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. 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. No Blurred Vision (contrast with Scleritis)
  4. Mild photophobia
  5. 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. Dilated Episcleral blood vessels
    2. Episcleral Edema

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

VIII. Course

  1. Resolves spontaneously within days

IX. Management

  1. No treatment needed (resolves spontaneously)
  2. Ocular NSAID

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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Related Studies

Ontology: Episcleritis (C0014583)

Definition (NCI) Inflammation of the thin layer of tissue lining the sclera of the eye characterized by redness in the white portion of the eye.(NICHD)
Concepts Disease or Syndrome (T047)
MSH D015423
ICD10 H15.1
SnomedCT 194139000, 155201000, 815008
English Episcleritides, EPISCLERITIS, episcleritis, episcleritis (diagnosis), Episcleritis NOS, Bulbar Conjunctivitis, Episcleritis (disorder), Episcleritis, NOS, Episcleritis
Portuguese EPISCLERITE, Episclerite NE, Episclerite
Spanish EPISCLERITIS, Episcleritis NEOM, Episcleritis, epiescleritis (trastorno), episcleritis (trastorno), epiescleritis, episcleritis
Dutch episcleritis NAO, episcleritis, Episcleritis
French Episclérite SAI, Episclérite, EPISCLERITE, Épisclérite
German Episkleritis NNB, Episkleritis, EPISKLERITIS
Italian Episclerite NAS, Episclerite
Japanese 上強膜炎, 上強膜炎NOS, ジョウキョウマクエンNOS, ジョウキョウマクエン
Czech Episkleritida NOS, Episkleritida, episkleritida
Korean 상공막염
Hungarian Episcleritis, Episcleritis k.m.n.
Norwegian Episkleritt