Write a prescription (Rx) for a healthy 15‑year‑old with simple sectoral episcleritis.

Prescription for Simple Sectoral Episcleritis in a Healthy 15-Year-Old

For a healthy adolescent with simple sectoral episcleritis, prescribe artificial tears for symptomatic relief and reserve topical NSAIDs or corticosteroids only if symptoms persist beyond 1-2 weeks, as most cases are self-limiting and resolve within 1-3 months without intervention. 1, 2, 3

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Rx Format

Patient: [Name], 15 years old
Date: [Current Date]

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Primary Treatment (First-Line)

℞ Artificial Tears (preservative-free)

• Instill 1-2 drops in affected eye(s)
• Use 4-6 times daily as needed for comfort
• Quantity: 2 bottles (5 mL each)
• Refills: 2

1, 2, 3

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Adjunctive Therapy (Symptomatic Relief)

Cold compresses

• Apply to closed eyelid for 10-15 minutes
• Use 3-4 times daily as needed
• No prescription required

3

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Instructions to Patient/Guardian:

• Simple episcleritis typically resolves on its own within 1-3 months 3, 4
• Continue artificial tears regularly for comfort and lubrication 1, 2
• Apply cold compresses as needed for additional symptom relief 3
• Return immediately if: severe eye pain develops, vision becomes blurred, photophobia (light sensitivity) occurs, or no improvement after 2-4 weeks 1, 2
• These warning signs may indicate scleritis or uveitis, which require urgent ophthalmology evaluation 1, 2

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Follow-Up Plan:

• Reassess in 2-4 weeks if symptoms persist 2, 5
• If no improvement at that time, consider topical NSAID (e.g., ketorolac 0.5% four times daily) or topical corticosteroid (e.g., prednisolone acetate 1% four times daily) for 1-2 weeks 5, 3, 6
• Ophthalmology referral is not required for simple episcleritis with mild symptoms and clear diagnosis 1, 2
• Ophthalmology referral is mandatory if severe pain, visual disturbance, photophobia, or diagnostic uncertainty develops 1, 2

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Clinical Rationale

Simple episcleritis in a healthy adolescent is typically idiopathic and self-limiting, requiring only supportive care. 1, 2, 3 The condition presents with mild or no pain, superficial vessel hyperemia, and preserved vision—distinguishing it from scleritis, which causes severe pain, deep vessel injection, and potential vision loss. 2, 6

No routine laboratory workup or systemic evaluation is needed for simple, unilateral episcleritis without red flags in an otherwise healthy patient. 2 Targeted investigations would only be warranted if gastrointestinal symptoms (suggesting inflammatory bowel disease) or joint symptoms (suggesting rheumatoid arthritis) were present. 2

Artificial tears and cold compresses provide adequate symptomatic relief for most cases, with topical NSAIDs or corticosteroids reserved for persistent symptoms beyond 2-4 weeks. 1, 2, 5, 3 The nodular type tends to be more recurrent and painful than simple episcleritis, but both typically resolve within 1-3 months. 3, 4

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Critical Safety Points

• Do not mistake scleritis for episcleritis: Severe pain should immediately raise concern for scleritis, which requires urgent ophthalmology referral and systemic anti-inflammatory treatment 2, 5, 7
• Do not start topical corticosteroids before ophthalmology examination if diagnosis is uncertain: This may worsen infectious causes (e.g., herpetic keratitis) or mask accurate diagnosis 1
• Reassess diagnosis if no improvement after 2-4 weeks of conservative treatment, as this may indicate an alternative diagnosis or need for escalation 2, 5