- 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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