Episcleritis

Background

• Abrupt onset of inflammation in the episclera
• 70% of cases occurs in women (usually young and middle-aged)
• Usually a benign, self-limited condition
• Usually not associated with an underlying disease

Diagnosis

• History
  • Abrupt onset of redness, irritation, and watering of the eye
  • Pain is unusual
  • Vision unaffected
  • 50% of cases are bilateral
• Physical
  • Vasodilatation of the superficial episcleral vessels
  • Focal area(s) of redness
  • May have a tender scleral nodule (nodular episcleritis)

Work-Up

• Must distinguish from scleritis
  • Phenylephrine drops lead to transient resolution of episcleral redness permitting evaluation of the sclera
• Must distinguish from conjunctivitis
  • If the conjunctival injection is localized rather than diffuse, episcleritis is more likely

DDx

1. Scleritis
2. Conjunctivitis
3. Herpes Keratitis

Eye Algorithm (Main)

Treatment

1. Topical lubricants
   1. Artificial tears q4-6hr
2. Oral NSAIDs

Disposition

Refer to ophtho to reduce chance of misdiagnosis

Prognosis

Self-limiting (will resolve within 2-3 weeks)

See Also

Scleritis

Source

UpToDate