Scleritis is most common among women aged 30 to 50. In one third of cases, it affects both eyes. Scleritis may accompany rheumatoid arthritis, systemic lupus erythematosus, or another autoimmune disorder (a malfunction of the body's immune system that causes the body to attack its own tissues). About half of the cases of scleritis have no known cause. (See also Overview of Conjunctival and Scleral Disorders.)
Symptoms of scleritis include pain in the eye (typically a deep ache) that is often constant and severe enough to interfere with sleep and reduce appetite. Other symptoms include eye tenderness, increased watering of the eye, and sensitivity to bright light. Redness that is purplish in color occurs over part or all of the eye.
Rarely, inflammation is severe enough to cause a hole to form in the eyeball (perforation) and loss of the eye. Such severe inflammation is called necrotizing scleritis. People who have necrotizing scleritis often have many years of problems such as autoimmune disorders (for example, rheumatoid arthritis, granulomatosis with polyangiitis, polyarteritis nodosa, and relapsing polychondritis) in other organs of the body.
To treat scleritis, doctors usually give corticosteroids taken by mouth (such as prednisone). Very rarely, nonsteroidal anti-inflammatory drugs taken by mouth are enough treatment for mild cases. If the person has an autoimmune disorder or does not respond to corticosteroids, drugs that suppress the immune system (immunosuppressants), such as methotrexate, cyclophosphamide, or rituximab, may be needed.
People who are at risk of a perforation may need surgical repair.