Eye Pain in a Woman With Multiple Health Conditions

Byung Josh Kim, OD; Case Series Editor: Jean Marie Pagani, OD

Disclosures

March 24, 2014

Treatment and Clinical Course

Even though episcleritis is self-limited, topical drop intervention is usually the mainstay treatment course for patients who are symptomatic. Topical steroids or topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to alleviate any redness and inflammation. Oral NSAIDs can also be used for patients who are in significant pain. Resolution can take 2-21 days.[7]

Because of her symptoms, the patient was placed on loteprednol ophthalmic eye drops, 4 times daily to the right eye for 1 week. She was also given artificial tears to use throughout the day and was educated to use cold compresses.

Because of her history of rheumatoid arthritis and sarcoidosis, the patient was asked to return to the clinic for follow-up in 1 week in case her condition worsened. No additional blood work-up was indicated because she reported that she recently had blood work done and she was being followed for her existing conditions by her primary care provider.

The patient returned 2 weeks later, and the episcleritis had completely resolved. The loteprednol drops were tapered quickly.

Even though the injection was diffuse and the patient presented with significant pain, the condition resolved quickly without any complication, so no further evaluation was indicated at this time.

Conclusion

In most cases, episcleritis is benign and self-limited. Treatment is justified, however, on the basis of the patient's symptoms or if the condition is recurrent or persistent. Treatment options may include cold compresses, artificial tears, topical NSAIDs, and topical steroids.

Complications of long-term topical steroid treatment include glaucoma, cataract formation, and susceptibility to infections. Although the incidence of progression is low, this possibility needs to be considered.

Most cases of episcleritis are idiopathic, but 26%-32% of patients have an associated systemic disorder. Therefore, a thorough review of systems is important.[1,8] Conversely, patients with rheumatoid arthritis or other associated systemic diseases should be carefully examined for ocular complications.

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