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Episcleritis, Inflamation of Episclera

Episcleritis, Inflamation of Episclera

Episcleritis

Episcleritis refers to inflammation of episclera, which is a clear layer on top of the white part of your eye, called the sclera. There’s another clear layer outside of the episclera called the conjunctiva. This inflammation causes your eye to look red and irritated. Episcleritis often looks like pink eye, but it doesn’t cause discharge. It also may go away on its own.

Etiology of Episcleritis

The majority of episcleritis cases are idiopathic, but 26% to 36% of patients have an associated systemic disorder that is responsible for the pathological process and development of episcleritis. These include:

  • Systemic diseases associated with this include gout, rosacea, psoriasis, and connective tissue disorders.
  • Hypersensitivity reaction to endogenuous tubercular or streptococcal toxins is also reported.
  • Herpes zoster virus, syphillis, Lyme disease and tuberculosis may cause Infectious episcleritis.

Pathology

Histologically, there occurs localised lymphocytic infiltration of episcleral tissue associated with oedema and congestion of overlying Tenon’s capsule and conjunctiva.

Clinical features

Symptoms
It shows redness, mild ocular discomfort described as gritty, burning or foreign body sensation. Many a time it may not be accompanied by any discomfort at all. Rarely, mild photophobia and lacrimation may occur.

Signs
On examination two clinical types, simple and nodular may be recognised. Episclera is seen acutely inflamed in the involved area.

Simple episcleritis: Redness in a section and sometimes throughout the eye with minimal discomfort

Nodular episcleritis: Slightly raised bumps surrounded by dilated blood vessels, usually in one area of the eye, that may cause discomfort.

Clinical course of Episcleritis

Episcleritis runs a limited course of 10 days to 3 weeks and resolves spontaneously. However, recurrences are common and tend to occur in bouts.

Differential diagnosis

  • Confusion of simple one can happen rarely with conjunctivitis.
  • Nodular onemay be confused with inflamed pinguecula, swelling and congestion due to foreign body lodged in bulbar conjunctiva and, very rarely with scleritis.

Treatment of Episcleritis

  1. Topical NSAIDs, e.g., ketorolac 0.3% may be useful.
  2. Topical mild corticosteroid eyedrops e.g., fluorometholone or loteprednol instilled 2-3 hourly, render the eye more comfortable and resolve it within a few days.
  3. Cold compresses applied to the closed lids may offer symptomatic relief from ocular discomfort.
  4. Topical artificial tears e.g., 0.5% carboxy methyl cellulose have soothing effect.
  5. Systemic nonsteroidal anti inflammatory drugs (NSAIDs) such as flurbiprofen in recurrent cases.

Home remedies

While you wait for your episcleritis to clear up, there are few things you can do to manage its symptoms, such as:

  • Applying cold compress over your eyes with your eyes closed.
  • Applying artificial tear eyedrops.
  • Wearing sunglasses outside.

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