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By Melvin I. Roat, MD, FACS, Clinical Associate Professor of Ophthalmology; Cornea Service, Sidney Kimmel Medical College at Thomas Jefferson University; Wills Eye Hospital

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Episcleritis is self-limiting, recurring, idiopathic inflammation of the episcleral tissue that does not threaten vision. Symptoms are a localized area of hyperemia of the globe, irritation, and lacrimation. Diagnosis is clinical. Treatment is symptomatic.

Episcleritis occurs in young adults, more commonly among women. It is usually idiopathic; it can be associated with connective tissue diseases and rarely with serious systemic diseases.

Mild irritation occurs. Additionally, a bright red patch is present just under the bulbar conjunctiva (simple episcleritis). A hyperemic, edematous, raised nodule (nodular episcleritis) may also be present. The palpebral conjunctiva is normal.

Episcleritis is distinguished from conjunctivitis by hyperemia localized to a limited area of the globe, much less lacrimation and no discharge. It is distinguished from scleritis by lack of photophobia and lack of severe pain.

The condition is self-limited, and a diagnostic assessment for systemic disorders is not routinely warranted. A topical corticosteroid (eg, prednisolone acetate, 1% drops qid for 7 days, gradually reduced over 3 wk) or an oral NSAID usually shortens the attack; corticosteroids are usually prescribed by an ophthalmologist. Topical vasoconstrictors (eg, tetrahydrozoline) to improve appearance are optional.

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