SCLERITIS: 

The sclera is the protective white outer covering of the eye and inflammation of the sclera is known as Scleritis.

CAUSES OF SCLERITIS:

1) It is more common in the old age group of people but the age group which can be affected is mostly 40 years and above.

2) Females are at more risk for developing Scleritis.

3) Granulomatous diseases like syphilis, tuberculosis, and leprosy.

4) Sometimes patients can suffer from Scleritis after any eye surgery.

5) Patients suffering from autoimmune diseases like rheumatoid arthritis, and SLE can develop scleritis.

6) Patients suffering from gout, and thyrotoxicosis can develop scleritis especially if the disease is not under control.

7) Chemical burns

8) Infectious scleritis due to Herpes Zoster, staphylococcus and streptococcus.

9) Behcet’s disease

10) Sometimes scleritis can be idiopathic in nature.

TYPES OF SCLERITIS:

1) INFECTIOUS SCLERITIS 

2) NON INFECTIOUS 

Non-infectious scleritis can be further classified as:

a) Anterior scleritis

b) Posterior scleritis. 

Now let’s discuss types of scleritis in detail:

1) INFECTIOUS SCLERITIS- It is less common as compared to the non-infectious type. It can be either exudative type, fistula, or ulcerative type. Infections type scleritis is difficult to differentiate from non-infectious type at the beginning of the disease.

2) NON-INFECTIOUS SCLERITIS- These are immune-mediated scleritis. These are further classified into non-necrotizing and necrotizing scleritis.

A) NON-NECROTIZING ANTERIOR SCLERITIS: 

As the name suggests it does not cause necrosis. It is divided into two types:

1) Anterior diffuse-type- It is the most common type which involves the inflammation of the anterior part of the sclera. The inflamed part will look pinkish and slightly elevated compared to the normal sclera.

2) Anterior nodular type-  In this type hard nodular structures are seen which are purplish in colour. These nodules can be felt near the limbus.

B) NECROTIZING ANTERIOR SCLERITIS:

1) Anterior necrotizing scleritis with inflammation: It is a more serious form of scleritis in which the inflammation is severe as infarction occurs in the sclera. If not controlled in starting then it can slowly lead to thinning out of the sclera and slowly reaching the uveal tissue. The patient can sometimes suffer from anterior uveitis.

2) Anterior necrotizing scleritis without inflammation: As the name suggests in this type the sclera doesn’t undergo inflammation but this type of sclera starts melting because of disturbance in blood flow to the sclera. This leads to the separation of the conjunctiva from the sclera.

POSTERIOR SCLERITIS:

It is the most misdiagnosed scleritis. In this, the inflammation of the sclera occurs on the backside also called the equator. The patient can suffer from retinal detachment if left untreated.

CLINICAL FEATURES OF SCLERITIS:

1) Patients usually complain of mild to severe pain in the eyes and this pain can radiate to the jaw or temple area.

2) Blurring or loss of vision can occur.

3) Secretion from the eyes.

4) Redness of eyes.

5) Photophobia or difficulty to see in the light.

INVESTIGATION:

1) Blood investigation like Total leucocyte count (TLC), Differential leucocyte count (DLC), and Erythrocyte sedimentation rate (ESR) can be helpful to rule out any infection.

2) Blood sugar level and blood pressure should be examined to find out any other causes of eye problems like diabetes and hypertension.

3) Rheumatoid factor, Antinuclear antibodies (ANA), and complement C3 tests are done to find any immunological cause for the eye problem.

7) Urine test

8) Chest x-ray, paranasal, and orbital x-ray should be done.

9) TSH ( Thyroid-stimulating hormone), T3, and T4 should be checked to rule out a thyroid problem.

TREATMENT:

1) Infectious scleritis needs proper antibiotic cover to prevent the spread of infection.

2) If suffering from tuberculosis, or syphilis then the patient should be treated accordingly.

3) In the case of the necrotizing type of scleritis, wound debridement should be done.

4) Topical and systemic steroids have been found useful in the treatment but should be done with caution as they may lead to thinning and perforation of the sclera.

5) If autoimmune disease is the cause of scleritis then immunosuppressive therapy is prescribed like methotrexate and cyclophosphamide.

6) If the patient is suffering from a thyroid problem then thyroid medication should be taken as prescribed by the doctor.

7) Chemical burn patients need to be attended on an emergency basis to prevent the severity of the eye damage and proper rehabilitation should be done.

IMPORTANT POINT:

It is important to visit the doctor and get your eyes checked properly rather than using eye drops and medicine without a prescription because it may lead to worsening of the condition and sometimes loss of vision.