How is scleritis treated?

Updated: Aug 29, 2019
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Treatment of scleritis almost always requires systemic therapy. Patients with an associated disease, such as rosacea, gout, atopy, or infection, need disease-specific treatment. Systemic therapy complements aggressive topical corticosteroid therapy, generally with difluprednate, prednisolone or loteprednol etabonate. Use of both topical and systemic modalities reduces the dose requirements of each. This combination therapy mitigates, to some extent, the inherent risks of systemic steroids, including hypertension and diabetes, among many others; the risks of GI and renal morbidity caused by oral nonsteroidal anti-inflammatory drugs (NSAIDs); and the risks of elevated IOP and cataractogenesis due to topical steroids.

Treatment of noninfectious scleritis: Systemic NSAIDs, corticosteroids, or immunomodulatory drugs are indicated. [10] Topical therapy is routinely insufficient. This treatment must be individualized for the severity of the scleritis, response to treatment, adverse effects, and presence of associated disease.

Systemic dosing information is as follows:

  • Methotrexate 7.5-25 mg PO/IM once a week
  • Azathioprine 1-2.5 mg/kg/day PO
  • Cyclophosphamide 1.5-3 mg/kg/day PO
  • Mycophenolate mofetil 1 g PO bid
  • Infliximab 3-5 mg/kg IV q6-8wk
  • Adalimumab 40 mg every 2 weeks

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