Autoimmune scleritis: A new look at etiopathogenesis and treatment

Abstract

At present, the etiopathogenesis of autoimmune scleritis is not fully understood, the trigger of the disease is unknown, and treatment is ineffective. The author's hypothesis: the trigger of scleritis may be a weakness of accommodation caused by genetic ("tight" anterior segment of the eye) and epigenetic (chronic stress) factors. In order to restore accommodation, it is proposed to: a). form rounded non-penetrating supraciliary sclerectomies in the upper half of the eyeball (imitation of anterior scleral staphyloma); b).to form simple myopic astigmatism in the cornea up to 1.5 diopters, which gives the maximum amount of pseudo-accommodation (imitation of the effect of peripheral ulcerative keratitis on the refraction of the eye). c). if necessary, to form laser mydriasis. The parameters of operations should be established experimentally. This surgical approach can be applied to the treatment of systemic autoimmune diseases, which are often associated with scleritis and may have a common trigger - poor accommodation.