Scleritis is closely tied to the immune system. A 2020 review published in the journal Ocular Immunology and Inflammation found that roughly half of patients with scleritis have an underlying autoimmune condition. Rheumatoid arthritis is the most common link. If you have been diagnosed with rheumatoid arthritis, lupus, or another autoimmune disorder, you are at higher risk for this type of eye inflammation.
In some cases, scleritis is actually the first sign that an autoimmune condition exists. This is one reason why a thorough workup matters. Treating the eye alone without investigating the bigger picture can leave the root cause unaddressed.
Scleritis most commonly appears in adults between the ages of 40 and 60, though it can occur at any age. Women are affected slightly more often than men. According to a 2020 study in the journal Clinical Ophthalmology, scleritis affects 5.5 out of every 100,000 people in the United States each year, resulting in an estimated 10,500 new cases annually.
If you have had previous episodes of eye inflammation, your risk of developing scleritis may be higher. This includes conditions like uveitis (inflammation inside the eye) or episcleritis (a milder inflammation of the tissue just above the sclera). Recurring inflammation in or around the eye is worth discussing with your eye doctor, especially if the pain pattern changes or worsens.
Think of the sclera as the shell of your eye. It is the white, fibrous outer layer that gives the eyeball its shape and protects the delicate structures inside. Unlike the cornea at the front, the sclera is thick and opaque. It is packed with collagen fibers that keep everything structurally sound.
In scleritis, the immune system triggers inflammation in this protective shell. The blood vessels within the sclera swell and the tissue becomes engorged. This is what causes the deep, aching pain. The sclera has nerve endings that respond to stretching and pressure. When those tissues swell, the pain feels like it radiates behind the eye, not just on the surface.
Unlike surface irritations that come and go, scleritis pain tends to be constant. Many patients notice it most at night or when their eyes are closed. The inflammation can also make the sclera appear darker than usual, sometimes with a violet or purplish tint.
With conjunctivitis or a surface irritation, the redness sits on top and the discomfort is more of an itch or gritty sensation. Scleritis pain is deeper. It often gets worse when you look side to side or up and down because the eye muscles pull against inflamed tissue. Some patients describe it as a constant ache that wakes them up at night. If your eye pain does not improve with over-the-counter drops and it hurts to move your eyes, that is an important clue.
This is the most common form, affecting the front portion of the sclera. It appears as a deep redness, sometimes with a violet or bluish hue. This color is different from the bright red of a typical irritated eye. The pain is usually moderate to severe and steady.
Anterior scleritis has three subtypes. Diffuse scleritis spreads across a wide area. Nodular scleritis forms a raised, tender bump on the sclera. Necrotizing scleritis is the most severe form, where the scleral tissue can thin or break down over time.
This type affects the back of the eye and is harder to detect on a standard external exam. Symptoms may include deep pain, vision changes, double vision, or pain with eye movement. Because the inflammation is behind the eye, your eye doctor may need advanced imaging to confirm it. An ultrasound of the eye is one common tool used for this. Posterior scleritis can affect the retina and optic nerve if left untreated.
When you come in with deep eye pain and redness, your eye doctor will start by asking about your symptoms. They will want to know how long the pain has been present and whether you have any known autoimmune conditions. A thorough external exam and slit lamp evaluation will help distinguish scleritis from other causes of red eye, such as episcleritis, conjunctivitis, or uveitis.
Your eye doctor will look at the pattern of redness, check for scleral thinning or nodules, and evaluate your vision. In some cases, imaging of the back of the eye may be needed to rule out posterior scleritis. Intraocular pressure (the fluid pressure inside your eye) will also be measured. Scleritis can sometimes cause secondary changes in eye pressure that need monitoring.
Because scleritis is so often linked to systemic autoimmune disease, your eye doctor may recommend blood work or a referral to a rheumatologist. For many patients, scleritis is the first sign that something is happening with their immune system. Identifying and managing the underlying condition is a key part of treating the eye inflammation. Without addressing the root cause, the inflammation is more likely to return.
Most cases of scleritis are treated with oral anti-inflammatory medications. Your eye doctor will coordinate with your primary care physician or rheumatologist to determine the right approach. Topical eye drops alone are usually not enough for scleritis because the inflammation sits deeper than drops can reach effectively. The treatment plan depends on the type and severity of your scleritis, as well as any underlying conditions.
While oral medication addresses the root inflammation, prescription eye drops may be used alongside to reduce surface redness and provide comfort. These drops help manage symptoms while the systemic treatment takes effect. Your eye doctor will guide you on how often to use them and when to taper off.
For patients with necrotizing scleritis or those whose condition keeps returning, stronger immunosuppressive medications may be needed. This is managed in close coordination with a rheumatologist or immunologist. The goal is to calm the overactive immune response that is driving the inflammation. These medications require monitoring, and your medical team will track your response and adjust dosing over time.
Deep, aching eye pain that worsens with eye movement is the hallmark symptom. Other signs include a dark red or violet-tinged appearance to the white of the eye and tenderness when you gently press on the eye through closed lids. Pain that disrupts sleep or makes it hard to concentrate during the day is another key signal. These symptoms are different from a typical red or irritated eye and warrant prompt evaluation.
Scleritis is a condition that benefits from early evaluation. At Insight Vision Optometry, Las Vegas, same-day emergency appointments are available for patients in Spring Valley and Southwest Las Vegas experiencing acute eye pain. Early assessment helps confirm the diagnosis and start treatment before the inflammation has a chance to cause structural damage to the eye.
Once diagnosed, your eye doctor will work with your broader medical team to develop a treatment plan. Follow-up visits will track how the inflammation responds and whether any adjustments are needed. For patients who discover an underlying autoimmune condition through their scleritis diagnosis, this process can be a turning point toward better overall health management.
Scleritis responds well to treatment when caught early. Your eye doctor will monitor the sclera for signs of healing at each visit and adjust the plan as needed. The goal is to resolve the current episode and reduce the chance of recurrence. With consistent follow-up, most patients see meaningful improvement and can manage the condition effectively over time.
No. Pink eye, or conjunctivitis, is an inflammation of the thin, clear membrane that covers the white of the eye and the inside of the eyelids. It usually causes itching, tearing, and discharge. Scleritis involves the sclera itself, the thick structural wall of the eye. The pain is much deeper and the redness often has a violet or bluish tone. Scleritis does not typically cause the watery discharge that conjunctivitis does.
If left untreated, severe scleritis can lead to complications that affect vision. The sclera can thin over time, and inflammation can spread to nearby structures like the cornea or retina. However, with timely diagnosis and proper treatment, most patients with scleritis maintain good vision. The key is getting evaluated promptly when deep eye pain develops.
The duration varies. Some episodes resolve within a few weeks with treatment, while others may take several months to fully settle. Recurrence is possible, especially if an underlying autoimmune condition is not well controlled. Ongoing management of the systemic condition helps reduce the frequency and severity of future episodes.
In most cases, no. Because the inflammation is deeper than the surface, topical drops do not penetrate well enough to control scleritis on their own. Oral anti-inflammatory or immunosuppressive medications are usually the primary treatment. Eye drops may be used for surface comfort, but they work best as a supplement to systemic therapy.
For deep, aching eye pain with redness, your eye doctor is often the best first step. Eye doctors have specialized equipment, including slit lamps and imaging tools, to distinguish scleritis from other red eye conditions. If you cannot reach your eye doctor and the pain is severe or your vision has changed suddenly, an emergency room visit is appropriate.
Our team at Insight Vision Optometry, Las Vegas offers same-day emergency eye care in Spring Valley and Southwest Las Vegas for exactly these situations.
