This guideline last updated 06/05/2022 17:53:11

Differential diagnosis

• Episcleritis
• Dry eye
• Thyroid eye disease
• Cluster headache

Possible management by Optometrist

Treatment

• Systemic analgesia (e.g. paracetamol, aspirin, ibuprofen)

Advice

• Usually requires oral steroids
• Discuss with ophthalmology
  
  • If they agree prescribe or co-prescribe
    • Omeprazole 20mg daily for gastric protection
    • Prednisolone 30mg daily for one week, 20mg daily one week, 15mg daily one week, 10mg daily one week
  • Will need reassessment when on 10mg daily and decision made in conjunction with ophthalmology about subsequent tapering.
    • 10mg of prednisolone unlikely to immunocompromise a patient.
• Advise patient to phone back if pain worsens

Management Category

• Urgent referral to ophthalmology

Possible management by Ophthalmologist

• Systemic immunosuppression
• Investigation for systemic vasculitis