Scleritis

Overview Of Scleritis

Scleritis is a rare and often painful inflammation of the sclera, the white part of the eye. The sclera serves as the structural outer layer of the eyeball, and when it becomes inflamed, it can lead to significant discomfort and, in severe cases, vision impairment. Scleritis is generally classified into two main types: anterior scleritis (the more common form, affecting the front portion of the eye) and posterior scleritis (which affects the back portion). This condition is typically linked to systemic diseases such as autoimmune disorders, infections, and certain inflammatory conditions. Although scleritis is less common than other eye inflammations, its potential for causing long-term damage to the eye, including blindness, makes early diagnosis and treatment crucial. The inflammation can be classified as non-necrotizing or necrotizing, with the latter being more aggressive and associated with more serious complications.

Causes of Scleritis

• Scleritis can be caused by a range of underlying conditions and factors: - Autoimmune Diseases: The most common cause of scleritis is autoimmune disorders, such as rheumatoid arthritis, granulomatosis with polyangiitis, lupus, and relapsing polychondritis. These conditions cause the body's immune system to mistakenly attack its own tissues, including the sclera. - Infections: Bacterial, viral, and fungal infections can lead to scleritis, although this is less common. In some cases, infections from conditions like tuberculosis or syphilis can also contribute. - Inflammatory Conditions: Systemic inflammatory diseases such as vasculitis or sarcoidosis can result in scleritis. - Trauma or Injury: Physical trauma to the eye or surrounding areas may also lead to scleritis, particularly if the injury causes disruption to the sclera. - Idiopathic: In some cases, the exact cause of scleritis cannot be identified, which is referred to as idiopathic scleritis.

Risk Factors of Scleritis

• Several factors increase the risk of developing scleritis, including: - Autoimmune Diseases: The presence of autoimmune disorders such as rheumatoid arthritis, lupus, or spondyloarthritis significantly raises the risk. - Systemic Inflammatory Conditions: Individuals with conditions like Wegener's granulomatosis or inflammatory bowel diseases (e.g., Crohn's disease) are at a higher risk. - Previous Eye Injury: Any history of trauma or surgical procedures involving the eye can increase the likelihood of developing scleritis. - Infection History: Those with a history of certain infections, such as syphilis, tuberculosis, or herpes simplex, may be more prone to scleritis. - Genetic Predisposition: In some cases, there may be a familial tendency toward autoimmune conditions that increase the risk of scleritis. - Age: While scleritis can occur at any age, it tends to affect middle-aged individuals more frequently.

Prevention of Scleritis

• Preventing scleritis primarily involves managing the underlying conditions that predispose individuals to this inflammation: - Managing Autoimmune Diseases: People with autoimmune conditions should work with their healthcare providers to control inflammation through medications such as corticosteroids or immunosuppressive drugs. - Early Detection and Treatment: Timely diagnosis and treatment of infections and autoimmune diseases can help prevent the development of scleritis. - Protecting the Eye: Avoiding trauma to the eye, wearing protective eyewear during high-risk activities, and preventing eye infections can help reduce the risk of scleritis. - Regular Monitoring: Those with a history of autoimmune diseases should have regular eye exams to monitor for signs of eye inflammation, ensuring early intervention if scleritis develops.

Prognosis of Scleritis

• The prognosis for scleritis depends on the underlying cause, the type of scleritis, and how early it is treated. When treated promptly, many patients recover well with minimal long-term consequences. However, if left untreated or if the condition is severe, scleritis can lead to serious complications such as: - Glaucoma: Chronic inflammation can increase intraocular pressure, leading to glaucoma. - Scleral Perforation: In necrotizing scleritis, the tissue can become so thin that it may perforate, leading to loss of the eye’s structural integrity. - Vision Loss: In severe cases, scleritis can cause permanent damage to the eye, leading to vision loss due to scarring or damage to the retina and other eye structures. - Systemic Involvement: If the scleritis is linked to an underlying autoimmune disease, the systemic condition may progress, requiring ongoing management.

Complications of Scleritis

• Scleritis can lead to a variety of complications, especially when it is not treated or if it is linked to severe systemic conditions: - Scleral Perforation: A rare but severe complication where the sclera thins and ruptures, potentially leading to complete loss of the eye. - Vision Loss: Scleritis, especially when it affects the posterior portion of the eye, can cause damage to the retina, optic nerve, or other structures, resulting in permanent visual impairment. - Glaucoma: Chronic inflammation of the eye can increase intraocular pressure, leading to glaucoma, which may cause optic nerve damage and further vision deterioration. - Retinal Detachment: Posterior scleritis can cause changes in the retina, leading to retinal detachment, a serious condition that may require surgical intervention. - Systemic Disease Progression: Scleritis associated with systemic conditions like rheumatoid arthritis or lupus may worsen the underlying disease, potentially leading to more extensive health problems.

Related Diseases of Scleritis

• Scleritis can be associated with several systemic and ocular conditions: - Rheumatoid Arthritis: This autoimmune disorder is a common underlying cause of scleritis, with inflammation in the joints often linked to similar inflammation in the eyes. - Lupus: Systemic lupus erythematosus (SLE) is another autoimmune disease that can result in scleritis. - Vasculitis: Conditions like granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) may lead to inflammation of blood vessels, including those in the sclera. - Sarcoidosis: A systemic inflammatory disease that can affect multiple organs, including the eyes, leading to scleritis. - Infectious Endophthalmitis: Infections affecting the inner eye may also present with similar symptoms to scleritis, particularly when the infection spreads to involve the sclera.

Treatment of Scleritis

The treatment of scleritis is tailored to the underlying cause and the severity of the inflammation: - **Anti-inflammatory Medications**: Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to manage mild cases of scleritis. However, for more severe cases, corticosteroids (either oral or injected into the eye) are frequently required to control inflammation. - **Immunosuppressive Therapy**: In cases where scleritis is caused by autoimmune diseases, immunosuppressive medications like methotrexate, azathioprine, or cyclophosphamide may be prescribed to control the overactive immune response. - **Antibiotics or Antivirals**: If an infectious cause is identified, appropriate antimicrobial treatment, including antibiotics or antiviral medications, will be used to treat the infection. - **Surgical Intervention**: In extreme cases where scleritis leads to complications such as scleral thinning or perforation, surgical intervention may be necessary to repair or reconstruct the eye's scleral tissue. - **Pain Management**: Due to the severe pain associated with scleritis, pain relievers, including stronger prescription pain medications, may be prescribed to manage discomfort.