Episcleritis and Scleritis

Definition | Episcleritis | Scleritis | References

Definition

Episcleritis and scleritis are inflammatory conditions affecting the outer layers of the eye. Episcleritis involves the episclera, a thin layer of tissue between the conjunctiva and sclera, while scleritis involves the sclera, the dense, white, outer layer of the eye.

Episcleritis

Definition: Episcleritis is a benign, self-limiting inflammation of the episclera, often presenting with redness and mild discomfort.

Aetiology: Often idiopathic but can be associated with systemic conditions such as rheumatoid arthritis, lupus, and inflammatory bowel disease.

Pathophysiology: Inflammation of the episcleral tissue without involvement of the deeper scleral layers, usually involving a segment of the episclera.

Risk Factors: Autoimmune diseases, systemic inflammatory conditions.

Signs and Symptoms:

• Redness of the eye, usually sectoral (in one area)
• Mild discomfort or tenderness
• No discharge
• Vision typically unaffected

Investigations:

• Clinical history and physical examination
• Slit-lamp examination to differentiate from scleritis
• Blood tests if an underlying systemic condition is suspected

Management:

Primary Care Management

• Topical lubricants: To relieve symptoms
• Topical NSAIDs
• Oral NSAIDs: For more severe discomfort (e.g., ibuprofen)
• Reassurance that the condition is typically self-limiting
• Referral to an ophthalmologist if symptoms persist or recur frequently

Scleritis

Definition: Scleritis is a severe, potentially sight-threatening inflammation of the sclera, often associated with systemic autoimmune diseases.

Aetiology: Frequently associated with systemic conditions such as rheumatoid arthritis, granulomatosis with polyangiitis, and systemic lupus erythematosus. Infectious causes are rare but include herpes zoster and syphilis.

Pathophysiology: Inflammation extends through the entire scleral thickness, leading to severe pain and potential complications such as scleral thinning, perforation, and vision loss.

Risk Factors: Autoimmune diseases, systemic vasculitis, infections.

Signs and Symptoms:

• Severe, deep eye pain
• Redness of the eye, often diffuse or sectoral
• Tenderness to touch
• Possible decrease in vision
• Photophobia

Investigations:

• Clinical history and physical examination
• Slit-lamp examination to assess the extent and depth of inflammation
• Blood tests to identify underlying systemic conditions
• Imaging (e.g., ultrasound, MRI) if posterior scleritis is suspected

Management:

Primary Care Management

• Urgent referral to an ophthalmologist: For further evaluation and treatment
• Pain management: Oral analgesics such as paracetamol or ibuprofen

Specialist Management

• Systemic NSAIDs: Such as indomethacin for pain and inflammation
• Systemic corticosteroids: For severe inflammation (e.g., prednisolone)
• Immunosuppressive therapy: For refractory cases or when associated with systemic autoimmune disease (e.g., methotrexate, azathioprine)
• Antibiotics or antiviral agents: If an infectious cause is identified
• Regular follow-up to monitor treatment response and detect complications

References

1. NICE. (2024). Episcleritis and Scleritis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Episcleritis and Scleritis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Episcleritis and Scleritis: Diagnosis and Management. Retrieved from BMJ
4. Patient.info. (2023). Episcleritis and Scleritis: Causes and Treatment. Retrieved from Patient.info

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