The Sclera pp 299-307 | Cite as

Treatment: The Massachusetts Eye and Ear Infirmary Experience

  • C. Stephen Foster
  • Maite Sainz de la Maza

Abstract

Episcleritis may or may not require treatment; scleritis always does. Although simple, diffuse episcleritis may produce low-grade aggravation and temporary cosmetic consequences for the patient, it does not absolutely require therapy, because untreated it will eventually resolve leaving no sequelae. Regrettably, topical steroid therapy appears to be the reflex treatment prescribed by many physicians in developed countries. This is regrettable not simply because of the potential side effects of such treatment, but because experience suggests that such treatment actually prolongs the overall duration of the patient’s problem: the number of recurrences following discontinuation of each episode of steroid therapy appears to be greater, and a so-called “rebound effect,” in which the episcleritis intensifies with each recurrent episode after discontinuation of steroid therapy, has been observed. Our philosophy, and that of Watson,1 is to leave simple episcleritis untreated except for comfort and supportive therapy, such as cold compresses and iced artificial tears. It appears that, on the basis of the results of a randomized double-masked placebo-controlled clinical trial, nonsteroidal antiinflammatory therapy is not effective.2

Keywords

Systemic Lupus Erythematosus Systemic Corticosteroid Polyarteritis Nodosa Relapse Polychondritis Oral Nsaid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Watson PG, Hazleman DL: The Sclera and Systemic Disorders. W.B. Saunders, Philadelphia, 1976, Chap 10, p 398.Google Scholar
  2. 2.
    Lyons CJ, Hakin KN, Watson PG: Topical flurbiprophen: An effective treatment for episcleritis? Eye 4: 521–525, 1990.PubMedCrossRefGoogle Scholar
  3. 3.
    Fronert PP, Scheps FG: Long term follow up study of patients with periarteritis nodosa. Am J Med 43: 8, 1967.CrossRefGoogle Scholar
  4. 4.
    Fauci AS: Vasculitis. In Parker CW (Ed): Clinical Immunology. W.B. Saunders, Philadelphia, 1980, pp 473–519.Google Scholar
  5. 5.
    McGavin DDM, Williamson J, Forrester JV, Foulds WS, Buchanan WW, Dick WC, Lee P, MacSween RNM, Whaley K: Episcleritis and scleritis. Br J Ophthalmol 60: 192, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Watson PG, Hayreh SS: Scleritis and episcleritis. Br J Ophthalmol 60: 163, 1976.PubMedCrossRefGoogle Scholar
  7. 7.
    Jones P, Jayson MIV: Rheumatoid arthritis of the eye. Proc Royal Soc Med 66: 1161, 1973.Google Scholar
  8. 8.
    Foster CS: Nonsteroidal antiinflammatory and immunosuppressive agents. In Lambert DW, Potter DE (Eds): Clinical Ophthalmic Pharmacology. Little, Brown, Boston, 1987, pp 173–192.Google Scholar
  9. 9.
    Hemady R, Tauber J, Foster CS: Immunosuppressive drugs in immune and inflammatory ocular disease. Sury Ophthalmol 35: 369–385, 1991.CrossRefGoogle Scholar
  10. 10.
    McCune WJ, Golbus J, Zeldes W, Bohlke P, Dunne R, Fox DA: Clinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe lupus erythema-tous. N Engl J Med 318: 1423–1431, 1988.PubMedCrossRefGoogle Scholar
  11. 11.
    Raizman MB, Sainz de la Maza M, Foster CS: Tectonic keratoplasty for peripheral ulcerative keratitis. Cornea 10: 312–316, 1991.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • C. Stephen Foster
    • 1
  • Maite Sainz de la Maza
    • 2
  1. 1.Harvard Medical School, Immunology and Uveitis ServiceMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Central University of BarcelonaBarcelonaSpain

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