What is swelling of the white of the eye (sclera) called?

Swelling of the White of the Eye

Swelling of the white of the eye (sclera) is called chemosis when it involves the conjunctiva (the clear membrane covering the sclera), or scleritis when it involves inflammation of the sclera itself.

Understanding the Terminology

The question asks about swelling of the "white of the eye," which requires clarification of the anatomical structures involved:

Chemosis

• Chemosis refers to edema (swelling) of the conjunctiva—the transparent membrane that covers the white part of the eye (sclera) 1.
• This presents as a swollen, gelatinous appearance of the conjunctival tissue, often described as "bulbar conjunctival injection" with associated swelling 1, 2.
• Chemosis commonly occurs in viral conjunctivitis, where it can be accompanied by eyelid swelling, erythema, and may even resemble orbital cellulitis on examination 1, 2.
• The conjunctiva becomes hyperaemic (red) and oedematous in inflammatory conditions 1.

Scleritis

• Scleritis is chronic inflammation involving the sclera itself—the outermost coat and structural skeleton of the eye 3, 4.
• The sclera appears with a muddy or discolored appearance, distinguishing it from simple conjunctival injection 5.
• This condition is often extremely painful and can lead to vision-threatening complications 3, 6.
• Scleritis is associated with systemic autoimmune diseases in approximately 30-50% of cases, including rheumatoid arthritis and granulomatosis with polyangiitis 3, 4, 6.

Clinical Distinction

Key Differentiating Features

• Chemosis typically presents with:

  • Watery or mucopurulent discharge 1, 2
  • Follicular or papillary conjunctival reaction 1, 2
  • Often bilateral involvement 2
  • Associated with conjunctivitis (viral, bacterial, or allergic) 1, 2

• Scleritis typically presents with:

  • Severe, boring pain that may radiate to the face 5, 3
  • Muddy or grayish discoloration of the sclera 5
  • Deep vascular engorgement 3, 6
  • Risk of vision loss in 20-50% of cases depending on type 6, 7

When to Suspect Each Condition

• If the swelling is superficial, gelatinous, and associated with discharge or itching, chemosis from conjunctivitis is most likely 1, 2.
• If there is deep, severe pain with a muddy appearance of the sclera and no significant discharge, scleritis should be suspected and requires urgent ophthalmology consultation 5, 3, 6.

Critical Management Implications

• Chemosis from conjunctivitis is generally self-limited in viral cases, though severe presentations may require supportive care or short-term topical corticosteroids with close monitoring 1, 2.
• Scleritis requires aggressive systemic anti-inflammatory treatment, starting with oral NSAIDs for non-necrotizing forms, and systemic corticosteroids plus immunosuppressive agents for necrotizing or refractory cases 5, 3, 8.
• Any patient with suspected scleritis requires urgent ophthalmology referral to confirm diagnosis, classify the subtype, and initiate appropriate treatment 5, 6.