The dermis (Latin sclera) is the outer layer of the eye that, together with the cornea, envelops the eye. It gives the eye stability and protects it at the same time.
Inflammation of the dermis can occur in the superficial layer (episcleritis) as well as in the deeper layer of the dermis (scleritis). The cause of the inflammation is often unknown. The inflammation leads to pain, a reddened eye and bluish discoloration of the dermis.
The clinical picture of dermatitis is not fully understood. The causes of a superficial and a deep-seated inflammation can be differentiated or divided into different categories.
The most common cause of superficial inflammation of the sclera (episcleritis) is idiopathic - this means that it is unknown. But there seems to be an association with stress and strain. Systemic diseases are another cause. These are diseases that affect not only one organ system but the whole body. Autoimmune diseases such as lupus erythematosus or rheumatoid arthritis are an example of this. In rare cases, bacteria or viruses can trigger episcleritis.
The most common cause of deep inflammation of the dermis (scleritis) are systemic diseases. These diseases are often rheumatoid arthritis, lupus erythematosus, polymyositis, or gout. But other systemic diseases can also cause scleritis. Furthermore, in part of the scleritis, the cause is idiopathic. Bacteria or viruses can also cause scleritis. However, this is seldom observed.
Also read the article: The autoimmune diseases.
The stress as the cause
The origin of this clinical picture is unfortunately not fully understood. In many cases one cannot find a cause at all. Rather, one assumes a dysregulated immune response in the body that causes this inflammation. The consequences of stress are very different because every body deals with it differently. However, it can be said that stress also influences the immune system and possibly triggers the development of this clinical picture.
Patients who have dermatitis but no clear cause can be identified often experience stress. So there seems to be a connection.
The accompanying symptoms
The inflammation can cause a variety of symptoms. Usually the dermis inflammation occurs only on one side. The symptoms are quite acute - no accident or injury has occurred before.
Pain can occur in the affected eye, and eye movements in particular can be uncomfortable. In addition, the eyes become red because the blood vessels are increasingly filled with blood and become more prominent. In addition to the redness, the eye can water and be sensitive to light.
In the case of scleritis, i.e. deep-seated inflammation of the dermis, there is reduced visual acuity. Affected patients only have blurred vision of the affected eye. With episcleritis (superficial inflammation of the dermis) the eyesight is not reduced.In addition, scleritis can lead to a bluish discoloration and thinning of the sclera (dermis). This can lead to tearing of the sclera, i.e. to a perforation, and must be treated surgically.
The diagnosis is based on the medical history, the symptoms present and an ophthalmological examination. The ophthalmologist examines the affected eye with a slit lamp and then largely rules out other diagnoses.
To identify the cause, a blood count and an immune serology should be done. This enables systemic diseases to be recognized. In addition, an infection serology should be carried out - this can be used to identify bacteria or viruses.
Is dermatitis contagious?
In most cases, dermatitis is not infectious, as bacteria and viruses are rare causes of this disease. The dermatitis is often caused by systemic diseases such as lupus erythematosus. In these cases, the inflammation is not contagious.
However, if bacteria or viruses are the cause of the disease, you should find out which bacterial strain or virus genus it is, as they are differently infectious. Your doctor should be able to assess this through the infection serology and inform you accordingly.
Treatment of episcleritis is usually done with eye drops. They contain anti-inflammatory substances and also reduce pain. In some cases, episcleritis heals without treatment.
Treatment for scleritis may differ depending on the underlying condition. Here, too, it is important to reduce inflammation. Anti-inflammatory drugs such as cortisone can be administered for this. The cortisone can be given in the form of eye drops but also in the form of tablets. Nonsteroidal pain relievers (NSAIDs), such as ibuprofen or ASA, can be taken for the pain. In addition to their analgesic effect, NSAIDs also have an anti-inflammatory effect.
Immunosuppressants are used in systemic diseases such as rheumatoid arthritis. They act on the immune cells and reduce the effect. In this way, less of the body's own cells are damaged and the inflammatory reaction is also lower. Well-known drugs in this class are methotrexate, azathioprine, and cyclosporine A.
If the dermis is so damaged by the inflammation that it threatens to tear through, the eye must be treated surgically. However, this is rarely the case.
Homeopathy as a treatment option
Homeopathy as the sole therapy is not recommended, especially not in the case of scleritis. However, supportive therapy with homeopathics can be quite useful.
Homeopathic remedies that can be used for treatment are the active ingredients Terebinthia oleum, Thuja occidentalis and Cinnabens. Mercurius solubilis can be used for scleritis, which is accompanied by bluish discoloration and thinning of the sclera.
Episcleritis is a common condition that heals within two weeks. There is hardly any permanent damage. However, the risk of recurrence is increased.
Scleritis progresses very differently from patient to patient. Because of this, it is difficult to predict the duration. In many patients the disease becomes chronic and does not heal for months. Over time, the other eye can also become infected. For this reason, it is particularly important to treat scleritis early and identify the causes.
What is the difference to conjunctivitis?
In conjunctivitis (Latin: conjunctivitis), only the conjunctiva is affected. The dermis remains unaffected. In order to better understand the exact difference, one should look at an anatomical image of the eye.
In addition, the causes of the two clinical pictures differ significantly. Infections are usually the cause of conjunctivitis. Non-infectious causes are foreign bodies in the eye, allergies or dry eyes can irritate the conjunctiva and cause inflammation. Most of the causes of dermatitis are idiopathic or caused by systemic diseases.
The symptoms of conjunctivitis are red and burning eyes. In addition, one can have a foreign body sensation, the conjunctiva can swell and increased tear production can occur. Photosensitivity and blurred vision can also occur. These symptoms are similar to the symptoms of dermatitis. That is why recording the medical history and a thorough ophthalmological examination are essential.
Find out all about the topic here: The conjunctivitis.