Diagnosis and management of non-infectious immune-mediated scleritis: current status and future prospects

Expert Rev Clin Immunol. 2016 Aug;12(8):827-37. doi: 10.1586/1744666X.2016.1171713. Epub 2016 Apr 8.

Abstract

Scleritis is an inflammatory process of the sclera and adjacent tissues with a wide spectrum of clinical presentations and co-morbidities. Careful clinical history taking, detailed ocular examination, and appropriate investigation for likelihood of an underlying systemic disease are essential for diagnosis. Treatment can be quite challenging in some cases. Conventional therapy with corticosteroids and immunosuppressive agents may not be sufficient to control ocular inflammation in refractory patients. In such cases new therapeutic agents, which have a more targeted and sustained effect on the immune response, so-called biologic response modifiers, are being used. This review focuses on both diagnosis and therapeutic options including traditional and emerging therapies of non-infectious scleritis.

Keywords: Scleritis; alkylating agents; anti-metabolites; biologic agents; diagnosis; therapy.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Animals
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / therapy
  • Diagnosis, Differential
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Immunotherapy / methods*
  • Microscopy, Acoustic
  • Sclera / diagnostic imaging*
  • Sclera / immunology
  • Scleritis / diagnosis*
  • Scleritis / therapy
  • Tomography, Optical Coherence
  • Tumor Necrosis Factor-alpha / immunology

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha