Scleritis

  • Medical Author:
    Andrew A. Dahl, MD, FACS

    Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What are signs of scleritis?

In scleritis, your physician will notice redness of the blood vessels adjacent to the sclera. This redness can have a bluish or violet tinge. With repeated episodes or long-standing scleritis, the sclera can thin and the underlying brown choroid may become visible through the residual sclera.

Scleritis may be nodular with multiple round or oval elevated areas of the sclera. Scleritis may also be necrotizing, resulting in areas of thinning and softening of the normally fairly rigid sclera. Areas of absence of redness may be due to death (necrosis) of inflamed blood vessels.

Scleritis can be characterized as being located in the front or back of the eye (anterior or posterior), depending on the location of the disease upon examination.

Visual acuity can be decreased if there is secondary clouding of the cornea or of the lens of the eye. Intraocular pressure can be increased from congestion of the blood vessels involved in draining aqueous fluid from the eye. Intraocular pressure can also be decreased if the ciliary body, which lies deeper than the sclera, is secondarily involved by inflammation.

Disturbances of eye movement can be seen since the extraocular muscles can become irritated where they insert into the sclera. This can cause double vision.

How is scleritis diagnosed?

Scleritis is usually diagnosed by the history and the clinical findings on slit lamp examination by an ophthalmologist. The slit lamp is a special viewing instrument that eye specialists use to stabilize the head while magnifying and viewing the structures of the eye.

In order to determine the cause of the scleritis, blood tests including rheumatoid factor, antinuclear antibodies, antineutrophil cytoplasmic antibodies, human leukocyte antigen typing, and erythrocyte sedimentation rate may be ordered. If infectious disease is suspected, appropriate cultures or serological tests may be necessary. If Wegener's granulomatosis is considered, sinus X-rays and a chest X-ray may be ordered. Radiographic examination of joints may assist in the diagnosis of various types of arthritis. If orbital inflammation is suspected in addition to the scleritis, an MRI of the orbit may be helpful for diagnosis.

Medically Reviewed by a Doctor on 3/23/2016

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