SCLERITIS

• Scleritis refers to an inflammation of the sclera proper. Scleritis causes piercing eye pain typically worse at night and with eye movement
• It is a comparatively serious disease which may cause visual impairment and even loss of the eye if treated inadequately
• Very painful, causing a deep 'boring' kind of a pain in or around the eye, redness, tearing, light sensitivity (photophobia), with decreased visual acuity is likely to be scleritis

Classification

Non-infectious Scleritis

Anterior scleritis(98%)

Non-necrotizing Scleritis (85%)

• Nodular
• Diffuse

Necrotizing scleritis (13%)

• Without inflammation 
• With inflammation

Posterior Scleritis(2%)

Infectious Scleritis

• 50% of cases of Scleritis are associated with some systemic diseases
• Autoimmune collagen disorders, especially Rheumatoid arthritis
• Metabolic disorders like gout and thyrotoxicosis
• Infections
• Granulomatous diseases like Tuberculosis, Syphilis, Sarcoidosis, Leprosy
• Idiopathic

Symptoms

• Pain: Patients complain of moderate to severe pain which is deep and boring and often wakes the patient early in the morning. Ocular pain radiates to the jaw and temple
• Redness -Localized or diffuse
• Photophobia and lacrimation -Mild to moderate
• Diminution of vision may occur occasionally

Signs

Non-necrotizing anterior Diffuse Scleritis

• The commonest variety
• Characterised by widespread inflammation involving a quadrant or more of the anterior sclera

Non-necrotizing anterior Nodular Scleritis.

• Characterised by one or two hard, purplish elevated immovable scleral nodules, usually situated near the limbus

Anterior necrotizing Scleritis with inflammation

• It is an acute severe form of scleritis characterised by intense localised inflammation associated with areas of infarction due to vasculitis

Anterior necrotizing Scleritis without inflammation

• Typically occurs in elderly females usually suffering from longstanding Rheumatoid arthritis

Posterior Scleritis

• An inflammation involving the sclera behind the equator
• Characterised by an exudative retinal detachment, macular oedema, proptosis and limitation of ocular movements

• TLC, DLC and ESR
• Serum levels of complement (C3), Immune complexes, Rheumatoid factor, Anti Nuclear Antibodies and L.E cells for an immunological survey
• FTA–ABS, VDRL for Syphilis
• Serum uric acid for gout
• Urine analysis
• Mantoux test
• X-rays of the chest, paranasal sinuses, sacroiliac joint and orbit
• Ultrasound – to detect signs of posterior scleritis

Non-infectious Scleritis

• Topical steroids
• Oral steroids on heavy doses tapered slowly
• Immunosuppressive agents

Infectious Scleritis

• Antimicrobial therapy, both with topical and oral agents
• Surgical debridement

Ayurvedic Treatment

• Differentiate Scleritis and Episcleritis with clinical features
• More attention to scleritis as it may cause vision loss

Internal medicines

• Pancha tikthaka Kashaya
• Guduchyadi kashaya
• Gugguluthikthaka Kashaya
• Kaisora guggulu
• Patoladi Gritha

Procedures

• Virechana – Avipathi choorna
• Purambada - Mukkadi Gulika + milk in swelling of Eyelids & Redness
• Aschotana - Chandanadi Varthi
• Seka - Yashti+ Darvi+ Lodhra Kashaya
• Jaloukavacharana - forehead (repeatedly)