severe reddening of the eyeball. In addition, the patient has a feeling of discomfort and burning in the eyeball. Accompanying symptoms may include lacrimation and photosensitivity. The acute eye pain in episcleritis is usually mild and limited to the eye itself. Importantly, when pressing the eyeball, the patient does not feel any pain. In episcleritis, visual acuity is maintained, and the disease itself likes to come back and can attack both the left and right eyes.

2. The main symptom of scleritis is hyperemia and redness of the eye accompanied by severe pain radiating towards the forehead, paranasal sinuses or jaw. This ailment has an insidious beginning. Occasionally, necrotizing scleritis causes pain so severe that patients are referred for thorough neurological examination before an appropriate diagnosis can be made. Inflammation of the posterior part of the sclera may result in paralysis of the muscles, in which the patient develops exophthalmos and loses his eyesight. To sum up, one and the main symptom of scleritis (of any type) is purple or even blue reddening of the eyeball. Scleritis can attack one eye and the other, or it can affect both eyes simultaneously.

What to do when symptoms occur?

It is imperative that you consult your doctor if you have had episcleritis for the first time. Patients who have relapses are able to recognize the disease on their own. Then you can ease the symptoms yourself, for example with cold compresses or over-the-counter drops containing artificial tears.

Scleritis gives such characteristic symptoms in the form of redness (even outside the eye) and a change in its appearance that patients have no doubts about visiting a doctor. Even in the case of relapses, consultation is necessary because permanent eye damage and life-threatening may result.

Scleritis diagnosis

The basis for the diagnosis of scleritis is to conduct a medical interview with the patient, during which the specialist collects information about general diseases and eye diseases. Daylight examination is also important, so that it is possible to distinguish scleritis from episcleritis. The differences are mainly related to redness, which turns pink or strong red in episcleritis, and purple or even blue in scleritis. This type of examination also helps determine the nature of the inflammation, is it nodular? or maybe spilled? If the patient is necrotic, the doctor will notice areas of thinning of the sclera and cavities.

Other tests used to diagnose scleritis include:

1. slit-lamp examination – allows to assess the depth of inflammatory changes and the involvement of the epidural vessels (superficial and deep). In addition, it is possible to determine the extent of swelling and hyperemia (especially in necrotic scleritis);
2. Type B ultrasound – this test is helpful in determining which area of ​​the sclera has become inflamed. In addition, it enables the diagnosis of posterior scleritis, which, if not diagnosed, causes loss of vision;
3. computed tomography and magnetic resonance imaging – they are not as valuable as the above-mentioned tests, but to determine to what extent they have been affected by the inflammation of the orbital tissue;
4. Fluorescein angiography or angiography with indocyanin green – a test that helps in the diagnosis of vasculitis and blood flow disorders.

In addition, in the diagnosis of scleritis, additional tests are performed, which include:

1. Blood tests,
2. urine test,
3. test to determine the concentration of C-reactive protein,
4. determination of autoantibodies,
5. syphilis tests
6. uric acid concentration
7. radiological examination (X-ray of the chest and sacroiliac joints).

Scleritis – treatment

Inflammation epidural is a condition that usually does not require treatment as it goes away on its own. However, when symptoms are severe, patients take drops containing corticosteroids. It is worth mentioning that these types of drugs can cause cataracts or glaucoma, so they should be discontinued as soon as possible after improvement. Failure to respond to corticosteroids requires topical administration of non-steroidal anti-inflammatory drugs that do not cause these side effects. Conversely, the lack of improvement after topical application leads to the administration of NSAIDs to the patient in general.

Treatment for scleritis is more severe than that of the epidural. Here, local treatment is auxiliary, but general treatment is necessary. If there is no necrosis, systemic NSAIDs are given. Oral corticosteroids are recommended for consecutive patients. In patients who are particularly resistant to treatment, a solution is being sought in the treatment of intravenous steroid pulses or immunosuppressants (especially in necrotic scleritis). Since this type of therapy may cause side effects, patients should be under the constant care of doctors (haematologists, neurologists, internists).

Surgical treatment is used in situations where there are complications in the form of a corneal defect, retinal detachment, glaucoma, cataracts or optic neuritis. If the scleritis was caused by infectious agents, the administration of immunosuppressants is contraindicated.

Scleritis – prevention

The type of work and time spent in preventing scleritis is important. If we are exposed to damage to joints, muscles or ligaments on a daily basis, e.g. during physical activity, there is a risk of cellulitis, and consequently scleritis. Early diagnosis is very important and treatment of diseases related to this ailment can prevent its occurrence.