Management of Scleritis in Older Adults

Abstract

Scleritis, an inflammatory disease of the eye affecting scleral tissue, presents unique challenges in the older adult population. Unlike their younger counterparts, older individuals manifest a distinct spectrum of the disease with different underlying etiologies, co-morbidities, altered immune function, and an increased risk of systemic side effects from medication choices. Addressing these complexities necessitates a comprehensive and multidisciplinary approach. Treatment of choice will depend on any underlying cause but generally involves non-steroidal anti-inflammatory drugs, systemic or local corticosteroids, and potentially disease-modifying anti-rheumatic drugs. Utilization of these therapeutic agents in older adults warrants careful consideration because of their potential side-effect profiles. This article critically examines the specific concerns for the use of these drugs in older patients and reviews the existing literature on their use in this specific cohort.

Fig. 1

Anterior non-necrotizing diffuse scleritis

Fig. 2

Necrotizing scleritis and keratitis a early with disruption of blood supply and b later with scleral melt

Fig. 3

Posterior scleritis demonstrating macular edema, retinal folds, and exudative retinal detachment

Fig. 4

Necrotizing scleritis secondary to systemic disease: a rheumatoid arthritis and b relapsing polychondritis

Fig. 5

Scleritis secondary to herpes zoster

Fig. 6

Subconjunctival triamcinolone in anterior non-necrotizing, non-infective scleritis