Episcleritis / Scleritis

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EPISCLERITIS

The episclera refers to the tissue lying on the surface of the white part of the eye and beneath the clear conjunctiva. When this tissue becomes inflamed the condition is called episcleritis. The condition usually affects younger adults who typically complain of a localized area of redness on either side of the cornea.
It is associated with watering and minimal tenderness. There is a diffuse (spread over all of the white of the eye) and nodular (raised) form of this problem.
Generally this is a self-limiting inflammation, which is not associated with any underlying disorder.

Treatment

In mild cases the condition can be left to settle on its own, taking a week or two to disappear. In more severe cases either non-steroidal anti-inflammatory eye drops may be required or a mild steroid eye drop.

SCLERITIS

Courtesy Dr Benelli

The inflammation involves the thick white sceral coat of the eye.
In the Rheumatoid Arthritis case on the right this has resulted in thinning and
bulging of the sclera. Generally these cases require systemic (tablet or injection) immunosuppressant drugs.

The sclera is the white coat of the eye. Scleritis describes an inflammation of this layer. Scleritis is less common than episcleritis. In about half of people diagnosed with scleritis there is an association with another disorder such as:

  • Rheumatoid arthritis
  • Wegeners granulomatosis
  • Polyarteritis nodosa
  • Systemic lupus erythematosis (SLE)

It may also occur following surgery to the eye.

Symptoms

Progressive redness, tenderness over the area, and dull pain, which is unremitting are critical symptoms and signs. Scleritis is altogether a more unpleasant condition than episcleritis.

Additionally, there can be longer-term complications such as “melting” of the sclera and cornea (front window of the eye). The sclera at the back of the eye can sometimes be affected, leading to swelling of the optic nerve and the retina. This may lead to sight loss and needs to be treated aggressively.

Management

Often a full systematic workup with blood tests and X rays may be required to exclude the potential underlying causes described above. Co-management with another physician (rheumatologist) may be advocated.

Drugs that control inflammation and dampen the immune response are used. In many cases just a non-steroidal aspirin-like drug is required, such as Voltaren.

For more difficult cases immune suppression with the steroid prednisolone is indicated. This may be needed to control the inflammation in the eye as well as dampen down the activity of the associated disease.

There are other immunosuppressant drugs that may be used, which are beyond the scope of discussion here.