Use of topical steroid therapy in the management of nonnecrotizing anterior scleritis

Background: Nonnecrotizing anterior scleritis may be treated with a variety of therapies, including topical steroid therapy, systemic therapy with nonsteroidal antiinflammatory drugs (NSAIDs) and systemic steroid therapy. This study was carried out to determine the efficacy of topical steroid therapy in treating diffuse and nodular scleritis, Methods: A phase I/II descriptive study was conducted, Thirty-two consecutive patients with nonnecrotizing anterior scleritis referred to a tertiary care ophthalmology cornea and uveitis practice in Ottawa were enrolled between September 1995 and February 1997, The patients received 1% prednisolone acetate, administered topically every 2 hours for at least 2 weeks, The drug was tapered off thereafter based on the clinical response. A successful treatment outcome was defined as resolution of scleritis without the need for systemic steroid or NSAID therapy by 2 months after initial presentation. Results: The 2-month success rate was 47%, Of the 17 patients in whom treatment failed, 5 (29%) still had some evidence of scleritis at 2 months despite systemic treatment with steroids. There was no difference between the two groups in the rate of first recurrence of scleritis (log-rank test). Interpretation: Although topical steroid therapy failed in over half of the patients, a significant number were spared systemic steroid therapy with its potential side effects. Despite the moderately high failure rate, topical steroid therapy could be considered as first-line treatment for nonnecrotizing anterior scleritis, especially in cases in which the likelihood of complications from systemic steroid or NSAID therapy is high.