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Therapeutic advances in ophthalmology
2022 Jan-Dec;14 25158414211070879.

Management of noninfectious scleritis.

Ahmad Abdel-Aty, Akash Gupta, Lucian Del Priore, Ninani Kombo
Author Information
  1. Ahmad Abdel-Aty: Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA.
  2. Akash Gupta: Department of Medicine, School of Medicine, Yale University, 20 York Street, New Haven, CT 06510, USA. ORCID
  3. Lucian Del Priore: Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA.
  4. Ninani Kombo: Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA.
PMID: 35083421 DOI: 10.1177/25158414211070879

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.

Keywords

NSAIDs TNF-α inhibitors alkylating agents antimetabolites biologics calcineurin inhibitors corticosteroids immunomodulators inflammatory eye disease ocular inflammatory disease scleritis

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