scleritis and episcleritis

Question 1

what are the features of scleritis?

Answer 1

• red eye
• painful (sometimes mild / discomfort)
• watering
• photophobia
• gradual decrease in vision

Question 2

what is scleritis?

Answer 2

inflammation of the sclera that causes a deep red or violet eye with ‘boring’ pain, visual change and photophobia

Question 3

what distinguishes scleritis from episcleritis?

Answer 3

1. scleritis is painful; episcleritis is painless
2. in episcleritis, injected vessels are mobile when gentle pressure is applied; vessels are deeper in scleritis and hence do not move
3. decreased visual acuity in scleritis; no decrease in visual acuity in episcleritis

Question 4

what may be used to differentiate between episcleritis and scleritis?

Answer 4

phenylephrine drops

• blanches the conjunctival and episcleral vessels but not the scleral vessels
• if eye redness improves after phenylephrine, Dx of episcleritis can be made

Question 5

what are the features of episcleritis?

Answer 5

• red eye
• classically not painful (mild pain may be present)
• watering and mild photophobia may be present
• injected vessels are mobile when gentle pressure is applied to sclera
• ~50% cases bilateral

Question 6

how is episcleritis managed?

Answer 6

• conservative

- artificial tears sometimes used