From the Guidelines
Episcleritis is a benign, self-limiting inflammation of the episclera, the thin layer of tissue between the conjunctiva and sclera of the eye, which can be effectively managed with topical corticosteroids and artificial tears, as recommended by the most recent guidelines 1.
Definition and Presentation
Episcleritis is characterized by mild pain, redness in a sectoral or diffuse pattern, and minimal discharge. The condition may recur and can sometimes be associated with underlying systemic diseases like rheumatoid arthritis, although most cases are idiopathic.
Management
For symptomatic relief, artificial tears and topical corticosteroids are recommended as first-line therapy 1. If symptoms are more severe, topical non-steroidal anti-inflammatory drugs (NSAIDs) like ketorolac 0.5% drops four times daily for 1-2 weeks can be effective. For persistent or recurrent cases, a short course of topical corticosteroids such as prednisolone acetate 1% four times daily for 7-10 days may be necessary, with gradual tapering.
Key Considerations
- Episcleritis typically resolves spontaneously within 1-3 weeks without treatment, but symptomatic relief can be provided with topical therapy.
- It is essential to distinguish episcleritis from scleritis, which is more serious and requires different treatment.
- Ophthalmology referral is recommended for all cases of episcleritis, even if asymptomatic, and holding immune checkpoint therapy until such evaluation is completed 1.
- Any visual compromise (vision < 20/40) should prompt urgent ophthalmology referral to assess the need for more specific interventions.
From the Research
Definition of Episcleritis
- Episcleritis is a benign disease that only affects the episclera, which is a thin layer of tissue on top of the white part of the eye (sclera) 2, 3, 4, 5.
- It is a self-limited disease, meaning it usually resolves on its own within 2 to 3 weeks, but severe symptoms may require treatment 3.
- Episcleritis is usually characterized by inflammation of the episcleral layer and injection of the superficial episcleral blood vessels, but it does not affect the underlying sclera or other parts of the eye 5.
Comparison with Scleritis
- Scleritis, on the other hand, is a more severe inflammatory disease that affects the sclera and can cause significant pain, redness, and vision problems 6, 2, 3, 4.
- Scleritis can be associated with systemic diseases, such as rheumatoid arthritis, and can lead to complications like uveitis, glaucoma, cataract, and retinal detachment if left untreated 6, 2, 3, 4.
- Differentiating between episcleritis and scleritis is crucial for planning treatment, as episcleritis has a self-limited course, while scleritis requires prompt treatment to prevent irreversible damage 2.
Treatment of Episcleritis
- Treatment of episcleritis usually involves oral non-steroidal anti-inflammatory drugs (NSAIDs) and/or topical steroids to reduce inflammation and relieve symptoms 3, 4, 5.
- In some cases, particularly those that are resistant to steroid therapy, topical tacrolimus may be used as an alternative treatment option 5.
- It is essential to note that episcleritis can be associated with systemic diseases, and a thorough systemic workup may be necessary to rule out underlying conditions 2, 4.