Scleritis: Causes, Symptoms, and When to Seek Treatment

This form causes even redness and tenderness across a broad front-sclera area. Patients often feel a constant, dull ache that worsens with eye movement or pressure. The sclera looks uniformly red and swollen without distinct lumps. Early NSAIDs or steroids can ease inflammation if started quickly.

Small, tender bumps or nodules form on the visible white of the eye in this type. These focal areas of inflammation may precede more severe disease forms. Nodules often feel firm but painful to touch, and redness surrounds each bump. Immunosuppressive therapy may be needed if nodules persist or worsen.

Necrotizing scleritis is the most serious form and can thin or break down the scleral wall. Tissue destruction may lead to permanent defects or perforation if not treated urgently. Strong immunosuppressive drugs or surgical support, such as scleral patch grafts, are often required. Close monitoring by an ophthalmologist and rheumatologist is critical to prevent vision loss.

Posterior scleritis affects the back of the eye and often causes deep pain around the eye or temple without obvious redness. It may present with swelling behind the eye, blurry vision, and even double vision. Imaging tests like B-scan ultrasound and OCT are used to detect hidden inflammation. Early detection guides prompt treatment to protect the optic nerve and retina.

Mild diffuse scleritis often improves with oral NSAIDs like ibuprofen or indomethacin. Patients should watch for stomach upset and take these medicines with food. Your doctor may switch to a selective COX-2 inhibitor if GI side effects occur. Regular blood tests check kidney function during NSAID therapy.

Moderate to severe scleritis often requires oral or injectable steroids such as prednisone. Treatment usually starts with high doses that taper gradually over weeks or months to prevent relapse. Doctors monitor for side effects like high eye pressure, weight gain, and mood changes. Steroid treatment may be combined with other medications to minimize long-term risks.

For necrotizing scleritis or cases tied to autoimmune disease, drugs like methotrexate, mycophenolate, or cyclophosphamide are used. These agents help control immune activity when steroids alone are not enough. Regular lab tests check blood counts and liver function during therapy. A rheumatologist often co-manages treatment to optimize dosing and monitor side effects.

Newer biologic drugs such as rituximab and adalimumab target specific parts of the immune system. Biologics are often used when conventional immunosuppressants fail or cause toxicity. Patients receive these by infusion or injection under specialist care. Biologic therapy can reduce flare-ups and spare steroid use over time.

If an infection causes scleritis, the doctor prescribes antibiotics, antifungals, or antivirals based on lab tests. Initial broad-spectrum treatment is refined once culture results return. Severe infections may need surgical cleaning of dead tissue to clear germs. Prompt antimicrobial care prevents spread and protects vision.

When the sclera becomes thin or starts to perforate, surgery like a scleral patch graft can repair the damage. Corneal or oculoplastic surgeons often assist to support the eye’s structure. Surgery may be combined with immunosuppressive therapy for best results. Close postoperative follow-up ensures healing and prevents recurrence.

Wearing protective eyewear during activities reduces the risk of injury-triggered inflammation. Managing underlying autoimmune disease through regular care lowers the chance of flare-ups. Using preservative-free artificial tears soothes irritation between treatments. Routine eye exams help detect early signs of recurrence and adjust therapy promptly.