What Is Scleritis and How It Affects Your Eyes
Understanding Scleritis
This section explains what scleritis is and why it requires prompt medical attention.
Scleritis affects the deep episcleral and scleral tissues, producing a violet-bluish hue and deep, aching pain that can radiate to the face or head. Without treatment, the inflammation may cause lasting damage.
The pain from scleritis is often severe, worsens with eye movement, and distinguishes it from more superficial eye conditions.
Types and Classifications of Scleritis
Scleritis is categorized by the location and severity of inflammation.
This common form affects the front part of the sclera and can appear in several patterns.
- Diffuse anterior scleritis causes widespread redness and edema.
- Nodular scleritis presents as tender nodules on the scleral surface.
- Necrotizing scleritis leads to tissue thinning, while scleromalacia perforans is a painless variant that can silently weaken the sclera.
Less common and harder to detect, posterior scleritis involves tissue behind the extraocular muscles and may lead to choroidal folds, retinal detachment, or optic nerve swelling.
Clinical Evaluation and Diagnosis
Accurate diagnosis distinguishes scleritis from other red-eye conditions and guides treatment.
A gradual onset of deep pain, especially at night or with eye movement, raises concern for scleritis and prompts evaluation for systemic autoimmune disease.
Slit-lamp biomicroscopy reveals inflamed deeper vessels that do not blanch with phenylephrine, helping differentiate scleritis from episcleritis.
B-scan ultrasonography or orbital MRI can detect posterior inflammation, scleral thickening, or nodules.
Blood work, including CBC, ESR, CRP, and autoantibody panels, helps uncover systemic conditions linked to scleritis.
Medical Therapy Options
Treatment is tailored to the severity and subtype of scleritis.
Oral NSAIDs such as indomethacin or ibuprofen reduce pain and inflammation in mild to moderate cases, with monitoring for gastrointestinal or renal side effects.
Systemic prednisone or similar agents are prescribed for more severe disease or when NSAIDs are inadequate. Patients must be aware of potential side effects like elevated eye pressure or mood changes.
Methotrexate, cyclosporine, mycophenolate mofetil, or TNF-alpha inhibitors may be recommended for long-term control or steroid-sparing therapy.
Surgical Intervention
Surgery is uncommon but may be necessary for certain complications.
Severe scleral thinning or risk of perforation can require a graft from donor sclera, periosteum, or fascia lata to stabilize the eye.
When the diagnosis is uncertain, a biopsy may help rule out infectious or neoplastic causes while preserving delicate tissue.
Risk Factors and Associated Conditions
Knowing risk factors supports early recognition and intervention.
Systemic vasculitis in rheumatoid arthritis is a leading association with scleritis.
Conditions such as systemic lupus erythematosus, Sjogren’s syndrome, and scleroderma can present with ocular inflammation.
Ulcerative colitis and Crohn’s disease are linked to scleritis in some patients.
Occasional triggers include infections, prior surgery, or ocular injury that compromise conjunctival integrity.
Signs and Symptoms
Recognizing the clinical presentation promotes timely treatment.
A deep, boring pain that can radiate to the face and head often worsens with eye movement.
The sclera may appear violet-bluish with noticeable swelling.
Even light touch can increase discomfort, distinguishing scleritis from milder eye irritation.
Blurred vision, tearing, and light sensitivity may occur, especially if adjacent structures become inflamed.
Joint pain, skin changes, or weight loss can accompany scleritis when autoimmune disease is present.
Distinguishing Scleritis from Similar Eye Conditions
Careful examination helps separate scleritis from other red-eye disorders.
Superficial inflammation causes mild discomfort that improves with topical therapy, and vessels blanch with phenylephrine, unlike in scleritis.
Often infectious or allergic, conjunctivitis produces irritation or itchiness rather than deep pain and is usually unrelated to systemic disease.
Inflammation of the uvea shares blurred vision and photophobia, but it affects different tissues and requires distinct management strategies.
Possible Complications and Effects on Vision
Uncontrolled inflammation can damage ocular structures and impair sight.
Corneal thinning, ulceration, or scarring may reduce visual clarity.
Persistent inflammation can lead to secondary glaucoma and additional pain.
Elevated intraocular pressure from disease or steroid use can harm the optic nerve.
Advanced necrotizing scleritis weakens the eye wall, risking perforation and vision loss.
Monitoring and Follow-Up Care
Ongoing care ensures that treatment remains effective and safe.
Corticosteroids are tapered gradually, and other drugs are adjusted based on response.
Regular blood tests track inflammation markers and medication side effects.
Repeat imaging checks that scleral and choroidal thickness return to normal in posterior disease.
Continuing Your Eye Health Journey
Scleritis is a complex condition, yet timely diagnosis and coordinated care can protect your vision and comfort. Our practice remains committed to guiding you through evaluation, treatment, and long-term monitoring so that you can enjoy clear and healthy sight.
I had an emergency the nurse was able to get me right in The Dr. was wondering, caring knowledgeable and took care of the problem
John Wick
Dr. Goyal is an amazing physician. I love the new office and location, and the staff was very friendly. Had an emergency appointment today and Dr. Goyal was very attentive and professional.
Mary Volpe
I recently saw Dr. DeSimone for an emergency visit for my styes in my eyes. He told me step by step of why I get them, and gave me antibiotic for my eyes. I recommend Re-Focus Eye Care to anyone.
Lovlie Cajuste
I was given an emergency appointment with Dr Rho. He looked in my eyes and saw a hole in my retina. I am so thankful to Dr. Rho and his team for making me feel comfortable and at ease.
H.S
So grateful the office kindly saw me same day for an urgent eye issue. I have been with the practice for several years and the doctors are very thorough.
Arthur Krevitz
Contact Us
Tuesday: 8AM-7PM
Wednesday: 8AM-4:30PM
Thursday: 8AM-7PM
Friday: 7:30AM-4:30PM
Saturday: 8AM-1:30PM
Sunday: Closed