Episcleritis: Difference between revisions
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* Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg RA, IBD | * Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg RA, IBD | ||
== | ==Clinical Features== | ||
* History | *History | ||
** Abrupt onset of redness, irritation, and watering of the eye | ** Abrupt onset of redness, irritation, and watering of the eye | ||
** Pain is unusual | ** Pain is unusual | ||
** Vision unaffected | ** Vision unaffected | ||
** 50% of cases are bilateral | ** 50% of cases are bilateral | ||
* Physical | *Physical exam | ||
** Vasodilatation of the superficial episcleral vessels | **Vasodilatation of the superficial episcleral vessels | ||
**Focal area(s) of redness | **Focal area(s) of redness | ||
**May have a tender scleral nodule (nodular episcleritis) | **May have a tender scleral nodule (nodular episcleritis) | ||
== | ==Differential Diagnosis== | ||
*[[Eye Algorithm (Main)]] | |||
*[[Scleritis]] | |||
*Conjunctivitis | |||
*Herpes Keratitis | |||
==Diagnosis== | |||
* Must distinguish from [[scleritis]] | * Must distinguish from [[scleritis]] | ||
**Scleritis likely to have pain and decreased vision | **Scleritis likely to have pain and decreased vision | ||
| Line 24: | Line 30: | ||
**Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in 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== | ==Disposition== | ||
Refer to ophtho is unsure of diagnosis or if steroids are necessary for Tx | *Refer to ophtho is unsure of diagnosis or if steroids are necessary for Tx | ||
*Self-limiting (will resolve within 2-3 weeks) | |||
== | ==See Also== | ||
*[[Scleritis]] | |||
== | ==External Links== | ||
==References== | ==References== | ||
<references/> | |||
UpToDate | UpToDate | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 00:18, 16 June 2015
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
- 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
- Eye Algorithm (Main)
- Scleritis
- Conjunctivitis
- Herpes Keratitis
Diagnosis
- 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.
- 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 Tx
- Self-limiting (will resolve within 2-3 weeks)
See Also
External Links
References
UpToDate