30/08/2025
Episcleritis is a benign, self-limiting inflammatory condition affecting the episclera, which is a thin layer of tissue lying between the conjunctiva and the sclera (the white part of the eye). It causes redness, irritation, and mild discomfort in the eye, often seen as localized or diffuse redness without affecting vision or causing discharge. Episcleritis typically resolves on its own but may recur and is sometimes linked with underlying systemic diseases
Definition and Anatomy:
Episcleritis refers to inflammation of the episclera, the clear, fibroelastic tissue layer between the sclera and conjunctiva, which has superficial and deeper vascular layers. This inflammation leads to engorgement of these blood vessels, causing the characteristic redness in the affected area
Types:
There are two main types of episcleritis:
Simple (diffuse or sectoral): Involves generalized or localized redness without nodules; typically less painful.
Nodular: Characterized by well-circumscribed, raised nodules on the episclera, which are tender and may cause more discomfort. Nodular episcleritis tends to have a less acute onset and a more prolonged course than simple episcleritis [1][2][5].
Symptoms:
- Redness of the eye, usually unilateral but occasionally bilateral.
- Mild discomfort or a gritty, prickly sensation.
- Tearing or watery eyes.
- Mild sensitivity to bright light (photophobia).
- Absence of discharge or changes in vision.
Pain is usually mild and episodes may last from days to a few weeks. Severe pain or vision changes are uncommon and should raise suspicion for other conditions like scleritis.
Causes and Associations:
Most cases are idiopathic with no specific cause identified. However, about one-third of cases are associated with systemic diseases, especially autoimmune or inflammatory disorders such as:
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Inflammatory bowel disease (Crohn’s, ulcerative colitis)
- Vasculitis (e.g., polyarteritis nodosa)
- Relapsing polychondritis
- Psoriatic arthritis and ankylosing spondylitis
Rarely, episcleritis can be associated with infections including Lyme disease, tuberculosis, syphilis, and herpes zoster. It usually does not lead to serious ocular complications
Diagnosis:
Diagnosis is clinical, based on history and eye examination. Key distinguishing points from other red eye causes include:
- Redness localized to episcleral vessels that move slightly with gentle pressure
- Absence of discharge (distinguishing from conjunctivitis)
- Mild or absent pain (distinguishing from scleritis)
- No effect on vision or anterior chamber inflammation (distinguishing from uveitis)
Slit-lamp examination may be performed to confirm episcleral involvement and exclude other disorders. Additional lab tests may be indicated if systemic autoimmune disease is suspected
Treatment:
- Episcleritis often resolves spontaneously within 1-3 weeks without treatment.
- For symptomatic relief: lubricating (artificial tears) eye drops and cold compresses may be used.
- More symptomatic or persistent cases may be treated with topical corticosteroids or oral nonsteroidal anti-inflammatory drugs (NSAIDs).
- Underlying systemic disease should be managed accordingly if identified.
Vision prognosis is excellent, and permanent damage is very rare with appropriate care.
Summary:
Episcleritis is an inflammatory but benign eye condition causing redness and mild discomfort due to inflammation of the episclera. It is generally self-limited, may be idiopathic or associated with systemic diseases, and typically does not impair vision or cause discharge. Treatment focuses on symptom relief, with good outcomes expected.
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