Add-on therapy with different non-steroidal anti-inflammatory agents in the management of non-infectious, non-necrotizing episcleritis

Abstract Background: Episcleritis is a common ocular inflammatory disease that can cause red eye. It is usually managed using single or combined topical corticosteroids and topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) as directed by clinical response. However, recurrence is possible. This study aimed to compare the effects of add-on therapies using different topical NSAIDs in the management of treatment-naive, non-infectious, non-necrotizing episcleritis. Methods: Seventy-five eyes of ۷۵ patients with non-infectious, non-necrotizing unilateral episcleritis were included in this study. Patients were allocated to one of three groups based on the NSAID used as add-on therapy: topical diclofenac sodium ۰.۱% (group D), topical nepafenac ۰.۱% (group N۱), and topical nepafenac ۰.۳% (group N۳). The time to symptom disappearance was defined as the recovery time. Results: There were no statistically significant differences in age, sex, initial best-corrected distance visual acuity, and intraocular pressure between groups (all P > ۰.۰۵). The mean recovery times of groups D and N۱ were comparable (۱۲.۸۶ ± ۵.۳۵ days and ۱۱.۴۵ ± ۵.۴۲ days, respectively) (P > ۰.۰۵). However, the mean recovery time of group N۳ was significantly shorter (۹.۷۰ ± ۳.۸۰ days, P < ۰.۰۵). Recurrence was observed in only one patient in group N۱ at ۳ months, and symptoms resolved when the same medication was reinstituted. Furthermore, we noted no side effects during the follow-up period for any of the treatment modalities. Conclusions: All three topical NSAIDs were effective add-on therapies in the management of non-infectious, non-necrotizing unilateral episcleritis. However, once-daily administration of topical nepafenac ۰.۳% had a shorter recovery time than topical diclofenac ۰.۱% and topical nepafenac ۰.۱%. Keywords: Anti-inflammatory agents episcleritis non-infectious non-necrotizing ocular surface red eye treatment