Patient is a UK registered trade mark. Laboratory testing may be ordered regularly to follow the therapeutic levels of the medication, to monitor for systemic toxicity, or to determine treatment efficacy. Episcleritis Diagnosis Diagnosis of episcleritis is made by an eye doctor through a comprehensive eye exam. Scleritis manifests as a very painful red eyebut it sometimes suggests that something deeper than the eye is involved. Another, more effective, option is a second-generation topical histamine H1 receptor antagonist.15 Table 4 presents ophthalmic therapies for allergic conjunctivitis. Treatment for Scleritis Scleritis is best managed by treating the underlying cause. Specialists put anterior scleritis into three categories: Nodular anterior scleritis causes abnormal growth of tissue called a nodule, visible on the sclera covering the front part of the eye. 5 Oral steroids are often prescribed, as well as a direct injection of steroids into the tissue itself. As scleritis may occur in association with many systemic diseases, laboratory workup may be extensive. Histologically, the appearance of episcleritis and scleritis differs in that the sclera is not involved in the former. 2005 - 2023 WebMD LLC. and omeprazole (20 mg/d) to counter the side effects of steroid treatment. In these patients, treatment for dry eye can be initiated based on signs and symptoms. Topical erythromycin or bacitracin ophthalmic ointment applied to eyelids may be used in patients who do not respond to eyelid hygiene. Hyperacute bacterial conjunctivitis (Figure 314 ) is often associated with Neisseria gonorrhoeae in sexually active adults. p255-261. ByAsagan (own work), CC BY-SA 3.0, via Wikimedia Commons. Sometimes there is no known cause. Scleritis is a painful, destructive, and potentially blinding disorder that may also involve the cornea, adjacent episclera, and underlying uveal tract. In episcleritis, hyperemia, edema and infiltration of the superficial tissue is noted along with dilated and congested vascular networks. Pharmacotherapy of Scleritis: Current Paradigms and Future Directions. It is more likely than episcleritis to be associated with an underlying inflammatory condition like rheumatoid arthritis. Cataracts Drugs used to treat scleritis include a corticosteroid solution that you apply directly to your eye, an oral corticosteroid ( prednisone) and a non-steroidal anti-inflammatory drug (NSAID). By Kribz (Own work), CC BY-SA 3.0, via Wikimedia Commons. We defined baseline as the initiation of tacrolimus eye drops. The non-necrotising types are usually treated with. Allergic conjunctivitis is primarily a clinical diagnosis. Contents 1 1.1 Disease The goal of treatment is to reduce the swelling in your eye, as well as in other parts of the body, if present. The most severe can be very painful and destroy the sclera. Scleritis is usually treated with oral anti-inflammatory medications, such as ibuprofen or prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs). Scleritis needs to be treated as soon as you notice symptoms to save your vision. It may also be infectious or surgically/trauma-induced. A meta-analysis based on five randomized controlled trials showed that bacterial conjunctivitis is self-limiting (65 percent of patients improved after two to five days without antibiotic treatment), and that severe complications are rare.2,7,1619 Studies show that bacterial pathogens are isolated from only 50 percent of clinically diagnosed bacterial conjunctivitis cases.8,16 Moreover, the use of antibiotics is associated with increased antibiotic resistance, additional expense for patients, and the medicalization of minor illness.4,2022 Therefore, delaying antibiotic therapy is an option for acute bacterial conjunctivitis in many patients (Table 2).2,9 A shared decision-making approach is appropriate, and many patients are willing to delay antibiotic therapy when counseled about the self-limiting nature of the disease. Oman J Ophthalmol. Topical antibiotics are rarely necessary because secondary bacterial infections are uncommon.12. Scleritis is characterized by significant pain, pain with eye movement, vision loss, and vessels that do not blanch with phenylephrine. Ophthalmology referral is required for recurrent episodes, an unclear diagnosis (early scleritis), and worsening symptoms. Posterior scleritisis the more rare form of the disease, and occurs at the back of the eye. Scleritis: Scleritis needs treatment with non-steroid anti-inflammatory drugs and steroids. Bilateral scleritis is more often seen in patients with rheumatic disease. Mild cases of keratopathy usually clear up with eye drops or medicated eye ointment. Uveitis. Chronic pain can be debilitating if not treated. About 40 people per 100,000 per year are thought to be affected. Sclerosing keratitis may present with crystalline deposits in the posterior corneal lamellae. A typical starting dose may be 1mg/kg/day of prednisone. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. Scleritis is severe inflammation of the sclera (the white outer area of the eye). For details see our conditions. However, it is generally a mild condition with no serious consequences. Episcleritis is most common in adults in their 40s and 50s. Karamursel et al. An eye doctor who sees these conditions frequently can tell them apart. Surgical biopsy of the sclera should be avoided in active disease, though if absolutely necessary, the surgeon should be prepared to bolster the affeted tissue with either fresh or banked tissue (i.e., preserved pericardium, banked sclera or fascia lata). Scleritis is similar to episcleritis in terms of appearance and symptoms. The most dreaded complication of scleritis is perforation, which can lead to dramatic vision loss, infection, and loss of the eye. Reinforcement of the sclera may be achieved with preserved donor sclera, periosteum or fascia lata. Even if your symptoms improve, it's important to follow up with an ophthalmologist on a . Hyperacute bacterial conjunctivitis is characterized by copious, purulent discharge; pain; and diminished vision loss. Posterior inflammation is usually not visible on exam, and the ophthalmologist can use ultrasound, looking for signs of inflammation behind the eye. These superficial vessels blanch with 2.5-10% phenylephrine while deeper vessels are unaffected. Preauricular lymph node involvement and visual acuity must also be assessed. If pain is present, a cause must be identified. Some schools require proof of antibiotic treatment for at least two days before readmitting students,7 and this should be addressed when making treatment decisions. Patients with necrotizing scleritis have a high incidence of visual loss and an increased mortality rate. To prevent the spread of viral conjunctivitis, patients should be counseled to practice strict hand washing and avoid sharing personal items; food handlers and health care workers should not work until eye discharge ceases; and physicians should clean instruments after every use.13 Referral to an ophthalmologist is necessary if symptoms do not resolve after seven to 10 days or if there is corneal involvement.4 Topical corticosteroid therapy for any cause of red eye is used only under direct supervision of an ophthalmologist.5,12 Suspected ocular herpetic infection also warrants immediate ophthalmology referral. Some doctors treat scleritis with injections of steroid medication into the sclera or around the eye. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Scleritis: a clinicopathologic study of 55 cases. International Society of Refractive Surgery, lupus, or other connective tissue disease, redness and swelling of the white part of the eye, look at the inside and outside of your eye using a, corticosteroid pills (medicine to control inflammation), nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen for pain and, drugs that weaken or modify the response of the immune system may be used with severe scleritis (immunosuppressive and immunomodulatory drugs). Fluorescein staining under a cobalt blue filter or Wood lamp is confirmatory. There may be cell-mediated immune response as there is increased HLA-DR expression as well as increased IL-2 receptor expression on the T-cells. The primary goal of treatment of scleritis is to minimize inflammation and thus reduce damage to ocular structures. A lamellar or perforating keratoplasty may be necessary. HOLLY CRONAU, MD, RAMANA REDDY KANKANALA, MD, AND THOMAS MAUGER, MD. For people with systemic inflammatory diseases such as rheumatoid arthritis, good control of the underlying disease is the best way of preventing this complication from arising. The clinical presentation of viral conjunctivitis is usually mild with spontaneous remission after one to two weeks.3 Treatment is supportive and may include cold compresses, ocular decongestants, and artificial tears. Vessels have a reddish hue compared to the deeper-bluish hue in scleritis. Injections. Over-the-counter antihistamine/vasoconstrictor agents are effective in treating mild allergic conjunctivitis. Necrotizing anterior scleritis is the most severe form of scleritis. This dose should be tapered to the best-tolerated dose. Episcleritis is a localized area of inflammation involving superficial layers of episclera. Scleritis may be active for several months or years before going into long-term remission. Formal biopsy may be performed to exclude a neoplastic or infective cause. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Treatment for scleritis may include: NSAIDs to reduce inflammation and provide pain relief Oral corticosteroids when NSAIDs don't help with reducing inflammation Immunosuppressive drugs for severe cases Antibiotics and antifungal medicines to treat and prevent infections Surgery to repair eye tissue, improve muscle function, and prevent vision loss More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis. Note: This page should not serve as a substitute for professional medical advice from a doctor or specialist. It also can be linked to issues with your blood vessels (known as vascular disease). Usually the treatment for uveitis is the same regardless of the cause, as long as the cause is not infectious. Two or more surgical procedures may be associated with the onset of surgically induced scleritis. It causes a painful red eye and can affect vision, sometimes permanently. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections. Postoperative Necrotizing Scleritis: A Report of Four Cases. We are vaccinating all eligible patients. The membrane over my eyeball has started sliding around and has caused a wrinkle on my eyeball. Early treatment is important. It also causes eye-swelling in some people. Upgrade to Patient Pro Medical Professional? As there are different forms of scleritis, the pathophysiology is also varied. You may have scleritis in one or both eyes. Medications that fit into this category, such as prednisone, are specifically designed to reduce inflammation. Scleritis is inflammation of the sclera, which is the white part of the eye. It is widespread inflammation of the sclera covering the front part of the eye. Most commonly, the inflammation begins in one area and spreads circumferentially until the entire anterior segment is involved. Cyclosporine is nephrotoxic and thus may be used as adjunct therapy allowing for lower corticosteroid dosing. Al-Amry M; Nodular episcleritis after laser in situ keratomileusis in patient with systemic lupus erythematosus. Cureus. Red eye is one of the most common ophthalmologic conditions in the primary care setting. It is characterized by severe pain and extreme scleral tenderness. If symptoms are mild it will generally settle by itself. The first and the most common symptom you are like to experience is the throbbing pain when you move your eyes. Certain conditions increase the risk of uveitis, but the disease often occurs for no known reason. Am J Ophthalmol. The episclera lies between the sclera and the conjunctiva. When this area is inflamed and hurts, doctors call that condition scleritis. Side effects of steroids that patients should be made aware of include elevated intraocular pressure, decreased resistance to infection, gastric irritation, osteoporosis, weight gain, hyperglycemia, and mood changes. Ophthalmology 2004; 111: 501-506. It causes redness and inflammation of the eye, often with discomfort and irritation but without other significant symptoms. Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma.27 Ocular allergies affect an estimated 25 percent of the population in the United States.28 Itching of the eyes is the most apparent feature of allergic conjunctivitis. Its rare, but if the sclera is torn or in danger of tearing, surgery may be needed to reinforce it. If the inflammation is more severe, steroid eye drops may be prescribed, and sometimes anti-inflammatory tablets are needed also. Both cause redness, but scleritis is much more serious (and rarer) than episcleritis. (October 2010). Uveitis. Scleritis. Episcleritis is defined as inflammation confined the more superficial episcleral tissue. Double-blind trial of the treatment of episcleritis-scleritis with oxyphenbutazone or prednisolone. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and corticosteroid pills, eye drops, or eye injections. In general, scleritis is more common in women than men and usually occurs during the fifth decade of life [2]. Scleritis presents with a characteristic violet-bluish hue with scleral edema and dilatation. Allergies or irritants also may cause conjunctivitis. It usually occurs in the fourth to sixth decades of life. After the . Research has shown that 15 percent of cases of scleritis are linked to arthritis. But common causes include having an autoimmune disease such as arthritis or having a post-surgical reaction. In idiopathic necrotizing scleritis, there may be small foci of scleral necrosis and mainly nongranulomatous inflammation with mainly mononuclear cells (lymphocytes, plasma cells and macrophages). Topical NSAIDs have not been shown to have significant benefit over placebo in the treatment of episcleritis.36 Topical steroids may be useful for severe cases. The most common form, anterior scleritis, is defined as scleral inflammation anterior to the extraocular recti muscles. 2013 Jan6(1):65-6. doi: 10.4103/0974-620X.111938. Treatment involves supportive care and use of artificial tears. If its not treated, scleritis can lead to serious problems, like vision loss. (August 2002). During your exam, your ophthalmologist will: Your ophthalmologist may work with your primary care doctor or a rheumatologist (doctor that treats autoimmune diseases) to help diagnose you. Small corneal perforations may be treated with bandage contact lens or corneal glue until inflammation is adequately controlled, allowing for surgery. Vitritis (cells and debris in vitreous) and exudative detachments occur in posterior scleritis. Postgrad Med J. What could this be? If the disease is inadequately controlled on corticosteroids, immunomodulatory therapy may be necessary. from the best health experts in the business. Medical disclaimer. Scleritis treatment . Some surgical procedures, such as pterygium surgery, can interfere with scleral tissues, causing inflammation and tissue death, leading to scleritis. Simple annoyance or the sign of a problem? Hyperemia and pain were scored before each treatment, at 1 and 2 weeks, and at 1 month after initiation of each treatment using 5 grades (0=none; 1+=mild; 2+=moderate; 3+=severe; 4+=extremely severe). A similar patient who presented with nodular, non-necrotizing scleritis. Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics.1 Causes of conjunctivitis may be infectious (e.g., viral, bacterial, chlamydial) or noninfectious (e.g., allergies, irritants).2 Most cases of viral and bacterial conjunctivitis are self-limiting. Scleromalacia perforans does not respond well to treatment - research continues to find the best way to manage this rare condition. The white part of the eye (sclera) swells and reddens. Please review our about page for more information. Ocular Examination. Its often, but not always, associated with an underlying autoimmune disorder. These steroids help treat mild scleritis, causing less severe side effects. Laboratory tests to identify bacteria and sensitivity to antibiotics are performed only in patients with severe cases, in patients with immune compromise, in contact lens wearers, in neonates, and when initial treatment fails.4,15 Generally, topical antibiotics have been prescribed for the treatment of acute infectious conjunctivitis because of the difficulty in making a clinical distinction between bacterial and viral conjunctivitis. methotrexate) and/or immunomodulators may be considered for treatment. About half of all cases occur in association with underlying systemic illnesses. Ultrasonographic changes include scleral and choroidal thickening, scleral nodules, distended optic nerve sheath, fluid in Tenons capsule, or retinal detachment. However, we will follow up with suggested ways to find appropriate information related to your question. https://eyewiki.org/w/index.php?title=Scleritis&oldid=84980. There is no known HLA association. 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).. It can occasionally be a little more painful than this and can cause inflamed bumps to form on the surface of the eye. In infective scleritis, if infective agent is identified, topical or . . Although scleritis can occur without a known cause, it is commonly linked to autoimmune diseases, such as rheumatoid arthritis. Ibuprofen and indomethacin are often used initially for treating anterior diffuse and nodular scleritis. Infectious Scleritis After Use of Immunomodulators. When arthritis manifests, it can cause inflammatory diseases such as scleritis. Treatment of episcleritis is often unnecessary. In addition to topical steroid drops, oral NSAIDs or oral steroids are Egton Medical Information Systems Limited. Some people only have one type of scleritis, but others can have inflammation at the front and back of the eye. Scleritis is the inflammation in the episcleral and scleral tissues with injection in both superficial and deep episcleral vessels. Treatment of Scleritis With Combined Oral Prednisone and Indomethacin Therapy. Examples of steroid drops include prednisolone and dexamethasone eye drops. Both anterior and posterior scleritis tend to cause eye pain that can feel like a deep, severe ache. 50(4): 351-363. Women are more commonly affected than men. Survey of Ophthalmology 2005. If other treatments don't work, your doctor might suggest surgery to put a small device called an implant into . The entire anterior sclera or just a portion may be involved. Implants. If you undergo a surgery then it approximately ranges from Rs. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. They also have eye pain. A very shallow anterior chamber due to posterior scleritis. Read our editorial policy. Atropine sulfate eye ointment (1 time/daily) and 0.1% fluorometholone eye drops (4 times/daily) along with . At one-week follow up, the scleral inflammation had resolved. The white part of your eye (called the sclera) is a layer of tissue that protects the rest of your eye. More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis. Sometimes the white of the eye has a bluish or purplish tinge. Registered in England and Wales. Oral non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line agent for mild-to-moderate scleritis. The sclera is the . Treatment includes supportive care, cycloplegics (atropine, cyclopentolate [Cyclogyl], homatropine, scopolamine, and tropicamide), and pain control (topical nonsteroidal anti-inflammatory drugs [NSAIDs] or oral analgesics). 2015 Mar 255:8. doi: 10.1186/s12348-015-0040-5. 9. Both can be associated with other conditions such as rheumatoid arthritis and systemic lupus erythematosus (SLE), although this is more likely in the case of scleritis. Scleritis may be differentiated from episcleritis by using phenylephrine eye drops, which causes blanching of the blood . Ibuprofen and indomethacin are often How long will the gas bubble stay in my eye after retinal detachment treatment? Do the following if you use eye . They are the only eye doctors with access to all diagnostic and treatment options for all eye diseases. Expert Opinion on Pharmacotherapy. A thorough patient history and eye examination may provide clues to the etiology of red eye (Figure 1). How should my husband treat psoriasis of his eyelids? Most people only have one type of scleritis, but others can have it at both the front and back of the eye. Get ophthalmologist-reviewed tips and information about eye health and preserving your vision. Patients will call the office and describe their eye as being really red, almost purple in color, and swollen. However, few studies have reported scleritis and/or uveitis accompanying a fundus elevated lesion, such as an intraocular tumor. The need for topical antibiotics for uncomplicated abrasions has not been proven. When diagnosing scleritis, the doctor or the nurse takes your medical history. A more recent article on evaluation of painful eye is available, Features and Serotypes of Chlamydial Conjunctivitis. Ocular side effects of bisphosphonates. Recurrent hemorrhages may require a workup for bleeding disorders. non-steroidal anti-inflammatory drugs (NSAIDs), Berchicci L, Miserocchi E, Di Nicola M, et al, Red Eye (Causes, Symptoms, and Treatment), It tends to come on more slowly than episcleritis. Cataract surgery should only be performed when the scleritis has been in remission for 2-3 months. Treatment depends on the cause of the scleritis, and may sometimes be long-term involving steroids or other immune-modulating medicines. Patient information: See related handout on pink eye, written by the authors of this article. If your sclera grows inflamed or sore, visit your eye doctor immediately. T-cells and macrophages tend to infiltrate the deep episcleral tissue with clusters of B-cells in perivascular areas. were first treated with steroids for 1 month and then switched to tacrolimus eye drops alone. Normal vision, normal pupil size and reaction to light, diffuse conjunctival injections (redness), preauricular lymphadenopathy, lymphoid follicle on the undersurface of the eyelid, Mild to no pain, diffuse hyperemia, occasional gritty discomfort with mild itching, watery to serous discharge, photophobia (uncommon), often unilateral at onset with second eye involved within one or two days, severe cases may cause subepithelial corneal opacities and pseudomembranes, Adenovirus (most common), enterovirus, coxsackievirus, VZV, Epstein-Barr virus, HSV, influenza, Pain and tingling sensation precedes rash and conjunctivitis, typically unilateral with dermatomal involvement (periocular vesicles), Eyelid edema, preserved visual acuity, conjunctival injection, normal pupil reaction, no corneal involvement, Mild to moderate pain with stinging sensation, red eye with foreign body sensation, mild to moderate purulent discharge, mucopurulent secretions with bilateral glued eyes upon awakening (best predictor), Chemosis with possible corneal involvement, Severe pain; copious, purulent discharge; diminished vision, Vision usually preserved, pupils reactive to light, conjunctival injections, no corneal involvement, preauricular lymph node swelling is sometimes present, Red, irritated eye; mucopurulent or purulent discharge; glued eyes upon awakening; blurred vision, Visual acuity preserved, pupils reactive to light, conjunctival injection, no corneal involvement, large cobblestone papillae under upper eyelid, chemosis, Bilateral eye involvement; painless tearing; intense itching; diffuse redness; stringy or ropy, watery discharge, Airborne pollens, dust mites, animal dander, feathers, other environmental antigens, Vision usually preserved, pupils reactive to light; hyperemia, no corneal involvement, Bilateral red, itchy eyes with foreign body sensation; mild pain; intermittent excessive watering, Imbalance in any tear component (production, distribution, evaporation, absorption); medications (anticholinergics, antihistamines, oral contraceptive pills); Sjgren syndrome, Dandruff-like scaling on eyelashes, missing or misdirected eyelashes, swollen eyelids, secondary changes in conjunctiva and cornea leading to conjunctivitis, Red, irritated eye that is worse upon waking; itchy, crusted eyelids, Chronic inflammation of eyelids (base of eyelashes or meibomian glands) by staphylococcal infection, Reactive miosis, corneal edema or haze, possible foreign body, normal anterior chamber, visual acuity depends on the position of the abrasion in relation to visual axis, Unilateral or bilateral severe eye pain; red, watery eyes; photophobia; foreign body sensation; blepharospasm, Direct injury from an object (e.g., finger, paper, stick, makeup applicator); metallic foreign body; contact lenses, Normal vision; pupils equal and reactive to light; well demarcated, bright red patch on white sclera; no corneal involvement, Mild to no pain, no vision disturbances, no discharge, Spontaneous causes: hypertension, severe coughing, straining, atherosclerotic vessels, bleeding disorders, Traumatic causes: blunt eye trauma, foreign body, penetrating injury, Visual acuity preserved, pupils equal and reactive to light, dilated episcleral blood vessels, edema of episclera, tenderness over the area of injection, confined red patch, Mild to no pain; limited, isolated patches of injection; mild watering, Diminished vision, corneal opacities/white spot, fluorescein staining under Wood lamp shows corneal ulcers, eyelid edema, hypopyon, Painful red eye, diminished vision, photophobia, mucopurulent discharge, foreign body sensation, Diminished vision; poorly reacting, constricted pupils; ciliary/perilimbal injection, Constant eye pain (radiating into brow/temple) developing over hours, watering red eye, blurred vision, photophobia, Exogenous infection from perforating wound or corneal ulcer, autoimmune conditions, Marked reduction in visual acuity, dilated pupils react poorly to light, diffuse redness, eyeball is tender and firm to palpation, Acute onset of severe, throbbing pain; watering red eye; halos appear when patient is around lights, Obstruction to outflow of aqueous humor leading to increased intraocular pressure, Diminished vision, corneal involvement (common), Common agents include cement, plaster powder, oven cleaner, and drain cleaner, Diffuse redness, diminished vision, tenderness, scleral edema, corneal ulceration, Severe, boring pain radiating to periorbital area; pain increases with eye movements; ocular redness; watery discharge; photophobia; intense nighttime pain; pain upon awakening, Systemic diseases, such as rheumatoid arthritis, Wegener granulomatosis, reactive arthritis, sarcoidosis, inflammatory bowel disease, syphilis, tuberculosis, Patients who are in a hospital or other health care facility, Patients with risk factors, such as immune compromise, uncontrolled diabetes mellitus, contact lens use, dry eye, or recent ocular surgery, Children going to schools or day care centers that require antibiotic therapy before returning, Patients without risk factors who are well informed and have access to follow-up care, Patients without risk factors who do not want immediate antibiotic therapy, Solution: One drop two times daily (administered eight to 12 hours apart) for two days, then one drop daily for five days, Solution: One drop three times daily for one week, Ointment: 0.5-inch ribbon applied in conjunctival sac three times daily for one week, Solution: One or two drops four times daily for one week, Ointment: 0.5-inch ribbon applied four times daily for one week, Gatifloxacin 0.3% (Zymar) or moxifloxacin 0.5% (Vigamox), Solution: One to two drops four times daily for one week, Levofloxacin 1.5% (Iquix) or 0.5% (Quixin), Ointment: Apply to lower conjunctival sac four times daily and at bedtime for one week, Solution: One or two drops every two to three hours for one week, Ketotifen 0.025% (Zaditor; available over the counter as Alaway), Naphazoline/pheniramine (available over the counter as Opcon-A, Visine-A). Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Ophthalmology referral is indicated if the patient needs topical steroid therapy or surgical procedures. It affects a slightly older age group, usually the fourth to sixth decades of life. This type has fewer additives and is generally recommended if you apply artificial tears more than four times a day, or if you have moderate or severe dry eyes.
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