Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis.

PURPOSE: Scleritis is a painful inflammation of the sclera that is often difficult to treat. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective. Results of treating 24 cases of diffuse anterior scleritis with the novel selective COX-2 inhibitor celecoxib are reported.

DESIGN: Nonrandomized prospective study.

METHODS: Twenty-four patients suffering from diffuse anterior scleritis were seen in the Interdisciplinary Uveitis Center in Heidelberg between April 2001 and April 2003. All patients were treated with a 200- to-800 mg dose of celecoxib per day, in divided doses, depending on the degree of discomfort and clinical severity.

RESULTS: Twenty-two patients experienced significant clinical improvement within an average of 5 days of starting celecoxib. These patients reported a complete loss of pain and scleral redness. As they experienced complete symptomatic remission, the dose of celecoxib was tapered. Three of these patients suffered from a second attack of scleritis, with one patient requiring long-term low-dose therapy, one patient showing a nodular form, and the third showing no improvement. Treatment with celecoxib was associated with no side effects apart from allergic exanthema in two patients.

CONCLUSION: Due to its anti-inflammatory potency and low rate of side effects, celecoxib is an effective drug for the treatment of diffuse anterior scleritis. Compared with other NSAIDs it shows minimal gastrointestinal side effects, so its high cost is justified. It represents an alternative drug therapy before systemic immunosuppressive treatment.