Ophthalmology & Optometry/Nodular episcleritis



Sorry I sent you a question earlier but I used the wrong email adress so im sending it again just in case...

My 9 month old son has just been diagnosed with nodular episcleritis and been prescribed FML drops. I've read online that this condition is generally the result of a more serious underlying condition and Im worried sick. He was also diagnosed with bacterial conjunctivitis last week and had drops for that too - could this be the cause? We also have a dog whom he loves to play with so could it be an allergic reaction?

He is very happy and extremely active - it seems as though nothing is wrong with him. Is it worth reviewing him for an underlying condition? He has now had 2 drops of FML and it seems as though his eye is slightly less red...


ANSWER: Modular episcleritis is treated with topical steroids (FML)  I wouldn't be too concerned about an underlying systemic cause at this juncture but if it reoccurs say two or three times it would be
Best to get him evaluated for any auto immune diseases like RA , lupus  and so
On.  Allergy could in fact irritate the eye and cause inflammation in one quadrant of the eye with nodules forming.  Keep him away from the dog until
His eye clears up and see what happens.  Good
Luck.  Dr Berger

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QUESTION: Many thanks.

When you talk of reoccurrence, what time frame are we talking about? Is it any reoccurrence at all or within a year etc

And sorry one more thing... I have been told me that nodular episcleritis is very rare in children and I should have taken him for a second opinion. My son was seen by an opthamologist so I did not doubt the diagnosis, this was backed up by the fact that his eye got better almost immediately after starting the FML drops. In your experience are there any other eye conditions with similar symptoms? Ie the partially red eye with a nodule/blister.  My husband had very similar symptoms himself yesterday for which he also took FML drops and his eyes have cleared up today.

Thanks again, I'm sure you can tell that I'm a first time mum who worries about everything!!

ANSWER: Worried and concerned and rightfully so.  It's true that most cases of episcleritis is in the adult group and with reoccurrences. Conditions like rheumatoid arthritis, lupus , and other auto immune conditions must be ruled out .  The fact is that 95% are self-limiting and respond well to topical steroids like FML, Lotemax, Pred Acetate  even Alrex.  And the likelihood that your baby developed an ocular allergy ( dog? Pollen? grass?  ) and responded well to the steroid drops .  The redness and bump indicates inflammation and steroids are used to treat inflammation. So in all likelihood, he may have been misdiagnosed but the treatment plan is similar .   Hope this clarifies it a bit

YOUR rating indicates that you are still unclear about my response to you . What question do you still  have? Perhaps I can further clarify the answer better

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Thank you so much for getting back to me! I was just unsure whether you were suggesting that we should rule out autoimmune diseases or if it may be that my son was misdiagnosed? I don't suppose the latter is likely given the appearance of a nodule.... I guess my question should be whether other conditions (eg allergies or conjunctivitis which he is still fighting off in his other eye) could cause nodules?

Thanks again :)

In some cases of Allergic conjunctivitis there is an appearance of an elevated pocket of conjunctival Edema which can be misconstrued as a nodule the treatment is cool compresses and if pain and inflammation is present  with severe amount of redness then steroids are often prescribed.  At your sons young age it is more likely to be an allergic reaction rather than nodular episcleritis caused by an auto
Immune response.   Furthermore most cases of nodular episcleritis are idiopathic meaning there is no discovered causative agent that triggered the reaction.  Phlyctenular conjunctivitis and a Trantas Dot can appear like a nodule and are not auto immune reactions  

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Any and all questions with regard to ocular ailments, eye diseases as cataracts, glaucoma, macular degeneration, diabetic retinopathy, etc , eye and visual sympomatology, eyeglasses, contact lenses, low or subnormal vision, pediatric vision conditions,and special and unique ailments will be discussed.


36 years of clinical experience in opticianry and therapeutic optometry. Still in private practice with special interests in vision conditions, diagnosing and treating ocular ailments, prescibing treatment plans which include medicine, eyeglasses, and contact lenses primarily. Although surgery is not within the realm of my area of expertise, I co-manage many pre and post -op surgical cases which include Lasik and PRK procedures.

New Jersey Society of Optometric Physicians American Optometric Association

B.A.,1968, Hunter College of the City University of New York B.S.,1970, Pennsylvania College of Optometry O.D.,1973, Pennsylvania College of Optometry Therapeutic Pharmaceutical Administration Certification, New Jersey 1992

Awards and Honors
Clinical Efficiency Award, 1973, Pennsylvaania College of Optometry

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