Eye conditions can significantly impact daily life, presenting a range of symptoms from mild irritation to severe pain and vision changes. Inflammatory eye diseases require careful distinction for proper diagnosis and effective management.
Scleritis: An Overview
Scleritis involves inflammation of the sclera, the tough, white outer protective layer of the eyeball. This condition often manifests with severe, deep, boring pain that can radiate to the forehead, brow, or jaw, sometimes worsening with eye movement. The affected eye shows a distinct redness, often a purplish hue, due to engorged blood vessels that do not blanch with topical vasoconstrictors. Individuals may also experience tenderness to the touch around the eye, heightened sensitivity to light, and blurred vision.
Scleritis frequently arises in association with systemic autoimmune diseases, affecting approximately half of all cases. Conditions such as rheumatoid arthritis, lupus, and granulomatosis with polyangiitis are commonly linked. Less frequently, scleritis can result from infections, including bacterial, fungal, or viral pathogens, or it may follow eye trauma or surgery.
Uveitis: An Overview
Uveitis refers to inflammation of the uvea, the eye’s middle layer, which includes the iris, ciliary body, and choroid. This condition is categorized by the specific part of the uvea affected: anterior uveitis involves the iris and ciliary body; intermediate uveitis affects the ciliary body and peripheral retina; posterior uveitis impacts the choroid and retina; and panuveitis denotes inflammation throughout all uveal layers. Symptoms vary by location but can include eye pain, redness, blurred vision, and floaters.
Light sensitivity is a common symptom, particularly in anterior uveitis, where the pupil may appear constricted or irregular. Causes of uveitis are diverse, ranging from autoimmune disorders like ankylosing spondylitis or sarcoidosis to infections such as herpes simplex virus, cytomegalovirus, or tuberculosis. Eye injuries can also trigger uveitis, and in many cases, the specific cause remains unidentified, categorized as idiopathic uveitis.
Differentiating Scleritis and Uveitis
Distinguishing between scleritis and uveitis involves careful consideration of their unique symptomatic presentations and underlying associations. Scleritis typically causes a severe, deep, aching pain that often radiates and is unresponsive to common pain relievers, whereas anterior uveitis presents with a more superficial eye ache. The redness in scleritis is a deeper, violaceous color that persists, while uveitic redness tends to be concentrated around the iris and may appear brighter. Vision changes can vary; scleritis might cause localized blurriness or vision loss in severe cases, while uveitis often leads to generalized blurred vision, floaters, and light sensitivity.
Diagnostic approaches for both conditions typically involve a comprehensive eye examination, including slit-lamp biomicroscopy. For scleritis, imaging such as ultrasound or optical coherence tomography may assess scleral thickness and inflammation. Uveitis diagnosis often involves evaluating for inflammatory cells and protein flare in the anterior chamber.
Doctors often pursue specific laboratory tests to identify systemic conditions contributing to inflammation. For scleritis, this might include tests for rheumatoid factor or antinuclear antibodies. In uveitis, tests for human leukocyte antigen B27 (HLA-B27) or infectious disease markers may be indicated.
Treatment for both conditions often involves corticosteroids to reduce inflammation, administered topically, orally, or via injection. Scleritis may also require nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management, or systemic immunosuppressants and biologics for severe, persistent cases. Uveitis treatment can also include pupil-dilating drops to prevent iris adhesions, and in chronic or recurrent cases, immunosuppressive therapies may be employed to manage the underlying immune response.
Seeking Medical Attention and Management
Any persistent eye pain, redness, or changes in vision warrant prompt medical evaluation by an eye care professional. Self-diagnosis of eye conditions is not advisable due to the potential for serious complications. Early diagnosis and appropriate treatment are necessary to preventing long-term damage, including irreversible vision loss, glaucoma, and cataracts. These conditions, if left untreated, can progress and significantly impair ocular function.
Following medical recommendations, including medication regimens and follow-up appointments, is important for effective management. Continuous monitoring by an ophthalmologist allows for adjustments to treatment plans based on disease activity and response. Adherence to prescribed therapies and regular check-ups help to manage symptoms, control inflammation, and preserve vision over time.