Based mainly on two randomized controlled studies, the authors recommend a 10-day course of either prednisolone 50 mg or prednisone 60 mg for five days followed by a five-day taper. The guideline authors also note that clinicians should explain the risks of oral corticosteroids when prescribing.
Regarding antiviral therapy, a strong recommendation against antiviral monotherapy is made, but the authors describe the use of combined oral corticosteroids and antiviral therapy as an “option.” They justify the optional addition of antiviral therapy to corticosteroid use by the relative low-risk profile for antiviral agents.
Lastly, there is a strong recommendation for providing eye care to patients with impaired eye closure. There is no evidence for this recommendation, but it is a strong recommendation based on expert opinion and preponderance of benefit over harm.
Dr. Gemme is a resident in emergency medicine at Alpert Medical School of Brown University, Providence, Rhode Island, and the 2013–2014 EMRA Representative to the ACEP Clinical Policies Committee.