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Inflammation of the sclera (scleritis)


What is scleritis?

The sclera is a white layer which, together with the cornea, forms the outer shell of the eye and gives the eye shape and stability.1 If inflammation of this outer layer develops, it is called scleritis.2 Affected patients often suffer from pain and redness in one or both eyes.3

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What types of scleritis are there?

Scleritis is distinguished according to its location, depth or character of the inflammation.

Episcleritis is the more common type of inflammation of the sclera. This is a superficial inflammation of the sclera and the surrounding connective tissue.1,4 It can occur locally in the form of a nodule (nodular episcleritis) or diffusely over the eye (diffuse episcleritis).1

The less common scleritis, on the other hand, is a deep inflammation of the sclera.1,4 Bacterial or viral inflammation tends to be rare, while inflammation due to autoimmunological or general rheumatic diseases is common.1 It can be unilateral or bilateral, and similar to episcleritis, it can occur locally in the form of nodules or be diffusely distributed over the eye.1 Depending on the location and severity, several types of scleritis can be distinguished.1,2,5

On the whole, scleritis tends to be rare, occurring predominantly in the fourth and sixth decades of life, and affecting more women than men.5

What causes scleritis?

Episcleritis often occurs without an identifiable cause.2 It is thought that stress and severe strain can trigger episcleritis.6 On the other hand, scleritis is due to an underlying disease in about half of the cases.1,2 These include:1,7

  • Rheumatic diseases: rheumatoid arthritis, psoriatic arthritis
  • Connective tissue diseases: systemic lupus erythematosus
  • Immunological diseases: polymyositis, dermatomyositis, Bechterew’s disease, vasculitis, Wegener’s granulomatosis
  • Vasculitis (inflammation of the blood vessels): Wegener's granulomatosis, Churg-Strauss syndrome, relapsing polychondritis
  • Chronic inflammatory bowel diseases: Crohn’s disease, ulcerative colitis
  • Metabolic disorders: gout
  • Infectious diseases: syphilis, herpes viruses

How does scleritis manifest itself?

Episcleritis occurs acutely and leads to a mostly sectoral redness on the eye and spontaneous, dragging, burning pain or local tenderness. 1,2,5 It usually progresses without serious complications.5

Scleritis can be chronic and recurrent, with symptoms often developing over several days.5 The complaints of affected patients include redness of the eye, increased lacrimation, increased sensitivity to light and severe pain. 2,5 A distinctive feature of posterior segment scleritis is that it can cause severe pain but progress without visible redness on the eye.1 In some forms, serious complications can occur in the course of the disease, such as swelling and disturbances of eye movement, thinning of the sclera with a resulting bluish discolouration, or detachment of the retina with reduced vision.1,2,5

How is scleritis diagnosed?

If symptoms occur that may suggest inflammation of the sclera, then an eye specialist should be consulted. Examination of the eye primarily involves an assessment of the blood vessels of the eye using a slit lamp, which allows magnification of the eye.5 Various blood vessels may be affected, depending on the depth of the inflammation.5 In special cases, a contrast medium examination (fluorescence angiography) may be useful to display the retinal vessels.5 Since vision may be impaired, visual acuity should also be assessed.2

Also interesting: What is inflammation of the iris?

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How is scleritis treated?

In most cases, episcleritis heals by itself within 1-2 weeks and only requires a short course of symptomatic therapy with analgesic and anti-inflammatory eye drops or ointments, with or without cortisone.1

The treatment of scleritis depends on the underlying disease. Here, obtaining a blood count or immune serology may be necessary. Pain-relieving and anti-inflammatory eye drops or ointments, mainly containing cortisone, are also used to treat the local inflammation in the eye.1,2,7 In more severe cases, systemic cortisone therapy or therapy with immunosuppressants may be necessary. Surgery may be necessary in isolated cases.1,2,5

References

    1. Grehn F. Augenheilkunde. Springer Berlin Heidelberg 2019.

      2. Lang GK. Augenheilkunde. Thieme 2014.

        3. Burk A, Burk R. Checkliste Augenheilkunde. Thieme 2014.

          4. Goebeler M, Walter P, Westhofen M. Augenheilkunde, Dermatologie, HNO in 5 Tagen. Springer Berlin Heidelberg 2018.

            5. Kampik A, Grehn F (Hrsg. 2008). Augenärztliche Differenzialdiagnose. 1. Auflage Thieme, s.l., 2008.

              6. Oestreicher E. HNO, Augenheilkunde, Dermatologie und Urologie für Pflegeberufe. Thieme 2003.

                7. Deuter C (Hrsg. 2015). SA 20 – Skleritis und Episkleritis – ein update von Diagnose und Therapie. German Medical Science GMS Publishing House, 2015.