Scleritis

Definition/diagnostic criteria Scleritis is a rare, severe inflammation of the sclera (the white part of the eyeball). It is a potentially sight-threatening condition and can be bilateral in about 50% of cases​​.

Epidemiology

  • Incidence: Approximately 3.4 per 100,000 per annum.
  • Age group: Predominantly affects individuals in the middle age group (40-60 years).
  • Gender prevalence: More common in females, with a male to female ratio of 2:3.
  • Associated conditions: Around 30-40% of cases are linked with autoimmune diseases​​.

Diagnosis
Clinical features:

  • Symptoms: Include moderate or severe eye pain, which can extend to the brow or jaw, sleep disturbance, tenderness of the globe, photophobia, epiphora (watery eyes) and visual loss.
  • Types: Can involve the anterior or posterior sclera, or both.
    – Anterior scleritis accounts for 90% of cases and is subdivided into non-necrotising (most common) and necrotising forms.
    – Posterior scleritis is less common but can present with more severe symptoms​​​​.

Investigations: Investigations for systemic associations and imaging to investigate posterior segment involvement are crucial for a comprehensive diagnosis. The type of scleritis (e.g., necrotising, non-necrotising) guides the approach to further investigations​​.

Treatment

  • Initial management: Systemic analgesia is recommended for pain management​​.
  • Referral: Necrotising anterior scleritis and posterior scleritis require emergency referral, while non-necrotising anterior scleritis calls for an urgent referral to an ophthalmologist.
  • Ophthalmologist management: May include systemic NSAIDs, topical steroids, systemic immunosuppression (corticosteroids, other immunosuppressant drugs, biologics like TNF alpha inhibitors), and imaging for posterior segment involvement​​.

Prognosis The prognosis of scleritis varies depending on the type and severity. Necrotising scleritis, particularly, can lead to significant visual impairment​​.

Further reading

Published: 31st July 2022 Updated: 14th February 2024

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Nursing in Practice Reference is based on the best-selling book Symptom Sorter. The experts behind Nursing in Practice Reference are Marilyn Eveleigh who is Nursing in Practice’s editorial advisor and a primary care nurse in East Sussex, Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.