Episcleritis

Overview

Episcleritis is inflammation of the episclera, a thin layer of tissue that lies just beneath the clear conjunctiva and over the white of the eye (the sclera). It usually causes a patch of redness and mild irritation in one part of one eye, though it can affect both eyes. Episcleritis is generally a mild condition that often clears up on its own within a couple of weeks.

It is important to distinguish episcleritis from scleritis, a deeper and more serious inflammation that can threaten vision. Episcleritis, by contrast, does not usually affect eyesight and is rarely associated with serious complications. It can recur, and in some people it is linked to an underlying inflammatory condition.

Symptoms

Symptoms are usually mild and limited to the surface of the eye:

• Redness in one section or across the white of the eye
• Mild irritation, a gritty feeling, or tenderness
• Watery eyes
• Mild sensitivity to light in some cases

Importantly, episcleritis does not usually cause significant pain, vision changes, or discharge. Severe pain, blurred vision, or marked light sensitivity suggest a more serious problem and need prompt eye evaluation.

Causes

In most cases the cause of episcleritis is unknown. When a cause or association is found, it may include:

• Inflammatory or autoimmune conditions: Such as rheumatoid arthritis, lupus, or inflammatory bowel disease.
• Infections: Less commonly, certain infections.
• Other triggers: Occasionally linked to gout or other conditions.

For many people, episcleritis occurs on its own without any identifiable underlying disease and resolves without complications.

Risk Factors

• Having an autoimmune or inflammatory condition, such as rheumatoid arthritis or inflammatory bowel disease
• A previous episode of episcleritis, since it can recur
• Being a young or middle-aged adult, in whom it is more common
• Being female, as it occurs somewhat more often in women

Diagnosis

Episcleritis is diagnosed by an eye examination:

• Slit-lamp examination: An eye specialist uses a special microscope to look closely at the inflamed tissue and confirm it is the episclera rather than the deeper sclera.
• Distinguishing from scleritis: Sometimes eye drops are used to help tell episcleritis from the more serious scleritis.
• Tests for underlying conditions: If episodes recur or other symptoms are present, blood tests may be done to look for an associated inflammatory disease.

Treatment

Episcleritis is often mild and may not need treatment, but options to ease symptoms include:

• Supportive care: Cool compresses and lubricating (artificial tear) eye drops for comfort.
• Anti-inflammatory medication: For more bothersome cases, a doctor may prescribe anti-inflammatory eye drops or oral medication.
• Treating any underlying condition: Managing an associated inflammatory disease can reduce recurrences.

Most episodes resolve within one to two weeks, and the outlook is excellent. An eye doctor can advise on the best approach if episodes are frequent.

Self-Care and Prevention

• Use lubricating eye drops and cool compresses to soothe irritation
• Avoid rubbing the eyes
• Manage any underlying inflammatory or autoimmune condition with your doctor
• Follow up if episodes keep returning, to check for an associated cause
• Seek evaluation if symptoms become severe or vision is affected

When to See a Doctor

See an eye doctor if eye redness lasts more than a week or two, keeps coming back, or you are unsure of the cause. Seek prompt eye care if you have severe eye pain, blurred or reduced vision, marked sensitivity to light, or if the redness is accompanied by these warning signs, as these can indicate scleritis or another serious eye condition that needs urgent treatment to protect your sight.

Related Topics

Frequently Asked Questions

References

1. American Academy of Ophthalmology. Episcleritis.
2. Mayo Clinic. Red eye — Causes.
3. MedlinePlus, U.S. National Library of Medicine. Episcleritis.
4. Merck Manual. Episcleritis.