Scleritis is inflammation of the sclera, which is the white part of the eye. Wilmer Eye Institute ophthalmologist Meghan Berkenstockexplains what you need to know about scleritis, which can be painful and, in some cases, lead to vision loss.

Types of Scleritis

There are two main types of scleritis:

1. Anterior scleritis is the more common form, and occurs at the front of the eye.

There are three types of anterior scleritis:

• The most common form can cause redness and irritation throughout the whole sclera and is the most treatable.
• Another type causes tender nodules (bumps) to appear on the sclera.
• The most severe can be very painful and destroy the sclera.

2. Posterior scleritis is the more rare form of the disease, and occurs at the back of the eye.

People with this type of scleritis may have pain and tenderness in the eye. This form can result in retinal detachment and angle-closure glaucoma.

Some people only have one type of scleritis, but others can have inflammation at the front and back of the eye.

Scleritis Causes

Although scleritis can occur without a known cause, it is commonly linked to autoimmune diseases, such as rheumatoid arthritis.

Other conditions linked to scleritis include:

• Eye infections
• Sarcoidosis
• Lupus
• Inflammatory bowel disease (IBD)
• Sjogren’s syndrome 
• Vasculitis
• Scleroderma

Other causes can include eye trauma and — in very rare cases — fungal or parasite infections.

Scleritis Symptoms

• Eye pain or tenderness
• Redness and swelling of the sclera
• Blurred vision
• Frequent tearing
• Sensitivity to light

Episcleritis vs. Scleritis

Scleritis is similar to episcleritis in terms of appearance and symptoms. However, scleritis is usually much more painful, and it can lead to vision loss due to progressive inflammation of the ocular tissues or even morbidity and mortality due to an underlying collagen vascular disease. Episcleritis is a more superficial inflammation that can be treated with topical medications, such as nonsteroidal eye drops.

Scleritis Diagnosis

Your eye doctor may be able to detect scleritis during an exam with a slit lamp microscope. You may need an additional visit with a primary care doctor or rheumatologist to perform blood tests or X-rays to uncover a related underlying medical condition.

Scleritis Treatment­­­

If scleritis is diagnosed, immediate treatment will be necessary. Treatment will vary depending on the type of scleritis, and can include:

• Steroid eye drops
• Anti-inflammation medications, such as nonsteroidal anti-inflammatories or corticosteroids (prednisone)
• Oral antibiotic or antiviral drugs

Medications that change or weaken the response of the immune system may be used with severe cases of scleritis.