Episcleritis

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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

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.[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 treatment
  • Self-limiting (will resolve within 2-3 weeks)

See Also

External Links

References

  1. Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am 2008; 26:35-55.