Episcleritis
Related Subjects:
|Episcleritis
|Scleritis
|Assessing a Red eye
|Acute Angle Closure Glaucoma
|Allergic and Infective Conjunctivitis
|Anterior and Posterior Uveitis
💡 Pearl: Topical phenylephrine (2.5–10%) blanches episcleritis vessels (redness fades) ✅ but has no effect on deeper scleral vessels in scleritis ❌.
👁️ About
- ✨ Benign, usually self-limiting inflammatory condition of the episcleral membrane.
- 🧩 Uncertain aetiology; inflammation lies between conjunctiva and sclera.
🦠 Aetiology
- Often idiopathic (no clear cause).
- 📌 Sometimes linked to systemic autoimmune disease (RA, IBD, SLE, vasculitis) — though less so than scleritis.
🧾 Clinical
- ⏱️ Acute onset focal redness and mild discomfort (not severe pain).
- 👍 Much less severe than scleritis (patients are unwell with scleritis, but not here).
- 👁️ Mild irritation, tearing; visual acuity, cornea, and pupil are normal.
- 📍 Localised redness around the conjunctiva — often sectoral.
🔍 Investigations
- 💉 Phenylephrine blanching test: episcleral vessels constrict → redness resolves; scleral vessels remain red in scleritis.
- Systemic workup rarely needed unless recurrent or atypical.
⚖️ Differentials
- 🔥 Scleritis: Severe boring pain (may wake patient at night), tender to touch, deeper violaceous hue.
- 👁️🗨️ Conjunctivitis: More diffuse redness + discharge; tarsal conjunctiva involved.
- 🌵 Pterygium (inflamed): Raised triangular nasal lesion, localised redness, may show punctate fluorescein staining.
💊 Management
- 💧 Frequent preservative-free lubricating drops, gels, or ointments (1st line).
- 😎 Minimise sun, wind, and air-conditioning exposure.
- 💊 Oral NSAIDs may help with symptoms.
- 👨⚕️ Ophthalmology referral if recurrent, atypical, or concerns.
- ⚠️ Occasionally topical NSAIDs or mild topical steroids required under specialist supervision.
