Cargando…

Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report

A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit...

Descripción completa

Detalles Bibliográficos
Autor principal: Alghamdi, Ali Hendi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644324/
https://www.ncbi.nlm.nih.gov/pubmed/38022063
http://dx.doi.org/10.7759/cureus.47057
_version_ 1785134522749157376
author Alghamdi, Ali Hendi
author_facet Alghamdi, Ali Hendi
author_sort Alghamdi, Ali Hendi
collection PubMed
description A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique.
format Online
Article
Text
id pubmed-10644324
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-106443242023-10-15 Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report Alghamdi, Ali Hendi Cureus Ophthalmology A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique. Cureus 2023-10-15 /pmc/articles/PMC10644324/ /pubmed/38022063 http://dx.doi.org/10.7759/cureus.47057 Text en Copyright © 2023, Alghamdi et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Ophthalmology
Alghamdi, Ali Hendi
Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title_full Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title_fullStr Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title_full_unstemmed Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title_short Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report
title_sort treatment of steroid-resistant nodular episcleritis with tacrolimus: a case report
topic Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644324/
https://www.ncbi.nlm.nih.gov/pubmed/38022063
http://dx.doi.org/10.7759/cureus.47057
work_keys_str_mv AT alghamdialihendi treatmentofsteroidresistantnodularepiscleritiswithtacrolimusacasereport