Episcleritis/Scleritis Flashcards
Episcleritis
Benign and self-limiting localised inflammation of the episclera
Episclera
The outer most layer of the sclera.
The episclera is situated just underneath the conjunctiva
Which conditions are associated with episcleritis
Inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease
Presentation of episcleritis
Acute onset unilateral symptoms:
- Painless/ mild pain
- Segmental redness (rather than diffuse).
- Patch of redness in the lateral sclera
- Foreign body sensation
- Dilated episcleral vessels
- Watering of eye
- No discharge
Management of episcleritis
Doubt about the diagnosis - refer to ophthalmology
Lubricating eye drops can help symptoms
Simple analgesia, cold compresses and safety net advice
Severe cases - systemic NSAIDs (e.g. naproxen) or topical steroid eye drops
Investigations for episcleritis
Fundoscopy
Scleritis
Inflammation of the full thickness of the sclera
Presentation of scleritis
Acute onset unilateral symptoms:
- Painful as deep vessels affected
- Pain with eye movements
- Photophobia
- Reduced visual acuity
- Abnormal pupil reaction to light
- Diffuse redness
- Foreign body sensation
- Watering of eye
- No discharge
Necrotising scleritis
Have visual impairment but may not have pain
It can lead to perforation of the sclera
Complication of scleritis
Necrotising scleritis
Associated Systemic Conditions for scleritis
Rheumatoid arthritis
Systemic lupus erythematosus
Inflammatory bowel disease
Sarcoidosis
Granulomatosis with polyangiitis
Management of scleritis
Management in secondary care involves:
Consider an underlying systemic condition
- NSAIDS (topical / systemic)
- Steroids (topical / systemic)
- Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)
How long does episcleritis take to settle
Recover in 1-4 weeks
