Dawaa Reference

chronic

Episcleritis (simple & nodular)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e) · FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383) · Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt) · Ibuprofen 400 mg film-coated tablets (POM) SmPC sections 4.3 and 4.4 (eMC product 7020)

Verified against4 documents
  • Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e)
  • FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383)
  • Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt)
  • Ibuprofen 400 mg film-coated tablets (POM) SmPC sections 4.3 and 4.4 (eMC product 7020)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

  • Sudden redness of one or both eyes, usually affecting just one side [redness]
  • Mild aching or tenderness over the red area, without discharge, photophobia, or vision loss [photophobia]

Signs — what you find (2)

  • A localized inflamed nodule is found in only 15% to 30% of cases, marking the nodular subtype
  • Topical phenylephrine causes the redness to fade when the inflamed vessels are episcleral rather than scleral [redness]

Tests (5)

  • When systemic autoimmune disease is suspected, blood work includes a CBC, ESR or CRP, rheumatoid factor, ANA, anti-CCP, HLA-B27, and ANCA
  • A Lyme antibody ELISA is ordered when Lyme disease is a possible cause
  • Suspected tuberculosis prompts a PPD skin test plus a chest x-ray
  • Syphilis workup uses RPR or VDRL together with FTA-ABS or another treponemal-specific test
  • A tissue biopsy is considered when the inflammation persists despite treatment

If not this — what else fits (6)

  • Recent sleeping in contact lenses with pain, photophobia, and tearing points to contact lens-associated red eye
  • Discharge, itching or burning, and swollen eyelids point toward conjunctivitis instead
  • Coexisting blepharitis from a delayed hypersensitivity reaction suggests phlyctenular conjunctivitis instead
  • An inflamed area overlying a visible pinguecula points to pingueculitis
  • Circumlimbal ciliary flush plus keratic precipitates with anterior chamber cells and flare point to iritis
  • Vessels that fail to blanch with phenylephrine, unlike episcleritis, point to the more severe scleritis

SourceStatPearls "Episcleritis" - disease-level clinical article

Presentation findings are traced to the source above.

1

SODIUM HYALURONATE

1st line

Formeye

Adult dose and duration

Instil 1 drop into the affected eye at least four times daily. Keeping the bottle in the fridge adds to the relief - the article's recommendation is refrigerated artificial tears. - Until it settles - most episcleritis resolves within 2 to 21 days

Paediatric dose

Same as the adult: 1 drop at least four times daily. A surface lubricant has no weight-based dose.

Dose source

Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt)

Why

Mild, self-limiting episcleritis responds well to supportive ocular lubrication

Cautions
  • No licensed ophthalmic dose exists for this drug to quote. The UK and US regulate ocular hyaluronate as a device rather than a medicine, and the only medicine label under the name is the intra-articular injection - a different route entirely. The frequency here is the disease article's recommendation for artificial tears in episcleritis, and this drop is one of that class.
  • Differentiate from TRUE SCLERITIS (scleritis causes deep severe boring eye pain, bluish scleral hue, and threatens vision; requires urgent ophthalmology referral).
  • Phenylephrine 2.5% drop causes blanching of episcleral vessels but not deep scleral vessels.
Egyptian brands
Egyptian brandManufacturerIndicative price
LUBRIVISC 0.1% EYE DROPS 10 MLRAMEDA > HIKMA PHARMA32.00 EGP
HYALUGRAND 0.2% EYE DROPS 10 MLDELTA GRAND PHARMA41.00 EGP
HYALOPTIC 0.2% EYE DROPS 10 MLPHARCO48.00 EGP
HYFRESH 0.2% EYE DROPS 10 MLJAMJOOM PHARMACEUTICALS75.00 EGP
XILOIAL MONO EYE DROPS 20 RE-CLOSABLE VIALS * 0.5 MLFARMIGEA > HABIB SCIENTIFIC OFFICE265.00 EGP
VISMED MULTI 0.18% EYE DROPS 10 MLTRB CHEMEDICA SA > RHEUMA335.00 EGP
VISMED MULTI 0.3% EYE GEL 10 MLTRB CHEMEDICA SA > RHEUMA390.00 EGP
AQUALARM INTENSIVE UD EYE DROPS 30 X 0.5ML SDUBAUSCH AND LOMB425.00 EGP
2

FLUOROMETHOLONE

2nd line

Formeye

Adult dose and duration

Instill 0.1% ophthalmic suspension 1 drop 4 times daily for 7 days under ophthalmologist guidance x 7 days

Paediatric dose

Ophthalmologist prescription only in children

Dose source

FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383)

Why

Soft topical corticosteroid for moderate-to-severe discomfort unresponsive to artificial tears

Cautions
  • Ophthalmic steroids MUST NOT be prescribed without slit-lamp examination to rule out herpes simplex keratitis.
  • There is a risk of intraocular pressure spike, glaucoma, and cataract formation with extended use.
  • A week is the limit without an eye specialist watching and measuring the pressure. Past that, steroid drops raise intraocular pressure, cut the optic nerve, and build a posterior subcapsular cataract.
  • A history of herpes simplex keratitis demands great caution - a steroid on a dendritic ulcer is how a cornea perforates. Slit lamp before and during.
  • It masks an untreated eye infection and can make it worse. Be sure what you are treating first.
  • In a chronic case do not stop dead - taper the frequency down.
Egyptian brands
Egyptian brandManufacturerIndicative price
FLUMETOL S 0.1% STERILE EYE DROPSKAHIRA3.50 EGP
SWIXFLUR S 0.1% EYE DROPS 5 MLCHEMIPHARM3.50 EGP
FML LIQUIFILM 0.1% EYE DROPS 5 MLEIPICO > ALLERGAN5.55 EGP
FLUCON 0.1% EYE DROPS 5 MLNOVARTIS > NOVARTIS SCIENTIFIC OFFICE12.60 EGP
3

KETOROLAC TROMETHAMINE

2nd line

Formeye

Adult dose and duration

Instill 0.5% ophthalmic solution 1 drop 4 times daily x 7-10 days

Paediatric dose

(Child >=2 years: 1 drop 4 times daily for 7 days)

Dose by age
2 years and over:1 drop into affected eye 4 times daily for 7 days.
Choice

Alternatives. A topical NSAID avoids the intraocular-pressure rise a topical steroid can cause, which is the safer default when the eye is being managed outside ophthalmology.

Dose source

Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e)

Why

Topical NSAID alternative avoiding corticosteroid-induced intraocular pressure spikes

Cautions
  • There is a rare risk of corneal melting with prolonged topical NSAID use.
  • No contact lenses while these drops are in use.
  • Topical NSAIDs slow healing of the ocular surface, so keep the course short and stop if the eye gets worse rather than better - that is how corneal thinning starts.
  • The label covers allergic conjunctivitis and post-cataract inflammation. Episcleritis is outside it: a reasonable use, but an off-label one.
  • Transient ocular burning or stinging can occur upon instillation.
Egyptian brands
Egyptian brandManufacturerIndicative price
KETOROLAC 0.5% EYE DROPS 5 MLMEMPHIS6.00 EGP
KETOROLIN 0.5% EYE DROPS 15 MLPHAROPHARMA16.50 EGP
POLYOTHALMIC 5MG/ML EYE DROPS 5 MLDELTA GRAND PHARMA5.50 EGP
SAMULGIN 0.5GM/100ML EYE DROPSAMOUN8.00 EGP
FAM 5MG/ML EYE DROPS 5 MLALFACURE PHARMACEUTICALS9.00 EGP
ACULAR LS 0.4% EYE DROPS 5 MLALLERGAN > SOFICOPHARM41.50 EGP
4

IBUPROFEN

2nd line

Formoral.solid

Adult dose and duration

200 to 600 mg 3 to 4 times per day - up to two weeks

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt) for the indication; the paediatric dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)", which the eye article does not carry.

Why

Oral NSAID option for episcleritis as an alternative to topical steroids.

Cautions
  • CONTRAINDICATED, UK label verbatim (Ibuprofen 400 mg film-coated tablets, section 4.3): "severe renal failure or severe hepatic failure" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); "active, or history of recurrent peptic ulcer/haemorrhage" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); "significant dehydration (caused by vomiting, diarrhoea or insufficient fluid intake)" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); "last trimester of pregnancy" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); and "previous hypersensitivity reactions (e.g. asthma, rhinitis, urticaria or angioedema) in response to acetylsalicylic acid or other NSAIDs" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020). Section 4.4 adds special care in "Reduced renal function" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020), "Hepatic dysfunction" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020) and "chronic obstructive airway disease or bronchial asthma" (<meta name="description" content="Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020) - so ordinary asthma and lesser renal impairment are a caution, not a bar.
  • Do not give an NSAID in suspected chickenpox or dengue - both can present with fever, and both raise serious risk.
  • With food. In a child aged 3-5 months seek advice if symptoms last beyond 24 hours.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 200 MG 20 CAPSCOPAD PHARMA4.00 EGP (0.20/unit)
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
NOVA-PROFEN 200MG 30 TABS.SANOFI9.00 EGP (0.30/unit)
MARCOFEN 400 MG SR 10 CAPS.GLAXO SMITHKLINE5.85 EGP (0.58/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
FLAMOTAL 800 MG 10 TABS.GLOBAL NAPI PHARMACEUTICALS > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)35.00 EGP (3.50/unit)
BRUFEN 600 MG 20 EFF. GR. IN SACHETSKAHIRA > ABBOTT LABORATORIES120.00 EGP
SPIDIDOL 600 MG 12 EFF. GR. IN SACHETSZAMBON > PHARMACON132.00 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
5

NAPROXEN

2nd line

Formoral.solid

Adult dose and duration

250 to 500 mg twice per day - up to two weeks

Paediatric dose

Naproxen is not recommended for use in any other indication in children under 16 years of age. That sentence is the Naproxen 500mg Tablets SmPC section 4.2, verbatim.

Dose source

Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt)

Why

Oral NSAID option for episcleritis as an alternative to topical steroids.

Cautions
  • Co-prescribe PPI gastroprotection for continuous long-term use.
  • Urgent rheumatology referral is required for biologic disease-modifying anti-rheumatic drugs (TNF inhibitors / IL-17 inhibitors).
  • Co-prescribe PPI in elderly or ulcer-prone patients.
Egyptian brands
Egyptian brandManufacturerIndicative price
NAPROFEN 250MG 10 TAB.EL NILE.3.65 EGP (0.36/unit)
NAPROSYN 250 MG 20 TAB.MISR > F.HOFFMAN LA ROCHE9.30 EGP (0.47/unit)
MYOPROX 250MG 20 F.C.TAB.EL-OBOUR11.00 EGP (0.55/unit)
ORGOPROXEN 500 MG 20 TAB.ORGANOPHARMA > ORGANO16.00 EGP (0.80/unit)
NAPROSYN 500 MG 10 TAB.MISR > F.HOFFMAN LA ROCHE8.05 EGP (0.81/unit)
NAPROFEN 500MG 10 TAB.EL NILE.12.00 EGP (1.20/unit)
NAPROFEN 500MG 20 TAB.EL NILE.24.00 EGP (1.20/unit)
NALEVE 375 MG 10 ENTERIC COATED TAB.SIGMA4.75 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.