Episcleritis Treatment & Management
- Author: Hampton Roy, Sr, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc more...
Episcleritis is a self-limiting disease producing little or no permanent damage to the eye. Therefore, many, if not most, patients with episcleritis will not require any treatment. However, some patients with mild symptoms demand treatment and may benefit from the use of artificial tears.
Occasionally, a clear history of an exogenous sensitization can be obtained, and removal of this agent will prevent recurrent attacks.
Simple episcleritis often requires no treatment. Artificial tears are useful for patients with mild-to-moderate symptoms. Patients with severe or prolonged episodes may require artificial tears and/or topical corticosteroids.
Nodular episcleritis is more indolent and may require local corticosteroid drops or anti-inflammatory agents.
Topical ophthalmic 0.5% prednisolone, 0.1% dexamethasone, loteprednol etabonate 0.5%, or 0.1% betamethasone daily may be used.
If nodular episcleritis is unresponsive to topical therapy, systemic anti-inflammatory agents may be useful.
Flurbiprofen (100 mg tid) is usually effective until inflammation is suppressed.
If there is no response to flurbiprofen, indomethacin can be used; 100 mg daily and decreased to 75 mg when there is a response. Naproxen 220 mg is a useful over-the-counter (OTC) oral nonsteroidal anti-inflammatory agent (NSAID) and can be used up to 6 times per day. Higher–prescription strength naproxen 500 mg is useful for larger patients or more severe episcleritis.
Many patients who do not respond to one NSAID may respond to another NSAID. These agents are best given with food in order to prevent gastrointestinal side effects.
Sunglasses may be useful for patients with sensitivity to light.
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