Scleritis

Scleritis

Scleritis is an inflammation of the dermis (sclera) of the eye which, if left untreated, can lead to loss of vision. The peak age of the disease is between the ages of 40 and 60, with women being affected significantly more often than men.

What is scleritis?

Scleritis is a diffuse or locally limited inflammation of the dermis, which in many cases has a chronic course with recurrences (40 percent). Depending on the location and course, different forms of scleritis are differentiated. For what does hypersomnia mean, please visit etaizhou.info.

If the inflammation is in the front area or in front of the eyeball equator, it is an anterior scleritis, while a focus of inflammation in the rear area or behind the eyeball equator is referred to as posterior scleritis. In addition, anterior scleritis is divided into necrotizing forms with whitish areas of necrosis, diffuse scleritis, which usually affects the eyeball in sectors, and nodular subtypes with movable reddish-blue nodules.

As a result of the inflammation, edematous (fluid stored) swellings of the sclera manifest with pronounced tenderness in the affected eye, which in combination with lid edema and chemosis can cause visual impairment. The pressure pain characteristic of scleritis can radiate to the affected half of the face.

Causes

In many cases, the cause of scleritis cannot be clarified (idiopathic scleritis). In about 50 percent of cases, the disease can be associated with underlying systemic diseases such as rheumatic disorders (including collagen diseases such as periarteritis nodosa or lupus erythematosus, chronic polyarthritis), Crohn’s disease, gout or autoimmune diseases.

Scleromalacia perforans (necrotizing scleritis) in particular is often associated with pronounced rheumatoid arthritis. Infectious diseases such as tuberculosis, herpes zoster or syphilis can also cause scleritis.

In some cases, keratitis ( inflammation of the cornea ) or iridocyclitis (inflammation of the iris involving the ciliary body) can also cause secondary inflammation of the dermis. Scleritis is rarely caused iatrogenically by medical intervention.

Symptoms, Ailments & Signs

Scleritis initially manifests itself through typical signs of inflammation such as redness, pain and itching in the area of ​​the affected eye. Characteristic is the constant tearing of the affected eye, combined with visual disturbances such as blurred vision or double vision, whereby the disturbances are not severe and usually pass quickly.

As a result of the inflammation and the persistent flow of tears, swelling forms, which can be seen externally. In addition, reddish-blue nodules can appear in the area of ​​​​the eye. In addition, visual acuity may temporarily decrease when symptoms are associated with eyelid edema or chemosis.

In severe cases, scleritis can lead to the development of staphyloma. Scars often form or permanent impairment of vision occurs. Symptoms of scleritis appear within a few hours to days. Visible reddening typically occurs shortly after the triggering event.

This is followed by the characteristic swelling, accompanied by a sudden decrease in vision. If the disease is treated immediately, the symptoms usually subside quickly. Untreated scleritis can become chronic and, in the worst case, lead to blindness in the affected eye.

Diagnosis & History

The diagnosis of scleritis is usually based on the symptoms characteristic of the disease, in particular on the basis of the pronounced pressure pain. Physical examination with the slit lamp can reveal thickening of the sclera in the slit image due to the swollen sclerotic area.

In addition, the extent of the inflammation and the clinical form of the scleritis can be determined using the slit image. Sonography (ultrasound) can show the sclera changes. Scleritis should be differentiated from conjunctivitis, corneal inflammation and episcleritis in the differential diagnosis.

Furthermore, if scleritis is confirmed, a possible systemic underlying disease should be checked. The prognosis and course of scleritis depend heavily on the specific form present. Patients with anterior diffuse scleritis (9 percent) have a much lower risk of vision loss than those with nodular (25 percent), necrotizing (75 percent), or posterior scleritis (80 percent). Underlying autoimmune diseases also have an unfavorable effect on the prognosis.

Complications

In some cases, scleritis can occur in connection with corneal inflammation or iris inflammation. This can intensify the original symptoms. The edema and swelling can become infected and cause further complications. In extreme cases, the infection spreads to other parts of the body.

Very rarely – for example, if the patient is already weakened by another illness – blood poisoning can occur, which may be fatal. In the case of longer-lasting illnesses, the eye pain can also cause psychological problems. The same applies to visual disorders, which are often extremely stressful for young patients in particular. Scleritis therapy is usually symptom-free.

However, anti-inflammatory drugs, anti-inflammatory drugs and other drugs that are usually prescribed can cause side effects and interactions. Occasionally there are allergic reactions or an existing intolerance causes symptoms. The usual complications can occur during a surgical procedure: bleeding, secondary bleeding and infections.

If the course is severe, vision loss can occur in rare cases. Wound healing disorders can occur after the operation. In addition, scars often develop, which can be associated with pain and a feeling of pressure in the area of ​​​​the intervention.

When should you go to the doctor?

Medical treatment is required for scleritis. In the worst case, if left untreated, the person affected by this disease will suffer a complete loss of vision, which is usually irreversible. For this reason, a doctor should always be consulted immediately if you have scleritis. A doctor should be consulted if the affected person suffers from severe redness or severe itching of the eye. This leads to a severe inflammation of the eye, which does not go away on its own.

In general, sudden visual problems indicate scleritis and should be evaluated by a doctor if they occur without a specific reason. In many cases, those affected also suffer from double vision or blurred vision and can no longer cope in their everyday lives.

If these symptoms occur, the person concerned should consult an ophthalmologist. Further treatment depends on the severity of the scleritis, so that no general prognosis can be given.

Treatment & Therapy

In the case of scleritis, the therapeutic measures are based on the specific underlying disease and aim to reduce the symptoms. Systemically, non-steroidal anti- inflammatory drugs or anti -inflammatory drugs such as flurbiprofen or indomethacin are used systemically to reduce symptoms, which are administered orally and gradually tapered off over several months of therapy (gradual reduction in the drug dose).

The individually present pain can support the determination of the appropriate dose, as this serves as an indicator for the extent of the inflammatory activities. Acute inflammation can be treated systemically with pronounced pain with corticosteroids (including prednisolone ). If this medication is ineffective or if there are pronounced side effects, the therapy can be adjusted and non-steroidal immunosuppressants such as cyclosporine A, methotrexate or azathioprine can be used instead.

In the case of necrotizing scleritis, immunosuppressants (especially cyclophosphamide) and initially, if necessary, oral or intravenous steroids are used as standard. Nonsteroidal anti-inflammatory drugs are recommended for people with rheumatoid arthritis and diffuse or nodular scleritis, with a switch to methotrexate if necessary for nodular scleritis.

If there is progressive necrosis of the sclera with an increased risk of bulbus perforation, surgical intervention (sclera transplantation) with peri- or postoperative immunosuppressive therapy is indicated. In addition, possible concomitant infections of the scleritis should be treated with antibiotics (bacterial induced) or cold pads and/or synthetic tears (viral induced).

Prevention

Scleritis can be prevented by consistent and adequate therapy of the underlying rheumatic, autoimmune or infectious diseases. However, due to the unknown etiology, there are no prophylactic measures against idiopathic scleritis.

Aftercare

In the case of scleritis, those affected usually have only a few and only limited follow-up measures available. For this reason, the patient should consult a doctor as soon as the first symptoms and signs of the disease appear, so that further complications can be prevented. As a rule, self-healing is also not possible, so that the person concerned is usually always dependent on medical examination and treatment.

The sooner a doctor is consulted, the better the further course of the disease. This disease does not require permanent treatment, although regular check-ups and examinations by a doctor are very important. The kidneys and urinary tract should be checked regularly.

Regular blood tests should also be carried out. In some cases, scleritis can cause infection or inflammation of the urinary tract or kidneys, requiring treatment with antibiotics. Regular medical check-ups are also very important. If the disease is treated by surgery, the person concerned should take it easy after the procedure and especially protect the affected region.

You can do that yourself

In the case of scleritis, medical treatment is required first. In addition, a whole range of self-help measures can be taken to support the drug or surgical treatment and thus contribute to a speedy recovery.

First of all, it is important to treat the individual symptoms individually. Pads and cooling help with reddened skin and infections. If necessary, the stress on the skin can be reduced by dieting. It is advisable to avoid dairy products and spicy foods. Alcohol and nicotine are also considered harmful and should be avoided. Any concomitant infections are treated with cold pads. In consultation with the doctor, so-called synthetic tears can also be used. Treatment with the strong active ingredient must always be carried out under medical supervision in order to avoid complications and to be able to clarify queries quickly.

Scleritis is a serious disease associated with various symptoms and signs. Home remedies and self-help measures can support medical therapy, but cannot replace it. If the above tips do not bring any improvement, the family doctor must be informed so that the medical treatment can be adjusted.

Scleritis