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In scleritis, scleral edema and inflammation are present in all forms of disease. Scleritis and episcleritis ICD9 379.0 (excludes syphilitic episcleritis 095.0). Most of the time, though,. Treatment Episcleritis often requires no treatment but in some cases a course of steroid eye drops is required. Scleritis may affect either one or both eyes. Episcleritis is a localized area of inflammation involving superficial layers of episclera. . Epub 2013 Nov 12. Scleromalacia perforans does not respond well to treatment - research continues to find the best way to manage this rare condition. If an autoimmune disorder is causing your scleritis, your doctor may give you medicine that slows down your immune system or treats that disorder in another way. Scleritis. Pulsed intravenous methylprednisolone at 0.5-1g may be required initially for severe scleritis. etc.) Scleritis: A Case Report and Overview - University of Iowa Patients with mild or moderate scleritis usually maintain excellent vision. . MyVision.org is an effort by a group of expert ophthalmologists and optometrists to provide trusted information on eye health and vision. Episcleritis: Causes and treatment - All About Vision It causes a painful red eye and can affect vision, sometimes permanently. What Is Episcleritis? - WebMD International Society of Refractive Surgery. Rheumatoid arthritis is the most common. Chronic pain can be debilitating if not treated. Vision may be blurred, the eye may be watery (although there is no discharge) and you may find it difficult to tolerate light (photophobia). By submitting your question, you agree to be answered by email. Scleritis is an inflammation of the sclera, the white outer wall of the eye. This pain is characteristically dull and boring in nature and exacerbated by eye movements. Mild scleritis often responds well to oral anti inflammatory medications such as indomethacin, ibuprofen and diclofenac. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye. Treatment involves eyelid hygiene (cleansing with a mild soap, such as diluted baby shampoo, or eye scrub solution), gentle lid massage, and warm compresses. Scleritis: Scleritis can lead to blindness. Treatments of scleritis aim to reduce inflammation and pain. Arthritis with skin nodules, pericarditis, and anemia are features of rheumatoid arthritis. These steroids help treat mild scleritis, causing less severe side effects. If this isn't enough (more likely in the nodular type) steroid eye drops are sometimes used, although only under the care of an eye specialist (ophthalmologist). Related letter: "Features and Serotypes of Chlamydial Conjunctivitis.". Scleritis is severe inflammation of the sclera (the white outer area of the eye). Journal of Clinical Medicine. The globe is also often tender to touch. ByAsagan (own work), CC BY-SA 3.0, via Wikimedia Commons. It is common in patients that have an underlying autoimmune disease (e.g. Patients with granulomatosis with polyangiitis may require cyclosphosphamide or mycophenolate. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Conjunctivitis is the most common cause of red eye. Because its usually related to autoimmune disorders, your doctor may suggest that you see a rheumatologist (a doctor who specializes in autoimmune conditions). It also causes eye-swelling in some people. Likewise, immunomodulatory agents should be considered in those who might otherwise be on chronic steroid use. Please review our about page for more information. Scleritis treatment . The use of humidifiers and well-fitting eyeglasses with side shields can also decrease tear loss. A thorough patient history and eye examination may provide clues to the etiology of red eye (Figure 1). The most dreaded complication of scleritis is perforation, which can lead to dramatic vision loss, infection, and loss of the eye. This page was last edited on September 12, 2022, at 08:54. Sometimes the white of the eye has a bluish or purplish tinge. Scleritis - Wikipedia The eye is likely to be watery and sensitive to light and vision may be blurred. People with this type of scleritis may have pain and tenderness in the eye. PDF Basic Management of Anterior Scleritis Parentin F, Lepore L, Rabach I, et al; Paediatric Behcet's disease presenting with recurrent papillitis and episcleritis: a case report. Scleritis is an inflammatory ocular disorder within the scleral wall of the eye [].It has been repeatedly reported that a scleritis diagnosis is most often associated with a systemic disease [1,2,3].Previous studies have reported that 40% to 50% of all patients with scleritis have an associated infectious or autoimmune disease; 5% to 10% of them have an infectious disease as the origin, while . Topical erythromycin or bacitracin ophthalmic ointment applied to eyelids may be used in patients who do not respond to eyelid hygiene. Inflammatory Arthritis and Eye Health: Prevention, Symptoms, Treatment Episcleritis and scleritis are inflammatory conditions. . It is common for people with scleritis to have another disease, likerheumatoid arthritis or other autoimmune disease. In patients with corneal abrasion, it is good practice to check for a retained foreign body under the upper eyelid. Red eye is one of the most common ophthalmologic conditions in the primary care setting. For very mild cases of scleritis, an over-the-counter non-steroidal anti-inflammatory drug (NSAID) like ibuprofen may be enough to ease your eye inflammation and pain. Upgrade to Patient Pro Medical Professional? As there are different forms of scleritis, the pathophysiology is also varied. Some types of scleritis, while painful, resolve on their own. Your email address will only be used to answer your question unless you are an Academy member or are subscribed to Academy newsletters. (October 1998). All patients on immunomodulatory therapy must be closely monitored for development of systemic complications with these medications. Formal biopsy may be performed to exclude a neoplastic or infective cause. On slit-lamp biomicroscopy, inflamed scleral vessels often have a criss-crossed pattern and are adherent to the sclera. National Eye Institute. Prescription eye drops are the most common treatment. There are several types of scleritis, depending on what part of the eye is affected and how inflamed the tissues are: Episcleritis does not necessarily need any treatment. It tends to come on more slowly and affects the deep white layer (sclera) of the eye. It causes redness - often in a wedge shape over the white of the eye - and mild discomfort. A similar condition called episcleritis is much more common and usually milder. Both scleritis and conjunctivitis cause redness of the eye. Scleritis, or inflammation of the sclera, can present as a painful red eye with or without vision loss. T-cells and macrophages tend to infiltrate the deep episcleral tissue with clusters of B-cells in perivascular areas. Steroid drops are the main treatment for uveitis and may be the only treatment for mild attacks. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. It can spread to affect the adjacent layers around the sclera, including the episclera and the cornea. A branching pattern of staining suggests HSV infection or a healing abrasion. There are additional images of types of scleritis in Further Reading below. Patients with a history of pterygium surgery with adjunctive mitomycin C administration or beta irradiation are at higher risk of infectious scleritis due to defects in the overlying conjunctiva from calcific plaque formation and scleral necrosis. Some cases only respond to stronger medication, special contact lenses, or eyelid injections. Artificial tears are also available as nonprescription gels and gel inserts. PDF Original Article Thats called a scleral graft. Episcleritis - College of Optometrists Treatment involves eyelid hygiene (cleansing with a mild soap, such as diluted baby shampoo, or eye scrub solution), gentle lid massage, and warm compresses. Patients with rheumatoid arthritis may be placed on methotrexate. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Middle East African Journal of Ophthalmology. Symptoms of scleritis include pain, redness, tearing, light sensitivity (photophobia), tenderness of the eye, and decreased visual acuity. Treatments can restore lost vision and prevent further vision loss. Case 3. Doctors predominantly prescribe them to their patients who are living with arthritis. Yanoff M and Duker JS. Scleritis can occasionally be caused by infection with germs such as bacteria, viruses or, rarely, fungi. Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics.1 Causes of conjunctivitis may be infectious (e.g., viral, bacterial, chlamydial) or noninfectious (e.g., allergies, irritants).2 Most cases of viral and bacterial conjunctivitis are self-limiting. If the patient is taking warfarin (Coumadin), the International Normalized Ratio should be checked. The management will depend on what type of scleritis this is and on its severity. Ocular manifestations of systemic lupus erythematosus At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Cortical Visual and Perceptual Impairments. Episcleritis is defined as inflammation confined the more superficial episcleral tissue. However, these drops should be used only on special occasions because regular use leads to even more redness (called a rebound effect). TNF-alpha inhibitors may also result in a drug-induced lupus-like syndrome as well as increased risk of lymphoproliferative disease. Pharmacotherapy of Scleritis: Current Paradigms and Future Directions. There is an increase in inflammatory cells including T-cells of all types and macrophages. These may cause temporary blurred vision. rheumatoid arthritis) or other disease process. However, we will follow up with suggested ways to find appropriate information related to your question. The most common form, anterior scleritis, is defined as scleral inflammation anterior to the extraocular recti muscles. It is widespread inflammation of the sclera covering the front part of the eye. When either episcleritis or scleritis occurs in association with an underlying condition like rheumatoid arthritis then its progress tends to mirror that of the underlying disease. Scleritis tends to be very painful, causing a deep 'boring' kind of pain in or around the eye: that's how it is distinguished from episcleritis which is uncomfortable but not that painful. Referral to an ophthalmologist is indicated if symptoms worsen or do not resolve within 48 hours. The most common type can inflame the whole sclera or a section of it and is the most treatable. It may involve the cornea, adjacent episclera and the uvea and thus can be vision-threatening. Reinforcement of the sclera may be achieved with preserved donor sclera, periosteum or fascia lata. This is more prevalent with necrotizing anterior scleritis. If you, or someone you know is suffering from scleritis, encourage them to seek care from an ophthalmologist. A very shallow anterior chamber due to posterior scleritis. Scleritis can develop in the front or back of your eye. Treatment will vary depending on the type of scleritis, and can include: Medications that change or weaken the response of the immune system may be used with severe cases of scleritis. from the best health experts in the business. Scleritis affects the sclera and, sometimes, the deeper tissues of the eye. The sclera is the . Eye drops that constrict blood vessels of the eye, such as tetrahydrozoline, can temporarily decrease the redness. The sclera is the white part of the eye. Treatment depends on the cause of the scleritis, and may sometimes be long-term involving steroids or other immune-modulating medicines. Several treatment options are available. Survey of Ophthalmology 2005. What Is Scleritis? - American Academy of Ophthalmology https://patient.info/eye-care/eye-problems/episcleritis-and-scleritis, How to reduce eye strain while watching TV, How to look after your eyes while working from home. Pharmacotherapy of Scleritis: Current Paradigms and Future Directions. Rheumatoid Arthritis and Your Eyes: What To Know - Verywell Health The first and the most common symptom you are like to experience is the throbbing pain when you move your eyes. Expert Opinion on Pharmacotherapy. The sclera is notably white, avascular and thin. Blood, imaging or other testing may be needed. Scleritis presents with a characteristic violet-bluish hue with scleral edema and dilatation. There isnt always an obvious reason it happens, but most of the time, its caused by an autoimmune disorder (when your bodys defense system attacks its own tissues). Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. However, laboratory testing is often necessary to discover any associated connective tissue and autoimmune disease. The most common form is diffuse scleritis and the second most common form is nodular scleritis [1]. If your eye hurts, see your eye doctorright away. Scleritis: Causes, vs. Episcleritis, Treatment, Signs & Symptoms These drugs have been used to prevent rejection of transplants and these are used as chemotherapy for cancers. Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment.2 Patients with chlamydial infection also may present with chronic follicular conjunctivitis. Subconjunctival hemorrhage is diagnosed clinically. This dose should be tapered to the best-tolerated dose. (October 1998). Treatment for scleritis may include: NSAIDs to reduce inflammation and provide pain relief Oral corticosteroids when NSAIDs don't help with reducing inflammation Immunosuppressive drugs for severe cases Antibiotics and antifungal medicines to treat and prevent infections Surgery to repair eye tissue, improve muscle function, and prevent vision loss However, scleritis is usually much more painful, and it can lead to vision loss due to progressive inflammation of the ocular tissues or even morbidity and mortality due to an underlying collagen vascular disease. This topic will review the treatment of scleritis. In idiopathic necrotizing scleritis, there may be small foci of scleral necrosis and mainly nongranulomatous inflammation with mainly mononuclear cells (lymphocytes, plasma cells and macrophages). Masks are required inside all of our care facilities. Scleritis - MERSI If scleritis is diagnosed, immediate treatment will be necessary. When scleritis is in the back of the eye, it can be harder to diagnose. Often, though, scleritis has no identifiable cause. Ibuprofen and indomethacin are often used initially for treating anterior diffuse and nodular scleritis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. In this study, we report a case of rheumatoid uveitis associated with an intraocular elevated lesion. Episcleritis: Symptoms, Causes, and Treatment - Healthline You may need any of the following: . If pain is present, a cause must be identified. Scleritis: Symptoms, Causes, & Treatment - WebMD This content is owned by the AAFP. We are vaccinating all eligible patients. Another type causes tender nodules (bumps) to appear on the sclera. 2008. The clinical presentation of viral conjunctivitis is usually mild with spontaneous remission after one to two weeks.3 Treatment is supportive and may include cold compresses, ocular decongestants, and artificial tears. The primary goal of treatment of scleritis is to minimize inflammation and thus reduce damage to ocular structures. The diagram shows the eye including the sclera. Pain is nearly always present and typically is severe and accompanied by tenderness of the eye to touch. Al-Amry M; Nodular episcleritis after laser in situ keratomileusis in patient with systemic lupus erythematosus. Finally, the conjunctival and superficial vessels may blanch with 2.5-10% phenylephrine but deep vessels are not affected. Oman J Ophthalmol. Cyclosporine is nephrotoxic and thus may be used as adjunct therapy allowing for lower corticosteroid dosing. Management of scleritis involves ophthalmology consultation and steroids . It is usually self-limiting (lasting up to three weeks) and is diagnosed clinically. So, its vitally important to get to the bottom of this uncommon but aggravating condition. Other conditions linked to scleritis include: Other causes can include eye trauma and in very rare cases fungal or parasite infections. Other common causes of red eye include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline. If the infection does not improve within one week of treatment, the patient should be referred to an ophthalmologist.4,5. Scleritis Responds to Oral Anti-Inflammatories In addition to topical steroid drops, oral NSAIDs or oral steroids are indicated for treating scleritis. It is slightly more common in women than in men, and in people who have connective disease disease such as rheumatoid arthritis. How should my husband treat psoriasis of his eyelids? Theymay refer you to a specialist or work with your primary care doctor to use blood tests or imaging tests to check for other problems that might be related to scleritis. Ophthalmology 1999; Jul: 106(7):1328-33. . Episcleritis is often a recurrent condition, with episodes occurring typically every few months. As mentioned earlier, the autoimmune connective tissue diseases of rheumatoid arthritis, lupus, sero-negative spondylarthropathies and vasculitides such as granulomatosis with polyangiitis and polyarteritis nodosa are most frequently seen. There also can be pain of the jaw, face, or head. J Med Case Rep. 2011 Feb 255:81. doi: 10.1186/1752-1947-5-81. See permissionsforcopyrightquestions and/or permission requests. Oral non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line agent for mild-to-moderate scleritis. Both can be associated with other conditions such as rheumatoid arthritis and systemic lupus erythematosus (SLE), although this is more likely in the case of scleritis. Uveitis. The cost of treatment depends on the type of inflammation and also the type of scleritis. (November 2021). Medical disclaimer. Hyperacute bacterial conjunctivitis is characterized by copious, purulent discharge; pain; and diminished vision loss. Most of the time, though, a prescription medication called a corticosteroid is needed to treat the inflammation. Reproduction in whole or in part without permission is prohibited. The non-necrotising types are usually treated with. HSV infection with corneal involvement warrants ophthalmology referral within one to two days. Certain types of uveitis can return after treatment. This pain may radiate to involve the ear, scalp, face and jaw. Scleritis is a serious inflammatory disease that . Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective second-generation topical histamine H. Anti-inflammatory agents (e.g., topical cyclosporine [Restasis]), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye. Cataract surgery should only be performed when the scleritis has been in remission for 2-3 months. Patients need prompt ophthalmology referral for aggressive management.4,12 Acute bacterial conjunctivitis is the most common form of bacterial conjunctivitis in the primary care setting. Episcleritis is most common in adults in their 40s and 50s. The condition is usually benign and can be managed by primary care physicians. However, one must be prepared to place a scleral reinforcement graft or other patch graft as severe thinning may result in the presentation of intraocular contents. Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. HOLLY CRONAU, MD, RAMANA REDDY KANKANALA, MD, AND THOMAS MAUGER, MD. Postoperative Necrotizing Scleritis: A Report of Four Cases. A lamellar or perforating keratoplasty may be necessary. Scleritis - StatPearls - NCBI Bookshelf Episcleritis is typically less painful with no vision loss. Scleritis is often associated with an underlying systemic disease in up to 50% of patients. American Academy of Ophthalmology. What Is Scleritis? - American Academy of Ophthalmology Its often, but not always, associated with an underlying autoimmune disorder. Ibuprofen and indomethacin are often An example of such a drug is bisphosphonates, a cure for osteoporosis. Scleritis - Types, Pictures, Causes, Diagnosis, Work Up and Treatment Journal Francais dophtalmologie. It might take approximately Rs. Scleritis may cause vision loss. What are the possible complications of episcleritis and scleritis? If left untreated by corticosteroid eye drops, anti-inflammatory drugs or other medications, scleritis can lead to vision loss. Scleritis Treatment If scleritis is diagnosed, immediate treatment will be necessary. When inflammation is the main factor in dry eye, cyclosporine ophthalmic drops (Restasis) may increase tear production.5 Topical cyclosporine may take several months to provide subjective improvement. In the diffuse form, anterior scleral edema is present along with dilation of the deep episcleral vessels. Another, more effective, option is a second-generation topical histamine H1 receptor antagonist.15 Table 4 presents ophthalmic therapies for allergic conjunctivitis. Azithromycin eye drops may also be used in the treatment of blepharitis. In some cases, people lose some or all of their vision. Posterior scleritis is defined as involvement of the sclera posterior to the insertion of the rectus muscles. It also can be linked to issues with your blood vessels (known as vascular disease). Scleritis treatment. Patients who have had multiple eye surgeries are also at high risk of getting scleritis. Uveitis is an inflammation of the uvea, the middle part of the eye, which lies just behind the sclera. Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial. Complications are frequent and include peripheral keratitis, uveitis, cataract and glaucoma. Preauricular lymph node involvement and visual acuity must also be assessed. Am J Ophthalmol. Both are slightly more common in women than in men. Treatment varies depending on the type of scleritis. NSAIDs work by inhibiting enzyme actions causing inflammation. Vitamin A Vitamin A contains antioxidant compounds that are important in promoting healthy vision by reducing inflammation. Ophthalmologists who specialize in the diagnosis and treatment of inflammatory diseases of the eye are called uveitis specialists. If symptoms are mild it will generally settle by itself. Non-selective COX-inhibitors such as flurbiprofen, indomethacin and ibuprofen may be used. Experience With 0.1% Tacrolimus Eye Drop for Noninfectious, Non - LWW Normal vision, normal pupil size and reaction to light, diffuse conjunctival injections (redness), preauricular lymphadenopathy, lymphoid follicle on the undersurface of the eyelid, Mild to no pain, diffuse hyperemia, occasional gritty discomfort with mild itching, watery to serous discharge, photophobia (uncommon), often unilateral at onset with second eye involved within one or two days, severe cases may cause subepithelial corneal opacities and pseudomembranes, Adenovirus (most common), enterovirus, coxsackievirus, VZV, Epstein-Barr virus, HSV, influenza, Pain and tingling sensation precedes rash and conjunctivitis, typically unilateral with dermatomal involvement (periocular vesicles), Eyelid edema, preserved visual acuity, conjunctival injection, normal pupil reaction, no corneal involvement, Mild to moderate pain with stinging sensation, red eye with foreign body sensation, mild to moderate purulent discharge, mucopurulent secretions with bilateral glued eyes upon awakening (best predictor), Chemosis with possible corneal involvement, Severe pain; copious, purulent discharge; diminished vision, Vision usually preserved, pupils reactive to light, conjunctival injections, no corneal involvement, preauricular lymph node swelling is sometimes present, Red, irritated eye; mucopurulent or purulent discharge; glued eyes upon awakening; blurred vision, Visual acuity preserved, pupils reactive to light, conjunctival injection, no corneal involvement, large cobblestone papillae under upper eyelid, chemosis, Bilateral eye involvement; painless tearing; intense itching; diffuse redness; stringy or ropy, watery discharge, Airborne pollens, dust mites, animal dander, feathers, other environmental antigens, Vision usually preserved, pupils reactive to light; hyperemia, no corneal involvement, Bilateral red, itchy eyes with foreign body sensation; mild pain; intermittent excessive watering, Imbalance in any tear component (production, distribution, evaporation, absorption); medications (anticholinergics, antihistamines, oral contraceptive pills); Sjgren syndrome, Dandruff-like scaling on eyelashes, missing or misdirected eyelashes, swollen eyelids, secondary changes in conjunctiva and cornea leading to conjunctivitis, Red, irritated eye that is worse upon waking; itchy, crusted eyelids, Chronic inflammation of eyelids (base of eyelashes or meibomian glands) by staphylococcal infection, Reactive miosis, corneal edema or haze, possible foreign body, normal anterior chamber, visual acuity depends on the position of the abrasion in relation to visual axis, Unilateral or bilateral severe eye pain; red, watery eyes; photophobia; foreign body sensation; blepharospasm, Direct injury from an object (e.g., finger, paper, stick, makeup applicator); metallic foreign body; contact lenses, Normal vision; pupils equal and reactive to light; well demarcated, bright red patch on white sclera; no corneal involvement, Mild to no pain, no vision disturbances, no discharge, Spontaneous causes: hypertension, severe coughing, straining, atherosclerotic vessels, bleeding disorders, Traumatic causes: blunt eye trauma, foreign body, penetrating injury, Visual acuity preserved, pupils equal and reactive to light, dilated episcleral blood vessels, edema of episclera, tenderness over the area of injection, confined red patch, Mild to no pain; limited, isolated patches of injection; mild watering, Diminished vision, corneal opacities/white spot, fluorescein staining under Wood lamp shows corneal ulcers, eyelid edema, hypopyon, Painful red eye, diminished vision, photophobia, mucopurulent discharge, foreign body sensation, Diminished vision; poorly reacting, constricted pupils; ciliary/perilimbal injection, Constant eye pain (radiating into brow/temple) developing over hours, watering red eye, blurred vision, photophobia, Exogenous infection from perforating wound or corneal ulcer, autoimmune conditions, Marked reduction in visual acuity, dilated pupils react poorly to light, diffuse redness, eyeball is tender and firm to palpation, Acute onset of severe, throbbing pain; watering red eye; halos appear when patient is around lights, Obstruction to outflow of aqueous humor leading to increased intraocular pressure, Diminished vision, corneal involvement (common), Common agents include cement, plaster powder, oven cleaner, and drain cleaner, Diffuse redness, diminished vision, tenderness, scleral edema, corneal ulceration, Severe, boring pain radiating to periorbital area; pain increases with eye movements; ocular redness; watery discharge; photophobia; intense nighttime pain; pain upon awakening, Systemic diseases, such as rheumatoid arthritis, Wegener granulomatosis, reactive arthritis, sarcoidosis, inflammatory bowel disease, syphilis, tuberculosis, Patients who are in a hospital or other health care facility, Patients with risk factors, such as immune compromise, uncontrolled diabetes mellitus, contact lens use, dry eye, or recent ocular surgery, Children going to schools or day care centers that require antibiotic therapy before returning, Patients without risk factors who are well informed and have access to follow-up care, Patients without risk factors who do not want immediate antibiotic therapy, Solution: One drop two times daily (administered eight to 12 hours apart) for two days, then one drop daily for five days, Solution: One drop three times daily for one week, Ointment: 0.5-inch ribbon applied in conjunctival sac three times daily for one week, Solution: One or two drops four times daily for one week, Ointment: 0.5-inch ribbon applied four times daily for one week, Gatifloxacin 0.3% (Zymar) or moxifloxacin 0.5% (Vigamox), Solution: One to two drops four times daily for one week, Levofloxacin 1.5% (Iquix) or 0.5% (Quixin), Ointment: Apply to lower conjunctival sac four times daily and at bedtime for one week, Solution: One or two drops every two to three hours for one week, Ketotifen 0.025% (Zaditor; available over the counter as Alaway), Naphazoline/pheniramine (available over the counter as Opcon-A, Visine-A).