eye disorders
Scleritis
Treatment of Scleritis
Systemic corticosteroids Rarely, nonsteroidal anti-inflammatory drugs are sufficient for mild cases of scleritis. However, usually a systemic corticosteroid (eg,prednisone1 to 2 mg/kg orally once a day for 7 days, then tapered off by 10 mg each week as tolerated or as indicated based on the clinical picture) is the initial therapy. If inflammation returns, a longer dose of oral corticosteroid, also starting atprednisone1 to 2 mg/kg orally once a day or pulsed intravenous corticosteroid, such asmethylprednisolone1000 mg IV daily for 3 days, can be considered. If patients are unresponsive to or intolerant of systemic corticosteroids or have necrotizing scleritis and systemic rheumatic disease, systemic immunosuppression withcyclophosphamide,methotrexate,mycophenolatemofetil, or biologic agents (eg,rituximab,adalimumab) is indicated but only in consultation with a rheumatologist. Scleral grafts may be indicated for threatened perforation. Carefully consider infection in patients with scleritis, particularly before initiating immunosuppressive therapy. 