Definition

Episcleritis is an inflammation of the episcleral tissue, the outermost layer of the sclera (the white part of the eye). Although a rare condition, episcleritis can occur in individuals with underlying systemic disorders. Unlike scleritis, episcleritis is generally mild and often resolves without treatment, affecting only the superficial episcleral tissue. Scleritis, on the other hand, involves deeper layers of the eye and presents with more severe symptoms.

The incidence of episcleritis is challenging to quantify, as the condition is usually self-limiting and asymptomatic, leading many affected individuals to not seek medical attention. Episcleritis can occur in individuals aged 20-50 and affects both genders, though some reports suggest it is more common in women.

Causes

Episcleritis can be caused by certain systemic diseases such as rheumatoid arthritis, lupus, and others. These conditions can lead to ongoing inflammation of the eye layers, which in turn may cause blockage or swelling of the blood vessels in the episcleral layer, resulting in eye redness.

Risk Factor

Episcleritis is often associated with underlying systemic diseases, including rheumatic diseases like rheumatoid arthritis, lupus (systemic lupus erythematosus or SLE), inflammatory bowel disease (IBD), vasculitis, gout, and a family history of allergies. Additionally, the use of certain medications, such as topiramate and pamidronate, has been linked to episcleritis. Cancerous conditions like leukemia and Hodgkin's lymphoma are also associated with this eye condition.

Symptoms

Common symptoms of episcleritis include:

• Eye redness without significant irritation, especially in the exposed area
• Eye discomfort
• Sensation of foreign bodies in the eye
• Mild eye pain
• Rapid onset of symptoms with spontaneous resolution within a few days
• A nodule-like shape, where a small lump may appear in the eye, causing discomfort

Episcleritis has two forms. The first form usually lasts for 5-10 days and completely resolves within 2-3 weeks. Episcleritis is prone to recurrence, often reappearing within 2 months of the initial episode. Recurrences can persist for 3-6 years, with a decrease in frequency after 3-4 years. The initial inflammation is usually moderate to severe, while subsequent episodes tend to be more severe and are often linked to systemic disease.

Diagnosis

To diagnose episcleritis, the doctor will conduct a visual acuity test, examine the redness area, and assess the involved blood vessels. Diagnostic tools such as 10% phenylephrine drops or sterile cotton swabs may be used to help diagnose this condition. The doctor will also inquire about the symptoms, exposure to risk factors, any systemic diseases affecting the patients or their family, occurrence of joint pain, the presence of eye discharge, and any history of eye trauma.

In some cases, blood tests, liver and kidney function tests, uric acid levels, and X-rays may be conducted to identify any underlying diseases contributing to your condition.

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Management

Episcleritis often resolves on its own without treatment. You can apply cold compresses to the eyes to reduce irritation. If you experience pain, your doctor may prescribe oral or topical pain relievers. If your condition does not improve with artificial tears and pain relievers, your doctor may recommend stronger eye drops for a short duration. It is crucial not to self-medicate, as improper use of medication can lead to complications such as cataracts, glaucoma, and corneal damage. Episcleritis is not threatening to vision.

Complications

Although episcleritis rarely causes complications, they can occur, particularly if it affects the area near the cornea, leading to corneal swelling. This can result in thinning of the corneal surface and the development of new, more fragile blood vessels (neovascularization). Additionally, individuals with episcleritis are at a higher risk of developing scleritis, a more severe condition involving deeper eye tissue. Long-term use of corticosteroids can also cause complications, so it is essential to avoid self-medications without advice from doctors.

Prevention

While episcleritis itself cannot be prevented, managing underlying systemic diseases may help reduce the incidence or severity of episcleritis episodes.

When to See a Doctor?

If you experience severe eye pain, redness, and visual impairment, your condition may not be episcleritis, and you should seek immediate medical attention. Additionally, if your episcleritis does not improve within 2 weeks or if it recurs frequently, consult a doctor for further evaluation.

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