What Is Scleritis and How Is It Managed?

Written by Medicover Team and Medically Reviewed by Dr Vompolu Kamakshi Bhaskar , Ophthalmologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Scleritis is a severe inflammatory eye disease that affects the sclera, the white protective outer layer of the eye. Unlike milder eye inflammations, scleritis can cause intense eye pain and may lead to permanent vision loss if left untreated. The condition is frequently associated with autoimmune diseases, although infections and trauma may also trigger it. Early diagnosis and prompt treatment are essential to control inflammation, relieve symptoms, preserve vision, and prevent complications.

What Are the Types of Scleritis?

Scleritis is classified according to the location and severity of inflammation.

Anterior Scleritis: The most common type, affecting the front portion of the sclera.
Diffuse Anterior Scleritis: Widespread inflammation across the front of the sclera.
Nodular Anterior Scleritis: Characterized by one or more painful inflammatory nodules on the sclera.
Necrotizing Scleritis: The most severe form, causing tissue destruction, scleral thinning, and a high risk of vision loss.
Posterior Scleritis: A less common form affecting the back portion of the sclera, often difficult to diagnose.

What Are the Symptoms of Scleritis?

Symptoms vary depending on the type and severity of inflammation but usually develop gradually and worsen without treatment.

Severe, deep eye pain that may radiate to the face or jaw
Persistent eye redness
Blurred or reduced vision
Excessive tearing
Light sensitivity (photophobia)
Eye tenderness
Pain with eye movement
Headache around the affected eye

What Causes Scleritis?

Scleritis is most commonly caused by autoimmune inflammation, although infections, trauma, and certain medications can also contribute.

Autoimmune diseases
Rheumatoid arthritis
Systemic lupus erythematosus
Granulomatosis with polyangiitis (formerly Wegener's granulomatosis)
Ankylosing spondylitis
Inflammatory bowel disease
Bacterial, viral, or fungal infections
Eye trauma or previous eye surgery

When Should You See a Doctor for Scleritis?

Scleritis requires urgent medical evaluation because delayed treatment can result in permanent vision damage. Anyone experiencing severe eye pain, persistent redness, blurred vision, or light sensitivity should consult an ophthalmologist immediately.

Since scleritis is frequently linked to autoimmune diseases, treatment may also involve a rheumatologist, immunologist, infectious disease specialist, or other specialists depending on the underlying cause as part of a multidisciplinary care team.

Seek immediate medical attention if you experience:

Severe or worsening eye pain
Persistent redness that does not improve
Blurred or sudden vision loss
Severe light sensitivity
Pain when moving the eyes
Symptoms along with a known autoimmune disease

Early diagnosis and prompt treatment can protect vision and reduce the risk of serious complications.

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How Is Scleritis Diagnosed?

Diagnosis involves a detailed eye examination and investigations to determine the cause and severity of inflammation.

Comprehensive eye examination
Slit-lamp examination
Visual acuity testing
Dilated retinal examination
Blood tests to identify autoimmune or infectious diseases
Ultrasound (B-scan) for posterior scleritis
MRI or CT scan in selected cases

How Is Scleritis Treated?

Treatment for scleritis focuses on controlling inflammation, relieving pain, treating the underlying cause, and preventing permanent vision loss.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Often used for mild to moderate inflammation.
Corticosteroids: Oral, injectable, or intravenous steroids for more severe disease.
Immunosuppressive medications: Drugs such as methotrexate, azathioprine, mycophenolate mofetil, or cyclophosphamide for autoimmune-related scleritis.
Biologic therapies: May be recommended for refractory autoimmune cases.
Antibiotics or antiviral medications: Used when infection is the underlying cause.
Surgical treatment: Scleral grafting or repair may be required for severe scleral thinning or perforation.

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What Are the Risk Factors for Scleritis?

Several factors increase the likelihood of developing scleritis.

Autoimmune diseases
Rheumatoid arthritis
Connective tissue disorders
Previous eye surgery
Eye trauma
Eye infections
Female sex (more common in women)
Middle adulthood

What Complications Can Scleritis Cause?

Untreated or severe scleritis can lead to serious eye complications.

Permanent vision loss
Scleral thinning or perforation
Corneal inflammation (keratitis)
Glaucoma
Cataracts
Retinal detachment
Uveitis
Chronic eye pain

Can Scleritis Be Prevented?

Although scleritis cannot always be prevented, managing autoimmune diseases, treating infections promptly, protecting the eyes from injury, attending regular eye examinations, and following prescribed medications can reduce the risk of flare-ups and complications.

How Is Scleritis Different From Episcleritis and Conjunctivitis?

Scleritis is a deeper and more serious inflammation than episcleritis or conjunctivitis. Unlike episcleritis, which usually causes mild discomfort and resolves on its own, scleritis causes severe pain and may threaten vision. Conjunctivitis mainly affects the conjunctiva and is commonly caused by infections or allergies, often producing discharge and itching rather than intense pain. An ophthalmologist can distinguish these conditions through a comprehensive eye examination.

What Is the Outlook for People With Scleritis?

The prognosis depends on the underlying cause, severity, and how quickly treatment begins. Most patients respond well to early medical treatment, especially when associated autoimmune diseases are effectively controlled. Regular follow-up with an ophthalmologist and other specialists is essential to prevent recurrence and preserve long-term vision.