Is there a cure for episcleritis?


My 18 month old golden retriever has enlarged eyes with swelling that sometimes causes the whites of her eyes to protrude over her lower eyelid.  She is being treated with steroids and her eyes are still bulging.  Sometimes the bulging is severe other times it is minimal.  She has been diagnosed with episcleritis. Any suggestions?


Episcleritis is an autoimmune surface disease affecting the white portion of the eyes (sclera) and can result in redness and have a swollen appearance to the eyes.  This disease can affect one eye or both eyes and can be difficult to get resolved completely.  Your veterinarian was correct in being concerned about this disease and steroid therapy should help control episcleritis.  Often times dogs need more aggressive therapy (topical and systemic steroids) if it is a severe case and usually requires long term medication to keep the autoimmune disease in check.

Another consideration for what is being described is a disease that affects both eyes of young Golden Retrievers.  There is a disease process that affects the muscles responsible for holding the eyes in proper position (called the extraocular muscles), which can become inflamed and result in a bulging or enlarged appearance to the eyes.  This disease that I am referring to is called extraocular polymyositis.  This is also considered an autoimmune disease where the body attacks the specific support muscles of the eye and can affect eye movement. With a tricky case such as this one that has not resolved completely with the current therapy, the first recommendation is to have a veterinary ophthalmologist exam your dog in order to help to determine the underlying cause of your dogs’ eye condition. 

Based on the eye exam, an ophthalmologist may recommend further diagnostics like advanced imaging (CT or MRI) to look for inflamed extraocular muscles or other potential work up based on the exam findings. Typically, the extraocular polymyositis responds to immunosuppressant doses of oral steroids, however it would be important to rule out any potential infections or body system issues with bloodwork and urinalysis prior to using a high dose of steroids. A veterinary ophthalmologist would work with you and your local veterinarian to formulate the best treatment plan to ensure that your young Golden Retriever maintains eye comfort and continues to have the best vision possible in both eyes.