Episcleritis

Question 1

Aetiology

Answer 1

inflammation of the episclera - connective tissue between sclera and conjunctiva
usually idiopathic but up to a third are associated with systemic disease - nodular / bilateral types especially

Question 2

Predisposing factors

Answer 2

Can be associated with systemic conditions such as:
RA
Lupus
IBS
Ankylosing spondylitis

Prev Hx of episcleritis
Infection e.g. HZO

Commonest in 4th and 5th decades of life

Question 3

Symptoms

Answer 3

Unilateral red eye (can be bilateral)
Acute onset
Mild ache and burning
Tender on palpation
Watering
Can be recurrent

Question 4

Signs

Answer 4

Hyperaemia from dilated episcleral blood vessels in one or more quadrants of one or both eyes. Hyperaemia blanches with vasoconstrictors such as phenylephrine 2.5%.

Can be simple or nodule
Simple: sectoral or diffuse, dilated episcleral blood vessels follow a regular radiating pattern and are immovable unlike the finer conjunctival vessels
Nodular: nodule (elevation of conjunctiva) with injection, usually within palpebral aperture, blood vessels are movable as lesion is elevated

AC normal
Cornea clear
VA normal

Question 5

Non-pharmacological management

Answer 5

Cold compresses
Self limiting in 7-10 days, may be longer for nodular

Question 6

Pharmacological management

Answer 6

If asymptomatic, none.
If symptomatic, give cooled artificial tears along with oral NSAID.
Inconsistent evidence to support topical NSAID use
Nodular types may respond to short course of FML for 1-2 weeks, monitoring IOP and reviewing closely,

Question 7

Refer?

Answer 7

Referral usually not required but if symptoms suggestive of systemic disease, or 2nd recurrence (third episode), refer to GP for checks.