DEFINITION: It is the inflammation of the sclera, the white part of the eye.

SYMPTOMS AND FINDINGS: It is characterized by a severe pain in the eye not responding to painkillers and more perceivable in the morning. It may cause a local redness and sensitivity to light in the white part of the eye and sometimes a decreased vision.

Figure 1. Slit lamp appearance of diffuse (left) and nodular (right) episcleritis.

CAUSES AND RISK FACTORS: It mostly accompanies serious rheumatic and systemic diseases. Among the most common ones are rheumatoid arthritis, Wegener's granulomatosis, relapsing polychondritis, polyarteritis nodosa, systemic lupus erythematosus, spondyloarthropathy, Behcet's Disease, sarcoidosis, and gout. Although rare, infectious eye diseases (herpes zoster, syphilis, lyme, leprosy, tuberculosis, etc.) may cause scleritis.

AUXILIARY INVESTIGATIONS AND DIAGNOSIS: Diagnosis is made through biomicroscopic examination. It is important that the patient is examined for systemic diseases.

TREATMENT: Although topical steroids alleviate local symptoms, they are not quite effective in the clinical progress of the disease. Systemic steroids and NSAIDs are used. Steroid injections, cytotoxic agents or immunemodulators can be added to the treatment, depending on the clinical severity.