Episcleritis Treatment & Management
- Author: Ellen N Yu-Keh, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc more...
Episcleritis is a self-limited inflammation that generally causes little or no permanent damage to the eye. Many patients with episcleritis may not require any treatment.
Diffuse 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.
About two-thirds of patients with episcleritis respond to topical therapy alone.
Systemic anti-inflammatory agents may be useful in eyes that are not responsive to topical therapy.
Systemic nonsteroidal anti-inflammatory drugs (NSAIDs) may be given until inflammation is suppressed. NSAIDs used in treatment of episcleritis include flurbiprofen (100 mg tid), indomethacin (100 mg daily initially and decreased to 75 mg), and naproxen (220 mg up to 6 times per day). Naproxen 500 mg is reserved for patients with more severe episcleritis.
The response to NSAIDs differs, and an NSAID that is effective in one patient may not be effective in another. These agents should be given with food in order to prevent gastrointestinal side effects.
Patients who do not respond or who have an incomplete response to both local therapy and systemic NSAIDs after one month may be treated with oral corticosteroids for at least one month in a tapering dose. About 20% of patients with episcleritis require oral corticosteroid treatment.
Patients with episcleritis secondary to infectious causes need appropriate antibiotic therapy.
Sunglasses may be useful for patients with sensitivity to light.
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