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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.
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Patients may complain of foreign-body sensation, mild tenderness, irritation, mild photophobia, and excessive lacrimation. Pain is unusual but can occur, particularly in chronic cases. 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.
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Episcleritis is usually an isolated condition, although it may be associated with a number of systemic diseases, including rheumatoid arthritis, inflammatory bowel disease, lupus, and vasculitis.
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Management and Disposition
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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. Topical or oral NSAIDs may also be used. For those with recurrent or recalcitrant lesions, referral to the ophthalmologist is indicated.
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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.
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.