Episcleritis

Background

• Abrupt onset of inflammation in the episclera
• 70% of cases occurs in women (usually young/middle-aged)
• Usually a benign, self-limited condition
• Can be classified into simple (more common) or nodular types
• Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg RA, IBD

Clinical Features

Episcleritis

History

• Abrupt onset of redness, irritation, and watering of the eye
• Pain is unusual
• Vision unaffected
• 50% of cases are bilateral

Physical exam

• Vasodilatation of the superficial episcleral vessels
• Focal area(s) of redness
• May have a tender scleral nodule (nodular episcleritis)

Differential Diagnosis

Unilateral Red Eye

• Acute angle-closure glaucoma^
• Anterior uveitis
• Caustic keratoconjunctivitis^^
• Conjunctival laceration
• Conjunctivitis
• Corneal abrasion
• Corneal erosion
• Ocular foreign body
• Corneal ulcer^
• Endophthalmitis^
• Episcleritis
• Globe rupture^
• Herpes zoster ophthalmicus
• Intraocular foreign body
• Inflamed pingueculum
• Inflamed Pterygium
• Keratoconjunctivitis
• Keratoconus
• Lens dislocation
• Nontraumatic iritis
• Scleritis^
• Subconjunctival hemorrhage
• Traumatic hyphema
• Traumatic iritis
• Ultraviolet keratitis

^Emergent diagnoses

^^Critical diagnoses

Evaluation

• Must distinguish from scleritis
  • Scleritis likely to have pain and decreased vision
  • Use of 2.5% phenylephrine drops will cause vasoconstriction/blanching of episcleral but not scleral vessels. Thus, there will be decreased injection and redness in episcleritis but not scleritis.
  • Red area will be mobile if moved with a moist q-tip
• Must distinguish from conjunctivitis
  • Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in conjunctivitis.

Management

• Topical lubricants
  • Artificial tears q4-6hr
• Oral NSAIDs

Disposition

• Refer to ophtho is unsure of diagnosis or if steroids are necessary for treatment
• Self-limiting (will resolve within 2-3 weeks)

See Also

• Scleritis

References

Authors

Ross Donaldson, Christopher Mathew, Daniel Ostermayer, Neil Young