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Scleritis

Disease Details

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Description: Scleritis is an inflammatory disease affecting the white outer coating of the eye (sclera), leading to redness, pain, and possible vision impairment.
Type: Scleritis is typically not associated with a specific type of genetic transmission. It is an inflammatory disease of the sclera, the white outer layer of the eyeball, often linked to autoimmune disorders like rheumatoid arthritis. While genetic factors may contribute to the underlying autoimmune conditions that predispose individuals to scleritis, the condition itself doesn't follow a defined pattern of genetic inheritance.
Signs And Symptoms: Symptoms of scleritis include:
Redness of the sclera and conjunctiva, sometimes changing to a purple hue
Severe ocular pain, which may radiate to the temple or jaw. The pain is often described as deep or boring.
Photophobia and tearing
Decrease in visual acuity, possibly leading to blindnessThe pain of episcleritis is less severe than in scleritis. In hyperemia, there is a visible increase in the blood flow to the sclera (hyperaemia), which accounts for the redness of the eye. Unlike in conjunctivitis, this redness will not move with gentle pressure to the conjunctiva.
Prognosis: The prognosis for scleritis varies depending on the underlying cause, severity, and promptness of treatment. With early and appropriate anti-inflammatory and immunosuppressive therapy, many patients can achieve good control of the disease and prevent complications. However, if left untreated, scleritis can lead to significant complications, including vision loss due to damage to the sclera, cornea, or other eye structures. Regular follow-up with an ophthalmologist is essential for monitoring and managing the condition to ensure the best possible outcome.
Onset: Scleritis is characterized by the following:

- **Onset**: The condition typically presents gradually and can occur over days to weeks.
- **Nan**: This abbreviation is not typically associated with medical terminology for scleritis. If referring to the average onset age, scleritis can occur in adults, with a higher prevalence in individuals aged 30 to 50.
Prevalence: The exact prevalence of scleritis is not well-defined, but it is generally considered a rare condition. Estimates suggest an incidence of about 6 cases per 100,000 person-years. Scleritis most commonly affects adults, particularly between the ages of 30 and 50, and is often associated with underlying systemic autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus.
Epidemiology: Scleritis is not a common disease, although the exact prevalence and incidence are unknown. It is somewhat more common in women, and is most common in the fourth to sixth decades of life.
Intractability: Scleritis can be challenging to treat, but it is not typically classified as intractable. With appropriate medical management, which may include anti-inflammatory medications, corticosteroids, or immunosuppressive agents, most patients can achieve control of the disease. However, some severe or refractory cases may require more intensive intervention.
Disease Severity: Scleritis is characterized by inflammation of the sclera, the white part of the eye. Disease severity can vary from mild to severe and is often classified based on its type:

1. **Diffuse Anterior Scleritis**: Generally less severe, with widespread inflammation.
2. **Nodular Anterior Scleritis**: Moderate severity, characterized by localized nodules.
3. **Necrotizing Scleritis with Inflammation**: Highly severe, with significant pain and risk of scleral thinning.
4. **Necrotizing Scleritis without Inflammation (Scleromalacia Perforans)**: Severe, but typically less painful, often associated with autoimmune diseases.

Accurate severity assessment requires medical evaluation, including determining underlying causes and potential complications such as vision loss.
Healthcare Professionals: Disease Ontology ID - DOID:13452
Pathophysiology: Most of the time, scleritis is not caused by an infectious agent. Histopathological changes are that of a chronic granulomatous disorder, characterized by fibrinoid necrosis, infiltration by polymorphonuclear cells, lymphocytes, plasma cells and macrophages. The granuloma is surrounded by multinucleated epitheloid giant cells and new vessels, some of which may show evidence of vasculitis.
Carrier Status: Scleritis is an inflammatory disease affecting the sclera, the white outer wall of the eye. It is not a condition that involves carrier status, as it is not typically inherited in a genetic manner. The disease can be associated with underlying systemic autoimmune disorders, such as rheumatoid arthritis or lupus, rather than a genetic carrier state.
Mechanism: Scleritis is an inflammatory disease affecting the sclera, the white outer coating of the eye.

**Mechanism:**
Scleritis is primarily an autoimmune condition where the immune system mistakenly attacks the body's own tissues. It can also be associated with systemic inflammatory diseases such as rheumatoid arthritis, lupus, and granulomatosis with polyangiitis. The inflammation can lead to tissue damage and thinning of the sclera, causing severe pain and potentially compromising vision.

**Molecular Mechanisms:**
The molecular mechanisms involved in scleritis include:

1. **Immune Complex Formation:** Antigen-antibody complexes can deposit in the scleral tissue, leading to complement activation and recruitment of inflammatory cells.

2. **Pro-inflammatory Cytokines:** Elevated levels of cytokines such as TNF-alpha, IL-1, and IL-6 promote inflammation and tissue damage in the sclera.

3. **Matrix Metalloproteinases (MMPs):** These enzymes, which degrade extracellular matrix components, are often upregulated and contribute to scleral thinning and tissue remodeling.

4. **T-Cell Mediated Immunity:** T-cells are activated and infiltrate the sclera, releasing inflammatory mediators and perpetuating the inflammatory response.

Understanding these mechanisms is crucial for developing targeted therapies to manage and treat scleritis effectively.
Treatment: Scleritis is an inflammatory condition affecting the sclera, the white outer layer of the eye.

Treatment typically includes:
1. **Non-steroidal anti-inflammatory drugs (NSAIDs):** For mild cases.
2. **Corticosteroids:** Administered either topically (eye drops) or systemically (oral or injectable) for more severe inflammation.
3. **Immunosuppressive agents:** Such as methotrexate or cyclophosphamide, for patients who do not respond to corticosteroids or have underlying systemic autoimmune diseases.
4. **Biologic agents:** Including infliximab or rituximab, might be used in refractory cases.

Management also involves treating any underlying systemic conditions and regular monitoring by an ophthalmologist.
Compassionate Use Treatment: Scleritis is a serious inflammatory condition affecting the white outer coating of the eye (sclera). While standard treatments include corticosteroids and immunosuppressants like methotrexate or cyclophosphamide, there are some off-label and experimental treatments that might be considered under compassionate use circumstances for patients who do not respond to conventional therapies. These include:

1. **Biologic agents:**
- **Rituximab:** An anti-CD20 monoclonal antibody often used in refractory cases of autoimmune diseases.
- **Adalimumab:** A TNF-α inhibitor which has been used off-label for severe, non-infectious scleritis.
- **Infliximab:** Another TNF-α inhibitor that can be considered for patients unresponsive to other treatments.

2. **Other immunosuppressive drugs:**
- **Mycophenolate mofetil:** Used off-label for its immunosuppressive properties.
- **Tacrolimus:** A calcineurin inhibitor, can be applied either topically or systemically.

3. **Intravenous immunoglobulin (IVIG):** Occasionally considered for severe, treatment-resistant scleritis.

These treatments should be administered under the guidance of an ophthalmologist experienced in managing complex ocular inflammatory diseases, often in collaboration with a rheumatologist or immunologist.
Lifestyle Recommendations: For scleritis, lifestyle recommendations include:

1. **Eye Protection**: Wear protective eyewear to shield your eyes from potential irritants, debris, or injury.
2. **Manage Underlying Conditions**: If you have an autoimmune disorder, work closely with your healthcare provider to manage it effectively.
3. **Avoid Triggers**: Stay clear of known triggers such as stress or allergens that may exacerbate symptoms.
4. **Anti-inflammatory Diet**: Consider incorporating anti-inflammatory foods like fruits, vegetables, and omega-3 rich foods into your diet.
5. **Stress Management**: Practice stress-reducing activities such as yoga, meditation, or deep-breathing exercises.
6. **Regular Follow-Ups**: Keep up with regular check-ups with your ophthalmologist to monitor your condition.
7. **Hydration**: Drink plenty of water to help keep your tissues hydrated.
8. **Avoid Smoking and Alcohol**: Both can have negative effects on the immune system and overall health.

Always consult with your healthcare provider before making significant lifestyle changes.
Medication: Scleritis is an inflammatory disease affecting the white outer coating of the eye (sclera). Treatment typically involves:

1. **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)**: For mild cases, drugs like ibuprofen or naproxen may be used to reduce inflammation and pain.

2. **Corticosteroids**: For more severe inflammation, oral or topical corticosteroids such as prednisone or prednisolone may be prescribed.

3. **Immunosuppressive Agents**: For cases that do not respond to steroids, medications like methotrexate, azathioprine, or mycophenolate mofetil might be used.

4. **Biologic Agents**: Medications like infliximab or rituximab may be considered for severe, refractory cases.

Close monitoring by an ophthalmologist is crucial for effective management and to prevent complications.
Repurposable Drugs: Scleritis is an inflammatory disease affecting the sclera, the white outer wall of the eye. While the treatment primarily involves immunosuppressive and anti-inflammatory drugs, some drugs approved for other conditions may be repurposed for scleritis. These include:

1. **Methotrexate:** Originally used for cancer and rheumatoid arthritis.
2. **Azathioprine:** Used primarily for organ transplantation and autoimmune diseases.
3. **Rituximab:** Approved for certain cancers and autoimmune conditions like rheumatoid arthritis.
4. **Mycophenolate mofetil:** Used to prevent organ transplant rejection and treat autoimmune diseases.
5. **Infliximab:** Typically used for autoimmune diseases including Crohn's disease and rheumatoid arthritis.

These drugs can help manage and reduce the inflammation associated with scleritis, especially in more severe or refractory cases.
Metabolites: Scleritis is an inflammatory condition affecting the sclera, the white outer coating of the eyeball.

**Metabolites:** The inflammatory process in scleritis involves various metabolites, including cytokines and other inflammatory mediators. Elevated levels of cytokines such as interleukins (IL-1, IL-6), tumor necrosis factor-alpha (TNF-α), and other immune cell metabolites are often observed, contributing to tissue inflammation and damage.

**Nan:** The use of nanotechnology in scleritis treatment is an emerging field. Nanoparticles can potentially deliver targeted anti-inflammatory drugs directly to the site of inflammation, minimizing systemic side effects and improving the efficacy of treatment. This approach is still largely in research phases but holds promise for future therapeutic protocols.
Nutraceuticals: Nutraceuticals are food-derived products that offer health benefits beyond basic nutrition. For scleritis, which is an inflammation of the sclera (the white part of the eye), there is limited scientific evidence supporting the effectiveness of specific nutraceuticals. However, some general recommendations that might help with inflammatory conditions include:

1. Omega-3 fatty acids: Found in fish oil, these are known for their anti-inflammatory properties and could potentially help in reducing inflammation in conditions like scleritis.
2. Vitamin D: Adequate levels of vitamin D can support immune regulation and may help in controlling autoimmune conditions that could exacerbate scleritis.
3. Turmeric (Curcumin): Known for its strong anti-inflammatory effects, curcumin can be a beneficial supplement.

It's important to consult with a healthcare provider before starting any new supplements, especially for a condition as serious as scleritis. Traditional treatments, such as corticosteroids and immunosuppressive drugs, are often necessary and should not be replaced without medical guidance.
Peptides: Scleritis is a painful inflammation of the sclera, the white outer layer of the eye. While treatment often involves corticosteroids or immunosuppressive drugs, there is emerging interest in using peptides and nanotechnology in managing this condition.

Peptides have anti-inflammatory or immunomodulatory properties that could potentially target the underlying causes of inflammation in scleritis more precisely than traditional treatments.

Nanotechnology offers the possibility of delivering drugs more effectively to the affected area. Nanoscale drug delivery systems can enhance the bioavailability of medications, reduce side effects, and provide sustained release, potentially improving outcomes in scleritis management.