Management of noninfectious scleritis

Abstract

Scleritis is a manifestation of inflammatory eye disease that involves the sclera. It can be divided into multiple subtypes, including diffuse anterior, nodular anterior, necrotizing, and posterior scleritis. In many cases, scleritis is restricted to the eye; however, it can occur in the context of systemic illness, particularly autoimmune and infectious conditions. Patients with autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and polyangiitis with granulomatosis, may develop scleritis flares that may require topical and systemic therapy. Initial therapy typically involves oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, it is important to address the underlying condition, particularly if systemic. Other treatment regimens typically involve either local or systemic steroids or the use of immunomodulatory agents, which have a wide range of efficacy and documented use in the literature. There is a myriad of immunomodulatory agents used in the treatment of scleritis including antimetabolites, calcineurin inhibitors, biologics, and alkylating agents. In this review, we highlight the various subtypes of noninfectious scleritis and explore each of the mainstay agents used in the management of this entity. We explore the use of steroids and NSAIDs in detail and discuss evidence for various immunomodulatory agents.

A rare case of scleritis and multiple rheumatoid pulmonary nodules associated with seronegative rheumatoid arthritis

“…Scleral inflammation can involve the uvea and retina, leading to occlusion of the retinal vessels and optic edema [ 5 ]. If posterior scleritis without necrotising scleritis does not improve with systemic administration of steroids, then topical steroids (such as STTA) should be considered [ 6 ]. In our case, the posterior scleritis, which did not improve with oral steroids, was successfully treated with STTA injections.…”

Management of Scleritis in Older Adults

“…In a failure of NSAIDs to control symptoms, the next step would typically be oral corticosteroids in the form of prednisone. They may also be started as first line in patients with posterior or necrotizing scleritis, contraindications to NSAIDs, in those judged to have a higher degree of scleral inflammation, or those with associated systemic disease [ 1 , 48 ]. In cases of severe inflammation, such as necrotizing scleritis with impending perforation, intravenous corticosteroids may be used and are discussed separately below.…”

Inflammatory eye disease for rheumatologists

“…They may often still be difficult to control. Other factors likely to point to the need for IMT include bilateral disease and association with a systemic autoimmune disease such as RA or GPA [54]. Commonly used IMT consists of MTX, MMF, AZA, anti-TNF agents, rituximab, and cyclophosphamide [52].…”