Treatment Patterns among Patients with Non-Infectious Anterior Scleritis
Alexander Altman MD. Roshun Sangani MD. David Chu MD.
New Jersey Medical School Department of Ophthalmology and Visual Sciences
Purpose: This study seeks to evaluate the treatment patterns for patients with non-infectious anterior scleritis who present to tertiary care eye center, as well as determine the percentage of patients who were misdiagnosed with scleritis upon initial evaluation by their primary ophthalmologist.
Methods: We retrospectively analyzed longitudinal data of 86 patients between (month) 2016 to (month)2022 from a tertiary uveitis practice in order to evaluate treatment patterns among referring ophthalmologists for scleritis. Inclusion criteria entailed a definitive diagnosis of anterior non-infectious scleritis after evaluation by a uveitis specialist upon initial visit. Variables collected include demographics such as age, gender, race, initial treatment when presenting to uveitis specialist, underlying immunologic diagnoses, associated ophthalmic conditions, and initial visual acuity.
Results: Of 86 patients that were referred to a tertiary uveitis practice, 46 were diagnosed correctly with scleritis and 38 were misdiagnosed as other conditions. The groups were similar in terms of race distributions and age ranges. Relevant differences included group 1 having a higher percentage of female patients, 73.7%, compared to group 2, 63.0%. Of the 38 that were misdiagnosed upon initial referral, 12 (31.6%) were initially on no treatment, 20 (52.6%) were on topical steroids, and 3 (8.3%) were on oral steroids. As for the patients that were correctly diagnosed with scleritis upon referral, only 11 (23.9%) were initially on an oral NSAID as part of their initial treatment regimen. 11 (23.9%) patients were on topical steroids as their only treatment.
Only a small percentage of patients with scleritis are started on oral NSAID’s upon initial diagnosis, despite being considered the standard of care. Scleritis is frequently undertreated.