scleritis vs episcleritis

Question 1

how to differentiate episcleritis from scleritis?

Answer 1

blanching test: give topical phenylphrine (alpha1 agonist, vasoconstrictor)
vessels in episclera= constrict (tx is symptomatic, self limiting disease)

vessels in sclera =will not constrict (emergency)

Question 2

causes of scleritis and episcleritis?

Answer 2

autoimmune: SLE, RA
scarcoidosis
IBD

Question 3

scleritis signs and symptoms? complications?

Answer 3

red eye, pain, photophobia, decreased vision (just like episcleritis)

scleral thinning (blue hue in natural light), and injection, fails blanching test

complication: scleromalacia -> perforation, glaucoma, cataracts

Question 4

management of scleritis?

Answer 4

1. admit pt
2. give topical steroid
3. tx underlying cause