Episcleritis is a self-limiting, recurrent inflammatory condition of the episclera. We present a case of a patient with recurrent episodes of episcleritis, non-responsive to treatment with topical anti-inflammatories, showing rapid resolution, following the infusion of infliximab.

A 44-year-old woman presented with intermittent episodes of nodular episcleritis alternating between the right and left eyes. She had a background of Crohn's disease, psoriasis and enteropathic arthropathy, which were currently inactive on daily doses of 150mg azathioprine and 30mg prednisolone. Previous treatment with topical non-steroidal anti-inflammatories and steroids had not resolved her symptoms.

She reported her symptoms and signs were improved by an infusion of infliximab. On this occasion she presented with right-sided episcleritis. She was due an infusion of infliximab, so no topical therapy was started. Within 5-hours of completion of this infusion, the right eye showed marked reduction in redness and within 24-hours there was full symptomatic and clinical resolution of the episcleritis and there have been no further recurrences.

Infliximab is a chimeric monoclonal antibody to the inflammatory mediator tumor necrosis factor-alpha (TNF-α). Our case highlights the therapeutic value of infliximab in recurrent episcleritis refractory to conventional anti-inflammatory topical therapy, particularly in cases of episcleritis secondary to a systemic cause.