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Episcleritis is a benign, self-limiting inflammatory disease affecting the episclera.
The episclera is a thin layer of tissue that lies between the conjunctiva and the connective tissue layer that forms the white of the eye (sclera).
Episcleritis is a common condition.
Typically affects young adults, and may be more common in women.
Associated with abrupt onset of mild eye pain and redness.
Two types of episcleritis exist: one where the episclera is diffusely affected (diffuse episcleritis), and the other where nodules are present in the episclera (nodular episcleritis).
Most cases have no identifiable cause.
Often a recurrent process.
Treatment to decrease discomfort with lubricating eye drops.
More severe cases may be treated with topical corticosteroids or oral anti-inflammatory medications.
Symptoms of episcleritis include mild eye pain, redness, and watery eyes.
The pain of episcleritis is typically mild.
The eye may be tender to palpation.
The diffuse type of episcleritis may be less painful than the nodular type.
Small nodules present within the episclera may move slightly over the sclera with gentle pressure.
Discharge is absent.
Vision is unaffected.
Patients experience far less photophobia than patients with uveitis.
Most of the time, the cause is idiopathic.
An identifiable cause is discovered in about one third of cases, and include systemic vasculitic diseases (polyarteritis nodosa, granulomatosis with polyangiitis), connective tissue diseases, rheumatoid arthritis, rosacea, atopy, gout, and ulcerative colitis.
59 percent of patients with relapsing polychondritis have episcleritis or scleritis.
Rarely, may be caused by scleritis.
The redness in the eye is due to engorgement of the large episcleral blood vessels, which run in a radial direction from the limbus.
With episcleritis there is typically no uveitis, or thickening of the sclera.
Diagnosis is based upon the history and physical examination.
The history could indicate the presence of the diseases associated with episcleritis, and the symptoms they cause, such as rash, arthritis, venereal disease, and recent viral infection.
Differentiated from scleritis by using phenylephrine or neosynephrine eye drops, which causes blanching of the blood vessels in episcleritis, but not in scleritis.
Often, treatment is not necessary.
Artificial tears may be used to help reduce irritation and discomfort.
In severe cases topical corticosteroids or oral non-steroidal anti-inflammatory drugs can be used.
Most cases resolve within 7–10 days.
The nodular type is a more aggressive pro ss and takes longer to resolve
Rarely may progress to scleritis.
In general, does not cause complications in the eye.