Non-Necrotizing Scleritis When NSAIDs Have Not Achieved Adequate Disease Control

Non-necrotizing scleritis often responds to systemic non-steroidal anti-inflammatory drugs as an initial measure. When this first-line approach does not bring the scleral inflammatory process under adequate control, a structured escalation is indicated.

Clinical Scenario

This protocol addresses anterior non-necrotizing scleritis — a form that, while generally less aggressive than posterior or necrotizing disease, still requires prompt escalation when the initial treatment goal is not met.

Prior Treatment & Failure Condition

Previous line — insufficient response

Systemic non-steroidal anti-inflammatory drugs (cox inhibitors) — including non-selective cox inhibitors and more selective cox-2 inhibitors — did not achieve the required goals: control of the scleral inflammatory process and relief of pain.

Next Therapeutic Step

For patients who do not respond to cox inhibitors, the approach involves systemic corticosteroids administered to induce disease remission. Local steroid injections represent an additional option in selected cases. The complete structured regimen — including route selection, dosing strategy, and reduction schedule — is set out in the full protocol.

Clinical goal: disease remission with control of scleral inflammation.

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.
Corticosteroids are usually reserved for patients who do not respond to cox-inhibitors or those with posterior or necrotizing disease.
Both systemic administration and orbital floor and subconjunctival injections have been successful although local steroid injections are less commonly used.
Systemic corticosteroids may be administered orally or intravenously at high doses to induce disease remission.

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