[Episcleritis and scleritis. An overview of modern diagnostic and therapeutic concepts]

The clinical differentiation of the various subtypes of scleral and episcleral inflammation is crucial for its early and adequate management. Particularly important is the recognition of necrotizing scleritis, since it is frequently associated with ocular complications, going along with a bad ocular prognosis. In patients who suffer from associated vasculitic systemic disease, the appearance of scleritis indicates a generalization of the vasculitis, which can result in potentially lethal systemic complications. Only the early diagnosis and an adequate aggressive therapy can preserve ocular functions and the patients life. Conventional steroid therapy generally fails to control the inflammatory activity in necrotizing scleritis. However, application of nonsteroidal immunosuppressive drugs has been shown to control the vasculitic conditions in the majority of cases, to improve ocular prognosis and to reduce mortality.