AAOpt 2024: Solving the scleritis dilemma

Eric Hinel, OD, MS, FAAO, sat down with Optometry Times to chat about his presentation on "Solving the Scleritis Dilemma" at the American Academy of Optometry (AAOpt) meeting. Hinel provided an overview of his presentation, which focused on the approach clinicians should take when evaluating a patient with suspected scleritis.

The first step is to differentiate between episcleritis and scleritis, as they have different prognoses and treatment approaches. Scleritis is more severe and often requires systemic treatment, whereas episcleritis is more mild and self-limiting. After making this distinction, Hinel emphasized the importance of classifying the type of scleritis, such as posterior, anterior, nodular, diffuse, or necrotizing, as this guides the management strategy. A thorough review of the patient's medical history and appropriate laboratory testing are crucial to identify any underlying systemic conditions that may be contributing to the scleritis. Common causes include rheumatoid arthritis, inflammatory bowel diseases, and ANCA-associated vasculitis. Hinel stressed the need for clinicians to be proactive in ordering these tests, rather than deferring to the primary care physician.

Regarding treatment, Hinel noted that while topical steroids were traditionally not recommended for scleritis, newer formulations like difluprednate have shown efficacy in mild to moderate cases. For more severe or recurrent scleritis, systemic medications such as disease-modifying anti-rheumatic drugs (DMARDs) and biologics, often in collaboration with rheumatologists, have significantly improved patient outcomes. The key takeaways from Hinel's presentation were the importance of recognizing that 40% of scleritis patients may have an underlying systemic condition, and the need for clinicians to take charge in ordering appropriate laboratory tests and co-managing these patients with relevant medical specialists. Prompt diagnosis and treatment are critical to prevent potentially serious complications.