From the Guidelines

Pain management options for anterior uveitis and scleritis differ significantly.

Topical corticosteroids are the first-line treatment for anterior uveitis, preferably prednisolone acetate or dexamethasone 1.
Systemic NSAIDs may be used as additional therapy, but have no demonstrable effect as monotherapy 1.
Systemic immunosuppression is recommended if poor prognostic factors are present, or if inactivity could not be reached within 3 months, or inflammation is reactivating during steroid dose reduction 1.
Methotrexate is the first choice as systemic immunosuppression, followed by tumor necrosis factor inhibitor (TNFi) biologics, such as adalimumab and infliximab 1.

Scleritis, on the other hand, often requires more aggressive treatment, including oral NSAIDs and immunosuppressive therapy 1.
Biologic agents, such as rituximab and abatacept, may be considered for refractory cases of scleritis 1.

The treatment approach for anterior uveitis and scleritis should be individualized, taking into account the severity of the disease, the presence of systemic comorbidities, and the patient's response to previous treatments 1.
A shared decision-making process between the patient, ophthalmologist, and rheumatologist is crucial to determine the best course of treatment 1.

From the Research

The management of pain in patients with anterior uveitis and scleritis involves various treatment strategies.

For anterior uveitis, treatment options include:
- Cycloplegics and topical corticosteroid therapy, which can provide satisfactory treatment in many cases 2
- Systemic nonsteroidal anti-inflammatory drugs, which have been shown to be beneficial in some patients 3
For scleritis, treatment options include:
- Systemic cytotoxic immunosuppressive therapy, such as azathioprine, which has been found to be beneficial in some cases 3
- Biologics, such as tumor necrosis factor-α inhibitors, which have been shown to be effective in managing scleritis and uveitis associated with inflammatory bowel disease 4

The choice of treatment for anterior uveitis and scleritis depends on the underlying cause and severity of the disease.

Anterior uveitis can often be managed with topical corticosteroids and cycloplegics, while scleritis may require more aggressive treatment with systemic immunosuppressives or biologics 3, 5
In some cases, biologics such as TNFis may be recommended for long-term control of uveitis relapses 4

It is essential to tailor the treatment protocol to suit the individual patient and to frequently assess the patient during the treatment period.

The presence of underlying systemic disease, such as inflammatory bowel disease or spondyloarthritis, should be considered when managing anterior uveitis and scleritis 3, 4
The use of biologics and other targeted therapies may provide avenues to control both the underlying disease and uveitis manifestations 4, 5