Episcleritis

👁️‍🗨️ Episcleritis

🔍 Definition

Episcleritis is a benign, self-limited inflammation of the episclera, the thin vascular connective tissue layer between the conjunctiva and the sclera.

🧠 It usually causes mild discomfort and redness, but no vision loss. Often idiopathic, but may be linked to systemic diseases.

 

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🔬 Anatomy Recap

• Conjunctiva (outermost layer)

• Episclera (vascular, loose connective tissue)

• Sclera (dense, avascular white layer)

Episcleritis affects the episclera, unlike scleritis, which involves the deeper scleral layers.

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🧨 Causes & Associations

✅ Common Causes

Type	Examples
Idiopathic	Most common (~70%)
Autoimmune	Rheumatoid arthritis, lupus, IBD
Infectious (rare)	Herpes zoster, syphilis, TB

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🔍 Types of Episcleritis

1. Simple Episcleritis (Most common)

   • Diffuse or sectoral redness

   • Minimal discomfort

   • Often recurrent

2. Nodular Episcleritis

   • Localized, raised, mobile nodule

   • More tender, longer-lasting

   • More commonly associated with systemic disease

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🧪 Symptoms

• 🔴 Sectoral or diffuse redness

• 😣 Mild discomfort or irritation

• 👁️ No discharge, no vision loss

• 🌞 Mild photophobia

• Usually unilateral

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🩺 Signs on Exam

Sign	Notes
Redness	Bright red, localized or diffuse
Tenderness	Mild (more in nodular type)
No scleral thinning	Unlike scleritis
Blanches with phenylephrine 2.5%	Helps differentiate from scleritis

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🔍 Differentiating: Episcleritis vs Scleritis

Feature	Episcleritis	Scleritis
Pain	Mild discomfort	Severe, boring pain
Redness	Sectoral, superficial	Deep, violaceous hue
Blanches with phenylephrine	✅ Yes	❌ No
Vision changes	❌ None	✅ Possible
Onset	Sudden	Gradual
Associated disease	Sometimes	Often

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💊 Treatment

🔹 Simple Episcleritis

• Often self-limiting (7–14 days)

• Artificial tears for comfort

• Cold compresses

• Short course of topical NSAIDs (e.g., ketorolac) if symptomatic

• Topical steroids (e.g., fluorometholone) if severe or nodular

🔹 Nodular or Recurrent Cases

• Investigate for underlying systemic disease

• Consider oral NSAIDs (e.g., ibuprofen)

• Referral to rheumatologist if autoimmune disease suspected

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🔁 Prognosis

• Excellent overall

• Recurrence is common in idiopathic cases

• Nodular type may persist longer but still resolves without complications

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🧠 Mnemonic: "EPI-Red but Easy"

• Episclera (superficial layer)

• Pain is mild

• Idiopathic mostly

• Redness sectoral

• Easily treated

• Avoids vision loss

• Scleritis it is not

• Yield good outcomes

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✅ Summary

Feature	Episcleritis
Common age	20–50 years
Pain	Mild
Vision	Normal
Exam	Sectoral redness, blanches
Treatment	Supportive ± topical meds
Referral	Recurrent/nodular/systemic signs

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Would you like:

• A visual comparison: episcleritis vs scleritis?

• A case scenario for practice?

• Or notes in flashcard-style format?