episcleritis + scleritis Flashcards
what is episcleritis?
a benign and self limiting inflammation of the episclera
what is the episclera?
the outermost layer of the sclera just underneath the conjunctiva
presentation of episcleritis
acute onset unilateral symptoms
typically not painful (mild) segmental redness (patch) foreign body sensation dilated episcleral vessels watering eye no discharge
*often associated with RA and IBD
management of episcleritis
refer to ophthalmology
self limiting 1-4 weeks
no tx necessary
lubricating eye drops can help symptoms
simple analgesia / NSAIDs
cold compression
topical steroid eye drops
safety net.
what is scleritis?
inflammation of the full thickness of the sclera
more serious than episcleritis
not usually caused by infection
necrotising scleritis
most severe type
most patient has visual impairment but may not have pain
can lead to perforation father sclera
associated systemic conditions with scleritis
Rheumatoid arthritis Systemic lupus erythematosus Inflammatory bowel disease Sarcoidosis Granulomatosis with polyangiitis
how does scleritis present?
Severe pain Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of the eye
*around half cases are bilateral
how is scleritis managed?
NSAIDs (topical / systemic)
steroids
immunosuppression (if underlying condition)
refer for same day ophthalmologist
how to differentiate episcleritis from scleritis?
give topical phenylephrine 10%
in episcleritis- this will make the redness disappear
in scleritis- it will have no effect on the redness as its a topical vasoconstrictor and therefore constricts the more superficial episcleral vessels in episcleritis (not deeper vessels in the scleritis)
