Use of cyclosporine A 0.05% ophthalmic emulsion for a distinctive intrapalpebral phenotype of anterior scleritis

Chronic scleritis poses a diagnostic and therapeutic challenge with multiple mimickers, underlying autoimmune conditions, diverse presentations and variable course. Treatment for mild forms includes topical corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). For long-term control in patients with inadequate responses to steroids and NSAIDs, immunomodulators are employed. While oral cyclosporine has been used for inflammatory ocular conditions, research on topical cyclosporine for scleritis is limited. We present two cases: a man in his early 60s and a women in her late 20s, both with chronic, bilateral, intrapalpebral nodular scleritis with the clinical appearance of an inflamed pinguecula. After an initial poor response to conventional treatments, both patients responded positively to cyclosporine 0.05% ophthalmic emulsion as long-term monotherapy, likely due to cyclosporine's inhibitory effects. These outcomes suggest topical cyclosporine as an effective additive therapy to steroids to maintain quiescence for this particular subset of nodular scleritis, especially when traditional therapies are inadequate.