Episcleritis Flashcards
Describe Episcleritis (onset, what it is, layers involved)
- Benign, sudden onset
- Inflammation of the episclera
- Involves conjuctival vessels, deep episcleral plexus and superficial scleral plexus (Tenon’s vessel, most painful)
Describe Symptoms of Episcleritis (redness, pain, discharge)
- acute onset of redness
- mild pain in one or both eyes, not very painful
- may be recurrent
- no discharge
Describe Clinical Signs of Episcleritis
- sectorial (see it one localized area), sometimes diffuse redness in one or both eyes
- mild tenderness over episcleral injection
- nodule that can be moved slightly
- anterior uveitis/corneal involvement rare
- normal vision
Describe Associations of Episcleritis
- mostly no association with systemic disease
- women 20-40, majority of cases
- If underlying etology: do lab tests, ANA, rheumatoid factor, ESR, uric acid levels, RPR, FTA-ABS
How do you differentiate episcleritis from scleritis, iritis, conjunctivitis contact lens wear?
- Scleritis: pain is deep and severe
- Iritis: cells & flares in anterior chamber
- Conjunctivitis: - discharge and inferior tarsal conjunctival follicles or papillae
- Contact Lens overwear or tight contact lenses
What are the most common causes of episcleritis?
- most common cause is idiopathic
- next biggest cause is connective tissue disease (rheumatoid arthritis, gout)
- infectious disease, inflammatory bowel disease
- rosacea
- thyroid disease
What external clues are you looking for in episcleritis when doing work up? (how to differentiate from scleritis and what do to if you suspect underlying etiology)
- look for blueish hue to see if it’s scleritis
- Drop phenylephrine, episcleral vessels should blanche
if Hx suggests underlying etiology, do lab tests for ANA, Rheumatoid factor, ERS, serium uric acid, FTA-ABS
Which of the follow is the most appropriate work up for episcleritis?
A. Look externally for bluish hue to confirm scleritis
B. SLE all frontal structures and anesthetize cornea to determine dpeth of injected blood vessels)
C. Drop phenylephrine to see if episcleral vessels bleach
D. Run lab tests for ANA, Rheumatoid factor, ESR, uric acid levels, FTA-ABS
E. All of the above
E. All of the above
What is the most common form of episcleritis?
A. Sectoral
B. Diffuse
C. Nodular
D. Chronic
A. Sectoral
Describe simple episcleritis
Swellings, injections, nodules (if any) how long it takes to resolve
- moderate episcleral swelling and injection
- greyish infiltrates
- resolves 1-3 weeks
Describe nodular episcleritis
Swellings, injections, nodules (if any) how long it takes to resolve
- localized edema within area of injection
- movable nodule over deep episcleral plexus
- longer resolution
What is the treatment for mild, moderate nodular episcleritis?
- None. may be self limiting
- Mild: iced artificial tears, topical decongestants, cold compresses
- Moderate to severe: mild topical steriod (Loteprenol, Lotemax, fluoremetholone)
- Oral ASA or NSAID (ibuprofen or naproxen)
Your patient presents with a localized edema within an area of injection that is movable over deep episcleral plexus. What type of episcleritis is it?
A. Sectoral
B. Diffuse
C. Nodular
D. Chronic
C. Nodular
What is the treatment for severe nodular episcleritis?
A. Iced artificial tears, topical decongestants, cold compresses
B. Mild topical steroid (Lotemax, Loteprednol) with tapering
C. Oral ASA or NSAID (ibuprofen or naproxen)
D. B & C
D. B & C
B. Mild topical steroid (Lotemax, Loteprednol) with tapering
C. Oral ASA or NSAID (ibuprofen or naproxen)
What is the follow up schedule for episcleritis? (Steroids and aritificial tears)
- Steriods - check IOP’s weekly
- Artificial tears - follow up 2-3 weeks
