Episcleritis

Inflammation of the episclera, the thin vascular sheet which lies between the conjunctiva and sclera; more superficial and less severe than scleritis

Aetiology

Idiopathic

• Accounts for the majority of cases

• Often recurrent and self-limiting

Associated Systemic Conditions

• Rheumatoid arthritis

• Systemic lupus erythematosus

• Inflammatory bowel disease

• Vasculitides (e.g., polyarteritis nodosa)

• Gout

• Herpes zoster infection (less common)

Clinical presentation

Symptoms

• Acute onset of redness in one or both eyes

• Mild ocular discomfort or tenderness

• Foreign body sensation

• Rarely photophobia

• No significant visual impairment

Signs

• Sectoral or diffuse bright red injection

• Superficial episcleral vessels that are mobile over the sclera

• Minimal or absent discharge

• Nodular episcleritis presents with a localized, tender episcleral nodule

• No corneal involvement

Management

Conservative Treatment

• Reassurance

• Lubricating eye drops

• Cold compresses

Medical Treatment

• Topical nonsteroidal anti-inflammatory drugs (NSAIDs)

• Topical corticosteroids (short-term use in symptomatic cases)

• Oral NSAIDs for nodular episcleritis or significant discomfort