Episcleritis

Episcleritis is a common, usually sectorial, inflammation of the conjunctiva. It is a benign, asymtomatic condition but can cause concerns to patients who often present in practice asking for advice and guidance. There is normally no cause that can be identified although it can be associated with other systemic diseases. More common in women between the ages of 40 – 50 yrs.

Signs/Symptoms:

• Sectorial redness of the conjunctiva
• Epiphora
• Lack of pain
• Diffuse episcleritis effects a wider area of the conjunctiva but is less common than sectorial episcleritis
• Usually monocular
Causes:
• Often unknown but may be linked to rheumatoid arthritis, Sjogren’s syndrome, herpes zoster, inflammatory bowel disease and previous episodes.

Diffuse temporal episcleritis.

Same eye showing the sectorial nature of episcleritis- note the absence of any hyperaemia in this sector of the sclera.

Differential Diagnosis:

• Scleritis (see A-Z index)
• Pingueculitis
• Anterior uveitis
• Conjunctivitis

Treatment:

• Cold compresses may alleviate any mild discomfort
• Ocular lubricants
• Advise patient that the condition self-limits, normally within 7 days
• Recurrent episodes can be treated with non-steroid anti-inflammatory drugs

Red Flags:

• Scleritis
• Recurrent episodes require referral for further investigations

Red Flags: When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service.