Episcleritis

Background

• Abrupt onset of inflammation in the episclera
• 70% of cases occurs in women (usually young and middle-aged)
• Usually a benign, self-limited condition
• Usually not associated with an underlying disease

Diagnosis

• History
  • Abrupt onset of redness, irritation, and watering of the eye
  • Pain is unusual
  • Vision unaffected
  • 50% of cases are bilateral
• Physical
  • Vasodilatation of the superficial episcleral vessels
  • Focal area(s) of redness
  • May have a tender scleral nodule (nodular episcleritis)

Work-Up

• Must distinguish from scleritis
  • Phenylephrine drops lead to transient resolution of episcleral redness permitting evaluation of the sclera
• Must distinguish from conjunctivitis
  • If the conjunctival injection is localized rather than diffuse, episcleritis is more likely

DDx

1. Scleritis
2. Conjunctivitis
3. Herpes Keratitis

Treatment

1. Topical lubricants
   1. Artificial tears q4-6hr
2. Oral NSAIDs

Disposition

Refer to ophtho to reduce chance of misdiagnosis

Prognosis

Self-limiting (will resolve within 2-3 weeks)

See Also

Scleritis

Source

UpToDate