Diagnosis → Ophthalmology

Episcleritis

Etiology

Cause [7vf][9fk]

• Unknown

• Systemic conditions (26% to 36%)

  • Rheumatoid arthritis

  • Systemic lupus erythematosus

  • Polyarteritis nodosa

  • Crohn disease

  • Ulcerative colitis

  • Wegener granulomatosis (granulomatosis with polyangiitis)

  • Juvenile idiopathic arthritis

  • Behcet disease

  • Cogan syndrome

  • Seronegative spondyloarthropathies:

    • Ankylosing spondylitis

    • Reactive arthritis

    • Psoriatic arthritis

• Infections

  • Bacteria: Tuberculosis, Lyme disease, syphilis, cat-scratch disease

  • Viruses: herpes simplex, herpes zoster, Covid-19

  • Fungi

  • Parasites

Pathophysiology [9fk]

1. An inflammatory response localized to the superficial episcleral vascular network

2. Release inflammatory mediators --> vasodilation + increased vascular permeability

3. Infiltration of lymphocytes, plasma cells, and macrophages along with edema

4. Clinical presentation:

   • Eye redness

   • Mild ocular discomfort or pain

   • Discharge (rare)

   • Photophobia (rare)

   • No intraocular inflammation

5. Diffuse episcleritis: 84% of cases

   • Intermittent bouts of inflammation

   • Last 7 to 10 days

   • Recur at 1-3-month intervals

6. Nodular/focal episcleritis: 16% of cases

   • Prolonged attacks of inflammation

   • Typically more painful than diffuse episcleritis

   • Associated with systemic disease

Complications

• Iridocyclitis

• Glaucoma

• Cataract

Epidemiology

Incidence per 100.000 [c1a][vfy][t4o][ivb]

Default

Approach

• Clinical diagnosis based on slit-lamp examination:

  • Edema of the episcleral tissue

  • Injection of superficial episcleral vessels

  • Dilated episcleral vessels are easily blanched with phenylephrine

• Blood test: CBC, ESR, ANA, Rheumatoid factor, uric acid

• Lyme serelogy

• Chest x-ray

• Venereal disease test

Treatment

1. Episcleritis is self-limited and will resolve without intervention within 2 to 21 days

2. Treat the underlying condition

   • Infection --> appropriate antibiotic therapy

3. Symptomatic treatment:

   • Artificial tears

   • Sunglasses

   • Mild topical corticosteroids if severe or prolonged symptoms

   • Systemic NSAIDs (Ibuprofen 200-600mg x 3/day)

   • Systemic corticosteroids

Differential diagnoses

Conjunctivitis, Foreign body, Glaucoma, Iridocyclitis, Keratitis, Keratoconjunctivitis sicca, Lymphoma, Scleritis, Subconjunctival hemorrhage