Scleritis (inflammation of the sclera): symptoms, causes, diagnosis and treatment
This condition rarely resembles a common irritation. The eye becomes red, the pain becomes very severe, sometimes radiating to the temple or intensifying with movement. This type of inflammation of the sclera affects more than just the superficial mucous membrane. The tough outer layer of the visual apparatus is also affected.
Therefore, an in-person examination is necessary for scleritis. This condition should never be treated at home with eye drops for irritation.
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What is scleritis and why is it dangerous?
The sclera is a dense, white membrane. It maintains the shape of the eyeball and protects its internal structures. With scleritis, inflammation affects the deep layers of this membrane. Due to its rich innervation, pain can be severe. It interferes with sleep, reading, and looking at light.
Scleritis can be anterior or posterior. The anterior type is often noticeable by deep redness, while the posterior type can masquerade as other conditions and manifest as:
- Pain
- Vision loss
- Tissue swelling
This is why diagnosing scleritis involves more than just a physical examination.
Why this condition shouldn't be ignored
Inflammation of the membrane is associated with autoimmune diseases, infections, injuries, or complications after surgery. Without treatment, there is a risk of corneal, choroidal, and retinal involvement, as well as increased intraocular pressure. Complications depend on the type and severity of the condition.
Symptoms of scleritis
The main symptom is a deep, aching, or piercing pain in the eye, sometimes worsening at night. The redness of the eye is not superficial, but darker, purple-red. The discomfort may increase with touching or moving the eye.
- Photophobia, lacrimation and a feeling of pressure These symptoms arise from irritation of the inflamed tissues and adjacent structures. The patient may feel pressure, distension, or pain around the eye. These complaints cannot be explained solely by fatigue or dryness.
- Decreased vision and other warning signs These signs indicate a risk of deep involvement or complications. If the image becomes cloudy, pain occurs when moving the eye, photophobia, or severe redness occurs, consult a doctor immediately.
- Anterior and posterior variants of the disease: what are the differences? Anterior scleritis is more often visible upon examination: the eye becomes red and painful. Posterior scleritis manifests as pain, blurred vision, limited eye movement, and swelling around the optic nerve. To determine the exact type, the doctor prescribes diagnostic imaging tests.
How to distinguish scleritis from other eye diseases
This condition is often confused with conjunctivitis, uveitis, and keratitis. However, the urgency and treatment strategies for these conditions differ. A comparison helps highlight the key differences.
| Signature | Scleritis | Conjunctivitis | Uveitis |
|---|---|---|---|
| Pain | Severe, deep | Usually mild | Severe |
| Redness | Deep | Superficial | May be severe |
| Photophobia | Often present | Rarely | Often Yes |
| Risk of vision loss | Yes | Usually lower | Yes |
Even with similar symptoms, the final conclusion is made by an ophthalmologist. Pain and photophobia should be treated with particular caution: these symptoms rarely occur with simple irritation.
Scleritis and conjunctivitis
With conjunctivitis, the mucous membrane becomes inflamed, and there is often discharge and a gritty sensation. With scleritis, the pain is deeper, the redness is denser, and vasoconstrictor drops do not solve the problem. Treating scleritis as conjunctivitis can delay proper care.
Scleritis and uveitis
Uveitis affects the choroid and often causes photophobia, pain, and blurred vision. Scleritis can coexist with uveitis, so the doctor evaluates the anterior segment of the eye, pressure, the cornea, and the depth of inflammation.
Scleritis and keratitis
Keratitis is an inflammation of the cornea. It often causes burning, photophobia, a foreign body sensation, and decreased vision. If the cornea is involved in scleritis, the risk of complications is higher, and treatment requires special monitoring.
Diagnosing scleritis: how an ophthalmologist examines
Diagnosis of scleritis begins with a detailed examination of the patient's complaints. The doctor will ask:
- When the pain began
- Was there a fever, trauma, surgery, or systemic disease?
Then a biomicroscopy is performed—an examination of the eye under magnification. The doctor assesses the depth of redness, the condition of the cornea, anterior chamber, and blood vessels.
Instrumental diagnostic methods
If posterior scleritis is suspected, ultrasound, OCT, fundus examination, and other tests may be necessary. These can help detect swelling, changes in the membranes, and possible complications. The extent of the examination depends on the clinical presentation.
Analysis and consultations with related specialists
If the doctor suspects a systemic cause, blood tests and consultations with specialized specialists are ordered. This helps select not only local anti-inflammatory therapy but also systemic medications as indicated.
General information
Treatment: how we select therapy
Therapy may not be the same for everyone. Autoimmune inflammation, infection, and postoperative complications require different solutions. The doctor evaluates:
- The form and depth of the process
- Risk of complications
- The patient's general condition
Drug therapy
Treatment may include anti-inflammatory drugs, systemic medications, infection therapy, and supportive measures. Do not self-administer steroid, antibacterial, or vasoconstrictor drops. Incorrect treatment can worsen the disease.
Dynamic monitoring and complication management
After starting therapy, the doctor monitors pain, redness, vision, and the condition of the cornea and deep structures. Dynamic monitoring allows for the early detection of complications or relapses. If the cause is systemic, general disease monitoring is important.
"In our practice, scleritis is often initially mistaken for ordinary eye redness. Therefore, we emphasize a detailed diagnosis: this helps us quickly differentiate scleritis from conjunctivitis, uveitis, and other inflammatory diseases, and save time." — ophthalmologist
During the appointment, it's helpful to clarify the diagnosed form of the disease, whether there are signs of corneal involvement or uveitis, and whether tests and consultations with related specialists are needed. It's important for the patient to understand which symptoms should improve first and when treatment should be reconsidered.
We specifically explain that treatment should not be discontinued just because the pain has subsided. Inflammatory activity is assessed by examination, not just by sensation. This monitoring helps to more safely stabilize treatment.
FAQ
What is scleritis and why is it dangerous?
How can you differentiate scleritis from conjunctivitis?
Can scleritis be treated at home?
When should you see a doctor immediately?
Clinical Guidelines Portal of the Russian Ministry of Health — https://cr.minzdrav.gov.ru/
Russian Medical Journal — https://www.rmj.ru/
Media Sfera Publishing House — https://www.mediasphera.ru/
CyberLeninka (search for "scleritis") — https://cyberleninka.ru/
eLIBRARY.RU - https://elibrary.ru/
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Causes and risk factors of scleritis
In some patients, the disease is associated with systemic inflammation. It is detected:
In such situations, an ophthalmologist works in conjunction with a rheumatologist or general practitioner.
Infections, injuries, and surgeries
Infectious scleritis is less common. However, it requires special care. Inflammation can occur after injury, surgery, or the spread of infection from adjacent tissues. Treatment of scleritis in this case depends on the pathogen and the depth of the lesion.
When inflammation of the sclera is associated with general diseases of the body
If symptoms of the disease recur or are severe, the doctor looks for an underlying cause. Tests, consultations with related specialists, and evaluation of systemic symptoms help understand the cause of the disease. This investigation is important for preventing relapses.