Dermatitis

Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.

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Reddened and sore eyes indicate inflammation of the dermis. An inflammation of the dermis occurs both in the superficial and in the deeper layer of the dermis (episcleritis or scleritis). Depending on the cause (e.g. rheumatism), the doctor usually treats the inflammation with eye drops and medication. Read more about causes, course and treatment here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. H15

Brief overview

Description: inflammation of the outermost, white layer of the eye (also called the dermis or sclera)
Causes: Usually other diseases cause scleritis (e.g. autoimmune diseases such as rheumatism); infections with viruses, bacteria or fungi are less common.
Course: Episcleritis often lasts ten to 14 days and usually heals on its own. Scleritis is usually chronic (for months to years) and sometimes leads to serious complications (e.g. impaired vision).
Signs: pain, red eyes, bluish discoloration and / or swollen dermis
Diagnosis: conversation with the doctor, examination of the eyes (e.g. with a slit lamp), blood test to rule out other diseases
Treatment: The doctor usually treats the inflammation locally with eye drops or eye ointments. Depending on the cause, immunosuppressants, cortisone, pain relievers and rarely an operation are also used.

What is dermatitis?

In the case of dermis inflammation, the outermost, white fiber layer that surrounds the eye (dermis) is inflamed. Doctors refer to this layer of tissue in the eye as the "sclera". It extends from the point of entry of the optic nerve to the cornea of the eye.

The sclera protects the inside of the eye and, with its firm structure, gives the eye its round shape. An inflammation of the dermis is usually painful and in severe cases endangers the eyesight of the affected eye.

Depending on whether the sclera is inflamed in the deeper or superficial layer, a distinction is made between scleritis and episcleritis.

Scleritis

If the entire dermis in the deeper layer is inflamed, it is called scleritis. Doctors differentiate between "anterior" and "posterior scleritis". The anterior scleritis affects the anterior section of the sclera and is usually easy to recognize from the outside. Posterior scleritis, on the other hand, refers to inflammation in the back of the sclera. It is usually only noticeable through the pain in the affected eye.

Scleritis is a rare inflammatory eye disease, is often associated with complications and in some cases even threatens eyesight. Scleritis often occurs in people between the ages of 40 and 60. Women are affected more often than men.

Episcleritis

In episcleritis, the dermis is superficially inflamed - more precisely, the connective tissue layer between the dermis and the conjunctiva (episclera). Episcleritis is usually harmless and heals on its own. It often occurs in young adults and is more common in women than men.

How does dermatitis develop?

The causes of dermatitis often remain unclear, especially in episcleritis. It is rarely triggered by infections with viruses, bacteria or fungi. Often an autoimmune disease is behind an inflammation of the dermis.

Scleritis: causes

In about half of people with scleritis, an autoimmune disease is the cause of the inflammation of the dermis. These include, for example, diseases such as:

Rheumatism (Rheumatoid Arthritis): Chronic inflammation of the joints
Chronic inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis
Wegener's disease (granulomatosis): Chronic inflammatory disease of the blood vessels with small skin lumps
Lupus Erythematosus (Lupus Disease): Rare chronic inflammatory disease with inflammation of the skin, joints, nervous system and organs
Polychondritis: rare chronic inflammation of the cartilage (mostly the joints)

Immune reactions of the body to infectious diseases such as tuberculosis, syphilis, shingles (infection with the herpes zoster virus) or borreliosis are also possible triggers, albeit much less often. Gout also sometimes leads to dermatitis.

Episcleritis: causes

The doctor often does not find a clear cause for episcleritis. Doctors suspect, among other things, that stress or severe physical and emotional stress trigger episcleritis. Sometimes autoimmune diseases are also the trigger.

Risk factors

Some eye diseases increase the risk of dermatitis. In rare cases, for example, inflammation of the cornea (keratitis) triggers scleritis or episcleritis. Injuries or operations on the eye can also lead to inflammation if germs penetrate the dermis.

How long does dermatitis last?

The inflammation progresses differently depending on whether you have scleritis or episcleritis. Usually similar symptoms occur in both forms, but these are usually different in severity.

Course of scleritis

Scleritis varies from patient to patient. Often only one eye becomes infected at the beginning. In around 50 percent of those affected, the dermis inflammation later also occurs in the second eye.

In some people, dermis inflammation is mild: the dermis then swell only slightly.

However, in about two out of three people with scleritis, the inflammation is chronic and keeps coming back. In these cases, an inflammatory flare-up often does not heal for six months to six years. If the disease is severe, it is also possible that tissue in the eye is destroyed by the inflammation.

Without adequate treatment, chronic scleritis causes permanent visual damage to the affected eye. In rare cases, those affected go blind. It is therefore particularly important to recognize scleritis in good time and, depending on the cause, to treat it adequately.

Course of episcleritis

Episcleritis is usually harmless and lasts between ten and 14 days. It often heals by itself, and permanent damage rarely occurs. However, episcleritis occurs repeatedly in around 30 percent of those affected.

How is dermatitis manifest?

The symptoms of scleritis and episcleritis are often similar, but they usually differ in severity.

Symptoms of scleritis

The most common symptoms of scleritis are:

Severe, stabbing eye pain, those affected often perceive it as tenderness.
The affected eye is reddened. The blood vessels become more prominent.
The dermis is swollen.
The dermis turns dark red to bluish in color.
The eye is watering heavily (increased tear flow).
Affected people see indistinct and blurred.
The affected person's eyes are sensitive to light.

If you experience any of these symptoms, be sure to see an ophthalmologist!

Symptoms of episcleritis

The affected eye is also reddened with superficial dermatitis and pain occurs, but not as severe as with scleritis. Typical symptoms of episcleritis are:

The inflammation is limited to a small area of the eyeball (sector-shaped).
The eye is red and slightly swollen.
The affected person's eyes are sensitive and irritated.
The eye is watering heavily (increased tear flow).
The affected person's eyes are sensitive to light.
The eyesight is not impaired.

In less than a third of cases, episcleritis indicates another disease (associated systemic disease such as rheumatism).

Is dermatitis contagious?

In most cases, dermatitis is not contagious, as bacteria, viruses or fungi rarely trigger the disease. If, in rare cases, bacteria or viruses do cause the inflammation, it is important that the doctor determines the type of pathogen in question. In this way it is possible to treat the pathogen in a targeted manner (e.g. with a certain antibiotic).

How does the doctor examine dermatitis?

If scleritis or episcleritis is suspected, the first point of contact is the ophthalmologist. This makes the diagnosis based on the symptoms described and after examining the eye with a slit lamp.

Talk to the doctor

As part of the conversation, the doctor first asks the person concerned about their symptoms and medical history:

What symptoms do you have (e.g. pain in the eye, increased tearing or increased sensitivity to light)?
How long have the complaints existed?
Are you or in your family known to diseases such as rheumatism, lupus erythematosus, Crohn's disease or infectious diseases?
Do you suffer from severe stress or severe physical or emotional strain?

Examination with the slit lamp

During this examination, the doctor illuminates the eye brightly with the help of a special lamp that emits a beam of light that is bundled in a slit shape (so-called slit lamp) and looks at it at the same time through a microscope. In this way, the doctor will rule out other causes of the reddened eyes (e.g. conjunctivitis). It also determines whether the eye is damaged or changed.

In most cases, the doctor can tell whether it is episcleritis or scleritis based on a detailed conversation and a slit lamp examination.

Blood test

In order to clearly diagnose scleritis and treat it properly, it is important to find the causal disease. Therefore, for further clarification, it is often necessary for the doctor to examine the person's blood for infections (e.g. caused by bacteria or viruses) and other diseases (e.g. rheumatism) (blood test). If the doctor finds an autoimmune disease as the cause, for example, the treatment will also be based on it.

What is the difference to conjunctivitis?

In the case of conjunctivitis (conjunctivitis), only the conjunctiva of the eye is inflamed, but not the dermis. The conjunctiva (conjunctiva) is a thin layer that covers the dermis and the inside of the eyelids in the anterior segment of the eye.

The cause of conjunctivitis is usually different from that of dermis. Conjunctivitis often results from an infection with bacteria or viruses, a foreign body in the eye, allergies or from dry eyes.

The symptoms of conjunctivitis are similar to those of dermatitis, but in many areas. It is therefore important that those affected have symptoms such as reddened and swollen eyes, increased tears and a foreign body sensation in the eyes clarified by an ophthalmologist.

What can you do about dermatitis?

An inflammation of the dermis can be dangerous to the eye and, in the worst case, impair vision. It must therefore always be treated by a specialist (ophthalmologist). The doctor selects the therapy based on the disease that caused the dermis inflammation. Among other things, eye drops or ointments, pain relievers, cortisone, immunosuppressants and, in rare cases, an operation are used.

Eye drops and eye ointments

The doctor treats the inflammation of the eye locally with pain-relieving and anti-inflammatory eye drops or eye ointments. The symptoms usually subside within one to two weeks.

Painkiller

Under certain circumstances, the doctor may prescribe medication with pain relievers and anti-inflammatory agents, such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen or acetylsalicylic acid) in the case of dermatitis. They are available as tablets or eye drops.

cortisone

Occasionally, the doctor will also give cortisone (corticosteroids). The affected person takes the cortisone in the form of eye drops or tablets.

The ophthalmologist does not always treat episcleritis. It often heals on its own. However, eye drops, for example, alleviate the discomfort.

Immunosuppressants

If the cause of the dermatitis is an autoimmune disease such as rheumatism, it is important that the doctor treats this underlying disease adequately. To do this, the doctor usually prescribes drugs that suppress the immune system (immunosuppressants) and thus prevent inflammation. Well-known drugs for this are methotrexate, azathioprine and cyclosporine A.

The best thing to do is to seek out a specialist in internal medicine who specializes in rheumatic diseases (rheumatologist) and who works closely with your ophthalmologist.

surgery

If the dermis is badly damaged by the chronic inflammation and threatens to break through (perforation), it is necessary in rare cases to operate on the sclera. For example, the doctor sutures intact connective tissue from other parts of the body to the dermis.

How can you prevent dermatitis?

In contrast to other eye diseases such as conjunctivitis, there are few measures to prevent dermatitis. It is true that the triggers for dermatitis are rarely pathogens such as bacteria or viruses. Nevertheless, it is advisable that you observe good eye hygiene and avoid, for example, touching your eyes with dirty hands.

Especially if you wear contact lenses, it is important that you maintain adequate hygiene: wash your hands thoroughly before touching the lenses. Do not use tap water to clean the lenses, always keep the contact lens case clean, and change the cleaning fluid daily.

If you have any previous illnesses such as rheumatism, gout or Crohn's disease, it is also useful to discuss the risk of dermatitis with your ophthalmologist in advance. They will give you additional advice if you have any questions on the subject.

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