Treatment of Episcleritis and Scleritis

Abstract

The treatment of episcleritis can usually be strictly supportive, although in some instances systemic nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated. Diffuse and nodular scleritis can usually be effectively treated in the same way, that is, with NSAIDs. If NSAID therapy fails, systemic corticosteroid therapy is indicated, provided there are no contraindications to this approach. If the scleritis continues to recur with each attempt to discontinue steroid therapy after 6 months of treatment, immunomodulatory therapy (IMT) or biologic response modifiers (BRM) should be considered. The same applies for patients who develop serious steroid-induced side effects. Patients with an established, potentially lethal systemic vasculitis as the cause of scleritis (e.g., polyarteritis nodosa or granulomatosis with polyangiitis (Wegener)), and patients with necrotizing scleritis, always require treatment with IMT or BRM.