Diffuse episcleritis presents as acute redness and mild pain in one or both eyes. It typically presents in young adults who may have no significant past medical history. It can be localized in a conjunctival nodule or diffusely involve the globe.
Iritis (inflammation inside the eye) and conjunctivitis may also be present at the same time as episcleritis. What causes episcleritis? Most of the time it is idiopathic (we don't know why it happened), or it can be secondary to an infection such as herpes zoster (chicken pox reactivation) or other illness such as rosacea, thyroid disease or atopy.
Treatments include natural tears 4x/day for mild disease, and NSAID (ibuprofen 200-600mg TID) with or without mild topical steroids such as FML 0.1% qid for more serious presentations.
In your case, since it seems to be getting worse on the ibuprofen, and you have changes in your pupil I am concerned that you may have some anterior uveitis. If this is true, it is important that you be evaluated by your ophthalmologist so she can grade the amount of uveitis (swelling inside the eye) you may have. This can only be done with a slit lamp exam. Also, it is possible that the swelling of your nose and the puffiness could be from acne rosacea, which is known to be associated with scleritis. Once again, your ophthalmologist should be able to make this diagnosis in the office. One of the treatments for rosacea is doxycyclene 100 mg/day and/or metranidazole cream.
I agree with you that more then just diffuse episcleritis may be going on now in your case. I suggest you see your ophthalmologist for a re-evaluation.
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