Brief overview
- Description: Inflammation of the outermost, white layer of the eye (also called the sclera)
- Causes: Other diseases usually cause scleritis (e.g. autoimmune diseases such as rheumatism); infections with viruses, bacteria or fungi are less common.
- Course: Episcleritis often lasts ten to 14 days and usually heals on its own. Scleritis is usually chronic (lasting months to years) and sometimes leads to serious complications (e.g. visual impairment).
- Signs: pain, reddened eyes, bluish discolored and/or swollen sclera
- Diagnosis: Consultation with the doctor, examination of the eyes (e.g. with a slit lamp), blood test to rule out other diseases
- Treatment: The doctor usually treats the inflammation locally with eye drops or eye ointments. Depending on the cause, immunosuppressants, cortisone, painkillers and, in rare cases, surgery are also used.
What is dermatitis?
With scleritis, the outermost, white fibrous layer surrounding the eye (sclera) is inflamed. Doctors refer to this layer of tissue in the eye as the “sclera”. It extends from the entry point of the optic nerve to the cornea of the eye.
Depending on whether the sclera is inflamed in the deeper or superficial layer, a distinction is made between scleritis and episcleritis.
Scleritis
If the entire sclera is inflamed in the deeper layer, this is referred to as scleritis. Doctors differentiate between “anterior” and “posterior scleritis”. Anterior scleritis affects the anterior section of the sclera and is usually easy to recognize from the outside. Posterior scleritis, on the other hand, refers to inflammation at the back of the sclera. It is usually only noticeable through pain in the affected eye.
Scleritis is one of the rarer inflammatory eye diseases, is often associated with complications and in some cases even threatens vision. Scleritis often occurs in people between the ages of 40 and 60. Women are more frequently affected than men.
Episcleritis
In episcleritis, the sclera is superficially inflamed – more precisely, the connective tissue layer between the sclera and the conjunctiva (episclera). Episcleritis is usually harmless and heals on its own. It often occurs in young adults and is more common in women than in men.
How does episcleritis develop?
Scleritis: Causes
In around half of those affected with scleritis, an autoimmune disease is the cause of the inflammation of the dermis. These include diseases such as:
- Rheumatism (rheumatoid arthritis): Chronic inflammation of the joints
- Chronic inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis
- Wegener’s disease (granulomatosis): Chronic inflammatory disease of the blood vessels with small skin nodules
- Lupus erythematosus (lupus disease): Rare chronic inflammatory disease with inflammation of the skin, joints, nervous system and organs
- Polychondritis: Rare chronic inflammation of the cartilage (usually of the joints)
Immune reactions of the body to infectious diseases such as tuberculosis, syphilis, shingles (infection with the herpes zoster virus) or Lyme disease are also possible triggers, albeit much less frequently. Gout also sometimes leads to dermatitis.
Episcleritis: causes
Doctors often cannot find a clear cause for episcleritis. Doctors suspect, among other things, that stress or severe physical and mental strain trigger episcleritis. Sometimes autoimmune diseases are also the trigger.
Risk factors
How long does dermatitis last?
The inflammation progresses differently depending on whether scleritis or episcleritis is present. Similar symptoms usually occur in both forms, although these are generally of varying severity.
Course of scleritis
The course of scleritis varies from patient to patient. Initially, often only one eye becomes inflamed. However, in around 50 percent of those affected, the inflammation of the sclera later also occurs in the second eye.
In some people, the inflammation of the sclera is mild: the sclera then only swells slightly.
In around two out of three people with scleritis, however, the inflammation is chronic and recurs repeatedly. In these cases, an inflammatory episode often does not heal for six months to six years. In severe cases, it is also possible for the inflammation to destroy tissue in the eye.
Without adequate treatment, chronic scleritis causes permanent visual damage to the affected eye. In rare cases, those affected go blind. It is therefore particularly important to recognize scleritis in good time and to treat it adequately depending on the cause.
Progression of episcleritis
How does dermatitis manifest itself?
Although the symptoms of scleritis and episcleritis are often similar, they usually differ in severity.
Symptoms of scleritis
The most common symptoms of scleritis are
- Severe, stabbing pain in the eye; those affected often experience it as pressure pain.
- The affected eye is reddened. The blood vessels are more prominent.
- The sclera is swollen.
- The sclera turns a dark red to bluish color.
- The eye tears profusely (increased lacrimation).
- Affected people have blurred and indistinct vision.
- The eyes of those affected are sensitive to light.
If you experience one or more of these symptoms, be sure to consult an ophthalmologist!
Symptoms of episcleritis
The affected eye is also reddened and painful in the case of superficial inflammation of the sclera, but not as severely as in the case of scleritis. Typical symptoms of episcleritis are
- The inflammation is limited to a small area of the eyeball (sector-shaped).
- The eye is reddened and slightly swollen.
- The affected person’s eyes are sensitive and irritated.
- The eye is very watery (increased lacrimation).
- The affected person’s eyes are sensitive to light.
- Vision is not impaired.
Is dermatitis contagious?
In most cases, dermatitis is not contagious, as it is rarely caused by bacteria, viruses or fungi. If, in rare cases, bacteria or viruses do cause the inflammation, it is important that the doctor determines the type of pathogen in question. In this way, it is possible to treat the pathogen specifically (e.g. with a specific antibiotic).
How does the doctor investigate scleritis?
If scleritis or episcleritis is suspected, the first point of contact is the ophthalmologist. The doctor will make a diagnosis based on the symptoms described and after examining the eye with a slit lamp.
Consultation with the doctor
During the consultation, the doctor will first ask the patient about their symptoms and medical history:
- What symptoms do you have (e.g. pain in the eye, increased tearing or increased sensitivity to light)?
- How long have the symptoms been present?
- Do you or your family have any known illnesses such as rheumatism, lupus erythematosus, Crohn’s disease or infectious diseases?
- Do you suffer from severe stress or physical or mental strain?
Examination with the slit lamp
In most cases, the doctor will recognize whether it is episcleritis or scleritis after a detailed discussion and a slit lamp examination.
Blood test
In order to clearly diagnose scleritis and treat it correctly, it is important to find the cause of the disease. For further clarification, it is therefore often necessary for the doctor to examine the patient’s blood for infections (e.g. caused by bacteria or viruses) and other diseases (e.g. rheumatism) (blood test). If the doctor finds an autoimmune disease as the cause, for example, the treatment will also be based on this.
What is the difference to conjunctivitis?
In conjunctivitis, only the conjunctiva of the eye is inflamed, but not the sclera. The conjunctiva is a thin layer that covers the sclera and the inside of the eyelids in the front of the eye.
The cause of conjunctivitis is usually different from that of scleritis. Conjunctivitis is often caused by an infection with bacteria or viruses, a foreign body in the eye, allergies or overly dry eyes.
What can you do about dermatitis?
Dermatitis can be dangerous for the eye and, in the worst case, can impair vision. It should therefore always be treated by a specialist (ophthalmologist). The doctor will choose the treatment based on the disease that caused the scleritis. Among other things, eye drops or eye ointments, painkillers, cortisone, immunosuppressants and, in rare cases, surgery are used.
Eye drops and eye ointments
The doctor treats the inflammation in the eye locally with pain-relieving and anti-inflammatory eye drops or eye ointments. The symptoms usually subside within one to two weeks.
Painkillers
The doctor may prescribe medication with pain and anti-inflammatory agents, such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen or acetylsalicylic acid). They are available as tablets or eye drops.
Cortisone
Occasionally, the doctor also administers cortisone (corticosteroids). The affected person takes the cortisone in the form of eye drops or tablets.
The ophthalmologist does not always treat episcleritis. It often heals on its own. However, eye drops, for example, alleviate the symptoms.
Immunosuppressants
It is best to consult an internal medicine specialist who specializes in rheumatic diseases (rheumatologist) and works closely with your ophthalmologist.
Surgery
If the sclera is severely damaged by chronic inflammation and threatens to break through (perforation), it may be necessary to operate on the sclera in rare cases. The doctor sutures intact connective tissue from other parts of the body to the sclera, for example.
How can inflammation of the sclera be prevented?
In contrast to other eye diseases, such as conjunctivitis, there are only a few preventative measures for scleritis. It is true that the triggers for dermatitis are rarely pathogens such as bacteria or viruses. Nevertheless, it is advisable to maintain good eye hygiene and avoid touching your eyes with dirty hands, for example.
Especially if you wear contact lenses, it is important that you pay attention to sufficient hygiene: Wash your hands thoroughly before touching the lenses. Do not use tap water to clean the lenses, always keep the contact lens container clean and replace the cleaning fluid daily.
