Episcleritis: Difference between revisions

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==Background==
==Background==
* Abrupt onset of inflammation in the episclera
*Abrupt onset of inflammation in the episclera
* 70% of cases occurs in women (usually young and middle-aged)
*70% of cases occurs in women (usually young/middle-aged)
* Usually a benign, self-limited condition
*Usually a benign, self-limited condition
* Usually not associated with an underlying disease
*Can be classified into simple (more common) or nodular types
*Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg [[RA]], [[IBD]]
*Also associated with [[glaucoma]] and cataracts<ref>Honik G, Wong IG, Gritz DC; Incidence and prevalence of episcleritis and scleritis in Northern California. Cornea. 2013 Dec;32(12):1562</ref>


==Diagnosis==
==Clinical Features==
* History
[[File:Episcleritiseye.jpg|thumb|Episcleritis]]
** Abrupt onset of redness, irritation, and watering of the eye
===History===
** Pain is unusual
*Abrupt onset of [[red eye|redness]], irritation, and watering of the eye
** Vision unaffected
*Pain is unusual
** 50% of cases are bilateral
*Vision unaffected
* Physical
*50% of cases are bilateral
** Vasodilatation of the superficial episcleral vessels


==Work-Up==
===Physical exam===
* Must distinguish from scleritis
*Vasodilatation of the superficial episcleral vessels
** Phenylephrine drops lead to transient resolution of episcleral redness permitting evaluation of the sclera
*Focal area(s) of redness  
* Must distinguish from conjunctivitis
*May have a tender scleral nodule (nodular episcleritis)
** If the conjunctival injection is localized rather than diffuse, episcleritis is more likely


==DDx==
==Differential Diagnosis==
#Scleritis
{{Unilateral red eye DDX}}
#Conjunctivitis
#Herpes Keratitis


==Treatment==
==Evaluation==
# Topical lubricants
*Must distinguish from [[scleritis]]
## Artificial tears q4-6hr
**Scleritis likely to have pain and decreased vision
**Use of 2.5% phenylephrine drops will cause vasoconstriction/blanching of episcleral but not scleral vessels. Thus, there will be decreased injection and redness in episcleritis but not scleritis.<ref>Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am 2008; 26:35-55.</ref>
**Red area will be mobile if moved with a moist q-tip
*Must distinguish from [[conjunctivitis]]
**Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in conjunctivitis.
 
==Management==
*Topical lubricants
**Artificial tears q4-6hr
*Oral [[NSAIDs]]
*[[Topical steroids]] may relieve symptoms but are associated with rebound redness and potentially worse future events and are generally not recommended<ref>Akpek EK, Uy H, Christen W, et al. Severity of episcleritis and systemic disease association. Ophthalmology. 1999;106:729.</ref>


==Disposition==
==Disposition==
Refer to ophtho to reduce chance of misdiagnosis
*Refer to ophtho is unsure of diagnosis or if steroids are necessary for treatment
*Self-limiting (will resolve within 2-3 weeks)
 
==See Also==
*[[Scleritis]]
 
==External Links==


==Source==
==References==
UpToDate
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]

Latest revision as of 16:40, 5 October 2019

Background

  • Abrupt onset of inflammation in the episclera
  • 70% of cases occurs in women (usually young/middle-aged)
  • Usually a benign, self-limited condition
  • Can be classified into simple (more common) or nodular types
  • Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg RA, IBD
  • Also associated with glaucoma and cataracts[1]

Clinical Features

Episcleritis

History

  • Abrupt onset of redness, irritation, and watering of the eye
  • Pain is unusual
  • Vision unaffected
  • 50% of cases are bilateral

Physical exam

  • Vasodilatation of the superficial episcleral vessels
  • Focal area(s) of redness
  • May have a tender scleral nodule (nodular episcleritis)

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • Must distinguish from scleritis
    • Scleritis likely to have pain and decreased vision
    • Use of 2.5% phenylephrine drops will cause vasoconstriction/blanching of episcleral but not scleral vessels. Thus, there will be decreased injection and redness in episcleritis but not scleritis.[2]
    • Red area will be mobile if moved with a moist q-tip
  • Must distinguish from conjunctivitis
    • Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in conjunctivitis.

Management

  • Topical lubricants
    • Artificial tears q4-6hr
  • Oral NSAIDs
  • Topical steroids may relieve symptoms but are associated with rebound redness and potentially worse future events and are generally not recommended[3]

Disposition

  • Refer to ophtho is unsure of diagnosis or if steroids are necessary for treatment
  • Self-limiting (will resolve within 2-3 weeks)

See Also

External Links

References

  1. ↑ Honik G, Wong IG, Gritz DC; Incidence and prevalence of episcleritis and scleritis in Northern California. Cornea. 2013 Dec;32(12):1562
  2. ↑ Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am 2008; 26:35-55.
  3. ↑ Akpek EK, Uy H, Christen W, et al. Severity of episcleritis and systemic disease association. Ophthalmology. 1999;106:729.
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