Bright Sight

Oliver Backhouse, Consultant Eye Surgeon www.cataract.org.uk

Scleritis

The Sclera is the white part of the eye. When it becomes inflamed it is called Scleritis (Itis = inflammation). When only the outer part of the Sclera is inflamed it is called Episcleritis. This is a condition that often goes on its own without the need for treatment and does not disturb the vision. Patients with Scleritis are more commonly female and the greatest incidence is between the ages of 40-60 years. In 35-50% of cases the Scleritis is affecting both eyes. The eye appears red and is painful. Sometimes the inflammation is only apparent at the back of the eye and this can reduce the vision in an eye that is not red – this is called Posterior Scleritis.

Scleritis is caused by an immune response to something such as an infection, trauma or a virus which then ‘cross-reacts’ with the eye. While we want our immune system to fight infection we do not like the ‘side-effect’ of this process which can cause conditions such as Scleritis and Arthritis (joint inflammation). It is surprising how many Rheumatological and eye conditions go together. Some of the patterns of this type of inflammation (called autoimmune in that it is a reaction of the immune system against ones own body) have recognised signs and symptoms, examples being Rheumatoid arthritis and Wegners Granulomatosis (blood vessel inflammation – see Vasculitis Information sheet). Because Scleritis therefore can be part of a more generalised inflammation disorder it is important that the problem is correctly identified. Some Ophthalmologists have a special interest in these disorders and have a dedicated Inflammation (Uveitis) clinic. A Rheumatologist may also be in this clinic as well to help with the management.

Getting to the correct diagnosis involves sending of blood, X-ray, Ultrasound and occasionally eye / brain scanning investigations. The treatment options depend on the severity of the Scleritis. If mild it can be controlled on eye drop or tablet Non-steroidal anti-inflammatory drugs (NSAIDS). If more aggressive then steroid tablets are needed (see separate steroid information leaflet). If the dose of steroid is too high for too long a period then steroid-sparing medication will be discussed.
Other parts of the eye can be involved in the inflammation process as well and this is a further reason why a detailed examination of the eye is needed by an Ophthalmologist. Uveitis (inflammation of the coloured part of the eye), Glaucoma (high pressure inside the eye), Corneal ulcers and Cataract are some of the more common associations – see separate information leaflets on these conditions.

Sometimes Scleritis can run a severe course despite medical treatment but usually the inflammation can be brought under control and the vision remains good.