ConditionEyes & vision
Episcleritis
Episcleritis is inflammation of the episclera, the thin layer of tissue between the clear membrane of the eye (conjunctiva) and the tough white wall (sclera). It causes a red or pink patch on the white of the eye with mild discomfort, but vision stays normal. It usually clears on its own within 1 to 3 weeks and often recurs. It is harmless, but it must be told apart from scleritis, a painful and sight-threatening condition.
Also called: Inflammation of the episclera, simple episcleritis, nodular episcleritis
At a glance
- What it is
- Inflammation of the thin layer over the white of the eye.
- Symptoms
- Sectoral redness, mild irritation or tenderness, watering. Vision normal.
- Types
- Simple (diffuse redness) and nodular (a raised tender bump).
- Causes
- Usually unknown. Sometimes linked to rheumatoid arthritis, IBD, lupus or gout.
- Treatment
- Often none. Cool compresses, lubricating drops, oral NSAIDs, sometimes mild steroid drops.
- Course
- Clears in 1 to 3 weeks. Recurs in many people.
When to get help
Call 911 or go to the ER
- Severe, deep, boring eye pain that wakes you at night or spreads to the face, with redness, which may be scleritis
- Red eye with reduced vision, severe light sensitivity or a hazy cornea
See a doctor within a day or two
- Redness that has a bluish or violet tinge, or does not blanch with phenylephrine drops at the eye clinic
- Red eye in a contact lens wearer with pain or discharge
- A first episode of eye redness with pain in someone with rheumatoid arthritis or vasculitis
Book a routine appointment
- Episodes of sectoral redness that keep coming back
- Redness that has not settled after 3 weeks
Usually safe to manage at home
- A known episcleritis recurrence with mild irritation and normal vision, managed with cool compresses and lubricating drops
What episcleritis looks like
- a wedge-shaped or patchy area of redness on the white of the eye, often near the colored part, usually in one eye
- mild aching, grittiness or tenderness when pressing on the eyelid
- watering, but no sticky discharge
- normal vision and no light sensitivity
Simple episcleritis (the most common type, about 70 to 80%) causes flat redness that comes on quickly. Nodular episcleritis produces a raised, tender, movable bump of inflamed tissue and tends to last longer.
Causes
In most cases no cause is found. It is more common in young to middle-aged adults and in women. Associations include:
- rheumatoid arthritis and other connective tissue diseases
- inflammatory bowel disease
- systemic lupus erythematosus
- gout
- rosacea
- herpes zoster and other infections, rarely
- possibly stress, hormonal changes and allergies
Episcleritis vs other red eyes
| Condition | Pain | Discharge | Vision | Clues |
|---|---|---|---|---|
| Episcleritis | Mild | None or watery | Normal | Sectoral redness, vessels move over the sclera, blanches with phenylephrine drops |
| Scleritis | Severe, deep, boring | None | May be reduced | Bluish-violet tinge, very tender, often linked to systemic disease |
| Conjunctivitis | Gritty | Sticky or watery | Normal | Diffuse redness, eyelid involvement, itching with allergy |
| Uveitis (iritis) | Moderate ache | None | Blurred | Redness around the cornea, light sensitivity, small pupil |
| Subconjunctival hemorrhage | None | None | Normal | Flat, bright red patch of blood |
Diagnosis
An eye doctor examines the eye with a slit lamp. Placing a drop of phenylephrine, which constricts surface vessels, makes episcleritis redness fade, while scleritis redness persists. Recurrent or severe cases, or symptoms suggesting systemic disease, may lead to blood tests such as rheumatoid factor, ANA, uric acid and inflammation markers.
Treatment
Many cases need no treatment and resolve within 1 to 3 weeks.
- Cool compresses several times a day
- Lubricating eye drops (artificial tears), refrigerated for extra comfort
- Oral NSAIDs such as ibuprofen for discomfort, especially in nodular episcleritis. Follow the label dose
- Mild topical steroid drops for a short course in persistent or uncomfortable cases, prescribed and monitored by an eye doctor because steroid drops can raise eye pressure
- Treating associated conditions, such as rheumatoid arthritis or rosacea
Topical NSAID eye drops and vasoconstrictor "red eye" drops are generally not very helpful.
Outlook
Episcleritis does not damage the eye or vision. Recurrences occur in many people, sometimes over years, and usually become less frequent. Rarely, a condition first thought to be episcleritis turns out to be scleritis, so a red eye that becomes very painful needs prompt review.
Frequently asked questions
What causes episcleritis?
Most cases have no identifiable cause. It is sometimes associated with rheumatoid arthritis, inflammatory bowel disease, lupus, gout or rosacea. Stress and hormonal changes may trigger episodes in some people.
What is the difference between episcleritis and scleritis?
Episcleritis affects the thin layer on the surface of the sclera, causes mild discomfort and never threatens vision. Scleritis affects the deeper sclera, causes severe pain and can damage the eye. Scleritis often has a bluish tint and is strongly linked to autoimmune disease.
How long does episcleritis last?
Simple episcleritis usually clears within 1 to 3 weeks, often in 7 to 10 days. Nodular episcleritis can last a little longer. Recurrences are common.
Is episcleritis contagious?
No. Episcleritis is an inflammatory condition, not an infection, so it cannot spread to other people or the other eye by contact.
Can episcleritis cause blindness?
No. Episcleritis does not affect vision or cause lasting damage. If you develop severe pain, reduced vision or light sensitivity, see an eye doctor promptly, because these suggest a different, more serious condition.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Episcleritis (EyeWiki)
- American Academy of Ophthalmology: What is episcleritis?
- MedlinePlus: Episcleritis
- NHS: Episcleritis
- College of Optometrists: Clinical Management Guidelines, Episcleritis