Scleritis

Published by Bupa's Health Information Team, January 2011.

This factsheet is for people who have scleritis, or who would like information about it.

Scleritis is inflammation of the white, outer layer of the eyeball (sclera). It can affect one or both eyes.

About scleritis

The white layer of your eye (sclera) is made up of connective tissues that form a protective coating around your eye. The front part of the sclera is covered by a thin layer of tissue called the episclera and then a transparent layer called the conjunctiva.

Scleritis can affect the front of your eyeball (anterior scleritis), which is most common, or the back part of your eyeball (posterior scleritis).

Anterior scleritis

There are four types of anterior scleritis.

• Diffuse anterior scleritis. This is when the front part of the sclera has widespread inflammation. It’s the most common type of scleritis and the least damaging.
• Nodular anterior scleritis. This is when very small, red, tender swellings (nodules) form on the front part of the sclera. It develops into more serious forms of scleritis in one in five people.
• Necrotising scleritis. This is the most severe form of scleritis. It’s also referred to as brawny scleritis. It causes severe inflammation and pain in either one area or over the entire front part of the sclera. It can cause the sclera to thin, which can put your eyeball at risk of serious damage.
• Necrotising scleritis without inflammation or ‘scleromalacia perforans’. This is similar to necrotising scleritis, but doesn’t cause any pain or inflammation. It’s a rare condition. It can cause the sclera to become thinner, which may cause bulges to form and can put your eyeball at risk of being punctured.

Posterior scleritis

Posterior scleritis affects only about one in every 10 people with scleritis. It can cause the sclera to become thinner, which may result in bulges forming and can put your eyeball at risk of serious damage.

Scleritis affects women more than men, and most commonly occurs between the ages of 30 and 60.

Necrotising scleritis (both types) and posterior scleritis are most common in people who have disorders such as rheumatoid arthritis that affect the connective tissues in their body.

Scleritis can lead to permanent damage to your vision. Prompt diagnosis and treatment can reduce the chance of this happening.

Symptoms of scleritis

Symptoms of scleritis include: 

• a red area on the surface of your eye or red blood vessels – this may be in only one small area or it may cover the entire front part of your eye
• a constant, severe, deep boring or pulsating pain in your eyeball – the pain is often worse when you move your eye and may cause you to wake at night
• watering eyes
• loss of vision
• sensitivity to light
• pain in your eyebrow, temple or jaw

Symptoms usually start quite slowly, and can affect one or both of your eyes.

If you have any of these symptoms, see your GP.

Complications of scleritis

The most serious complication of scleritis is thinning of the sclera. This can lead to your eyeball being punctured. If this happens, you will need urgent treatment from an ophthalmologist (a doctor who specialises in eye health, including eye surgery).

 Other complications can include:

• loss of vision
• damage to your cornea, such as inflammation of the cornea (keratitis), inflammation of the middle layer of your eye (uveitis), glaucoma and cataracts
• damage to the back of your eye, including inflammation of the optic nerve, retinal detachment, swelling of the optic disc and swelling of the macula

Causes of scleritis

Scleritis is often related to another health condition you have. This is usually a disease that affects the bones, cartilage, tendons or other connective tissues of your body, such as:

• rheumatoid arthritis – one in six people with scleritis have rheumatoid arthritis
• ankylosing spondylitis
• lupus (systemic lupus erythematosus)
• psoriatic arthritis
• inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
• bacterial or viral infection such as Lyme disease, syphilis, shingles or tuberculosis

Other, less common, causes of scleritis include gout and high blood pressure.

Diagnosis of scleritis

 Your GP or optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses) will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP or optometrist will refer you to an ophthalmologist if he or she suspects you have scleritis.

Your doctor may carry out further tests, such as a blood test, to find out if the scleritis is related to an underlying health condition.

Treatment for scleritis

Treatment for scleritis is usually with non-steroidal anti-inflammatory drugs (NSAIDs), such as indometacin or flurbiprofen. These will help to relieve your pain and reduce inflammation in your eye. You will be advised to keep taking them until your symptoms have gone. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Occasionally, if your condition is severe, your ophthalmologist will prescribe oral steroids or immunosuppressive medicines.

If you have a suspected puncture or hole in your eyeball, an eye guard or shield will be put over your eye to protect it until an ophthalmologist treats you.

Any underlying conditions that have been found as a result of you having scleritis will also require treatment. You may be referred to another specialist such as a rheumatologist (a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues) for treatment.

Scleritis can last for several months, or even years. It may be necessary to try a variety of treatments before the inflammation is brought under control.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.