Novel strategies for the diagnosis and treatment of scleritis

Introduction: Scleritis is a severe, vision-threatening ocular inflammation often associated with systemic diseases that carry high risks of morbidity. Timely diagnosis and management are crucial to prevent sequela. Areas Covered: This review encompasses the etiology, pathophysiology, classification, diagnosis, and treatment of scleritis with an emphasis on novel diagnostic and treatment modalities. A review of the literature was performed using the keywords 'scleritis,' 'autoimmune diseases,' 'non-steroidal anti-inflammatory drugs,' 'antimetabolite,' 'immunomodulatory therapy,' 'tumor necrosis factor alpha inhibitors,' biologic response modifier' and 'optical coherence tomography.' Expert Opinion: Scleritis is mainly a clinical diagnosis. Nevertheless, multimodal imaging may be used in diagnostically challenging cases. New approaches such as anterior segment optical coherence tomography (OCT), OCT angiography (OCTA), and ultrasound biomicroscopy (UBM) may serve as more objective measures to diagnose and monitor scleritis patients. The etiology, severity, anatomical location, and associated systemic inflammatory diseases should be considered when determining scleritis treatment. Currently, first-line treatment in low grade non-necrotizing anterior scleritis is usually non-steroidal anti-inflammatory drugs (NSAIDs) and/or topical/systemic corticosteroids. In non-responsive cases, systemic immunomodulatory therapy (IMT) is recommended. Novel treatment with biologic response modifiers (BRMs) is promising in refractory scleritis. Further studies are needed to evaluate efficiency and safety of BRMs.

Automated summary

Scleritis is a severe ocular inflammation associated with systemic diseases, timely diagnosis and treatment are crucial. Traditional treatment methods are being replaced by novel diagnostic and treatment modalities to improve patient outcomes.