Ophthalmological manifestations in autoimmune diseases: Overcoming diagnostic and therapeutic challenges

Table 2 Ocular symptoms, severity, and treatment strategies in autoimmune diseases

Ocular symptoms	Sever characteristics	Treatment options	Details	Ref.
Uveitis	Mild/moderate	Topical CS	Initial management for anterior uveitis; reduces redness and photophobia	[111-114]
	Severe	Systemic CS, systemic immunosuppressants	High-dose prednisone (> 60 mg daily); IV CS for acute cases (1000 mg/day for 3 days)	[113,115,125-127]
	Recurrent	Gradual CS taper	Reduce to 7.5 mg/day maintenance to prevent complications like cataracts	[113,116]
Keratitis	Mild	Environmental modifications	Avoid dry/windy conditions; avoid activities with reduced blinking	[117-119]
	Severe	Topical CS, lubricating drops, systemic immunosuppressants	Controls dryness, reduces inflammation	[117-119,125-128]
ON	Acute	High-dose IV CS	IV methylprednisolone 1 g/day for 3-7 days; followed by oral CS	[121,122]
Episcleritis	Mild	Low-dose CS or NSAIDs	Often self-resolving	[105]
Scleritis	Severe	Systemic CS, immunosuppressants	Controls inflammation	[105,123,125-128]
Chronic ocular inflammation	Chronic cases	Immunosuppressive agents	Methotrexate (first line for non-infectious cases), mycophenolate mofetil (chronic use), azathioprine, and cyclosporine	[129-133]
Refractory cases	Resistant to initial treatments	Alkylating agents (e.g., cyclophosphamide)	Reserved for severe, non-responsive cases due to toxicity	[134,135]

This table outlines the ocular symptoms associated with autoimmunity, categorizing them by severity and clinical characteristics. It highlights corresponding treatment options and provides additional details to guide clinical decision-making. The table includes both acute and chronic ocular conditions with specific therapeutic approaches for each. CS: Corticosteroids; IV: Intravenous; NSAIDs: Non-steroidal anti-inflammatory drugs; ON: Optical neuritis.