Medical Care
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.
Local therapy
Diffuse episcleritis often requires no treatment. Artificial tears are useful for patients with mild-to-moderate symptoms. [24] 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.
In a small series of patients at a tertiary referral center, about three quarters of patients with episcleritis responded to topical therapy alone. [5]
Systemic therapy
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 daily), 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 1 month may be treated with oral corticosteroids for at least 1 month in a tapering dose. [5] About 20% of patients with nodular episcleritis require oral corticosteroid treatment. [19]
Patients with episcleritis secondary to infectious causes need appropriate antibiotic therapy.
Activity
Sunglasses may be useful for patients with sensitivity to light.
Long-Term Monitoring
Patients should watch for the appearance of new systemic symptoms and should be advised to seek medical attention to rule out a systemic disease.
Long-term continuous therapy with steroid preparations should be avoided because of the danger of inducing cataract, glaucoma, and systemic complications. Moreover, excessive steroid use in episcleritis may increase the risk of recurrence.
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Localized temporal inflammation in a patient with nodular episcleritis.
