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Scleritis

By

Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Scleritis is severe, destructive inflammation of the sclera (the tough, white, fiber layer covering the eye) that may threaten vision.

  • Scleritis sometimes occurs in people who have a bodywide inflammatory disease.

  • The main symptom is a deep, painful ache in the eye.

  • Sometimes imaging tests are done to confirm the diagnosis.

  • Treatment typically begins with corticosteroids.

Scleritis is most common among women aged 30 to 50. In one third of cases, it affects both eyes. Scleritis may accompany rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) , systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more Systemic Lupus Erythematosus (SLE) , or another autoimmune disorder Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers autoimmune disorders is not known. Symptoms vary depending on... read more (a malfunction of the body's immune system Overview of the Immune System The immune system is designed to defend the body against foreign or dangerous invaders. Such invaders include Microorganisms (commonly called germs, such as bacteria, viruses, and fungi) Parasites... read more 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 Overview of Conjunctival and Scleral Disorders The conjunctiva is the membrane that lines the eyelid and loops back to cover the sclera (the tough white fiber layer covering the eye), right up to the edge of the cornea (the clear layer in... read more .)

An Inside Look at the Eye

An Inside Look at the Eye

Symptoms of Scleritis

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.

Diagnosis of Scleritis

Prognosis of Scleritis

About 14% of people who have scleritis develop significant decrease in vision within 1 year, and 30% develop significant decrease in vision within 3 years. About 50% of people with necrotizing scleritis die within 10 years, often due to a heart attack.

Treatment of Scleritis

  • Corticosteroids

  • Sometimes immunosuppressants

  • Sometimes surgical repair

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 Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers autoimmune disorders is not known. Symptoms vary depending on... read more 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.

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Herpes Zoster Ophthalmicus
Herpes zoster ophthalmicus is an infection of the eye caused by the varicella-zoster virus. This virus also causes chicken pox and shingles. Which of the following describes the mechanism by which herpes zoster ophthalmicus causes infection?
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