Merck Manual

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Zeba A. Syed

, MD, Wills Eye Hospital

Reviewed/Revised Apr 2023
Topic Resources

Episcleritis is self-limiting, recurring, usually 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.

The episclera is a thin vascular membrane between the conjunctiva and the sclera.

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 (present in about 15% of patients). (See also Overview of Conjunctival and Scleral Disorders Overview of Conjunctival and Scleral Disorders The conjunctiva lines the back of the eyelids (palpebral or tarsal conjunctiva), crosses the space between the lid and the globe (forniceal conjunctiva), then folds back on itself as it spreads... read more Overview of Conjunctival and Scleral Disorders .)

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.

The condition is self-limited. If the review of systems does not suggest an underlying cause, unless the episode recurs, then a diagnostic assessment for systemic disorders is not routinely warranted.

Topical lubricating drops are typically used for patient comfort. A short course of topical corticosteroids (eg, prednisolone acetate, 1% drops 4 times a day for 7 days, gradually reduced over 3 to 4 weeks) or an oral nonsteroidal anti-inflammatory drug (NSAID) usually shortens the attack; corticosteroids are usually prescribed by an ophthalmologist. Topical vasoconstrictors (eg, tetrahydrozoline, brimonidine tartrate 0.025%) to improve appearance are optional; however, regular use can worsen erythema due to rebound vasodilation.

Drugs Mentioned In This Article

Drug Name Select Trade
AK-Pred, AsmalPred, Econopred, Econopred Plus, Flo-Pred, Hydeltrasol, Inflamase Forte, Inflamase Mild, Millipred , Millipred DP, Millipred DP 12-Day, Millipred DP 6 Day, Ocu-Pred , Ocu-Pred A, Ocu-Pred Forte, Omnipred, Orapred, Orapred ODT, Pediapred, Pred Mild, Predalone, Pred-Forte, Prednoral, Pred-Phosphate , Prelone, Veripred-20
Eye Drops, Geneye, Opti-Clear , Redness Reliever , Tyzine, Visine, Visine Red Eye Comfort
Alphagan, Alphagan P, LUMIFY, Mirvaso
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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