We treated 14 patients with scleritis with intermittent pulse doses of intravenous methylprednisolone. There was 13 patients with anterior scleritis and one patient with posterior scleritis. A grading system was developed to quantitate the degree of scleral inflammation and to follow up the response to treatment. A standard protocol of intravenous administration of methylprednisolone was followed, commencing with 1 g on three occasions in the first week. Additional immunosuppression was required in six patients. The therapy improved the patients' conditions, with a significant reduction in the severity of the scleritis in all patients. Side effects included psychological disturbances, hypertension, and elevated glucose levels, but no patient required cessation of treatment. Pulse methylprednisolone treatment alone or in combination with other immunosuppressive agents is an effective therapy in severe scleritis and has fewer potential side effects than more conventional regimens of corticosteroid administration.