Skip to main content
SpringerLink
Log in

Management with Steroids: Local and Systemic

  • Chapter
  • First Online:
Scleritis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

  • 607 Accesses

Abstract

Scleritis is a potentially sight-threatening ocular condition, which requires prompt initiation of treatment. Corticosteroids have been used in the treatment of ocular inflammatory conditions for decades. Upon ruling out infectious or masquerade conditions, anti-inflammatory medications and corticosteroids can then be used in the management of scleritis. There are various administration routes for corticosteroids, namely, topical, subconjunctival, and systemic.

Topical corticosteroids, alone, are useful for episcleritis or anterior uveitis, but they often do not penetrate the sclera to adequately treat scleritis. Subconjunctival corticosteroids have been shown to be effective in controlling the inflammation of non-necrotizing anterior scleritis. Systemic steroids are also used in the treatment of scleritis. Any underlying systemic conditions should also be identified and managed accordingly.

There are various side effects associated with the administration of corticosteroids, the commonest being raised intraocular pressure and cataracts. The route of administration, dosage, and duration of therapy must, therefore, be individualized. Corticosteroids remain the mainstay of treatment of scleritis, and a careful balance between the therapeutic value and the harmful side effects is imperative toward the treatment of scleritis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976;60:163–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Sims J. Scleritis: presentations, disease associations and management. Postgrad Med J. 2012;88(1046):713–8.

    Article  PubMed  Google Scholar 

  3. Peyman GA, Herbst R. Bacterial endophthalmitis. Treatment with intraocular injection of gentamicin and dexamethasone. Arch Ophthalmol. 1974;91:416–8.

    Article  CAS  PubMed  Google Scholar 

  4. Read RW, Ophthalmology AAo. Basic and Clinical Science Course (BCSC): Section 9: Intraocular Inflammation and Uveitis. MD HJI, editor 2014–2015.

    Google Scholar 

  5. Jabs DA, Mudun A, Dunn JP, et al. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol. 2000;130:469–76.

    Article  CAS  PubMed  Google Scholar 

  6. Finckh A, Aronson M. Cardiovascular risk of cyclooxygenase inhibitors: where we stand now. Ann Intern Med. 2005;142(3):212–4.

    Article  PubMed  Google Scholar 

  7. Zamir E, Read R, Smith RE, et al. A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis. Ophthalmology. 2002;109:798–805.

    Article  PubMed  Google Scholar 

  8. Albini T, Zamir E, Read RW, et al. Evaluation of subconjunctival triamcinolone for non-necrotizing anterior scleritis. Ophthalmology. 2005;112:1814–20.

    Article  PubMed  Google Scholar 

  9. Roufas A, Jalaludin B, Gaskin C, et al. Subconjunctival triamcinolone treatment for non-necrotising anterior scleritis. Br J Ophthalmol. 2010;94:743–7.

    Article  CAS  PubMed  Google Scholar 

  10. Sohn EH, Wang R, Read R, et al. Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis. Ophthalmology. 2011;118(10):1932–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gaudio PA. A review of evidence guiding the use of corticosteroids in the treatment of intraocular inflammation. Ocul Immunol Inflamm. 2004;12:169–92.

    Article  CAS  PubMed  Google Scholar 

  12. McGhee CN. Pharmacokinetics of ophthalmic corticosteroids. Br J Ophthalmol. 1992;76:681–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tu EY, Culbertson WW, Pflugfelder SC, et al. Therapy of nonnecrotising anterior scleritis with subconjunctival corticosteroid injection. Ophthalmology. 1995;102:718–24.

    Article  CAS  PubMed  Google Scholar 

  14. Robinson MR, Lee S, Kim H, et al. A rabbit model for assessing the ocular barriers to the transscleral delivery of triamcinolone acetonide. Exp Eye Res. 2006;82:479–87.

    Article  CAS  PubMed  Google Scholar 

  15. Giangiacomo J, Dueker D, Adelstein EH. Histopathology of triamcinolone in the subconjunctival. Ophthalmology. 1987;94:149–53.

    Article  CAS  PubMed  Google Scholar 

  16. Fraunfelder F, Watson P. Evaluation or eyes enucleated for scleritis. Br J Ophthalmol. 1976;60:227–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ober MD, Barile G, Tari SR, et al. Measurement of the actual dose of triamcinolone acetonide delivered by common techniques of intravitreal injection. Am J Ophthalmol. 2006;142:597–600.

    Article  CAS  PubMed  Google Scholar 

  18. Mills DW, Siebert L, Climenhaga DB. Depot triamcinolone-induced glaucoma. Can J Ophthalmol. 1986;21:150–2.

    CAS  PubMed  Google Scholar 

  19. Herschler J. Intractable intraocular hypertension induced by repository triamcinolone acetonide. Am J Ophthalmol. 1972;74:501–4.

    Article  CAS  PubMed  Google Scholar 

  20. Cantrill HL, Palmberg P, Zink HA, et al. Comparison of in vitro potency of corticosteroids with ability to raise intraocular pressure. Am J Ophthalmol. 1975;79:1012–7.

    Article  CAS  PubMed  Google Scholar 

  21. Herschler J. Increased intraocular pressure induced by repository corticosteroids. Am J Ophthalmol. 1976;82:90–3.

    Article  CAS  PubMed  Google Scholar 

  22. Kersey JP, Broadway D. Corticosteroid-induced glaucoma: a review of the literature. Eye. 2006;20:407–16.

    Article  CAS  PubMed  Google Scholar 

  23. Agrawal S, Agrawal J, Agrawal TP. Conjunctival ulceration following triamcinolone injection. Am J Ophthalmol. 2003;136:539–40.

    Article  PubMed  Google Scholar 

  24. Rubinstein A, Hanson RJ, Chen SD, Porter N, Downes SM. Conjunctival ischemia subsequent to posterior subtenon’s triamcinolone acetonide injection. Eye. 2006;20:388–9.

    Article  CAS  PubMed  Google Scholar 

  25. Gharaee H, Khalife M, Poor SS, Abrishami M. Infectious scleritis after subtenon triamcinolone injection. Am J Ophthalmol. 2011;136:539–40.

    Google Scholar 

  26. Okhravi N, Odufuwa B, McCluskey P, et al. Scleritis. Surv Ophthalmol. 2005;50:351–63.

    Article  PubMed  Google Scholar 

  27. Jabs DA, Nussenblatt RB, Rosebaum JT, SUN working group. Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.

    Article  PubMed  Google Scholar 

  28. Smith JR, Levinson R, Holland GN, et al. Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatic disease. Arthritis Care Res. 2001;45:252–7.

    Article  CAS  Google Scholar 

  29. Galor A, Perez V. Differential effectiveness of etanercept and infliximab in the treatment of ocular inflammation. Ophthalmology. 2006;113:2317–23.

    Article  PubMed  Google Scholar 

  30. Murphy CC, Ayliffe W, Booth A, et al. Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis. Ophthalmology. 2004;111:352–6.

    Article  PubMed  Google Scholar 

  31. Doctor P, Sultan A, Syed S, et al. Infliximab for the treatment of refractory scleritis. Br J Ophthalmol. 2010;94:579–83.

    Article  PubMed  Google Scholar 

  32. Kalina RE. Increased intraocular pressure following subconjunctival corticosteroid administration. Arch Ophthalmol. 1969;81:788–90.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethical Requirements

Authors declare that we have no conflict of interest.

No animal or human studies were carried out by the authors for this article.

Author information

Authors and Affiliations

  1. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore

    Mi Fang Helen MBBS, Dinesh Visva Gunasekeran MBBS & Rupesh Agrawal FRCS, MD

  2. Ministry of Health Holdings, Singapore, Singapore

    Mi Fang Helen MBBS & Dinesh Visva Gunasekeran MBBS

  3. Moorfields Eye Hospital (MEH), London, UK

    Dinesh Visva Gunasekeran MBBS

  4. Moorfields Eye Hospital, NHS Foundation Trust, London, UK

    Rupesh Agrawal FRCS, MD

Authors
  1. Mi Fang Helen MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dinesh Visva Gunasekeran MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rupesh Agrawal FRCS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rupesh Agrawal FRCS, MD .

Editor information

Editors and Affiliations

  1. Moorfields Eyes Hospital, London, United Kingdom

    Carlos Pavesio

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Helen, M.F., Gunasekeran, D.V., Agrawal, R. (2017). Management with Steroids: Local and Systemic. In: Pavesio, C. (eds) Scleritis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-49915-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-49915-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-49913-0

  • Online ISBN: 978-3-319-49915-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation