Date of last review: Due to be updated

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