Refractory Unilateral Diffuse Scleritis With Negative Autoimmune Workup Successfully Treated With Sub-tenon Triamcinolone Injection

Noninfectious anterior scleritis is a painful, potentially vision-threatening inflammatory disorder that may become steroid dependent despite negative systemic evaluation, posing significant management challenges. We report a man in his early sixties with an approximately eight-year history of recurrent unilateral diffuse anterior scleritis who was referred for rheumatology evaluation after infectious etiologies were excluded by ophthalmology. His disease repeatedly improved with high-dose systemic corticosteroids but relapsed during tapering, resulting in prolonged steroid dependence. Extensive systemic evaluation, including autoimmune and vasculitis testing with antinuclear antibody, extractable nuclear antigen panel, complement levels, and antineutrophil cytoplasmic antibody testing with proteinase-3 and myeloperoxidase antibodies, was repeatedly unremarkable. Steroid-sparing therapy with methotrexate and subsequent escalation to rituximab failed to achieve a durable remission. Ophthalmology-directed intrascleral triamcinolone resulted in sustained resolution and allowed successful discontinuation of systemic corticosteroids, supporting localized corticosteroid therapy as an effective steroid-sparing option in selected cases.