episcleritis

Introduction

Inflammation of the episcleral connective tissue.

Etiology

• allergy
• rheumatoid arthritis*
• spondyloarthropathy
  • enteropathic arthritis*
• vasculitis
  • ANCA-associated vasculitis
    • granulomatosis with polyangiitis (70% cANCA positive)

* minority of patients

Clinical manifestations

• unilateral red eye, eye irritation, & tearing
• superficial dilated blood vessels with white sclera visible between dilated vessels
  • red, flat or nodular, superficial lesion that allows visualization of the underlying vasculature
  • dilation of blood vessels resolves with 2.5% phenylephrine
• occasionally painful
• occasional photophobia
• rarely results in a discharge
• uncommonly associated with visual changes

Differential diagnosis

• scleritis
  • more commonly associated with eye pain & photophobia
  • more commonly associated with red eye, eye irritation & tears
  • edema of the sclera, violaceous discoloration of the globe
  • dilation of deeper blood vessels does not easily resolve with 2.5% phenylephrine
• uveitis typically causes severe eye pain & photophobia
• ciliary flush
• conjunctivitis
  • pain uncommon
  • itching is severe in allergic conjunctivitis
  • conjunctiva grossly injected
  • diffuse eye redness vs localized redness with episcleritis
    • bilateral vs unilateral with episcleritis
    • white sclera visible between dilated vessels with episcleritis with episcleritis (notdisinguishing feature)
  • tearing &/or mucus discharge uusual
    • watery discharge with viral conjunctivitis (disinguishing feature)
  • preauricular lymphadenopathy is commonly present with viral conjunctivitis

Management

• generally self-limited, resolving within several weeks
• NSAIDS for symptom relief

More general terms

• scleral disease
• inflammation

Additional terms

• episclera
• scleritis