Episcleritis

Question 1

What is episcleritis?

Answer 1

Episcleritis is benign and self-limiting inflammation of the episclera, the outermost layer of the sclera. The episclera is situated just underneath the conjunctiva.

Question 2

What causes episcleritis?

Answer 2

It is relatively common in young and middle-aged adults and is not usually caused by infection. It is often associated with inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease.

Question 3

What are the clinical features of episcleritis?

Answer 3

Episcleritis usually presents with acute onset unilateral symptoms:

• Typically not painful but there can be mild pain
• Segmental redness (rather than diffuse)
  
  • There is usually a patch of redness in the lateral sclera
• Foreign body sensation
• Dilated episcleral vessels
• Watering of eye
• No discharge

Question 4

Briefly describe the management of episcleritis

Answer 4

If in doubt about the diagnosis, refer to ophthalmology.

Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms.

Simple analgesia, cold compresses and safetynet advice are appropriate.

More severe cases may benefit from systemic NSAIDs (e.g. naproxen) or topical steroid eye drops.

Question 5

Give differentials for a painless red eye

Answer 5

• Conjunctivitis
• Episcleritis
• Subconjunctival Haemorrhage

Question 6

Give differentials for a painful red eye

Answer 6

• Glaucoma
• Anterior uveitis
• Scleritis
• Corneal abrasions or ulceration
• Keratitis
• Foreign body
• Traumatic or chemical injury