Episcleritis - A Brief Introduction

Introduction: Episcleritis is a common and benign inflammation of the episclera, typically affecting young and middle-aged adults. Seventy percent of cases occur in females.

The episclera lies just beneath the bulbar conjunctiva. Its vessels are large, run in a radial direction,
and can be seen beneath the overlying conjunctiva. Episcleral and conjunctival vessels blanch with the use of topical 5% phenylephrine drops, unlike deep episcleral vessels.

Clinical Features: 

• Patients may complain of foreign body sensation, mild tenderness, irritation, mild photophobia, and excessive lacrimation.
• Pain is unusual but can occur, particularly in chroniccases. 
• One-half of cases are bilateral. 
• Eye findings are notable for a localized pink or bright red conjunctival injection, with involvement of the vessels in the superficial episcleral vascular plexus. 
• Visual acuity is normal.

Associated  Conditions: Episcleritis is usually an isolated condition, though it may be associated with a number of systemic diseases, including rheumatoid arthritis, inflammatory bowel disease, lupus, and vasculitis.



Important Points To Remember: 
1. It is important to differentiate episcleritis from sight threatening scleritis. Episcleritis presents with only mild pain and bright red episcleral vessels, which will blanch with topical phenylephrine.
2. Conjunctivitis is a more common cause of red eye, and symptoms usually include morning crusting. Injection that is localized rather than diffuse is more likely to be episcleritis

Management: For many patients, the condition is self-limited and will resolve within 3 weeks, with or without treatment. For mild cases, use over-the-counter artificial tears. For those with recurrent or recalcitrant lesions, referral to the ophthalmologist is indicated.