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Episcleritis is an inflammatory condition of the connective tissue between the conjunctiva and selera known as the episclera. The eye’s red appearance makes it look similar to conjunctivitis, or pink eye but there is no discharge or tearing.

Causes of Episcleritis

Episcleritis usually has no apparent cause. However, it is sometimes associated with systemic inflammatory conditions such as arthritis, lupus and inflammatory bowel disease.

Rosacea, herpes simplex, gout, tuberculosis and other diseases are also the causes of episcleritis. Women are particularly affected by this particularly affected by this disease more frequently than men. It characteristically occurs in people who are in there 30’s and 40’s and is often a recurrent problem.

Signs and Symptoms of Episcleritis

Episcetritis presents relatively asymptomatic acute onset redness in one or both eyes. Typically, we will observe a sectoral injection of the episcleral and overlying conjunctival vessels, although the redness may be diffuse throughout these tissues.

Occasionally, there may be translucent white nodule centrally within the inflamed area known as Nodular episcleritis. While some patients complain of milk pain or tenderness to the affected region, particularly upon manipulation, often there is no associated discomfort.

The cornea remains clear in this condition, although long-standing or recurrent episcleritis may lead to dellen formation. There is no associated anterior chamber reaction.

Episcleritis Diagnosis

Eye examination is usually sufficient to diagnose the disorder. No special tests are usually necessary. Episcleritis is diagnosed with a Slit lamp examination. The doctor will look for discharge, pain and involvement of the underlying scleral to rule out other problems.

Treatment for Episcleritis

Treatment for Episcleritis is usually not needed. Most cases of episcleritis are self limiting, meaning that they will resolve spontaneously within two to three weeks even if the patient does not undergo treatment.

However, patients who are experiencing discomfort may benefit from a regimen of topical anti-inflammatory agents and lubricants. Typically, prednisolone acetate 1 % or fluorometholone acetate applied, will speed resolution and decrease the tenderness.

The patient may use cold compresses and artificial tears liberally is discomfort persists. More severe cases, particularly nodular episclerilitis, may require oral Non-steroidal anti-inflammatory drugs to subside the inflammations. Re-examination of patients is done weekly.

For that one topical steroid therapy for more than two weeks, perform tonometry to monitor for elevation of Intra ocular Pressure. Because of the association with systemic disorders, refer patients with extremely severe presentations or more than three recurrence for a medical evaluation.

Episcleritis is one of those condition, like sub conjunctival haemorrhage, that typically looks worse than it is. Reassure patients that they do not have “pink eye”. However, be sure to distinguish this condition from the more severe scleritis, which is far more painful.

In severe or diffuse cases in which the differential diagnosis is more difficult, blanching with phenylephrine 2.5% will allow for better evaluation of the underlying sclera.


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