Scleritis (Sclera is the white part of eyeball) eye diseases
Scleritis is a severe and sometimes necrotizing inflammation that threatens vision involving the deep episclera and the sclera. Symptoms are moderate to severe pain, redness of the eye, tearing and photophobia.
Scleritis is more common in women between the ages of 30 and 50. Both eyes are affected in a third of cases. Scleritis can be associated with rheumatoid arthritis, systemic lupus erythematosus, or another autoimmune disease (a dysfunction of the immune system in which the body attacks its own tissues). About half of all scleritis cases have no known cause. (See also Overview of Diseases of the Conjunctiva and Sclera.)
Diseases of the sclera are primarily inflammations, which are seldom caused by local infection, but by systemic autoimmune diseases (e.g. rheumatism ) or gout, and more rarely by infectious diseases (syphilis, borreliosis, herpes zoster). This is especially true for deep scleritis (as opposed to episcleritis).
Read also: Eye Diseases and Common Eye Problems
In jaundice (icterus), scleric terus (yellowing of the sclera) occurs first when the total bilirubin in the serum rises> 2 mg / dl (or> 34 µmol / l), then the skin and mucous membrane also turn yellow. In addition, injuries to the sclera play an important role in ophthalmology.
- Scleritis is a severe and sometimes necrotizing inflammation that threatens vision.
- Symptoms include deep pain; photophobia and lacrimation; and focal or diffuse redness of the eye.
- Diagnosis is clinical and by slit lamp examination. Sometimes imaging tests are done to confirm the diagnosis.
- Treatment usually begins with corticosteroids. Most patients require systemic corticosteroids and / or systemic immunosuppressants, prescribed in consultation by a rheumatologist.
- A scleral graft may be indicated if there is a risk of perforation.
Scleritis or episcleritis?
Episcleritis is more frequent and often linked to pathologies of the ocular surface (blepharitis, dryness). Like scleritis, episcleritis can be lumpy. An etiological assessment will be carried out in the event of a nodular or recurrent episcleritis.
Episcleritis is the inflammation of the surface membrane surrounding the eyeball (episclera). This tissue is made up of a layer of vessels between the bulbar conjunctiva and the surface of the sclera. The condition is most often characterized by sectoral and unilateral redness of the episclera. The conjunctiva does not show any redness. Episcleritis rarely causes a real sensation of pain, but can cause discomfort in the person with the disease. It is sometimes accompanied by intermittent tearing and great sensitivity to light. Usually, the patient approaches the ophthalmologist because of the persistent redness or photophobia.
Often mild, episcleritis tends to heal on its own. In addition, the condition has no impact on visual acuity. Prescribing artificial tears is usually sufficient to reduce the discomfort felt by the subject. One-off treatment with topical steroids also helps speed up the healing process.
Symptoms of scleritis
Symptoms includes: eye pain (usually a deep pain) that is often constant and severe enough to disrupt sleep and reduce appetite. Other symptoms may be present, such as increased eye sensitivity, severe tearing, and photophobia. A purplish-colored erythema occurs in part of the eye or in the whole eye.
In rare cases, this inflammation is severe enough to cause perforation of the eyeball with loss of the eye. This severe inflammation is called necrotizing scleritis. People with necrotizing scleritis often have several years of problems such as autoimmune diseases (for example, rheumatoid arthritis, granulomatosis with polyangiitis, periarteritis nodosa, and chronic atrophic polychondritis) in other organs.
Diagnosis and Prognosis of scleritis
The diagnosis of scleritis is clinical and is made by slit lamp examination. Smears or biopsies are necessary to confirm an infectious origin of the scleritis. Ultrasound and CT may be needed for posterior scleritis.
Among patients with this disease, 14% have a significant decrease in visual acuity at 1 year and 30% at 3 years. In the case of underlying necrotizing scleritis and systemic vasculitis, mortality is up to 50% in 10 years (mainly from myocardial infarction).
Treatment of scleritis
Nonsteroidal anti-inflammatory drugs are sufficient in mild cases of scleritis. However, usually systemic corticosteroid therapy (eg, prednisone 1 to 2 mg / kg orally once / day for 7 days, then tapered off and stopped on day 10) is the initial treatment. If the inflammation recurs, a prolonged oral corticosteroid regimen, also starting with prednisone 1 to 2 mg / kg orally once / day or an intravenous bolus corticosteroid, such as methylprednisolone 1000 mg / day day IV for 3 days, may be considered.
In case of insufficient response or intolerance to systemic corticosteroid therapy or if the patient has necrotizing scleritis and connective tissue disease, systemic immunosuppressive therapy with cyclophosphamide or methotrexate or mycophenolate mofetil or biological agents (e.g. ., rituximab, adalimumab) is indicated, but only after advice from a rheumatologist. A scleral graft may be indicated if there is a risk of perforation.
Different forms and care
The ophthalmologic clinical examination should specify the type of scleritis, the associated damage (keratitis, etc.) and assess the
Nodular anterior scleritis: raised nodule, visible with a slit lamp
In practice, the management of scleritis
nodular is identical to that of anterior non-nodular scleritis.
Necrotizing anterior scleritis
The study of the vessels makes it possible to recognize them: the absence of vessels (occlusion of the capillaries) is visible in the center of the scleritis zone.
It is a severe form due to the potential visual impact, the frequency of association with systemic disease. It requires immunosuppressive treatment in all cases.
Scleromalacia perforans is a peculiar and rare form characterized by extensive necrotizing scleritis without inflammation in long-progressive rheumatoid arthritis.
Patients consult for increased pain when the globe is mobilized. The fundus examination reveals choroidal folds or detachment, exudative retinal detachment, papillary edema. The diagnosis will be confirmed with an ultrasound, CT scan or MRI. Their severity is linked to associated damage to the retina and the optic nerve.
Among the complications of previous scleritis, we note:
– scleral thinning leading to astigmatism and a risk of traumatic perforation;
– in the cornea, an infiltrate / thinning / peripheral corneal ulcer;
– secondary glaucoma;
– a secondary cataract:
– processing, in particular:
→ consider the risk of kidney failure when using nonsteroidal anti-inflammatory drugs (NSAIDs);
→ treatment linked to prolonged local or general corticosteroid therapy.
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.