Scleritis, which is inflammation of the tough white outer layer of the eye, is rare but very serious. It causes deep, boring pain and redness, which in some cases may put vision at risk. What we see in the early stages is that scleritis symptoms treatment can lower that risk if the condition is caught and treated. We also see that in many cases, it is related to autoimmune eye inflammation. If you have severe eye pain redness, which also includes blurred vision, you should seek an ophthalmologist’s care right away.
What Is Scleritis?
A scleritis eye will present redness and tenderness as the sclera is inflamed. Anterior scleritis, which is also the more frequent type, affects the eye’s front section. Posterior scleritis which in turn affects the back of the eye may go unnoticed in the appearance of the eye.
Scleritis is rare. In the Pacific Ocular Inflammation Study which reported on Kaiser Permanente Hawaii members we see 4.1 cases per 100,000 person years with women affected more than men.
Scleritis Symptoms and Warning Signs
Knowing the pain characteristic also helps speed scleritis symptoms treatment. Pain is deep, aching or boring in quality. It may radiate to the jaw or temple and also disrupt sleep. Severe eye pain redness and tenderness to touch are signs of scleral disease. Also, a scleritis eye may have a violet tone.
| Symptom | Possible Explanation | Urgency |
| Deep pain, worse at night | Scleral inflammation | Same-day review |
| Reduced or blurred vision | Posterior disease, uveitis or corneal involvement | Emergency |
| Itchy, watery red eyes | Allergy or infection | Routine to prompt |
Redness from eye allergies in children will present with itchiness, and allergy eye drops for kids don’t fix scleritis in kids. Seasonal eye infection in rainy season issues are mostly characterized by sticky discharge. That said, understanding eyebags means they are not a cause for severe pain.
Episcleritis vs Scleritis: How They Differ
Episcleritis vs scleritis is the comparison to consider. In contrast, scleritis is a deeper issue that causes more pain and carries a greater risk of damaging vision, so specialist-guided scleritis treatment is best. Episcleritis affects the thin layer over the sclera and generally goes away on its own.
| Feature | Episcleritis | Scleritis |
| Pain | Mild or none | Deep, severe |
| Redness | Bright, patchy | Violet-tinged |
| Vision | Usually normal | May blur |
| Urgency | Routine | Urgent |
Autoimmune Eye Inflammation and Other Causes
Many of my patients present with autoimmune eye inflammation. The American Academy of Ophthalmology reports that while injury, infection and surgery are also triggers, scleritis in fact is very often a component of some autoimmunity process. We see that rheumatoid arthritis and granulomatosis with polyangiitis are the primary associated conditions. That said, we approach a rheumatology review in identifying an immune cause which is at play in the case; thus a referral is common. Also, we note that inflammation of the uvea eye layer, which is called uveitis, also co-occurs with cases of scleritis. Identifying an immune cause helps guide scleritis symptoms treatment.
How Scleritis Is Diagnosed
Evaluation starts out with a history and slit lamp exam which is a test that magnifies the surface of the eye in the case of scleritis eye. Phenylephrine drops are used to tell apart episcleritis vs scleritis. Ultrasound or optical coherence tomography (OCT) a non-invasive scan may be used to look at the back wall. Blood work is done to check for autoimmune or infectious causes and also to guide the scleritis treatment. An accurate diagnosis is what forms the base of a good scleritis symptoms treatment plan from the first visit.
Scleritis Symptoms Treatment Options
Scleritis treatment varies by type and cause. While eye drops are used they do not usually access deep scleral inflammation which is why we see to it that we use oral medications.
- Oral non-steroidal anti-inflammatory drugs (NSAIDs) for mild anterior disease
- Oral corticosteroids for moderate or severe inflammation
- Immunosuppressive or biologic medicines for recurrent or autoimmune-linked disease
- Anti-infective therapy when infection causes scleritis
Specialized supervision is required, and self medication is not safe. At times we see that a thin layer of the eye requires surgical repair which then goes to corneal services.
When Should You Seek Medical Attention?
Sudden loss of vision needs to see a doctor right away. Severe eye pain which is with reduced vision, nausea, or halos around lights requires you to go in to the eye specialist as soon as possible. Severe eye pain redness which wakes you up at night also is a reason for the same day visit. Contact lens wearers with a painful red eye should remove lenses and get in to see the doctor as soon as you can. Proper contact lens hygiene reduces your risk of infection.
Eye Care at Vasan Eye Care
Vasan Eye Care provides ophthalmic evaluation for red and painful eyes. We may refer you for a slit-lamp assessment, imaging and co-management with rheumatology before we go over your treatment options for scleritis symptoms treatment.
Frequently Asked Questions
1. What is the first step in scleritis symptoms treatment?
An immediate eye examination is advised to rule out scleritis and identify any infections. An ophthalmologist will also prescribe anti-inflammatory medication and may perform tests for underlying autoimmune eye inflammation.
2. Can scleritis cause permanent vision loss?
Yes. Severe and unattended disease can cause glaucoma, cataract, retinal swelling or a thin wall in the scleritis eye. Early intervention in scleritis treatment reduces this risk, also if you have persistent severe eye pain redness with loss of vision seek prompt medical review.
3. How is episcleritis vs scleritis decided?
Depth of inflammation which is what we are to look at. In episcleritis we see mild discomfort and bright redness, in scleritis we see a more intense pain and violet toned redness. A slit lamp exam by an ophthalmologist will confirm these.
4. How long does scleritis symptoms treatment take?
Mild cases may resolve in a few weeks, but in many cases, it takes months of treatment and regular checkups. Flare-ups may return, which is why an ophthalmologist determines the length of treatment. For scleritis treatment, we continue treatment until the inflammation is controlled.
Persistent, sudden or worsening eye pain is a symptom which should be noted. An ophthalmologist will determine the cause and will see to it that it is evaluated whether it is a routine follow up or is an urgent case requiring scleritis symptoms treatment. For further evaluation patients are to book in for an eye exam at a Vasan Eye Care center.
References Links
- Incidence of Scleritis and Episcleritis: Results https://pmc.ncbi.nlm.nih.gov/articles/PMC3852161
- American Academy of Ophthalmology: What Is Scleritis?
https://www.aao.org/eye-health/diseases/what-is-scleritis