Episcleritis

Definition:

Episcleritis is a mild and self-limiting inflammatory condition of the episcleral tissue that lies between the conjunctiva and the sclera of the eye.

Specific characteristics of Episcleritis

• A red, and sometimes slightly yellow, raised area
• Acute onset
• Non-infectious
• Usually associated with an underlying systemic inflammatory or rheumatologic condition
• Condition may disappear and recur on its own
• Self-limiting disease causing little or no permanent damage to the eye
• Normal vision
• Similar to conjunctivitis but without discharge

Affected population

• Young adults
• Women are more affected than men

Causes of Episcleritis

Most of the cases of episcleritis are idiopathic; this means that there is no exact cause of its occurrence. But it is also a fact that up to one third cases of episcleritis has an underlying systemic inflammatory or rheumatologic condition that can be considered the cause of episcleritis. Other than this, some cases may also be caused by exogenous inflammatory stimuli.

Collagen-vascular diseases that may cause episcleritis are:

• Rheumatoid arthritis
• Systemic lupus erythematosus
• Polyarteritis nodosa
• Sjogren’s syndrome
• Seronegative spondyloarthropathies like:
  • Ankylosing spondylitis
  • Inflammatory bowel disease
  • Reactive arthritis
  • Psoriatic arthritis

Infectious diseases that may cause episcleritis are:

• Bacterial diseases like tuberculosis, Lyme disease, and syphilis
• Viral conditions, including herpes
• Fungi
• Parasites

Miscellaneous causes are:

• Gout
• Atopy
• Foreign bodies
• Chemicals

Symptoms of Episcleritis

• Generalized or local redness of the eyes
• Mild soreness
• Eye discomfort
• No visual problems
• Eye tenderness and irritation
• Slightly increased watering of the eye
• Mildly increased sensitivity to bright light

Clinical types of Episcleritis

Simple Episcleritis

• Common type
• Intermittent attacks of moderate-to-severe inflammation
• Attacks recur at 1- to 3-month intervals
• Episodes last 7-10 days, and most resolve after 2-3 weeks
• More common episodes in the spring or fall
• Attacks can be because of stress and hormonal changes

Nodular Episcleritis

• Prolonged and painful attacks of inflammation
• Characterized by presence of a freely moveable nodule
• Patients have an associated systemic disease

Exams and Tests

The diagnosis of episcleritis is quite obvious on history taking (symptoms) and physical examination of the eye. It usually does not require any special tests. But a complete work-up including a review of systems may be needed in some cases to uncover a possible underlying medical condition.

Treatment

Episcleritis generally goes away on its own without any treatment in 1-2 weeks, but treatment may relieve pain and other symptoms faster.

• Ocular therapy

  • Artificial tears
  • Topical corticosteroids
  • Anti-inflammatory agents.

• Systemic therapy

  • Systemic nonsteroidal anti-inflammatory drug

Prognosis of Episcleritis

Episcleritis is a self-limiting disorder that most often improves without any treatment. But if the symptoms of episcleritis last for more than 2 weeks or pain gets worse or there are any problems with vision, it is better to get your eyes thoroughly checked by an ophthalmologist.

Very rarely, episcleritis can give way to irritation and inflammation of the white part of the eye called scleritis.

An associated anterior uveitis may also occur in 10% of patients of episcleritis.