Treatment: The Massachusetts Eye and Ear Infirmary Experience
Episcleritis may or may not require treatment; scleritis always does. Although simple, diffuse episcleritis may produce low-grade aggravation and temporary cosmetic consequences for the patient, it does not absolutely require therapy, because untreated it will eventually resolve leaving no sequelae. Regrettably, topical steroid therapy appears to be the reflex treatment prescribed by many physicians in developed countries. This is regrettable not simply because of the potential side effects of such treatment, but because experience suggests that such treatment actually prolongs the overall duration of the patient’s problem: the number of recurrences following discontinuation of each episode of steroid therapy appears to be greater, and a so-called “rebound effect,” in which the episcleritis intensifies with each recurrent episode after discontinuation of steroid therapy, has been observed. Our philosophy, and that of Watson,1 is to leave simple episcleritis untreated except for comfort and supportive therapy, such as cold compresses and iced artificial tears. It appears that, on the basis of the results of a randomized double-masked placebo-controlled clinical trial, nonsteroidal antiinflammatory therapy is not effective.2
KeywordsSystemic Lupus Erythematosus Systemic Corticosteroid Polyarteritis Nodosa Relapse Polychondritis Oral Nsaid
Unable to display preview. Download preview PDF.
- 1.Watson PG, Hazleman DL: The Sclera and Systemic Disorders. W.B. Saunders, Philadelphia, 1976, Chap 10, p 398.Google Scholar
- 4.Fauci AS: Vasculitis. In Parker CW (Ed): Clinical Immunology. W.B. Saunders, Philadelphia, 1980, pp 473–519.Google Scholar
- 7.Jones P, Jayson MIV: Rheumatoid arthritis of the eye. Proc Royal Soc Med 66: 1161, 1973.Google Scholar
- 8.Foster CS: Nonsteroidal antiinflammatory and immunosuppressive agents. In Lambert DW, Potter DE (Eds): Clinical Ophthalmic Pharmacology. Little, Brown, Boston, 1987, pp 173–192.Google Scholar