- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
Episcleritis is defined by the abrupt onset of inflammation in the episclera of one or both eyes, typically presenting as redness, irritation, and watering of the eye with preserved vision. Most patients with episcleritis have a mild, isolated problem that responds readily to topical therapy alone and does not pose a threat to vision. Indeed, many patients with episcleritis require no treatment per se since the condition typically resolves over a short course. A small fraction of patients with episcleritis have an underlying systemic disease that signifies a serious health concern and that requires additional therapy.
Episcleritis is only one of many potential causes of a red eye, although other causes can generally be distinguished clinically from episcleritis based upon the medical history and the examination of the eye.
The clinical manifestations, diagnosis, and treatment of episcleritis will be reviewed here. The evaluation of the red eye and the clinical manifestations, diagnosis, and treatment of scleritis are discussed separately. (See "Evaluation of the red eye" and "Clinical manifestations and diagnosis of scleritis" and "Treatment of scleritis".)
Approximately 70 percent of cases of episcleritis occur in females . It occurs most frequently in young and middle-aged adults but may affect all age groups. There are no reliable data regarding the true incidence of episcleritis since it is often mistaken for other conditions such as conjunctivitis or “pink eye.”
Episcleritis is usually classified as either simple or nodular (picture 1 and picture 2). Simple episcleritis is usually sectoral, confined to a carefully delimited portion of the episclera, but can also be diffuse, involving the entire surface of the eyeball. Nodular episcleritis is raised and thus usually limited to just one area of the eyeball.
- McGavin DD, Williamson J, Forrester JV, et al. Episcleritis and scleritis. A study of their clinical manifestations and association with rheumatoid arthritis. Br J Ophthalmol 1976; 60:192.
- Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol 1976; 60:163.
- Jabs DA, Mudun A, Dunn JP, Marsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol 2000; 130:469.
- Aurich-Barrera B, Wilton L, Harris S, Shakir SA. Ophthalmological events in patients receiving risedronate: summary of information gained through follow-up in a prescription-event monitoring study in England. Drug Saf 2006; 29:151.
- Fraunfelder FW, Fraunfelder FT, Jensvold B. Scleritis and other ocular side effects associated with pamidronate disodium. Am J Ophthalmol 2003; 135:219.
- Daniel Diaz J, Sobol EK, Gritz DC. Treatment and management of scleral disorders. Surv Ophthalmol 2016; 61:702.
- Berchicci L, Miserocchi E, Di Nicola M, et al. Clinical features of patients with episcleritis and scleritis in an Italian tertiary care referral center. Eur J Ophthalmol 2014; 24:293.
- Sainz de la Maza M, Jabbur NS, Foster CS. Severity of scleritis and episcleritis. Ophthalmology 1994; 101:389.
- Williams CP, Browning AC, Sleep TJ, et al. A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis. Eye (Lond) 2005; 19:739.
- Leibowitz HM, Hyndiuk RA, Lindsey C, Rosenthal AL. Fluorometholone acetate: clinical evaluation in the treatment of external ocular inflammation. Ann Ophthalmol 1984; 16:1110.
- CLINICAL MANIFESTATIONS
- Clinical features
- Systemic disease associations
- POSTDIAGNOSTIC EVALUATION FOR ASSOCIATED CONDITIONS
- Initial episode of episcleritis
- Recurrent episcleritis or suspected systemic disease
- - When to refer
- - Basic tests
- - Specialized serologic assays
- - Imaging
- - Other testing
- DIFFERENTIAL DIAGNOSIS
- Initial therapy with topical lubricants
- Topical NSAIDs for persistent discomfort despite lubricants
- Resistant to lubricants and topical NSAIDs
- Resistant disease
- SUMMARY AND RECOMMENDATIONS