Scleritis (Episcleritis)

Refers to any inflammation of the sclera including episcleritis, a benign condition affecting only the episclera, which is generally short-lived and easily treated. Classic scleritis, on the other hand, affects deeper tissue and is characterized by higher rates of visual acuity loss and even mortality, particularly in necrotizing form. Its characteristic symptom is severe and general head pain. Scleritis has also been associated with systemic collagen disease. Etiology is unknown but is thought to involve a local immune response. Treatment is difficult and includes administration of anti-inflammatory and immunosuppressive agents such as corticosteroids. Inflammation of the sclera may also be secondary to inflammation of adjacent tissues, such as the conjunctiva.

Also Known As:

Networked: 521 relevant articles (61 outcomes, 23 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Inflammation
2.	Uveitis
3.	Rheumatoid Arthritis
4.	Scleritis (Episcleritis)
5.	Retinal Detachment (Retinal Detachments)

Experts

1.	Foster, C Stephen: 12 articles (01/2012 - 09/2002)
2.	Rosenbaum, James T: 9 articles (10/2014 - 01/2006)
3.	Jabs, Douglas A: 9 articles (03/2014 - 03/2004)
4.	Thorne, Jennifer E: 8 articles (01/2013 - 12/2002)
5.	Suhler, Eric B: 7 articles (10/2014 - 09/2003)
6.	Nussenblatt, Robert B: 7 articles (08/2012 - 09/2003)
7.	Chu, David S: 5 articles (12/2014 - 03/2008)
8.	Hsiao, Ching-Hsi: 5 articles (06/2011 - 08/2002)
9.	Kempen, John H: 5 articles (03/2010 - 08/2005)
10.	Sen, H Nida: 4 articles (03/2015 - 09/2003)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Scleritis:

1.	infliximab (Remicade)FDA Link 12/01/2012 - "Infliximab may be a useful treatment for treatment-resistant scleritis." 06/01/2009 - "This study aimed to evaluate the possible safety and effectiveness of infliximab in patients with active scleritis. " 08/01/2014 - "Infliximab infusion resulting in rapid resolution of episcleritis." 01/01/2011 - "Episcleritis Related to Drug-Induced Lupus Erythematosus following Infliximab Therapy: A Case Report." 06/01/2010 - "Infliximab could be a new weapon to treat refractory scleritis due to RP."
2.	SteroidsIBA 09/01/1993 - "Addition or substitution of steroids or immunosuppressive drugs as second- or third-line therapies helped control the scleritis. " 01/01/2015 - "However, steroids could prove detrimental when used to treat infectious scleritis. " 04/01/2014 - "Two patients developed scleritis requiring a short course of systemic steroids. " 12/01/2010 - "Systemic immunosuppression was required in addition to steroids for treating diffuse and necrotizing scleritis. " 12/01/2010 - "Nonresolving fungal scleritis mimicking noninfective scleritis was treated with systemic and topical antifungals and low topical steroids after diagnosis was established on scleral scraping. "
3.	rituximab (Mabthera)FDA Link 10/01/2014 - "Rituximab was effective treatment for 9 of 12 enrolled patients with refractory, noninfectious scleritis at 24 weeks, although 7 required reinfusion with rituximab to maintain inflammatory control. " 08/01/2013 - "Rituximab was found to be an effective treatment for refractory idiopathic anterior and posterior scleritis." 09/01/2008 - "Rituximab may be effective to induce remission in patients with scleritis due to WG." 10/01/2014 - "Further long-term studies are warranted to determine the safety and efficacy of rituximab in treating noninfectious scleritis and other ocular inflammatory diseases." 12/01/2015 - "Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener's)."
4.	Adrenal Cortex Hormones (Corticosteroids)IBA 02/01/1996 - "[Necrotizing scleritis--case report of a patient effectively treated with high doses of corticosteroids]." 01/01/2015 - "Corticosteroids are the mainstay of treatment for immune-mediated scleritis. " 11/01/2011 - "In the isolated scleritis group 16.7% used anti-inflammatory, 33.3% corticosteroids, 27.8% corticosteroids with one immunosuppressive drug, 5.5% two immunosuppressive drugs, 16.7% corticosteroids with two immunosuppressive drugs and 33.3% pulse of immunosuppressive drugs, there was remission in 88.9%. " 12/01/2012 - "Post-streptococcal scleritis: corticosteroids avoid visual acuity loss." 10/01/2012 - "Regional corticosteroids for scleritis."
5.	Cyclosporine (Ciclosporin)FDA LinkGeneric 09/01/1989 - "To ascertain the efficacy of systemic cyclosporin therapy in the management of scleritis we performed an open, uncontrolled study of the use of this drug in severe refractory disease. " 05/01/2015 - "Findings from these cases indicate that cyclosporine is an effective drug for controlling severe scleritis. " 05/01/2015 - "We report two cases of unilateral scleritis that were resistant to corticosteroid therapy but responsive to systemic administration of cyclosporine. " 05/01/2015 - "The application of systemic cyclosporine had a satisfactory effect in controlling the scleritis. " 05/01/2015 - "Systemic Cyclosporine Therapy for Scleritis: A Proposal of a Novel System to Assess the Activity of Scleritis."
6.	Prednisolone (Predate)FDA LinkGeneric 01/01/2015 - "After tapering the prednisolone, the scleritis in both eyes improved. " 08/01/2014 - "The treatment regimen was prednisolone 30 mg/day, and the posterior scleritis resolved. " 02/01/2003 - "We describe a patient with posterior scleritis that presented as facial pain and was cured by oral prednisolone." 01/01/1990 - "Topical flurbiprofen was compared with placebo and prednisolone 0.3% in the treatment of episcleritis by a randomised double-blind trial. " 03/01/2012 - "Fatal Pneumocystis jirovecii pneumonia following immunosuppressive therapy with rituximab and prednisolone for posterior scleritis."
7.	Cyclophosphamide (Cytoxan)FDA LinkGeneric 01/01/2009 - "Systemic cyclophosphamide caused regression of systemic symptoms, cutaneous lesions, and episcleritis. " 02/01/2007 - "An 82-year-old man was diagnosed with immune-based scleritis and treated with oral cyclophosphamide 50 mg twice daily. " 06/01/2010 - "Cyclophosphamide induced complete regression of acute stromal keratitis and anterior uveitis, but scleritis was still active and persistent. " 04/01/1991 - "In seven patients the scleritis responded well to pulsed immunosuppressive therapy followed by long term oral steroids and cyclophosphamide. " 08/01/1997 - "Posterior scleritis responded favourably to therapy with systemic steroids and cyclophosphamide. "
8.	Anti-Bacterial Agents (Antibiotics)IBA 01/01/2009 - "aureus infectious scleritis required combination systemic, periocular, intraocular, and topical antibiotics for complete resolution. " 05/01/2008 - "Resistance to commonly used empiric antibiotics may further complicate the diagnosis and management of infectious scleritis." 01/01/2010 - "Pseudomonal scleritis complicating scleral buckling surgery is described in a patient unable to tolerate systemic side effects from aminoglycoside antibiotics. " 12/01/1997 - "Early recognition and aggressive treatment with antibiotics initially, followed by surgical debridement of necrotic tissue, resulted in an unexpected successful outcome in a patient with pseudomonas scleritis." 11/15/1991 - "Five eyes with isolated scleritis without corneal involvement were treated with conjunctival recession and cryotherapy in addition to aggressive antibiotics, and four were treated with antibiotics alone. "
9.	Triamcinolone Acetonide (Azmacort)FDA LinkGeneric 04/01/2002 - "Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. " 10/01/2011 - "Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis. " 10/01/2011 - "We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis. " 08/01/2011 - "Infectious scleritis after subtenon triamcinolone acetonide injection." 07/01/2010 - "Sub-tenon triamcinolone acetonide injection in the treatment of scleritis."
10.	MethylprednisoloneFDA LinkGeneric 02/01/2005 - "To evaluate the efficacy of deep intramuscular methylprednisolone (IMMP) in the treatment of recurrent scleritis. " 02/01/2005 - "Deep intramuscular methylprednisolone treatment of recurrent scleritis." 06/01/1987 - "We treated 14 patients with scleritis with intermittent pulse doses of intravenous methylprednisolone. " 06/01/1987 - "Intravenous pulse methylprednisolone in scleritis." 06/01/1987 - "Pulse methylprednisolone treatment alone or in combination with other immunosuppressive agents is an effective therapy in severe scleritis and has fewer potential side effects than more conventional regimens of corticosteroid administration."

Therapies and Procedures

1.	Injections 02/01/2005 - "There was a documented improvement in scleritis after 21/24 (87.3%) injections with a mean duration of improvement of 5.7 months. " 10/01/2001 - "To analyze the efficacy of transeptal corticosteroid injections in necrotizing scleritis as additional treatment to systemic immunosuppressors. " 12/01/2012 - "Treatment options include local therapy with subconjunctival steroid injections for non-necrotising scleritis, and systemic anti-inflammatory or immunosuppressive therapy. " 08/01/2011 - "Although uncommon, infectious scleritis can occur following uncomplicated subconjunctival corticosteroid injections. " 01/01/2010 - "A retrospective chart review was conducted of all patients at our institution receiving sub-Tenon TA injections for scleritis between August 2001 and August 2007. "
2.	Aftercare (After-Treatment) 01/01/2015 - "For the various subtypes of scleritis, BCVA values after treatment and time to remission significantly differed (P<0.05, all cases). " 12/01/2010 - "BCVA after treatment and time to remission also showed significant differences among the different scleritis subtypes. " 09/01/1996 - "A 56-year-old female with the chief complaint of conjunctival injection was referred to our hospital after treatments with oral and topical corticosteroid under the diagnosis of episcleritis without any therapeutic efficacy. " 06/01/2012 - "Collected data included prior medical and surgical history, latency period between pterygium surgery and presentation of infectious scleritis, culture and histopathologic findings, antibiotic regimen, length of hospital stay, visual acuity before and after treatment, and complications. " 06/01/1990 - "After treatment with adrenocorticosteroid, right optic neuritis and abducens nerve paresis improved together with bilateral interstitial keratitis and episcleritis. "
3.	Transplants (Transplant) 11/01/2015 - "In conclusion, autologous perichondrium conchal cartilage graft may be effective in surgical management of Pseudomonal infectious scleritis when non-surgical medical treatment is ineffective. " 02/01/1998 - "Despite systemic cure with triple antileprotic therapy, he developed recurrent scleritis that required multiple scleral patch grafts for scleral thinning and, subsequently, an enucleation. " 11/01/2015 - "We reports herein the effectiveness of an autologous perichondrium conchal cartilage graft for infectious scleritis caused by Pseudomonas aeruginosa. " 11/01/2015 - "Successful Treatment of Infectious Scleritis by Pseudomonas aeruginosa with Autologous Perichondrium Graft of Conchal Cartilage." 09/01/2011 - "Autologous fascia lata grafts for scleral repair in eyes with infectious necrotizing scleritis."
4.	Debridement 01/01/2014 - "As no response was noted with empiric treatment for bacterial scleritis, debridement was performed. " 06/01/2012 - "Twelve patients underwent prompt surgical debridement after infectious scleritis diagnosis (median, 2.5 days). " 06/01/2012 - "In contrast to the generally poor outcomes in the literature, early surgical debridement of pterygium-associated infectious scleritis appears to offer improved prognosis." 06/01/2012 - "The purpose of this study was to report outcomes of infectious scleritis after pterygium surgery, managed with antibiotic therapies and early scleral debridement. " 06/01/2012 - "Early surgical debridement in the management of infectious scleritis after pterygium excision."
5.	Cryotherapy (Therapy, Cold) 01/01/1980 - "[Cryotherapy of recurrent episcleritis (author's transl)]." 09/01/1979 - "Cryotherapy of Pseudomonas keratitis and scleritis." 10/01/1995 - "Although therapy with oral fluconazol and topical amphotericin B was begun, the scleritis continued to worsen, so cryotherapy and dura mater grafting were performed. " 11/15/1991 - "Five eyes with isolated scleritis without corneal involvement were treated with conjunctival recession and cryotherapy in addition to aggressive antibiotics, and four were treated with antibiotics alone. " 12/01/2013 - "Patient 1 had nodular scleritis after undergoing penetrating keratoplasty and was treated successfully with double freeze-thaw cryotherapy; patient 2 had intraocular dissemination of the amoeba detected in a retrocorneal membrane; and patient 3 had, after undergoing tectonic keratoplasty, intraocular dissemination of the amoeba that was treated successfully with intraocular and systemic voriconazole and, afterwards, a nodular scleritis treated with double freeze-thaw cryotherapy and a large-diameter corneal graft to treat corneal recurrence. "