Dermatitis: episcleritis and scleritis

Dermatitis: causes

The causes of scleritis and episcleritis sometimes remain unclear. Infections with viruses, bacteria or fungi are very rarely the reason for dermatitis in Germany, more often an autoimmune disease is behind it.

Episcleritis: causes

Often the doctor cannot find the reason for the episcleritis. Scientists are discussing whether the disease is triggered by stress or whether extraordinary physical and mental stress are possible causes of episcleritis. Sometimes a link to autoimmune diseases can be demonstrated.

Scleritis: causes

In around half of the patients with scleritis, dermis inflammation develops as part of an autoimmune disease . Examples of such diseases in which the immune system goes crazy and attacks the body's own structures such as the dermis are (by frequency):

• Rheumatoid arthritis (common parlance: rheumatism ): The inflammation mainly affects the joints.
• Wegener's disease : inflammation of the smallest blood vessels, almost always begins in the airways
• Lupus erythematosus : skin disease that affects other organs as well
• Polychondritis : The cartilage tissue - mostly the joints - is destroyed.
• Inflammatory bowel disease : Crohn's disease and ulcerative colitis

Infection can only be proven to be the cause of scleritis in around five percent of patients . Possible pathogens are viruses, such as the herpes zoster virus - it also triggers shingles and chickenpox . Bacteria, parasites or fungi are less to blame for dermatitis. Infectious bacterial diseases that may be associated with scleritis are tuberculosis , syphilis, and borreliosis .

External factors can also be a cause, for example injuries or operations on the eye. Then germs can penetrate the dermis.

Doctors also associate the metabolic disease gout with scleritis. Corneal inflammation rarely spreads to the dermis. However, the cause of the scleritis often remains unclear.

Dermatitis: symptoms

The symptoms of episcleritis and scleritis are similar, but they differ in severity. The consequences of both forms of dermatitis are also different: While episcleritis is usually harmless and heals without complications, scleritis can cause permanent visual damage without adequate treatment.

Episcleritis: symptoms

Symptoms of episcleritis are similar to those of conjunctivitis : 

• The eye is reddened and inflamed, and only a small, limited area is affected.
• Eye pain (less severe than scleritis)
• Sometimes red-colored nodules develop on the eye, which can be moved and are painful.
• The eye is watering.
• The eye is sensitive and irritated to touch or wind.
• There is an increased sensitivity to light.

The symptoms usually subside on their own.

Scleritis: symptoms

The main symptoms of scleritis are: 

• a severe, stabbing eye pain, many describe it as pronounced tenderness
• The dermis is swollen, which can often be seen with the naked eye; the pain arises because the rigid dermis hardly yields when it swells.
• The dermis turns dark red to bluish in color.
• increased tear flow
• Many see indistinct and blurred.
• increased sensitivity to light, photophobia

Dermatitis: course of the disease

Episcleritis: duration

The duration of episcleritis is usually between ten and 14 days . It often heals on its own, but it can always come back. Around 30 percent of patients experience such a relapse.

Scleritis: consequences and course

Scleritis can develop very differently from person to person. In many cases it is chronic - two out of three patients repeatedly suffer relapses in which the dermis flares up again. A scleritis flare-up can last six months to six years.

At the onset of scleritis, usually only one eye becomes infected. In around 50 percent of patients, dermatitis later affects the second eye as well .

In some cases, the dermis is easily inflamed and there is only limited, inflammatory swelling of the dermis with small nodules. But there is also the severe form , which is chronic and in which the tissue is lost.

In contrast to episcleritis, eyesight is at risk in scleritis . If the scleritis is not treated, there is a risk of gradual loss of vision and even blindness . In about 70 percent of patients, the scleritis recurs.

It is therefore particularly important to discover the scleritis in good time, track down the causes and adequately treat the scleritis.

Dermatitis: treatment

Episcleritis: treatment

Ophthalmologists do not necessarily treat episcleritis. It often heals again without episcleritis therapy. Doctors usually use eye drops to relieve symptoms . They contain anti-inflammatory agents such as cortisone and pain relievers, for example the active ingredient diclofenac. 

Scleritis: treatment

The treatment of scleritis, which is often caused by autoimmune diseases such as rheumatoid arthritis, is different. Then it is important to adequately treat this underlying disease. It is best to see a specialist, such as a rheumatologist, who works closely with the ophthalmologist. The triggering disease determines the treatment of the scleritis. The severity and location of the dermis inflammation also determine the choice of treatment.

The following treatment options are available for scleritis:

• anti-inflammatory drugs (corticosteroids), such as cortisone as eye drops or tablets
• Nonsteroidal anti-inflammatory drugs : pain relievers that also have anti-inflammatory effects. They are available as tablets or eye drops.
• Immunosuppressants for severe forms of scleritis, for example the active ingredients methotrexate, azathioprine, cyclosporine A or mycophenolate mofetil
• Biologics as second-line drugs, such as infliximab or adalimumab; However, they are not approved for the clinical picture of scleritis.
• Surgery when the dermis threatens to break through

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