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By Melvin I. Roat, MD, FACS

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Episcleritis is self-limiting, recurring, idiopathic inflammation of the episcleral tissue that is 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 (see Overview of Conjunctivitis) by hyperemia localized to a limited area of the globe, much less lacrimation and no discharge. It is distinguished from scleritis (see 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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