What is the treatment for scleral swelling after rubbing?

Scleral Swelling After Rubbing

For scleral swelling after eye rubbing, stop rubbing immediately, apply cool compresses, use lubricating eye drops, and observe for 24-48 hours—most cases resolve spontaneously without intervention.

Immediate Management

The primary treatment is cessation of mechanical trauma and supportive care. Eye rubbing causes direct mechanical trauma to the conjunctiva and episcleral tissues, leading to localized edema and vascular congestion that typically resolves without specific medical intervention.

First-Line Interventions

• Stop all eye rubbing immediately to prevent further mechanical trauma and allow tissue recovery
• Apply cool compresses for 10-15 minutes several times daily to reduce swelling and provide symptomatic relief
• Use preservative-free artificial tears 4-6 times daily to maintain ocular surface hydration and comfort
• Elevate the head of the bed during sleep to facilitate fluid drainage and reduce periocular edema

When to Escalate Care

Seek immediate ophthalmologic evaluation if any of the following develop:

• Pain disproportionate to the visible swelling, which may indicate deeper scleral inflammation or posterior scleritis 1
• Vision changes, including blurred vision or visual field defects
• Persistent swelling beyond 48-72 hours despite conservative measures
• Signs of infection: increasing redness, warmth, purulent discharge, or fever 2
• Anterior chamber reaction or signs of intraocular inflammation 1

Differential Considerations

While simple mechanical trauma from rubbing is most common, clinicians must exclude more serious conditions:

• Posterior scleritis presents with eye pain, eyelid swelling, and may show diffuse scleral injection with choroidal thickening on ultrasound—requires systemic corticosteroids (typically 60-80 mg oral prednisone) 1
• Scleral infection is rare but serious, particularly in immunocompromised or alcoholic patients, requiring immediate surgical intervention and dual antibiotic therapy 2
• Angle-closure glaucoma secondary to ciliary body swelling can occur with posterior scleral inflammation, presenting with elevated intraocular pressure and requires urgent treatment with systemic corticosteroids and cycloplegics 3

Critical Pitfalls to Avoid

• Do not prescribe topical corticosteroids empirically without ruling out infectious causes or establishing a specific inflammatory diagnosis
• Do not dismiss persistent or worsening symptoms as simple mechanical trauma—posterior scleritis can present with seemingly benign anterior findings 1
• Avoid contact lens wear during the acute phase, as this can exacerbate corneal and scleral edema 4
• Do not overlook systemic associations in recurrent cases—consider autoimmune workup if episodes are frequent or bilateral

Expected Timeline

• Mild cases: Resolution within 24-48 hours with conservative management alone
• Moderate swelling: May take 3-5 days to completely resolve
• Failure to improve by 72 hours warrants ophthalmologic referral for slit-lamp examination and possible ultrasound evaluation