Non-Necrotizing Scleritis: What to Do When Systemic Corticosteroids Have Not Achieved Remission

Non-necrotizing scleritis is the less severe end of the scleritis spectrum. While it often responds to initial anti-inflammatory treatment, a subset of patients does not reach sustained disease remission on high-dose systemic corticosteroids — or cannot maintain remission at an acceptable steroid dose. This protocol covers the escalation step for that situation.

Previous Treatment & Failure Condition

Prior therapy: Systemic corticosteroids (high-dose) Escalation to this protocol is indicated when systemic corticosteroids at high doses have failed to achieve disease remission with control of scleral inflammation, or when maintaining remission requires a corticosteroid dose that cannot be sustained.

Clinical Goal

Control of scleral inflammation and sustained disease remission.

Treatment Approach (partial overview)

The next step involves adjunctive second-line immunosuppressive therapy — a category of agents that can be combined with or used in place of ongoing corticosteroids to achieve and maintain remission. Which agent is selected, and how it is introduced and monitored, is detailed in the full protocol.

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.

Patients who relapse at doses of prednisolone >7.5–10 mg per day should be considered for adjunctive immunosuppressive therapy with a second-line agent that includes cyclosporin, mycophenolate, methotrexate, and anti-TNF blockers.

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