From the Guidelines
Episcleritis and chemosis are two distinct eye conditions that differ in their characteristics, treatments, and potential impacts on vision, with episcleritis being inflammation of the episclera and chemosis being conjunctival swelling.
Key Differences
- Episcleritis is characterized by localized redness with minimal discomfort and preserved vision, often associated with autoimmune conditions, and typically treated with artificial tears, topical NSAIDs like ketorolac 0.5% four times daily for 1-2 weeks, or oral NSAIDs such as ibuprofen 400-600mg three times daily for more severe cases 1.
- Chemosis, on the other hand, is conjunctival swelling due to fluid accumulation, resulting from allergies, infections, or trauma, and its treatment addresses the underlying cause, such as antihistamines for allergies, antibiotics for infections, or cold compresses and lubricants for irritation.
Treatment and Management
- For episcleritis, especially when related to immune checkpoint inhibitor therapy, referral to an ophthalmologist is recommended even if asymptomatic, and treatment may include artificial tears, topical corticosteroids, and cycloplegic agents, with systemic steroids reserved for rare cases 1.
- Chemosis treatment focuses on resolving the underlying cause, which could involve antihistamines like olopatadine drops twice daily for allergies, specific antibiotics for infections, or supportive care with cold compresses and lubricants for trauma or irritation.
Importance of Accurate Diagnosis
- Accurate differentiation between episcleritis and chemosis is crucial for appropriate management and to prevent potential complications, especially since episcleritis can be associated with systemic autoimmune conditions or be a side effect of certain therapies like immune checkpoint inhibitors 1.
- Given the potential for vision compromise, particularly with conditions like episcleritis that may require cessation of immune checkpoint therapy or the use of systemic steroids, prompt and accurate diagnosis is essential to preserve vision and quality of life 1.
From the Research
Definition and Characteristics
- Episcleritis is a benign and self-limiting disease, often with a recurrent course, manifesting mainly in young adults 2.
- It is characterized by inflammation of the thin, loose, highly vascular connective tissue layer that lies between the conjunctiva and sclera 3.
- Episcleritis is classified into simple and nodular types, with the nodular type tends to be more recurrent and painful 3.
Comparison with Chemosis
- There is no direct comparison between episcleritis and chemosis in the provided studies.
- However, episcleritis can be differentiated from scleritis, which is a painful, generalized inflammation of the eye that is often associated with systemic disease 4.
- Chemosis is not mentioned in the provided studies, but it is a condition characterized by swelling of the conjunctiva, which can be caused by various factors, including allergies, infections, and injuries.
Diagnosis and Treatment
- The diagnosis of episcleritis is essentially clinical, and eye pain or tenderness should raise the concern for scleritis 3.
- Treatment of episcleritis depends on the severity of symptoms and may involve cold compresses, artificial tears, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids 3.
- In cases of steroid-resistant nodular episcleritis, topical tacrolimus drops may be effective in suppressing inflammation and resolving symptoms 5.
- Differentiating episcleritis from scleritis is crucial, as scleritis requires early and aggressive anti-inflammatory treatment to prevent severe ocular complications and visual loss 2, 6.