Episcleritis

Aka: Episcleritis

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II. Pathophysiology

  1. Inflammation of connective tissue under Conjunctiva

III. Causes

  1. Idiopathic in most cases
    1. Contrast with Scleritis which is often a manifestation of Connective Tissue Disease
    2. May be associated wth Inflammatory Bowel Disease
  2. Allergy may underly many cases
  3. Uncommon other causes
    1. Connective Tissue Disease
    2. Acne Rosacea
    3. Atopic Patient

IV. Symptoms

  1. More mild eye discomfort than in Scleritis
    1. Red Eye with gritty, uncomfortable Sensation
  2. Sudden onset of symptoms (gradual onset in Scleritis)
  3. Unilateral in most cases
  4. No Blurred Vision (contrast with Scleritis)
  5. Mild photophobia
  6. Mild eye tearing

V. Signs

  1. No change in visual acquity
  2. Pupils equal and reactive to light
  3. Focal (single sector) of raised white area with blood vessels radiating out
    1. Superficial, Scleral blood vessel inflammation
    2. Dilated Episcleral blood vessels
    3. Episcleral Edema
    4. Vessels blanch when exposed to Phenylephrine

VI. Signs: Slit Lamp Exam

  1. Superficial Localized Edema over Sclera
  2. No Scleral thickening or other involvement
  3. Scleritis blanches with topical Phenylephrine 2.5% (contrast with Scleritis which does not blanch)

VII. Differential Diagnosis

  1. See Red Eye
  2. Scleritis
  3. Uveitis
  4. Conjunctivitis

VIII. Course

  1. Resolves spontaneously within days

IX. Management

  1. No treatment needed (resolves spontaneously)
  2. Ocular NSAID
  3. Differentiate from Scleritis and Uveitis, which present with severe pain, and even permanent Vision Loss

X. References

  1. Goldstein in Yanoff (1999) Ophthalmology, p. 13.1
  2. Ruddy (2001) Kelley's Rheumatology, Saunders, p. 396
  3. Nakla (1998) Gastroenterol Clin North Am 27:697-711 [PubMed]

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