8th December 2023

Episcleritis

Episcleritis is inflammation of the episcleral tissue. It is usually self-limiting. It is classified as nodular or simple episcleritis. Simple episcleritis, where there is injection of the episcleral vessels without a nodule is more common. In the nodular form, there is injection over an underlying nodule, which commonly occurs within the interpalpebral fissure. It is a benign condition which tends to recur. There is a female preponderance, and occurs in middle age. Although frequently idiopathic, associations have been found with autoimmune and inflammatory diseases. Patients present typically with acute onset sectoral or diffuse redness and may experience mild discomfort in the area. There are no visual changes, and there may have been previous episodes. Examination shows injected vessels which are mobile over the underlying sclera, even in the nodular form. Diagnosis is clinical and can be confirmed by the application of 2.5% phenylephrine with the episcleral vessels blanching. Laboratory tests may be required in patients who have no systemic disease presenting with recurrent episodes.

Duration of each episode ranges from 2-3 days up to 3 weeks. The nodular form presents sub-acutely and has a prolonged course. As this is a self-limiting condition, treatment is not usually required in mild cases. Cool compresses and refrigerated tears may help. In moderate to severe cases, oral NSAIDS such as Ibuprofen can be given, and topical week topical steroids for 1-2 weeks can be administered. Treatment is tailored to the severity of inflammation. The prognosis for episcleritis is good.

Image Source: Wikimedia Commons (2017). Episcleritis, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Episcleritis.jpg (Accessed on: 5  May 2022).

Image Source: Wikimedia Commons (2013). Episcleritiseye, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Episcleritiseye.jpg (Accessed on: 5  May 2022).