Episcleritis and scleritis

Question 1

Define scleritis and episcleritis

Answer 1

inflammation of the sclera

Episcleritis = inflammation of the episclera (layer underneath the conjunctiva)

Question 2

Aetiology of scleritis

Answer 2

Usually systemic

Rheumatoid arthritis
SLE
Sarcoidosis
Granulomatosis with polyangiitis

Question 3

Aetiology of episcleritis

Answer 3

Idiopathic
Inflammatory bowel disease
Rheumatoid arthritis

Question 4

Symptoms and signs of scleritis

Answer 4

Red eye
Severe pain in the orbit
Pain on eye movement
Photophobia
Watering eye
Gradual decrease in vision
Bluish tinge to the white of the eye in severe or necrotising scleritis
Systemic symptoms in ~50% of patients

Question 5

Symptoms and signs of episcleritis

Answer 5

Sectoral redness
Tenderness over the inflamed area
Milder pain compared to scleritis
Photophobia
Watering eye
Episcleral vessels move or blanch when pressed with a cotton bud

Question 6

Investigations for scleritis/episcleritis

Answer 6

Phenylephrine eye drops: causes conjunctival and episcleral vessels blanching → NO blanching suggests scleritis
Urine dipstick: ?renal disease

FBC: ? anaemia of chronic disease
CRP
U&Es
LFTs
Autoimmune serology e.g. RhF, anti-CCP

Question 7

Management for scleritis

Answer 7

Same day ophthalmology assessment
Mild: NSAIDs e.g. fluriprofen PO 100mg TDS
Severe: Corticosteroids e.g. PO prednisolone / pulsed IV methylprednisolone
Long-term: steroid-sparing therapy

Question 8

Management for episcleritis

Answer 8

Supportive
Self-resolving
Artificial tears

Question 9

Prognosis of scleritis

Answer 9

Less than 5% of patients lose useful vision long-term
Vision deteriorates in 25% of patients in the years following scleritis and some patients develop cataracts