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Episcleritis

Benign self-limiting inflammation of the episclera

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Episcleritis?

Episcleritis is acute inflammation of the episclera, the vascular layer between the conjunctiva and sclera, classified as simple (sectoral or diffuse) or nodular (focal raised lesion). It is far more common than scleritis and typically benign, self-limiting within 1-2 weeks. Episcleritis affects mostly young to middle-aged women, with bilateral involvement in 30%, and recurrence in 60% of patients.

Most cases are idiopathic, but underlying systemic associations include rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, systemic lupus erythematosus, gout, herpes zoster, and rarely tuberculosis or syphilis. Distinguishing episcleritis from scleritis is critical because scleritis is more severe, often associated with vision-threatening complications, and frequently linked to systemic disease requiring immunosuppression.

Diagnosis is clinical: phenylephrine 2.5% drops blanch episcleral vessels, while scleral vessels do not blanch (helping distinguish from scleritis). Anterior segment OCT and slit-lamp examination support diagnosis. Treatment includes topical lubricants, topical NSAIDs (ketorolac), topical corticosteroids in selected cases, and oral NSAIDs for severe or recurrent disease. Workup for systemic disease is reserved for recurrent, bilateral, or severe cases.

Symptoms

Localized or diffuse redness of one eye (occasionally bilateral)
Salmon-pink or bluish-pink hue of episcleral vessels
Mild discomfort, foreign body sensation
Tearing
Mild photophobia
Tenderness on palpation
Sectorial inflammation in simple episcleritis
Nodular elevated lesion in nodular episcleritis
Vessels blanch with phenylephrine 2.5% drops
Acute onset over hours to days
Resolution within 1-2 weeks
Often recurrent (60%)
Usually no vision change
No associated systemic features in most cases
Associated symptoms in systemic disease: joint pain, rash, gastrointestinal symptoms
Headache (rare)
Discharge typically absent
No corneal involvement
No anterior chamber inflammation
Bilateral involvement in 30%

Risk Factors

Female sex
Young to middle adult age (20-50 years)
Rheumatoid arthritis
Inflammatory bowel disease (Crohn, ulcerative colitis)
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Systemic lupus erythematosus
Gout, hyperuricemia
Sarcoidosis
Behçet disease
Atopic disease (controversial)
Infections: herpes zoster ophthalmicus, syphilis, tuberculosis, Lyme disease
Stress, fatigue (anecdotal)
Trauma, ocular surgery (rare)
Topical medications (rare)
Idiopathic (most common)
Recurrent episcleritis (consider systemic disease)
Bilateral disease
Severe or persistent inflammation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Acute red eye in young or middle-aged adult
  • Mild discomfort with localized redness
  • Recurrent episodes
  • Bilateral episcleritis
  • Severe pain (consider scleritis)
  • Vision change
  • Photophobia
  • Concomitant systemic symptoms
  • Rheumatoid arthritis or inflammatory bowel disease with eye redness
  • Failure of self-resolution after 2 weeks
  • Worsening symptoms
  • Concern for scleritis or other diagnosis
  • Workup for systemic disease in recurrent cases

Treatment Methods

01
Comprehensive ophthalmic evaluation by general ophthalmologist or uveitis specialist
02
Detailed history including systemic symptoms, prior episodes, comorbidities
03
Slit-lamp examination assessing episcleral vs scleral vessel involvement
04
Phenylephrine 2.5% test (blanches episcleral vessels, not scleral)
05
Anterior segment OCT and B-scan ultrasound when scleritis suspected
06
No systemic workup for first idiopathic episode
07
Workup for recurrent, bilateral, or severe disease: CBC, ESR, CRP, RF, ANA, ANCA, HLA-B27, urinalysis, ACE, lysozyme, syphilis, Lyme, TB testing as indicated
08
Rheumatology consultation for suspected systemic disease
09
Topical lubricants (preservative-free artificial tears) — first-line for mild cases
10
Cool compresses
11
Topical NSAIDs (ketorolac 0.5%, bromfenac, nepafenac) for moderate symptoms
12
Topical corticosteroids (loteprednol, fluorometholone, prednisolone acetate) for severe or persistent cases
13
Oral NSAIDs (ibuprofen, naproxen) for severe or recurrent cases
14
Treat underlying systemic disease
15
Avoid systemic corticosteroids for episcleritis (reserved for scleritis)
16
Monitor for progression to scleritis
17
Patient education on benign nature and recurrence likelihood
18
Reassurance
19
Avoid topical corticosteroids if herpes zoster ophthalmicus suspected
20
Recurrence prevention with oral NSAIDs in some cases
21
Multidisciplinary care if systemic disease: rheumatology, gastroenterology, dermatology
22
Routine follow-up at 1-2 weeks
23
Long-term follow-up for recurrent cases

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.