Scleritis
| Scleritis | |
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| Scleritis: Inflammation limited to the sclera. Note markedly dilated blood vessels which do not extend onto the underside of the lower lid, helping to distinguish scleritis from conjunctivitis. (Image courtesy of Charlie Goldberg, M.D.) | |
| ICD-10 | H15.0 |
| ICD-9 | 379.0 |
| DiseasesDB | 11898 |
| MedlinePlus | 001003 scleritis. MedlinePlus2 |
| eMedicine | emerg/521 oph/642 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The word sclera is derived from Greek word, "sklēros" meaning hard. It consists of the posterior five-sixths part of the fibrous outer tunic of the eye. The outer scleral surface is in contact with Tenon’s capsule and the bulbar conjunctiva. The sclera is covered by a thin layer of loose tissue called episclera. It is separated from the choroid by the suprachoroidal space. The extraocular muscles are also inserted in the sclera. The thickness of the sclera varies from place to place. The thickest part is at the posterior pole and the thinnest underneath the insertion of rectus muscles. The sclera thins out at the equator. Scleritis is a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera. The disease is often contracted through association with other diseases of the body, such as Wegener's granulomatosis or rheumatoid arthritis; it can also be attained through disorders of menstruation. For this reason, scleritis occurs frequently among young women. There are three types of scleritis: diffuse scleritis (the most common), nodular scleritis, and necrotizing scleritis (the most severe). Scleritis may be the first symptom of onset connective tissue disease[2].
The term "Episcleritis" refers to inflammation of the episclera.
Signs and symptoms
Symptoms of the disease include:
- Redness of the sclera and conjunctiva, sometimes changing to a purple hue
- Severe ocular pain (not present in episcleritis) which may radiate to the temple or jaw
- Increased light sensitivity and tearing
- Decrease in visual acuity, possibly leading to blindness
Diagnosis
Scleritis is best detected by examining the sclera in daylight; retracting the lids helps determine the extent of involvement. Other aspects of the eye exam (i.e. visual acuity testing, slit lamp examination, etc) can be normal. Ancillary tests CT scans, MRIs, and ultrasonographies can be helpful, but do not replace the physical examination.
Treatment
In very severe cases of necrotizing scleritis, eye surgery must be performed to repair damaged corneal tissue in the eye and preserve the patient's vision. For less severe cases, nonsteroidal anti-inflammatory drugs, such as ibuprofen, are prescribed for pain relief. Scleritis itself is treated with an oral medication containing corticosteroids and an eye solution. In some cases, antibiotics are prescribed. Simply using eye drops will not treat scleritis. If not treated, scleritis can cause blindness.
External links
References
- Sainz de la Maza, Maite, MD, PhD "Scleritis", eMedicine.com, September 26 2006. Accessed June 12 2007.