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    Early intervention considered key in diagnosis and treatment of scleritis

    Collaboration with rheumatologists key if biologics used for this sight-threatening disease

     

    To treat scleritis, Dr. de Luise has found oral nonsteroidal anti-inflammatory drugs (NSAIDs) to be of little value, and he advised moving immediately to oral steroids followed by oral cytotoxic immunosuppressives, assuming no systemic contraindications.

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    Methotrexate, azathioprine, and cyclophosphamide, are cytotoxic immunosuppressives that have shown efficacy in scleritis, Dr. de Luise said.

    Mycophenolate mofetil and cyclosporine have also been employed.

    Dr. de Luise said to use periocular steroids with caution as they have the risks of scleral melt and perforation.

    Oral tumor necrosis factor inhibitors (TNF-alpha inhibitors) and other biologics have also shown efficacy in patients with scleritis but should be prescribed in collaboration with a rheumatologist, as they have serious systemic side effects, Dr. de Luise said.

    Of the biologics, infliximab, adalimumab, daclizumab, rituximab, and etanercept have been used in the management of recalcitrant cases of scleritis, with variable degrees of effectiveness.

    For necrotizing scleritis, IV corticosteroids and IV methylprednisolone should be considered, Dr. de Luise advised.

    If there is impending scleral perforation, Dr. de Luise said that tectonic scleral patch graft surgery is the recommended initial management as the diagnosis is being pursued and oral treatment begun.

    Next: Episcleritis identification, treatment

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