Successful treatment of severe nodular scleritis with adalimumab

Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease. There are three types of anterior scleritis: diffuse, nodular, and necrotizing with and without inflammation (scleromalacia perforans). Nodular scleritis is the second cause of anterior scleritis representing 20% of all types of scleritis. The conventional treatment of nodular scleritis consists in topical steroids and DMARDS. In severe cases, the therapy with immunosuppressive agents to avoid complications is necessary. We describe a 46-year-old woman presented right nodular scleritis with rheumatoid arthritis. She was treated initially with topical steroids and DMARDs but was unable to received systemic steroids due to left open angle glaucoma in the opposite eye. After an ocular exacerbation, we initiated adalimumab with complete resolution of nodular scleritis. This is the first report of adalimumab in the treatment of nodular scleritis. Adalimumab could be a good alternative in patients with severe nodular scleritis who fail to have conventional treatment with DMARDs and unable to receive systemic steroids.