First-line treatment options for managing scleritis are not initiated in primary care NICE CKS,NICE CKS. Treatment with corticosteroid eye preparations, which may be used for inflammatory eye conditions, should always be initiated in secondary care by a specialist NICE CKS. Primary care's role is limited to continuing and monitoring treatment only after a specialist management plan has been established NICE CKS.
For suspected inflammatory eye conditions like uveitis, which shares similar management principles, primary care should not initiate treatment NICE CKS. This is because diagnosis requires a slit-lamp examination, which is not typically available in primary care NICE CKS. Initiating treatment without a confirmed diagnosis carries risks, such as worsening conditions like herpes simplex virus infections if corticosteroids are used inappropriately NICE CKS,NICE CKS. People with eye pain and vision loss require immediate ophthalmology referral NICE CKS. Specialist referral is appropriate if symptoms persist, if other diagnoses need to be ruled out, or to prevent rare complications like sight-threatening keratitis NICE CKS.