• 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



  • 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


  • 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.


  • 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]


  • 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


  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.