Therapeutic decision in anterior scleritis: our experience at a tertiary care eye center

To determine the characteristics of patients with anterior scleritis at a tertiary care eye center and determine which factors in these patients were associated with the need for systemic immunosuppressive therapy.

Retrospective study. Fifty patients with anterior scleritis presenting to the Cornea Service at Wills Eye Hospital from August 1996 to August 2001 were reviewed and divided into two groups. The control group included 35 patients who responded to oral non-steroid anti-inflammatory drugs (NSAIDs) and/or systemic steroids. The study group consisted of 15 patients who required additional treatment with systemic immunosuppressive agents. The influence of demographics, type of scleritis, bilateral disease, and ocular complications were analyzed. The presence of a systemic autoimmune disease, the best corrected visual acuity (BCVA), medications, and complications related to treatment were recorded. The statistical significance was evaluated by Student's t test for independence samples and Fisher's exact test; P<0.05 was considered significant.

After a mean follow-up of 19.3 +/- 24.9 months, an associated systemic autoimmune disease was present in 17 patients (34%). Scleritis was the first manifestation of the systemic disease in 10 out of 17 patients (59%). Patients who required immunosuppressive treatment had more frequent ocular complications (80% versus 26%, P=0.0004) than did patients who responded to oral NSAIDs and/or steroids.

Scleritis may be the sign of presentation of a systemic autoimmune disease. The presence of ocular complications, in particular corneal involvement, may be associated with the need for systemic immunosuppressive therapy.