Anterior scleritis is a painful inflammation of the white part of the eye at the front. People with anterior scleritis often have deep eye pain, redness, light sensitivity, and blurry vision. It can last for weeks or longer and may come back, and not everyone will have the same experience. Adults are most often affected, and it sometimes occurs with autoimmune diseases like rheumatoid arthritis. Treatment usually includes prescription anti-inflammatory medicines or steroids, and severe untreated cases can threaten vision.
Overview
Anterior scleritisSymptoms
Anterior scleritis causes severe, deep eye pain—often worsening at night or with eye movement—plus diffuse, purplish redness and tenderness. Early symptoms of anterior scleritis include light sensitivity, tearing, and aching around the eye. Blurred vision can occur.
Outlook and prognosis
Most people with anterior scleritis improve with timely anti‑inflammatory treatment, though recovery can take weeks to months. Flares can recur, especially when linked to autoimmune disease, so ongoing follow‑up matters. Prompt care helps protect vision and lowers complication risk.
Causes and risk factors
Anterior scleritis often arises from autoimmune disease (rheumatoid arthritis, granulomatosis with polyangiitis); less often from infections like herpes zoster, tuberculosis, or syphilis. Risks include prior eye surgery or trauma, certain medicines such as bisphosphonates, and family history of autoimmunity.
Genetic influences
Genetics play a modest role in anterior scleritis. Most cases stem from immune conditions rather than inherited changes, though certain HLA variants may raise risk. Family history of autoimmune disease can nudge susceptibility but rarely determines outcomes.
Diagnosis
Doctors diagnose anterior scleritis with a slit-lamp eye exam, guided by deep eye pain and redness. Blood tests or imaging can check for causes or autoimmune links. Prompt diagnosis of anterior scleritis helps prevent complications.
Treatment and drugs
Treatment for anterior scleritis aims to calm eye inflammation, ease pain, and protect vision. Doctors often use NSAIDs, steroid eye drops or pills, and, if needed, immune‑modulating medicines; antibiotics are added when infection is suspected. Regular follow‑up checks adjust therapy safely.
Symptoms
Anterior scleritis can make everyday activities—reading, driving, or looking at screens—uncomfortable because of deep eye pain and redness. Early symptoms of anterior scleritis may include a very sore, tender eye and pain that worsens with eye movement or at night. Bright light may feel harsh, and vision can look a bit blurred when inflammation is active. Symptoms vary from person to person and can change over time.
The pain feels deep and aching, not just surface irritation. It often worsens with eye movement or at night. In anterior scleritis, the pain can spread to the brow, temple, or jaw.
The white of the eye may look intensely red or have a purplish tint. Lubricating drops usually don’t clear it.
Bright light can feel piercing, making it hard to be outdoors or use screens. This is called light sensitivity (photophobia). During a flare of anterior scleritis, you may prefer dimmer rooms.
The eye may water a lot without itch or thick discharge. Lids can feel puffy, and the eye can look glossy.
How people usually first notice Anterior scleritis?
Many first notice anterior scleritis when one eye becomes deeply red with a dull, boring pain that can wake you at night or worsen with eye movement. The eye may be very tender to touch, and light sensitivity or blurred vision can follow, which often feels different from the scratchy irritation of common “pink eye.” People with autoimmune conditions, like rheumatoid arthritis, may recognize these first signs of anterior scleritis during a flare, but it can also be the first clue that an underlying inflammatory disease is present.
Types of Anterior scleritis
Anterior scleritis can look different from person to person, and those differences matter for treatment and eye-sparing care. Doctors recognize a few clear variants based on how the white part of the eye looks and how inflamed the tissue is, which helps explain why symptoms vary in intensity. People may notice different sets of symptoms depending on their situation. If you’re reading about types of anterior scleritis, the main differences relate to pain level, visible redness or violet hue, and whether the tissue is damaged or thinned.
Diffuse non-necrotizing
Redness spreads broadly across the white of the eye with deep, aching pain that may worsen at night or with eye movement. Vision is often preserved, but light sensitivity and tearing are common. Swelling is usually even rather than patchy.
Nodular non-necrotizing
One or more tender, raised nodules form on the white of the eye with significant, localized pain. Redness tends to cluster around the nodule, and the spot may feel sore to touch. Vision generally stays stable unless inflammation is severe.
Necrotizing with inflammation
Severe pain with a sector of the sclera looking intensely red or violaceous and becoming thin or gray. This form carries the highest risk for complications like tissue damage and vision changes. Urgent treatment is needed to prevent perforation.
Necrotizing without inflammation
Painless or minimally painful thinning where the sclera looks bluish or translucent, often in people with long-standing autoimmune disease. The quiet surface can be misleading despite serious underlying tissue loss. This variant still needs prompt specialist care to protect the eye.
Surgically induced
Inflammation arises near a prior eye surgery site, causing focal pain and redness that may appear weeks to months after the procedure. The area over or adjacent to the surgical wound is most affected. Managing both inflammation and any triggering factors from surgery is key.
What genetics can tell you about symptoms
Certain HLA types, like HLA-B27, can raise the risk of anterior scleritis with deeper eye pain, light sensitivity, and redness, often alongside autoimmune conditions. Variants affecting collagen or immune signaling may worsen inflammation, leading to tenderness and blurred vision.
Causes and risk factors
Anterior scleritis often stems from immune system diseases like rheumatoid arthritis or inflammation of blood vessels. Infections can cause it less often, especially shingles or bacteria after eye injury or surgery. Doctors distinguish between risk factors you can change and those you can’t. Risk rises with an autoimmune diagnosis, a past episode, family history of autoimmune disease, or recent eye surgery or trauma. If you notice early symptoms of anterior scleritis, see an eye doctor quickly.
Environmental and biological risk factors
Anterior scleritis is inflammation of the white outer coat at the front of the eye that can threaten sight if not treated. Understanding what can raise risk helps you spot patterns and seek timely care. Doctors often group risks into internal (biological) and external (environmental). Knowing these risks can help you act early if you notice early symptoms of anterior scleritis.
Diseases where the immune system attacks the body, such as rheumatoid arthritis or inflammatory bowel disease, raise the chance of anterior scleritis. Inflammation in the bloodstream can involve the eye. Blood vessel inflammation (vasculitis) is a notable example.
Infections in or around the eye, like shingles (zoster) or herpes, can trigger scleral inflammation. These infections may directly affect the sclera or set off an immune response that inflames it.
Certain whole-body infections such as tuberculosis or syphilis can involve the eye and lead to anterior scleritis. Past exposure or travel can matter even if you feel otherwise well.
Scleral inflammation can appear months to years after procedures such as pterygium removal or cataract surgery. Tissue changes and sutures can set up local triggers for inflammation.
Genetic risk factors
Genes don’t usually act as a direct cause, but inherited immune traits can raise a person’s susceptibility to anterior scleritis, mainly by increasing the likelihood of autoimmune diseases that trigger it. Carrying a genetic change doesn’t guarantee the condition will appear. Genetics influences risk, not the early symptoms of anterior scleritis, which are driven by inflammation regardless of the source.
HLA types: Certain immune system markers (HLA types) are linked to autoimmune conditions that sometimes lead to anterior scleritis. Examples include HLA-DR variants tied to rheumatoid arthritis and HLA-B27 linked to spondyloarthritis.
Rheumatoid arthritis genes: Variants that raise the chance of rheumatoid arthritis can indirectly raise the chance of anterior scleritis in those who develop RA. These inherited changes affect how the immune system recognizes joint and eye tissues.
Vasculitis genes: Genetic susceptibility to ANCA-associated vasculitis (such as granulomatosis with polyangiitis) is a risk because this disease often involves the eyes. When vasculitis is present, inherited immune variants can amplify inflammation in the sclera.
Relapsing polychondritis genes: Immune-related genetic patterns have been reported in this cartilage-inflammation disorder. In people with the disorder, those patterns may increase the likelihood of anterior scleritis during flares.
IBD risk genes: Genes that predispose to Crohn’s disease or ulcerative colitis can also be linked to eye inflammation, including anterior scleritis. The strength of this link varies between families and populations.
Family autoimmune history: Having close relatives with autoimmune disease suggests shared inherited immune traits. This background can raise the baseline risk of anterior scleritis when an autoimmune condition develops.
Lifestyle risk factors
Although medical causes drive this condition, everyday habits can shift the intensity, frequency, and recovery of flares. Understanding lifestyle risk factors for Anterior scleritis can help you reduce pain and improve treatment response. Small behavior changes may calm inflammation and make medications work more smoothly.
Tobacco smoke heightens systemic inflammation and reduces ocular blood flow, which can intensify anterior scleral pain and redness. Smokers often experience more persistent flares and slower response to therapy.
Frequent intake of refined carbs, sugary drinks, and fried foods can amplify inflammatory signaling, worsening scleral inflammation. Choosing fewer ultra-processed foods may reduce flare intensity.
Insufficient marine omega-3s limits pro-resolving mediators that help turn off ocular inflammation, potentially prolonging anterior scleritis episodes. Including fatty fish or omega-3 sources may support better symptom control.
Large blood sugar spikes promote oxidative stress and inflammation that can aggravate anterior scleritis. Stabilizing glycemia with balanced meals may help recovery and reduce flares.
Risk prevention
You can’t always prevent anterior scleritis, but you can lower the chance of flares and complications by protecting your eyes and managing underlying health conditions. Prevention is about lowering risk, not eliminating it completely. For many, that means staying on top of autoimmune disease care, acting quickly on eye symptoms, and avoiding eye injuries. If you ever notice deep, aching eye pain or purple-red redness, seek prompt eye care.
Keep rheumatoid arthritis, vasculitis, or other autoimmune disease well managed with your care team. Consistent treatment and regular check-ins can reduce the risk of anterior scleritis flares.
See an eye doctor routinely, especially if you live with an autoimmune condition or have had scleritis before. Early symptoms of anterior scleritis can be spotted and treated sooner, which may prevent vision-threatening complications.
Treat sinus, ear, dental, or eye infections right away and complete the full course of any prescribed antibiotics. Some cases of scleritis are linked to infections, so timely care reduces that risk.
Use safety glasses for sports, yardwork, or DIY projects to prevent eye trauma. Avoiding injuries lowers the chance of triggering inflammation in the eye’s outer coat.
Transmission
Anterior scleritis is an inflammation of the white part of the eye and is not contagious, so it cannot be transferred from one person to another. For most people, anterior scleritis comes from the immune system attacking the eye (often alongside autoimmune diseases), not from a germ. If you’re wondering how anterior scleritis is transmitted, it isn’t; being near someone with it, sharing towels, or casual contact does not spread it.
In a small number of cases, an infection in the eye or nearby tissue can trigger scleritis, usually after trauma or eye surgery; even then, the scleritis itself is not something you can catch. The underlying infection (for example, shingles) may spread in its usual ways, but anterior scleritis remains a result of local inflammation rather than person-to-person transmission.
When to test your genes
Consider genetic testing if you have recurrent anterior scleritis, early onset, a strong family history of autoimmune disease, or features suggesting a systemic condition (like uveitis, vasculitis, or inflammatory bowel disease). Testing can guide targeted monitoring and medication choices and help identify related risks. Discuss timing with a rheumatologist or ophthalmologist.
Diagnosis
Anterior scleritis is usually picked up when eye pain and deep redness start to interfere with reading, driving, or working on screens. Doctors usually begin by asking about your symptoms and looking closely at the front of the eye. The diagnosis of Anterior scleritis relies on eye exam findings, plus tests to rule out infections and check for autoimmune conditions that can be linked to it.
Your eye specialist asks about the pain quality, light sensitivity, and whether the redness is constant or patchy. They also review recent infections, injuries, and any autoimmune symptoms like joint pain or rashes.
A standard eye chart measures how clearly you see at distance and near. Changes can suggest inflammation is affecting vision and help track recovery over time.
A quick pressure test checks for raised or low intraocular pressure. Abnormal pressure can point to complications needing prompt treatment.
A microscope with a bright light lets the doctor see the white outer coat of the eye in detail. In scleritis, inflammation is deeper and more tender than surface redness from conditions like episcleritis.
Stages of Anterior scleritis
Anterior scleritis does not have defined progression stages. It tends to flare and settle rather than move through set steps, and doctors describe it by type and severity, then monitor changes with careful eye examinations. Diagnosis relies on your story and the exam—severe, deep eye pain, eye redness, light sensitivity, and reduced vision are common early symptoms of anterior scleritis, and a close look with a special microscope helps confirm it. Different tests may be suggested to help check for infections and related autoimmune conditions, since treating the underlying cause can prevent recurrences.
Outlook and prognosis
Flare-ups of anterior scleritis can be painful and disruptive—reading, screen time, or stepping into bright daylight may suddenly feel hard. Early care can make a real difference, especially if treatment starts before inflammation damages deeper eye layers. Most people improve with anti-inflammatory medicines or steroids, and many do well long term when the underlying trigger—often an autoimmune condition—is treated. Doctors call this the prognosis—a medical word for likely outcomes.
The outlook is not the same for everyone, but people with frequent or severe inflammation face a higher risk of complications like thinning of the white part of the eye, glaucoma, or vision loss. If an autoimmune disease such as rheumatoid arthritis or granulomatosis with polyangiitis is driving the inflammation, controlling that condition usually lowers the chance of future flares. Early symptoms of anterior scleritis that return after tapering steroids can signal the need for stronger, steroid-sparing medicines, which many living with anterior scleritis use safely for years.
Serious loss of sight is uncommon with prompt, consistent treatment, but delays in care raise the risk. Mortality directly from anterior scleritis is rare; when deaths occur, they are related to the severity of the underlying systemic illness rather than the eye inflammation itself. Knowing what to expect can ease some of the worry. Talk with your doctor about what your personal outlook might look like.
Long-term effects
Anterior scleritis can settle down with treatment, but some people face repeat flares and slow changes over time. Long-term effects vary widely, from no lasting changes to scarring that affects vision. Because problems can appear later, doctors often follow people for years even after the eye feels better.
Ongoing or repeated inflammation can blur vision or make it less sharp. Scarring or swelling at the front of the eye can warp focus and cause halos or glare.
The white of the eye can gradually thin, sometimes looking slightly bluish. Severe thinning increases the risk of eye shape changes and, rarely, a tear.
Anterior scleritis can return after months or years of quiet. Early symptoms of anterior scleritis like deep, boring eye pain and redness may signal a new flare. Repeated flares raise the chance of lasting damage.
The clear front window of the eye can become irritated, thin, or develop small ulcers. This can cause light sensitivity and irregular, fluctuating vision.
How is it to live with Anterior scleritis?
Living with anterior scleritis can feel unpredictable: days of deep, boring eye pain that worsens at night or with eye movement, then stretches of calmer moments when you’re vigilant for a flare. Light sensitivity, tearing, and blurred vision can make reading, driving, or screen work harder, so many build in rest breaks, use tinted lenses, and keep close follow-up with an eye specialist and, often, a rheumatologist. Because it can be linked to autoimmune disease and may flare, partners, family, and coworkers often play a role by helping with rides to appointments, adjusting lighting, or understanding when plans need to change. With the right treatment plan and prompt attention to new symptoms, many regain control and protect vision while keeping daily life steady.
Treatment and drugs
Anterior scleritis is treated promptly to reduce pain, protect vision, and calm eye inflammation. Doctors usually start with prescription anti-inflammatory medicines, often strong NSAIDs by mouth, and may move to corticosteroids by mouth or injection if pain and redness don’t settle. If flares are stubborn or keep coming back, immune‑modulating drugs such as methotrexate, mycophenolate, or biologics may be added to control the immune response and prevent damage; a doctor may adjust your dose to balance benefits and side effects. Alongside medical treatment, lifestyle choices play a role, such as using cold compresses for comfort, protecting the eyes from wind and bright light, and treating any linked conditions like rheumatoid arthritis or inflammatory bowel disease. If you develop severe pain, new light sensitivity, or blurred vision, ask your doctor about the best starting point for you, since early treatment of anterior scleritis can help preserve sight.
Non-drug treatment
Non-drug care for anterior scleritis focuses on comfort, protecting the eye, and spotting flares early while medical treatment tackles the inflammation. Alongside medicines, non-drug therapies can make day-to-day symptoms easier to live with and support recovery. These steps don’t replace prescription care, but they can reduce pain, light sensitivity, and irritation. Work with your eye team to tailor choices to your symptoms and any underlying condition.
Apply a clean, cool compress to the closed eye for 10–15 minutes to ease deep ache and tenderness. Use gentle pressure and a fresh cloth each time to avoid irritation. If early symptoms of anterior scleritis show up, brief cooling can help while you arrange care.
Wear wraparound sunglasses and a brimmed hat outdoors to reduce light sensitivity. Indoors, reduce glare and choose softer, indirect lighting. This can make reading and screen time more comfortable.
Pause contact lens use during a flare to avoid extra irritation. Use glasses until your eye specialist confirms it’s safe to resume. Restart lenses gradually with careful cleaning.
Take regular screen breaks, such as the 20-20-20 method, to lower strain and pain. Pace reading and close work through the day. Try introducing one change at a time, rather than doing everything at once.
Your genes may have an impact on how drugs work for you
Genes can influence how your immune system behaves and how your body processes medications, which can affect which anterior scleritis treatments work best and at what dose. Differences in drug-metabolizing enzymes may change response or side effects to corticosteroids, NSAIDs, or immunosuppressants.
Pharmacological treatments
Treating anterior scleritis aims to calm inflammation quickly, protect vision, and prevent flares. If early symptoms of anterior scleritis are mild and non-necrotizing, doctors often start with prescription-strength oral anti-inflammatories; more severe or necrotizing disease usually needs steroids and immune-suppressing medicines. Not everyone responds to the same medication in the same way. The plan also depends on any linked autoimmune condition or infection, and how your eyes and blood tests respond over time.
Indomethacin, ibuprofen, or naproxen can reduce pain and inflammation in non-necrotizing anterior scleritis. They are usually taken with food, and stomach protection may be recommended if used for more than a few days. If pain and redness don’t improve in a week or two, stronger therapy is considered.
Prednisone by mouth is used when NSAIDs are not enough or disease is more aggressive; very severe cases may need IV methylprednisolone. Doses are tapered as the eye calms to limit side effects like high blood sugar, mood changes, and bone thinning. Doctors often add stomach protection and plan steroid-sparing therapy if longer treatment is expected.
Methotrexate, mycophenolate mofetil, or azathioprine help control inflammation and reduce steroid exposure, especially with autoimmune causes. These medicines take weeks to reach full effect and require regular blood tests to monitor liver, kidney, and blood counts. They are chosen based on other health conditions and pregnancy plans.
Rituximab, infliximab, or adalimumab can help stubborn or necrotizing scleritis, particularly when linked to rheumatoid arthritis or granulomatosis with polyangiitis. Screening for infections like tuberculosis and hepatitis is done before starting, and treatment is given by infusion or injection with close monitoring. These are usually prescribed in partnership with a rheumatologist.
Genetic influences
Most cases of anterior scleritis are tied to how the immune system behaves, not to a single inherited gene that directly causes it. People may inherit a tendency toward autoimmune diseases such as rheumatoid arthritis or certain types of vasculitis, and that tendency can raise the chance of inflammation in the white part of the eye. Family history is one of the strongest clues to a genetic influence. In this way, genetic risk factors for anterior scleritis are usually indirect—genes that nudge the immune system toward overreacting, rather than genes that target the eye itself. Even with a family history, anterior scleritis is uncommon, and many with similar backgrounds never develop it. Because of this, routine genetic testing isn’t typically useful for anterior scleritis, but letting your care team know about autoimmune conditions in close relatives can help guide evaluation and treatment.
Is Anterior scleritis genetic?
Genetics play a modest role in anterior scleritis. Most cases stem from immune conditions rather than inherited changes, though certain HLA variants may raise risk. Family history of autoimmune disease can nudge susceptibility but rarely determines outcomes.
Pharmacogenetics—how genetics influence drug effects
Treating anterior scleritis often involves NSAIDs, steroids, and, when needed, immune‑suppressing medicines or biologics; your genes can influence how safely and effectively some of these work. This is where pharmacogenetic testing can help, by flagging when your body may process a drug unusually quickly or slowly. Differences in a liver enzyme gene such as CYP2C9 can slow the breakdown of certain NSAIDs (for example, celecoxib or ibuprofen), raising the risk of side effects; your care team may use a lower dose or choose a different NSAID. Before starting azathioprine, many doctors test TPMT—and sometimes NUDT15—because low activity in these genes can cause serious drops in white blood cells; in that case, the dose is reduced or the medicine avoided. For methotrexate and biologic drugs used when anterior scleritis is linked with systemic autoimmune disease, gene markers for response are still being studied and are not routine in everyday care. Genetic testing can sometimes identify how your body responds to a drug, but doctors still combine it with your medical history, lab results, and how you’re feeling. In practice, genetics may help tailor dosing for specific medicines in anterior scleritis, while the overall plan depends on the cause, disease severity, and your response over time.
Interactions with other conditions
Flares of joint pain, sinus inflammation, or skin rashes can track with eye pain and redness, because anterior scleritis often occurs alongside autoimmune diseases like rheumatoid arthritis, granulomatosis with polyangiitis, lupus, or inflammatory bowel disease. Doctors call it a “comorbidity” when two conditions occur together. When the body-wide condition is active, it can fuel scleral inflammation, and for many, this can mean longer or more intense eye flares unless the underlying disease is also controlled. Certain infections—such as shingles (herpes zoster), tuberculosis, or syphilis—can also trigger or mimic anterior scleritis, and they require very different treatment than autoimmune causes, which is why early symptoms of anterior scleritis should prompt careful evaluation. Within the eye, related problems like keratitis or uveitis may appear at the same time and can raise the risk of complications such as glaucoma; treating all active eye and systemic issues together helps protect vision. Medications for other conditions can interact too—for example, some arthritis drugs help calm scleral inflammation, while blood thinners or immune-suppressing plans may need adjustment during eye flares—so coordinated care between your eye specialist and your medical team is key.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Families and communities once noticed patterns of deep, aching eye pain that worsened at night or with eye movement, sometimes followed by a red-violet hue on the white of the eye. People with these flares often recalled tenderness to touch and light sensitivity that made reading or driving difficult. Long before modern tools, rest and cool cloths were tried, and relapses were remembered as part of the illness’s course.
Throughout history, people have described severe eye redness and pain that didn’t match the milder, gritty discomfort of common irritation. Early healers noted that this inflammation seemed to sit deep in the eye wall rather than on the surface. First described in the medical literature as a distinct, painful inflammation of the front part of the sclera, what we now call anterior scleritis stood apart from conjunctivitis by its persistent, boring pain and by color changes that looked bluish or violaceous in certain light.
From early theories to modern research, the story of anterior scleritis has been shaped by careful observation at the eye slit lamp. In the late 19th and early 20th centuries, clinicians documented how the redness did not blanch easily with drops and how touching the area could be exquisitely tender—features that helped separate it from episcleritis, a milder condition. Over time, descriptions became more precise: nodular forms, diffuse forms, and the rare but vision-threatening necrotizing type were recognized, giving doctors clearer language to match what people were experiencing.
As medical science evolved, links with whole-body conditions were uncovered. Doctors noticed that some people with anterior scleritis also had joint swelling, rashes, or long-standing autoimmune diagnoses. This shifted the view from a purely local eye problem to one that can be part of systemic inflammation. With each decade, better imaging and laboratory testing supported this connection, and treatment moved from simple soothing measures to targeted anti-inflammatory and immune therapies.
In recent decades, knowledge has built on a long tradition of observation. Safer corticosteroids, disease-modifying medicines, and, later, biologic therapies changed outcomes for many living with anterior scleritis, reducing the risk of complications like thinning of the eye wall or decreased vision. At the same time, careful follow-up became standard, since early symptoms of anterior scleritis can signal a flare of a broader autoimmune condition.
Understanding has changed, but the central goals have stayed constant: relieve pain, protect vision, and address any underlying condition. Knowing the condition’s history helps explain why eye specialists take a thorough medical history, check for systemic signs, and sometimes coordinate care with rheumatology. Today, earlier recognition and modern treatments offer a far better outlook than in the past, especially when symptoms prompt timely evaluation.