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Scleritis

The sclera is the white part of your eyes that is made up of protective and supportive tissue. Scleritis is a general term describing different types of inflammation of this tissue. Most of the time, scleritis is caused by an autoimmune disorder like rheumatoid arthritis, but can also be caused from infection. Scleritis can be an early sign of another connective tissue disorder. It can also be induced by head trauma or a side effect of ocular surgery.

Although there are multiple types of scleritis, most cases share the same symptoms with vary severity. The most prevalent symptom is the redness and inflammation of the sclera and cornea. The color can be a deep red or purple. Sensitivity to light and tearing are also common. Those with scleritis also experience a loss of visual acuity, and if left untreated can lead to blindness. Depending on the location of the inflammation, eye pain can occur. Scleritis is known to cause some of the most severe ocular pain out of any disease, with pain often radiating to the jaw or causing headaches and earaches. Moving the eye worsens pain. Untreated scleritis can lead to keratitis, uveitis, or blindness.

Anterior scleritis (AS) makes up all but 2% of scleritis cases. AS can additionally be broken down into three other subcategories. Diffuse AS is characterized by blood vessel dilation and edema.  Nodule AS is characterized by nodules made up of scleral edema appearing within the sclera. The final type is necrotizing, which is the most sever form of AS. Necrotizing AS causes the most severe pain. The eye is extremely sensitive to touch. Swollen blood vessel could lead to lack of blood flow and thus cell death. The choroid may become exposed due to the thinning of the outer layer of the eye. Uveal growths known as staphyloma may protrude from the eye. 

Posterior scleritis (PS) is more rare, but also more severe. PS occurs near the back of the sclera and can cause the choroid to fold or the retina to detach. It may also cause vitritis.

NSAIDs like ibuprofen are used to help to treat pain. Steroid solutions and oral medication are used to reduce inflammation. Extreme cases, particularly necrotizing AS, may require surgery to repair damage to the cornea or sclera.

Scleritis’s milder cousin is episcleritis, the inflammation of the episclera, which is the connective tissue outside the sclera. It is characterized by bloodshot eyes and excessive tearing. The pain during episcleritis is much less than that which is experienced during scleritis. Sensitivity to light, vision loss, and abnormal growths are not as prevalent as they are in scleritis. Episcleritis is also subdivided in the diffuse and nodular subcategories.  Episcleritis normally resolves itself on its own and does not lead to any other types of inflammation. Normally, only eye drops are needed to reduce pain during the healing process. In more advanced cases, especially nodal, steroids can be used to reduce inflammation.