Medication Summary
The goals of pharmacotherapy are to decrease pain, improve quality of life, to reduce morbidity, and to prevent complications. [25]
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Dexamethasone ophthalmic (Maxidex)
Suppresses the inflammatory response to a variety of agents and probably delays healing. Used for steroid responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe; when the inherent hazard of steroid use is accepted. Duration of treatment will vary from a few days to several weeks, according to therapeutic response.
Prednisolone acetate 1% (Pred Forte, Omnipred, Pred Mild)
Sterile ophthalmic suspension that is a topical anti-inflammatory agent for treating steroid responsive inflammation of palpebral and bulbar conjunctiva as well as cornea and anterior segment. Shake well prior to use. Do not discontinue therapy prematurely.
Loteprednol ophthalmic (Alrex, Lotemax, Inveltys, Eysuvis)
Sterile ophthalmic suspension with an ester steroid. This molecular change from the basic steroid ring structure substitutes an ester rather than a ketone at the 20 position, thus imparting a favorable IOP and cataractogenesis profile. It is available as a suspension in 0.2%, 0.25%, 0.5%, and 1% concentrations.
Nonsteroidal Anti-inflammatory Agents
Class Summary
Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Flurbiprofen
May inhibit cyclooxygenase enzyme, which, in turn, inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities. Available in 50- and 100-mg doses.
Indomethacin (Indocin, Tivorbex)
Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis. For use with episcleritis that has been nonresponsive to topical treatment.
Ibuprofen (Advil, Motrin, Addaprin, Dyspel, Provil)
Ibuprofen is usually the DOC for treating mild to moderate pain if no contraindications exist. It is one of the few NSAIDs indicated for fever reduction.
Ketoprofen
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient’s response.
Naproxen (Aleve, Anaprox, Anaprox DS, Naprelan, Naprosyn)
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing COX activity, which results in decreased prostaglandin synthesis.
-
Localized temporal inflammation in a patient with nodular episcleritis.
