The sclera is the white part of the eye. Scleritis is a severe, damaging, vision-threatening inflammatory process involving the deep episclera and sclera.

In many situations, the condition is immunologically related, and occurs in association with numerous systemic diseases. Sometimes cataract surgery triggers an onset.

The condition may occur unilaterally or bilaterally, sudden or insidious, or only once or be recurrent. More women are affected than men. The eye is tender, and the pain is constant, penetrating, and disturbs night sleep. There may be lacrimation, photophobia, and a bluish patch visible under the conjunctiva. The area may be widespread (diffuse scleritis), contain a reddish nodule (nodular scleritis), or have an avascular area (necrotizing scleritis). In necrotizing scleritis with inflammation, the eye may be destroyed within a few weeks.

Due to the numerous systemic diseases that may cause scleritis, the following laboratory tests are recommended: complete blood count (CBC); sedimentation rate (ESR); C3 serum complement level; serum rheumatoid factor; serum antinuclear antibodies; serum immune complexes; purified protein derivative (PPD); chest x-ray; VDRL; x-ray of the orbit for foreign bodies; x-ray of the sinuses; serum level of uric acid; and urinalysis. A slit lamp will be used to examine the eye.

The associated systemic disease will need specific treatment. Some of the following measures may also be used: immunosuppressive therapy; nonsteroidal anti-inflammatory drugs (NSAIDs); systemic steroid therapy; and treatment of any identified infectious organisms.

When necrotizing scleritis is associated with rheumatoid arthritis (see diagnostic Code: 5002 arthritis, rheumatoid), there is a mortality rate of 50% in ten years if immunosuppression is not included in the treatment. Complications following scleritis include: choroidal detachment, marginal keratolysis and retinal detachment.

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eye.

• Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.