Treatment of scleritis
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
Scleritis is a painful, destructive, and potentially blinding disorder that may also involve the cornea, adjacent episclera, and underlying uveal tract. Up to 50 percent of patients with scleritis have an underlying systemic illness, most often a rheumatic disease.
This topic will review the treatment of scleritis. The clinical manifestations and diagnosis of scleritis are presented separately. (See "Clinical manifestations and diagnosis of scleritis".)
Treatment of scleritis always requires systemic therapy with nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, or other immunosuppressive drugs. In one study, 67 percent of patients required either high-dose glucocorticoids or the combination of high-dose glucocorticoids and another immunosuppressive agent to control the disease . In some patients, particularly those with peripheral ulcerative keratitis or scleromalacia perforans, surgical intervention is required to preserve vision or prevent globe rupture.
General principles — Treatment must be individualized according to the severity of the patient's disease. As an example, patients with either necrotizing anterior scleritis or posterior scleritis require more intensive therapy than those who present with non-necrotizing disease of the anterior . The presence of a systemic inflammatory illness may also dictate an intensive course of therapy, even if the particular subtype of scleritis would normally call for a more benign treatment approach. (See "Clinical manifestations and diagnosis of scleritis", section on 'Scleritis subtypes'.)
It is absolutely essential that scleritis be managed by an ophthalmologist expert in the care of these patients and by a rheumatologist experienced in employing and managing the immunosuppressive therapies required to treat ocular inflammation.
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- General principles
- Nonsteroidal antiinflammatory drugs
- - Tapering regimen
- - Pulse glucocorticoid therapy
- Immunosuppressive medications
- - Rituximab
- - Cyclophosphamide
- - Cyclosporine
- - Maintenance therapy
- Duration of therapy
- Resistant disease
- - TNF inhibitors
- Role of surgery
- COURSE AND PROGNOSIS
- Disease complications
- - Corneal changes
- - Glaucoma
- - Cataracts
- - Posterior segment complications
- SUMMARY AND RECOMMENDATIONS