Scleral thinning WITH PICTURE

The sclera in both my eyes has been thinning out for some unknown reason. I have had CT scan of my head and the results showed no masses or inflammation. But that was the only test they really gave me besides a regular eye examine. After the doctor, a highly recommended orbit specialist from the Marshfield Clinic, saw my scan results he dismissed me. Never even considering looking for an underlying reason for the scleral thinning. Even though I have a long family history of auto immune diseases such as Lupus and Scleroderma. He told me that "some peoples eyes are just different". But I know something is wrong. I have constant everyday headaches and eye pain. Not to mention a long list of weird symptoms: constant lower rib pain, large joint pain, difficulty swallowing, and muscle spasms. How can it be possible that my eyes would just start thinning for no apparent reason? So I'm begging if anyone knows anything that I should have my general doctor look for, please, please comment. Also, I have added a picture of my eye. It's hard to see the thinning, since it's difficult to get a close up of an eyeball, not to mention that the thinning is better seen at a different angle. But the thinning is the same on all sides of my eyes. Like a blue band in an almost perfect circle.

[John C Hagan III, MD, FACS, FAAO]

This is from a past post:

The white part of the eye-the sclera- is normally white and is the outer of the three main layers of the eye "wall". Normally it is whitish in color, under the sclera is the "choroid" the layer that carries the arteries, veins and other blood vessels of the eye. The choroid has pigment cells in it and is dark blue in color, under the choroid and nearest the center of the eye is the "retina". The retina is the sight forming tissue of the eye. The retina is colorless and transparent in health.

When you look at someone's eye you see blood vessels that appear to be on the surface of the sclera. These are in the "conjunctiva" another transparent, elastic tissue that covers the sclera on the surface that we see when we look at someone's eyes. If the conjunctiva is irritated due to allergy, infection, or trauma the blood vessels dilate and the eye looks "blood-shot" or "pink".

The most common color change of the visible sclera is a yellowing that comes with age. This is really a result of the elastic fibers in the conjunctiva yellowing with time and exposure to ultraviolet light from the sun. A yellow thickening often develops at the 3  and 9 o'clock positions called a pingueculum. (a good reason to protect your eyes from extended bright sunlight with a hat and ultra-violet blocking sunglasses).


Now to your specific question. A blue appearance of the sclera is really due to thinning of the sclera allowing the bluish color of the choroid to show through. In older adults there often develops a localized blue spot on the visible conjunctiva called a "scleral plaque". It is not a serious problem and does not require any treatment.  When Ophthalmologists (EyeMDs or MD physicians that do medical and surgical eye care) operate on the back of the eye (especially retinal detachment surgery) there are often areas of blue sclera, sometimes rather large, that represent splits or almost absent areas of sclera. These are called "staphylomas".

Diffuse blue sclera results from thinning of the sclera. This might be present at birth or develop in childhood. Blue sclerae are most importantly associated with types I and II osteogenesis imperfecta. Blue sclera may also be associated with:

Ehler's danlos syndrome
pseudoxanthoma elasticum
Marfan's syndrome

Blue sclera may also be acquired through long-term use of corticosteroids.

There is no specific treatment usually done for blue sclera. Diagnosis and treatment of any underlying disease is very important. If a localized area of thinning is about to rupture sometimes a "scleral patch graft" can be used to strengthen the area.

With your daughter's complex history and the excellent job her physicians have done making these unusual and often difficult diagnoses, I'm sure she's seen a pediatric ophthalmologist and an endocrinologist. They would be in the best position to answer your question more specific to her case. I suggest you discuss your concern with them.


JCH MD

[Sarah_25]

But shouldn't there be some sort of testing done to ensure that it's not thinning do to an underlying disease? All the doctors did was test for scleritis. Should I be more vocal about getting some more tests done? Is it common for that much scleral thinning to just appear one day for no reason?

[John C Hagan III, MD, FACS, FAAO]

You can certainly get a second opinion. My recommendation would be an Eye MD that specializes in corneal/external disease. Find one near you at www.aao.org

Know that far, far and away the most common cause is just a relatively thin sclera (which gets thinner as we get older) showing the blue choroid layer under it.

Think of it like a thin person that has very visible veins under their skin. Its normal for a thin person.

JCH MD

[Sarah_25]

When you say it's normal from aging, do you mean that at any age it can happen? Because I'm only 25 years old.

[John C Hagan III, MD, FACS, FAAO]

Any age if you use the search feature you'll see than many of the questions like this are about newborns and babies.

JCH MD

[lully2505]

This was 3 years ago but I hope you still check this. I have the same problem, noticed 3 days ago. Seen 2 different doctors and all they tell me is they are baffled and dont know what it is. There is nothing wrong with my eyes, yet no one seems to know what is causing this. Please, please let me know if you ever found out what caused this. my email is ***@****

[John C Hagan III, MD, FACS, FAAO]

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[nikan]

I have a 3 months baby ,he has gray part in his sclera.in both eyes.i just wonder is that normal or not

[John C Hagan III, MD, FACS, FAAO]

It is almost always normal and due to the thin baby sclera (white part) over the blue choroid under it. As the sclera thickens it goes away. It is a frequently asked question and you can use the search feature and archives and read other posts.

JCH MD

[denty_denty]

My 2 monthes old daughter has blue-grey sclera i just noticed 2 days ago i have never noticed before..is that normal due to thin sclera or i have to consult a doctor to check if is it normal or sign of inheried bone disorder?