Treatment of Non-Necrotizing Scleritis

Non-necrotizing scleritis represents a distinct clinical presentation of scleral inflammation. Recognising it as a separate sub-type from necrotizing and posterior disease is central to selecting an appropriate, proportionate therapeutic strategy.

Clinical Scenario

Non-necrotizing scleritis often responds more readily to treatment than posterior or necrotizing forms of the disease. Patients presenting with anterior non-necrotizing disease typically require a less intensive approach than those with more severe variants, reflecting the comparatively accessible nature of this presentation.

Therapeutic Goals

Control of the scleral inflammatory process and relief of pain, thereby reducing the potential for ongoing damage to the eye.

Treatment Approach (partial overview)

First-line management centres on systemic anti-inflammatory therapy. Oral cox-inhibiting agents are employed — both non-selective and the more selective cox-2 class have been used — though the specific agent selection, sequencing, and full clinical algorithm are set out in the complete protocol.

Full regimen details, dosing guidance, and decision criteria available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.survophthal.2005.04.001

Non-necrotizing scleritis often readily responds to systemic non-steroidal anti-inflammatory drugs.

Patients with posterior or necrotizing scleritis need much more intensive and urgent therapy than those presenting with anterior non-necrotizing disease.

Both non-selective cox inhibitors (e.g., flurbiprofen, indomethacin, and to a lesser extent ibuprofen) and the more selective cox-2 inhibitors have been used successfully to treat this condition, although to date scant data have been published regarding the use of the selective cox-2 inhibitors in the treatment of scleritis.

The aim of treatment is to remove or treat the cause where possible but in the majority is to control the inflammatory process to relieve the pain and thereby reduce the damage to the eye.

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