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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Scleritis and Episcleritis

What is it?

Scleritis and episcleritis are inflammations of the protective outer layers of tissue that form the eyeball's shell. The deepest layer is the sclera, known commonly as the white of the eye. The transparent tissue covering the sclera is the episclera, which in turn is covered by a fine membrane called the conjunctiva. Inflammation of the episclera—or episcleritis—often resembles a localized form of conjunctivitis, but episcleritis is not accompanied by the watery or pusfilled discharge typical of conjunctivitis (see Conjunctivitis for more information). Episcleritis is usually a minor disorder that does not permanently damage the eye and generally resolves on its own within a week or two. Its presence occasionally indicates an underlying disease such as rheumatoid arthritis. Scleritis, a less common but more serious disease, most often occurs in association with an underlying systemic or autoimmune disorder, usually in people between the ages of 30 and 60.

What Causes It?

  • The cause of episcleritis and scleritis is unknown.
  • Both episcleritis and scleritis may be associated with a systemic disorder; that is, one affecting other organ systems in the body. Such disorders include autoimmune rheumatoid diseases (rheumatoid arthritis, scleroderma, systemic lupus erythematosus), inflammatory bowel disease, and tuberculosis.
  • Herpes zoster involving the eye can lead to scleritis.

Prevention

  • There is no way to prevent episcleritis or scleritis.

Diagnosis

  • Patient history and an eye examination by an ophthalmologist are required.
  • An ultrasound of the eyeball may be conducted.
  • A general physical examination by a medical doctor may be required to look for and treat an associated underlying disease.

How to Treat It

  • In episcleritis, steroids in eyedrop or ointment form may be prescribed to reduce inflammation.
  • The course of scleritis often parallels the activity and treatment of the associated systemic disorder. Corticosteroids, in tablet or eyedrop form, may reduce inflammation in some patients. Cycloplegic drugs may be administered to dilate the pupil, which may prevent scarring and alleviate pain somewhat. Immunosuppressive drugs may be prescribed in more severe cases.
  • Surgery may be required for scleritis if the sclera has perforated.

When to Call a Doctor

If you suspect you have either scleritis or episcleritis, consult an ophthalmologist immediately.