# Episcleritis (simple & nodular) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Sodium hyaluronate — eye - Fluorometholone — eye - Ketorolac tromethamine — eye - Ibuprofen — oral.solid - Naproxen — oral.solid ## Complete treatment card ```text EPISCLERITIS (SIMPLE & NODULAR) 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) Review status: REVIEWED against 4 sources listed above (2026-08) 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 Source StatPearls "Episcleritis" - disease-level clinical article Status traced to the source above 1. SODIUM HYALURONATE [1st line] Adult 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 Peds Same as the adult: 1 drop at least four times daily. A surface lubricant has no weight- based dose. Source Episcleritis (simple & nodular) - disease-level clinical article (episcleritis- clinical.txt) Why Mild, self-limiting episcleritis responds well to supportive ocular lubrication Caution 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. Egypt LUBRIVISC 0.1% EYE DROPS 10 ML RAMEDA > HIKM... 32.00 EGP HYALUGRAND 0.2% EYE DROPS 10 ML DELTA GRAND P... 41.00 EGP HYALOPTIC 0.2% EYE DROPS 10 ML PHARCO 48.00 EGP HYFRESH 0.2% EYE DROPS 10 ML JAMJOOM PHARM... 75.00 EGP XILOIAL MONO EYE DROPS 20 RE-CLOSABLE VIALS * 0.5 ML FARMIGEA > HABIB SC... 265.00 EGP VISMED MULTI 0.18% EYE DROPS 10 ML TRB CHEMEDICA SA > RHEUMA 335.00 EGP VISMED MULTI 0.3% EYE GEL 10 ML TRB CHEMEDICA... 390.00 EGP AQUALARM INTENSIVE UD EYE DROPS 30 X 0.5ML SDU BAUSCH AND LOMB 425.00 EGP 2. FLUOROMETHOLONE [2nd line] Adult Instill 0.1% ophthalmic suspension 1 drop 4 times daily for 7 days under ophthalmologist guidance x 7 days Peds Ophthalmologist prescription only in children 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 Caution 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. Egypt FLUMETOL S 0.1% STERILE EYE DROPS KAHIRA 3.50 EGP SWIXFLUR S 0.1% EYE DROPS 5 ML CHEMIPHARM 3.50 EGP FML LIQUIFILM 0.1% EYE DROPS 5 ML EIPICO > ALLERGAN 5.55 EGP FLUCON 0.1% EYE DROPS 5 ML NOVARTIS > NO... 12.60 EGP 3. KETOROLAC TROMETHAMINE [2nd line] Adult Instill 0.5% ophthalmic solution 1 drop 4 times daily x 7-10 days Peds 2 years and over: 1 drop into affected eye 4 times daily for 7 days. (Child >=2 years: 1 drop 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. 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 Caution 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. Egypt KETOROLAC 0.5% EYE DROPS 5 ML MEMPHIS 6.00 EGP KETOROLIN 0.5% EYE DROPS 15 ML PHAROPHARMA 16.50 EGP POLYOTHALMIC 5MG/ML EYE DROPS 5 ML DELTA GRAND PHARMA 5.50 EGP SAMULGIN 0.5GM/100ML EYE DROPS AMOUN 8.00 EGP FAM 5MG/ML EYE DROPS 5 ML ALFACURE PHAR... 9.00 EGP ACULAR LS 0.4% EYE DROPS 5 ML ALLERGAN > SO... 41.50 EGP 4. IBUPROFEN [2nd line] Adult 200 to 600 mg 3 to 4 times per day - up to two weeks Peds 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).) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) 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. Caution CONTRAINDICATED, UK label verbatim (Ibuprofen 400 mg film-coated tablets, section 4.3): "severe renal failure or severe hepatic failure" (