Scleritis — how to spot it fast and protect your sight

Scleritis is a deep, painful inflammation of the white part of the eye (the sclera). It’s not the same as simple red-eye. This one feels worse — a deep, boring pain that often gets worse with eye movement and can wake you up at night. Read on so you know when to act fast.

What causes scleritis and who gets it?

Many people with scleritis have an underlying autoimmune disease — think rheumatoid arthritis, lupus, or vasculitis. Infections can also trigger it, though that’s less common. It can appear at any age, but adults with known autoimmune conditions are at higher risk. If you have joint pain, rashes, unexplained fevers, or lung symptoms along with eye pain, tell your doctor — that combination matters.

Scleritis comes in types: anterior (visible as a very red, inflamed white of the eye) and posterior (hidden further back and harder to see). Anterior scleritis can be diffuse, nodular, or necrotizing. Necrotizing scleritis is the most serious — it can permanently damage the eye if not treated quickly.

How doctors diagnose and treat scleritis

Diagnosis starts with an eye exam. Your eye doctor will look for deep redness that doesn’t blanch fully with topical drops and check for tenderness. They’ll use a slit lamp to inspect the sclera and may do a dilated exam to check the back of the eye. If posterior scleritis is suspected, they’ll order an ultrasound (B-scan) or OCT to see inflammation behind the eye.

Expect blood tests too: markers like rheumatoid factor (RF), anti-CCP, ANA, and ANCA help find an autoimmune cause. If infection is possible, doctors will test for specific bacteria, fungi, or viruses before giving immune-suppressing drugs.

Treatment depends on severity. Mild cases may respond to NSAIDs (like oral ibuprofen) and steroid eye drops. More serious or sight-threatening cases need systemic steroids (oral or IV) and often steroid-sparing immunosuppressants: methotrexate, azathioprine, mycophenolate, or cyclosporine. Biologic drugs (for example, TNF inhibitors) can help when other meds fail. If an infection caused the scleritis, antibiotics or antifungals are used instead of immune suppression.

Don’t wear contact lenses during active scleritis. Use pain control and lubricating drops as recommended, and keep follow-up appointments — scleritis can flare again or cause complications like glaucoma, cataract, or thinning of the sclera.

When is it an emergency? See an eye doctor right away if you have sudden vision loss, severe worsening pain, or a rapidly enlarging area of redness or white thinning of the eye. Quick treatment can save vision.

Questions for your doctor: what caused this; do I need blood tests; which meds are best for me; what side effects should I watch for; how often should I follow up? Clear answers will help you avoid surprises and protect your sight.