Episcleritis and Rheumatoid arthritis



Submitted by bhs_83 on Wed, 04/01/2020 - 16:22
Did you perform any surgery for the eyes?

Corneal patch graft surgery in right eye

Cataract surgery in right eye

Capsulotomy in right eye

Do you suffer from pre-existing illnesses in the eye?

Dry eyes

Do you suffer from any diseases in the body?

Rheumatoid arthritis 

Do you use any eye drops?


General gel

Cyclomune 0.05%

Nepafenac 1 drop for 6 weeks in right eye due to capsulotomy

Do you wear Contact lenses or Eyeglasses?

Unaided vision dist: 6/9P RE  6/6P LE

Optical prescription

Dist - RE: +0.50 SPH -0.50 CYL 130                    AXIS 6/9 VN                                                 LE: -0.25 SPH 6/6 VN

Near - RE: +3.00 SPH -0.50 CYL130                   AXIS N6 VN                                                 LE: N6 VN






Dear Dr,

I am suffering from Rheumatoid arthritis from past 15 years. I have severe dry eyes and had corneal patch graft surgery in december 2019 and cataract surgery in August 2019 and capsulotomy in March 2020. I have punctual plugs inserted in both eyes. I am presently on medication Azathioprine 75 mg and Hydroxy chloroquine 300mg from past 4 months (earlier 400 mg), prednisolone 4mg twice a week (reduced from 40 mg to 4mg over past 3 years since my corneal surgery).

From past week I have developed redness, little pain and nodule like thing on upper white part in my left eye. We are in complete lock down due to Corona virus outbreak. I cannot visit my ophthamologist. She insists I stay at home due to my RA condition.

According to images I sent her she thinks I have developed Episcleritis and suggests to use FML drops for one week and increase my oral steroid dose to 4mg alternate days for one month and resend pictures after one week.

I am seriously concerned if my condition is really Episcleritis or any other serious condition like Scleritis. I don't feel like it is getting any better. I feel as though the nodule is getting bigger.

Please if you can examine my uploaded images and kindly suggest your opinion if my condition is Episcleritis and if I should continue with prescribed treatment or should I visit my ophthamologist immediately. If it is episcleritis how long it will take to heal. 

Please can you suggest any better treatment for dry eyes and any other treatment for my present eye condition. My drops doesn't seem to help at all.

Your honest opinion is really appreciated. Waiting for your suggestion and diagnosis.

Thank you





Thanks for your Question

Most likely it is episcleritis not scleritis. Don't increase the dose of oral steroid and this need a second opinion of your own doctor but you can use eye drops now to treat it.

You can use FML 3-5 times a day for at least 1 week and also add lubricant eye drops more frequently.

The best lubricant eye drops are those with no preservative ingredients and i think you can find plenty of those eye drops in India.

In case you didn't feel any improvement within a week of this treatment, you should visit an eye doctor for full evaluation.



Nodule and redness on upper white part in left eye