Spontaneous resolution is the likely outcome but if significant inflammation and symptoms are exhibited, a topical nonsteroidal anti-inflammatory such as ketorolac trometamol qid may be tried. Occasionally a systemic nonsteroidal anti-inflammatory such as indomethacin 50mg bd may be used to inhibit recurrence. All persistent or deteriorating cases should be referred for specialist assessment. Scleritis Cases with severe ocular inflammation in association with severe pain may represent scleritis. This is a relatively rare condition most commonly seen in elderly females.
Investigation is required to establish the diagnosis and underlying condition.
Second line management may include the use of high dose systemic antibiotics with or without systemic immunosuppressive therapy. Established cases of scleritis in the elderly are often associated with severe systemic conditions which may carry a poor life expectancy. It is important to emphasise that the need for referral will depend upon specific circumstances and if in doubt it is most appropriate to seek advice, particularly in acute cases, over the telephone from the local ophthalmologist s outpatient clinic or the Accident and Emergency department. Successful treatment depends upon establishing a rational working diagnosis or differential diagnosis. Give an adequate course of treatment for the primary diagnosis initially, and, if there is no response, alter the treatment to that appropriate for one of the secondary diagnoses.