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/middle-aged) | *70% of cases occurs in women (usually young/middle-aged) | ||
* Usually a benign, self-limited condition | *Usually a benign, self-limited condition | ||
* Can be classified into simple (more common) or nodular types | *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 | *Most commonly idiopathic but may occur as an ocular manifestation of underlying autoimmune conditions eg RA, IBD | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Episcleritiseye.jpg|thumb|Episcleritis]] | [[File:Episcleritiseye.jpg|thumb|Episcleritis]] | ||
===History=== | ===History=== | ||
* Abrupt onset of redness, irritation, and watering of the eye | *Abrupt onset of redness, irritation, and watering of the eye | ||
* Pain is unusual | *Pain is unusual | ||
* Vision unaffected | *Vision unaffected | ||
* 50% of cases are bilateral | *50% of cases are bilateral | ||
===Physical exam=== | ===Physical exam=== | ||
| Line 23: | Line 23: | ||
==Diagnosis== | ==Diagnosis== | ||
* Must distinguish from [[scleritis]] | *Must distinguish from [[scleritis]] | ||
**Scleritis likely to have pain and decreased vision | **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> | **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 | **Red area will be mobile if moved with a moist q-tip | ||
* Must distinguish from [[conjunctivitis]] | *Must distinguish from [[conjunctivitis]] | ||
**Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in conjunctivitis. | **Episcleritis will usually have a sectoral pattern of injection, as opposed to a diffuse injection seen in conjunctivitis. | ||
Revision as of 21:17, 5 July 2016
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
Clinical Features
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
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Diagnosis
- 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.[1]
- 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
Disposition
- Refer to ophtho is unsure of diagnosis or if steroids are necessary for Tx
- Self-limiting (will resolve within 2-3 weeks)
See Also
External Links
References
- ↑ Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am 2008; 26:35-55.