Episcleritis: Description, Causes and Risk Factors:ICD-10: H15.1.Inflammation of the episcleral connective tissue.Episcleritis is an inflammatory condition affecting the episcleral tissue between the conjunctiva (a transparent lubricating mucous membrane that covers the eyeball and the under surface of the eyelid) and the sclera (the white part of the eye). The red appearance caused by this condition looks similar to conjunctivitis, but there is no discharge.Statistically, women are more affected by episcleritis than men and it characteristically occurs in people who are in their 30's and 40's. Episcleritis can sometimes develop into a recurrent problem and in rare cases, may even develop into scleritis.Types:Simple episcleritis: Simple episcleritis is characterized by intermittent bouts of inflammation that occur every couple of months and last between one and two weeks. Some people report that these bouts are more likely to affect them in the spring and autumn, and although triggers often remain unidentified, some people find that stress or hormonal changes kick off the process.
  • Nodular episcleritis: Nodular episcleritis causes longer bouts of inflammation that are more painful than simple episcleritis. This type is more often associated with underlying medical conditions such as rheumatoid arthritis.
There is no apparent cause, but it can be associated with an underlying systemic inflammatory or rheumatologic condition such as rosacea, lupus or rheumatoid arthritis. It may also be associated with conditions such as gout and herpes simplex infection, inflammatory bowel disease. A minute number of patients also have rheumatoid arthritis, collagen vascular disease.Risk factors may include:Rheumatoid arthritis.
  • Systemic lupus erythematous.
  • Polyarthritis nodosa.
  • Bacteria, including tuberculosis, Lyme disease, and syphilis.
  • Viruses, includes herpes.
  • Necrobiotic xanthogranuloma.
  • Progressive hemifacial atrophy.
  • Oculovestibuloauditory syndrome.
  • Behcet's disease.
  • Conjunctivitis.
Symptoms:EpiscleritisGeneral symptoms may include:A pink or purple color to the normally white part of the eye.
  • Eye redness.
  • Tearing of the eye.
  • Eye pain and tenderness.
  • Sensitivity to light.
  • Mild irritation.
Diagnosis:Episcleritis is diagnosed with a slit lamp examinations. This is usually done by an optometrist and some general practitioners.Your doctor will be on the look out for any discharge and pain and will have to rule out other eye inflammatory conditions, such as scleritis, which can be more serious.Palpation of the globe often elicits markedtenderness in scleritis, but generally not inepiscleritis.Hyperemia usually blanches with topicalphenylephrine (2.5%) in episcleritis but notin scleritis.Episcleritis may be difficult to distinguish clinically from conjunctivitis or glaucoma. Keys to differentiating this from glaucoma are the absence of corneal edema and normal pupillary light response. As glaucoma is both more common and more devastating to vision, if in doubt about the diagnosis, confirmation by accurate measurement of intraocular pressure should be obtainedTreatment:Most cases of episcleritis are self-limiting, meaning that they will resolve spontaneously within two to three weeks even if the patient does not undergo treatment. However, patients who are experiencing discomfort may benefit from a regimen of topical anti-inflammatory agents and lubricants. For those who find that exposure to light makes their eyes feel uncomfortable, wearing sunglasses may help.Typically, prednisolone acetate 1% or fluorometholone acetate applied q. 3-4hr. will speed resolution and decrease the tenderness. The patient may use cold compresses and artificial tears liberally if discomfort persists. More severe cases, particularly nodular episcleritis, may require oral NSAIDs to quell the inflammation.Make sure you are aware of all the side-effects of the medication you are prescribed as some of these can be more troubling than the actual eye condition itself!Re-examine patients weekly for those on topical steroid therapy for more than two weeks, perform tonometry (the measurement of intraocular pressure by determining the amount of force needed to make a slight indentation in the cornea) to monitor for elevation of IOP (intraocular pressure). Because of the association with systemic disorders, refer patients with extremely severe presentations or more than three recurrences for a medical evaluation.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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