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Diagnosis and Management of Scleritis

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Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders

Abstract

Scleritis is a severe, potentially sight-threatening form of ocular inflammation characterised by oedema of the episcleral and scleral tissues with involvement of the deep episcleral vascular plexus. Scleritis may be associated with a systemic autoimmune disorder, or it may be either infectious or idiopathic in origin. A careful history, examination and targeted investigations are essential as scleritis may be the presenting feature of a potentially life-threatening systemic vasculitis. Also, failing to identify an infectious origin will lead to inappropriate therapy. Scleritis remains a therapeutic challenge, particularly in cases associated with a systemic autoimmune disorder. Treatment of scleritis involves a stepped approach. While the majority of patients will respond to oral nonsteroidal anti-inflammatory drugs (NSAIDs) or oral prednisolone, a significant percentage will require second-line immunosuppressive agents. Subconjunctival corticosteroid injection may be an option in non-necrotising noninfectious anterior scleritis, particularly in those who fail to respond to initial systemic therapy. Biologic agents, particularly infliximab and rituximab, may prove useful in refractory cases, but there is currently limited experience in their use in scleritis.

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Authors and Affiliations

  1. Department of Ophthalmology, Liverpool Hospital, 23/45-47 Goulburn Street, Liverpool, NSW, 2170, Australia

    Claire Hooper MBBS

  2. Department of Ophtalmology, Save Sight Institute, South Block Sydney Hospital & Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000, Australia

    Peter McCluskey MD, FRANZCO, FRACS

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  1. Claire Hooper MBBS
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  2. Peter McCluskey MD, FRANZCO, FRACS
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Correspondence to Peter McCluskey MD, FRANZCO, FRACS .

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Editors and Affiliations

  1. Department of Ophthalmology, Charité Campus Virchow-Klinikum, Berlin, Germany

    Uwe Pleyer

  2. Division of Ophthalmology, Miguel Hernandez University, Vissum-Instituto Oftalmologico de Alicante, Alicante, Spain

    Jorge L. Alió

  3. Centre of Ocular Inflammation and Infection OCUVAC, Medical University of Vienna Laura Bassi Centre of Expertise, Vienna, Austria

    Talin Barisani-Asenbauer

  4. Department of Ophthalmology, Pitié-Salpêtrière’s University Hospital, Paris, France

    Phuc Le Hoang

  5. Doheny Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Narsing A. Rao

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Hooper, C., McCluskey, P. (2014). Diagnosis and Management of Scleritis. In: Pleyer, U., Alió, J., Barisani-Asenbauer, T., Le Hoang, P., Rao, N. (eds) Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54350-0_3

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