What are Scleritis and Episcleritis

Scleritis and episcleritis are redness and inflammation of the white part of the eye (sclera). Episcleritis involves only the surface of the sclera. Episcleritis is a mild condition that does not affect your vision. It usually clears up in a few days without treatment.

Scleritis involves the body of the sclera. It is a serious condition that may cause severe pain and some vision loss. Scleritis often needs to be treated with strong medicines. Both of these conditions may affect one or both eyes.

These two conditions may occur along with other diseases that cause inflammation, including diseases in which your body’s defense system (immune system) mistakenly attacks normal body tissues (autoimmune diseases).

Rheumatoid arthritis is one common autoimmune disease that may cause episcleritis or scleritis. Other diseases that may cause these conditions include Crohn disease, lupus, and inflammatory bowel disease.

What are the causes?

Scleritis is usually caused by an autoimmune disease. Occasionally, it may be caused by infection. Episcleritis may also be caused by eye infections and irritations. In some cases, the cause of these conditions is not known.

What increases the risk?

These conditions are more likely to develop in:

• Women.
• People who are between 20 and 50 years of age.
• People who have an autoimmune disease, especially rheumatoid arthritis.

What are the signs or symptoms?

Symptoms of episcleritis include:

• Redness of the sclera. This may go away after several days.
• Mild pain.

Symptoms of scleritis include:

• Redness of the sclera.
• Moderate to severe pain.
• Pain that gets much worse with light exposure (photophobia).
• Tearing.
• Soreness when touched (tenderness).
• Vision problems. This can range from mild blurred vision to severe vision loss.

How is this diagnosed?

These conditions may be diagnosed based on your symptoms, your medical history, and a physical exam. You may need to see a health care provider who specializes in diseases and conditions of the eye (ophthalmologist). An ophthalmologist may:

• Put drops in your eye.
• Examine your eye with a certain type of light (slit lamp).
• Order blood tests or refer you to a specialist to check for autoimmune disease.

How is this treated?

Episcleritis often gets better without treatment after several days. During this time, treatment may include:

• Eye drops.
• Cold compresses.
• NSAID medicines to reduce discomfort and swelling.

Scleritis is a serious condition that needs to be treated. Treatment may include:

• Eye drops.
• NSAIDs.
• Prescription pain medicines.
• Steroid medicines.
• Medicines that suppress the immune system.
• Treatment of an underlying autoimmune disease.
• Eye surgery. This is rare.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Use eye drops only as told by your health care provider.
• If directed, use cold compresses over your eye or eyes to help relieve pain.
• Do not wear contact lenses until your health care provider says that you can.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms have not gotten better in the expected amount of time. This can take days to weeks.
• You develop new symptoms.
• You develop worsening pain, photophobia, or blurred vision.
• Your symptoms come back after treatment.

Get help right away if:

• You have severe pain or severe photophobia.
• You have sudden vision loss.