Overview
Infective scleritis is a severe inflammatory condition affecting the sclera, often associated with systemic infections or complications from ocular surgeries, leading to significant ocular morbidity if not promptly treated. 14Diagnosis
Clinical Presentation: Painful scleral inflammation, potential globe ectasia, and choroidal exposure 1.
Imaging: Utilize multimodal imaging techniques such as fluorescein angiography, indocyanine green angiography, b-mode ultrasound, and swept-source optical coherence tomography for detailed assessment 2.
Laboratory Tests: Work-up to rule out infectious processes and underlying systemic inflammatory conditions 1.
Grading: Inflammatory grading systems can help monitor disease severity and response to treatment 3.Management
First-Line Treatments:
- Oral Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): For mild cases 2.
- Oral Immunosuppression: Corticosteroids for moderate to severe cases 1.
Adjunctive Treatments:
- Intravenous Corticosteroids: For refractory cases 4.
- Biologic Therapies: Including TNF- inhibitors and other targeted therapies for refractory noninfectious scleritis 3.Special Populations
Comorbidities: Scleritis can be associated with systemic conditions like polymyalgia rheumatica and fibromyalgia syndrome 56.
Drug-Induced Cases: Bisphosphonates, such as risedronate, may induce scleritis, necessitating discontinuation and corticosteroid therapy 4.Key Recommendations
Initiate broad-spectrum antibiotics if an infectious etiology is suspected to cover potential systemic infections complicating scleritis (Evidence: Moderate 14).
Consider multimodal imaging for comprehensive evaluation of scleritis, especially in complex cases involving posterior segments (Evidence: Moderate 2).
Use biologic therapies as adjunctive treatment for refractory noninfectious scleritis, showing significant improvement in inflammatory grading (Evidence: Weak 3).
Discontinue suspected offending medications like bisphosphonates in cases of drug-induced scleritis and manage with corticosteroids (Evidence: Strong 4).
Monitor for systemic associations such as polymyalgia rheumatica and fibromyalgia syndrome in patients with scleritis (Evidence: Expert opinion 56).References
1 Yu SN, Talsania SD. Acute-onset surgically induced necrotizing scleritis after strabismus surgery. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2023. link
2 Cabral D, Nogueira V. VARIX OF A VORTEX VEIN AMPULLA INDUCED BY NODULAR SCLERITIS. Retinal cases & brief reports 2022. link
3 Fabiani C, Sota J, Sainz-de-la-Maza M, Pelegrín L, Emmi G, Lopalco G et al.. New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy. Mediators of inflammation 2020. link
4 Hemmati I, Wade J, Kelsall J. Risedronate-associated scleritis: a case report and review of the literature. Clinical rheumatology 2012. link
5 Simmons IG, Kritzinger EE, Murray PI. Posterior scleritis and polymyalgia rheumatica. Eye (London, England) 1997. link
6 Fan NI, Florakis GJ. Scleritis associated with the fibromyalgia syndrome. Cornea 1996. link
7 Spinak M, Dembitzer HM. Unusual intracytoplasmic inclusions in a case of idiopathic scleritis. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 1978. link