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Clinical Summary

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.

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.

FIGURE 2.38

Episcleritis. A localized area of hyperemia is seen involving the temporal sclera. (Photo contributor: Robert Trieff, MD.)

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.

Management and Disposition

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.

Pearls

  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.

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