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Dry eyes, joint swelling and pain, asymptomatic pain in eye movement. Lotemax. Help?

I am a 47 year old woman, who has been diagnosed with dry eyes and episcleritis for 5 months already. My eyes are diffusely pink when I wake up and become increasingly red at night, occasionally slightly painful on extreme eye movement but usually asymptomatic . It is affecting me more due to its cosmetic effect. The redness goes away with Loteprednol (Lotemax) drops 3x a day but would recur upon tapering . I stopped putting after 2 months due to worries of long-term consequences. At present, I am maintained on tears substitute as needed. I have been worked up for connective tissue diseases (auto-antibodies) which were negative. I do have some non-specific systemic symptoms like muscle and joint pains (without joint swelling) upon waking up in the morning; feeling thirsty when I wake up in the middle of the night; and I have been diagnosed with Allergic Rhinitis with strong Atopic history. I would like to know your thoughts about my case. Any suggestions with my management? Your opinion is highly appreciated. Thank you.
Asked On : Thu, 14 Mar 2013
Answers:  1 Views:  111
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Ophthalmologist 's  Response
Dear user
From history i can find out that you are having dry eyes and episcleritis with joint involvement.

Episcleritis is usually recurrent and it is rarely associated with connective tissue diseases. Since you have already been evaluated and tested negative for connective tissue diseases, the main treatment is by steroid eye drops like loteprednol. If it is not responding oral steroids can be used.

Since you have got dry eyes also, even dry can cause pain and redness of eyes and it is also known to be associated with connective tissue diseases. For dry eye you are on treatment with tear substitutes. I advice you to undergo dry eye evaluation to find out the type of dry eye to consider further options in treatment like cyclosporine eye drops,methods of tear preservation and so many.
I would like to advice you to undergo dry eye evaluation and modify the treatment for dry eye.
Thank you
Answered: Tue, 9 Jul 2013
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