Episcerlitis Flashcards
Define episcleritis
Inflammation of the episclera involving the superficial episcleral plexus.
Nodular episcleritis
Episcleritis with an associated nodule. Bump due to inflammatory response
Etiology/associations
60% idiopathic. Most likely! If recurrent or OU, then consider systemic.
Collagen vascular disease/vasculitis. RA, SLE, GPA, PAN, Bechets.
Systemic infection- herpes, lyme, sphilis, TB.
^Really anything that causes systemic inflammation.
Most commons symptoms and complaints of patients
Red eye !!!
No discharge, pain, or itchiness. If any, very mild. Otherwise, seems asymptomatic.
Signs
Sectoral episcleral junction. This is more common than a diffuse presentation.
There may be some secondary involvement of overlying conj vessels.
Chemosis (edema) in area of injection.
Mobile nodule in nodular episcleritis (yellow, white bumo under area of redness)
Rarely, AC rxn.
How to manage episcleritis
Dr. Ensor’s go to: Mild topical steroid.
Oral NSAIDs as an alternative to topical steroids.
Self limiting within days to weeks. Will go away on its own.
Cold compresses, topical lubricants for palliative therapy.
How to treat episcleritis if it has an infectious etiology?
Treat with appropriate anti-infective
What to do if it is bilateral, recurrent, or nodular and etiology is unknown?
Order lab work. Unless it is an initial episode of unilateral simple episcleritis without systemic symptoms.
If systemic symptoms, refer out for systemic treatment.
How often do you have simple vs nodular ?
Simple- 80%
Nodular- 20%
How long does simple vs nodular episcleritis usually last for?
Simple- Typically lasts a few days.
Nodular- can last for weeks.
Which type of scleritis is more associate with systemic disease?
Nodular
Bilateral
Recurrent
What can aid in differentiating between episcleritis and scleritis?
Instill phenyl 2.5% and reexamine after 15 mins.
Vessels blanch in episceritis, not in scleritis.
