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 by hyperemia localized to a limited area of the globe and much less lacrimation. 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 5 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.
Last full review/revision October 2012 by Melvin I. Roat, MD, FACS