What is scleritis?

Scleritis is a rare, severe inflammation of the sclera (the white part of the eyeball). It usually affects middle aged people, women more than men, around a third of whom have some other form of inflammation, such as rheumatoid arthritis or inflammation of the bowel, or long-standing infection elsewhere in the body. It may affect one or both eyes.

The condition begins gradually and patients experience an aching pain in the eye, which may spread to the brow region or to the jaw. This may be so severe as to cause loss of sleep. Patients may also find lights unbearably bright and the vision may be blurred.

There are two forms of scleritis: anterior scleritis, which makes up 9 out of 10 cases and involves the sclera of the front part of the eye, where the inflammation (redness and swelling) can easily be seen. An even more severe form of anterior scleritis seen in 15% of these cases is known as necrotising scleritis, in which the scleral tissue melts away, often without pain; vision is likely to be greatly impaired. One in 10 cases of scleritis takes the form known as posterior scleritis, which affects the sclera of the back part of the eye, so that the front of the eye may appear normal and the optometrist will need to use special instruments to help to make the diagnosis.

How is scleritis managed?

Scleritis is a serious condition and it is recommended that cases be referred as emergencies to the ophthalmologist, who will usually treat the condition with drugs given by mouth that reduce inflammation and suppress the body’s immune system.