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 non steroidal antiinflammatory drugs (NSAIDs) and systemic steroid therapy. Thi s study was carried out to determine the efficacy of topical steroid therap y in treating diffuse and nodular scleritis, Methods: A phase I/II descriptive study was conducted, Thirty-two consecuti ve patients with nonnecrotizing anterior scleritis referred to a tertiary c are ophthalmology cornea and uveitis practice in Ottawa were enrolled betwe en September 1995 and February 1997, The patients received 1% prednisolone acetate, administered topically every 2 hours for at least 2 weeks, The dru g was tapered off thereafter based on the clinical response. A successful t reatment outcome was defined as resolution of scleritis without the need fo r 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 treat ment failed, 5 (29%) still had some evidence of scleritis at 2 months despi te systemic treatment with steroids. There was no difference between the tw o 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 i ts potential side effects. Despite the moderately high failure rate, topica l steroid therapy could be considered as first-line treatment for nonnecrot izing anterior scleritis, especially in cases in which the likelihood of co mplications from systemic steroid or NSAID therapy is high.