Definition

Episcleritis is a benign, self-limiting inflammatory condition affecting the episclera, a thin layer of tissue between the conjunctiva and sclera of the eye. It is typically painless or mildly uncomfortable and is not associated with significant vision loss.

Types of Episcleritis

• Simple Episcleritis: Most common form. Redness appears in one or more sections of the eye and usually resolves in 1-2 weeks.
• Nodular Episcleritis: Less common but more severe. A localized, raised, red area (nodule) is observed. It resolves slower than simple episcleritis.

Causes

The exact cause of episcleritis is unknown, but it may be associated with:

• Idiopathic: Most cases are without a known cause.
• Autoimmune Disorders: Conditions such as rheumatoid arthritis, lupus, ankylosing spondylitis, and inflammatory bowel disease.
• Infections: Such as herpes simplex, herpes zoster, or tuberculosis.
• Environmental Factors: Including irritants like dust, smoke, and chemicals.

Signs and Symptoms

• Redness in one or both eyes (localized or diffuse).
• Mild discomfort or tenderness.
• No discharge (differentiates from conjunctivitis).
• Occasional watery eyes.
• Sensitivity to light (photophobia).

Diagnosis

Diagnosis includes a detailed clinical examination and differential diagnosis:

• Clinical Examination: History and slit-lamp examination to identify redness, swelling, or nodules.
• Differential Diagnosis: Episcleritis must be distinguished from scleritis, which is more severe.

Investigations

• Basic Investigations: Complete blood count (CBC), ESR, or CRP to assess inflammation.
• Specific Tests: Autoimmune screening for rheumatoid arthritis, lupus, etc., and infectious workup if a pathogen is suspected.

Treatment

Most cases resolve without treatment, but management includes:

• Medications:
  • Topical Lubricants: Artificial tears to soothe irritation.
  • Topical Corticosteroids: Fluorometholone or Loteprednol to reduce inflammation.
  • Oral NSAIDs: Ibuprofen or Indomethacin for severe or recurrent cases.
• Medications to Avoid: Avoid corticosteroids in viral infections like herpes simplex, as it may worsen the condition.

Vitamin Supplements

• Vitamin A: Promotes eye health and prevents dryness.
• Vitamin C: Reduces inflammation and strengthens blood vessels.
• Vitamin E: Acts as an antioxidant and protects tissues.

Lifestyle Effects

Episcleritis is not life-threatening but can cause discomfort. Lifestyle modifications include:

• Quit smoking and avoid irritants.
• Use sunglasses to reduce photophobia.
• Maintain hydration and a healthy diet.

Complications

Though rare, untreated episcleritis may lead to:

• Recurrence or chronic inflammation.
• Rare progression to scleritis.

Management

• Regular follow-ups to monitor for recurrence or progression.
• Treat underlying systemic conditions if present.
• Adopt a healthy lifestyle with stress management.