What is scleritis?

Scleritis

Scleritis is a condition that is characterized by the inflammation of the protective layer surrounding the eyeball. As a result of the disease, the sclera may lose its function, and the shape and stiffness of the eyeball may be at risk. We isolate the front and posterior scleritis, depending on where it is located. Treatment of ailments is based on the administration of antibiotics according to the instructions of the ophthalmologist.

What is scleritis?

Scleritis is a disease that is characterized by inflammation in the wall of the eyeball (sclera). The tibia is built from the front opening surrounding the cornea and the posterior opening, which covers the optic nerve canal, and its task is to protect the structure inside the eyeball.

Twardówka is an organ that consists of several layers:

• superficial episcleritis,
• scleral stroma,
• a brown plaque adhering to the vascular membrane inside the eyeball.

Scleritis is a rare condition but there is no accurate information on this topic. The fact is that very many cases are mild and patients do not go to the specialist with this problem, which unfortunately hinders epidemiological research.

Causes of scleritis

Inflammation can occur in the epidural and it is fairly mild, most patients have no specific cause. Episcleritis may affect us:

• in particularly stressful situations (1/3 of cases),
• as a result of migraines,
• as a result of rosacea,
• in patients with AD (atopic dermatitis),
• in the case of syphilis and borreliosis,
• due to connective tissue and vascular ailments.

Also various toxic agents can affect the occurrence of episcleritis.

In turn, scleral stromal inflammation, the main part of the eyeball, can cause serious consequences and indicate other general conditions. It may lead to damage to the eye and, consequently, to eyesight. The inflammation of the scar stroma may also surround the episcleral system. Inflammation of the sclera, especially of a necrotic nature, which proceeds with tissue necrosis is associated with connective tissue and vascular disorders. Diseases play an important role:

• systemic lupus erythematosus,
• RA - rheumatoid arthritis,
• Reiter's team,
• ankylosing spondylitis,
• recurrent inflammation of cartilage,
• nodular polyarteritis,
• psoriatic arthritis,
• giant cell arteritis,
• Wegener's granulomatosis.

Scleritis - symptoms

1. Episcleritis is a condition that attacks suddenly and leads to a strong redness of the eyeball. In addition, the patient has a feeling of discomfort and burning of the eyeball. Associative symptoms may include tearing and hypersensitivity to light. Acute pain in the episcleritis is usually mild and limited to the eye itself. What is important, during the pressure of the eyeball, the patient does not feel any pain. In episcleritis, visual acuity is preserved, and the disease itself relies to come back and may attack both the left and the right eye.

2. The main symptom of scleritis is congestion and redness of the eye, accompanied by severe pain radiating towards the forehead, paranasal sinuses or jaw. This ailment has a devious origin. It happens that necrotizing keratitis (leading to tissue death) causes such acute pain that patients are referred for accurate neurological examination before the right diagnosis is made. Inflammation of the back of the sclera may result in paralysis of the perinatal muscles, then the patient gets exophthalmos and loses sight. In summary, one and the main symptom of scleritis (any type) is redness of the eyeball, violet or even blue. Inflammation of the sclera can attack once and the second eye or occur simultaneously in both eyes.

What to do when symptoms occur?

It is essential to consult a physician if episcleritis first occurred. Patients who have a relapse are able to recognize the disease by themselves. You can then relieve the symptoms yourself, for example with cold compresses or over the counter drops containing artificial tears.

Inflammation of the sclera gives such characteristic symptoms in the form of redness (even outside the eye) and a change in its appearance that patients have no doubts about the doctor's visit. Even in the case of relapses, consultation is necessary because permanent eye damage and life-threatening may occur.

Diagnosis of scleritis

The basis for diagnosis of scleral inflammation is to conduct a medical interview with the patient during which the specialist collects information about general and eye diseases. It is also important to test in daylight, which makes it possible to distinguish between scleritis and episcleritis. Differences regarding mainly redness, which in the episcleritis takes a pink or strong red, while in scleritis - purple, or even blue. This type of examination also helps to determine the nature of inflammation, is it nodular? or maybe spilled? If the patient has a necrotizing nature of the inflammation, the doctor will notice areas of scleral thinning and defects.

Other tests used to diagnose scleritis are:

• examination in a slit lamp - allows to assess the depth of inflammatory changes and the involvement of episcleral vessels (superficial and deep). In addition, it is possible to determine the extent of edema and hyperemia (especially in necrotizing scleritis);
• type B ultrasound - a study helpful in determining what area of ​​the sclera has been occupied with inflammation. In addition, it enables recognition of posterior scleritis, which undiagnosed causes loss of vision;
• computed tomography and magnetic resonance imaging - are not as valuable as the above-mentioned studies, but determine to what extent they have been occupied by the inflammation of orbital tissue;
• fluorescein angiography or indocyanin green - a study helping to diagnose vasculitis and disorders in blood flow.

In addition, additional tests are performed in the diagnosis of scleritis, including:

• Blood tests,
• urine test,
• test determining the concentration of C-reactive protein,
• identification of autoantibodies,
• tests for syphilis,
• uric acid concentration,
• radiological examination (x-ray of chest and sacroiliac joints).

Scleritis - treatment

The episcleritis is a condition that usually does not require treatment because it resolves spontaneously. However, if the symptoms are very severe, patients take corticosteroid-containing drops. It is worth mentioning that these types of drugs can cause cataracts or glaucoma, so they should be discontinued as soon as possible after improvement. Lack of response to corticosteroids requires the administration of topical non-steroidal anti-inflammatory drugs that do not cause such side effects. In turn, the lack of improvement after topical administration results in NSAID administration to the patient in general.

Treatment of scleritis is heavier than episcleritis. Here, local treatment is ancillary, but general treatment is necessary. If necrosis has not occurred, NSAIDs are generally administered. Patients are prescribed oral corticosteroids. In patients particularly resistant to treatment, a solution is sought for treatment with intravenous steroid pulses or immunosuppressive preparations (especially in necrotizing scleritis). Because this type of therapy can cause side effects, patients should be under the constant care of physicians (hematologists, neurologists, internists).

Surgical treatment is used when there are complications in the form of corneal defect, retinal detachment, glaucoma, cataracts or optic neuritis. If the scleritis has caused infectious agents, it is contraindicated to administer immunosuppressive drugs.

Scleritis - prophylaxis

In the prevention of scleritis, the type of work and time spent is important. If every day we are exposed to damage to the joints, muscles or ligaments, e.g. during physical activity, there is a risk of inflammation of the connective tissue and, consequently, the occurrence of scleritis. It is very important to make an early diagnosis, and the treatment of diseases associated with this condition may prevent its occurrence.