Episcleritis

Episcleritis is benign and self-limiting inflammation of the episclera, the outermost layer of the sclera. The episclera is situated just underneath the conjunctiva.

It is relatively common in young and middle-aged adults and is not usually caused by infection. It is often associated with inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease.

 

Presentation

Episcleritis usually presents with acute onset unilateral symptoms:

  • Typically not painful but there can be mild pain
  • Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.
  • Foreign body sensation
  • Dilated episcleral vessels
  • Watering of eye
  • No discharge

 

Management

If in doubt about the diagnosis, refer to ophthalmology.

Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms.

Simple analgesia, cold compresses and safetynet advice are appropriate.

More severe cases may benefit from systemic NSAIDs (e.g. naproxen) or topical steroid eye drops.

 

Last updated April 2019
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