Summary about Disease
Episcleritis is an inflammatory condition affecting the episclera, which is the thin layer of tissue between the conjunctiva and the sclera (the white part of the eye). It is a generally benign and self-limiting condition, meaning it often resolves on its own. Episcleritis typically causes redness, irritation, and mild discomfort in the affected eye. It's often unilateral (affects one eye at a time) but can be bilateral.
Symptoms
Redness of the eye (usually sectoral, meaning in a specific area, but can be diffuse).
Mild ocular discomfort or irritation (gritty or burning sensation).
Tearing or watery discharge.
Sensitivity to touch or pressure on the eye.
Photophobia (sensitivity to light) is uncommon but can occur.
Vision is typically unaffected.
May feel a nodule or bump on the white of the eye (in nodular episcleritis).
Causes
In many cases, the cause of episcleritis is unknown (idiopathic). However, it can be associated with:
Systemic inflammatory conditions: Such as rheumatoid arthritis, lupus, inflammatory bowel disease (Crohn's disease or ulcerative colitis), and rosacea.
Infections: Rarely, viral or bacterial infections may be implicated.
Gout
Herpes Zoster (Shingles)
Stress
Hormonal changes
Medicine Used
Artificial tears: For mild cases, to relieve dryness and irritation.
Topical nonsteroidal anti-inflammatory drugs (NSAIDs): Such as diclofenac or ketorolac eye drops, to reduce inflammation and discomfort.
Topical corticosteroids: Such as prednisolone eye drops, used for more severe cases or when NSAIDs are ineffective. Use should be monitored by an ophthalmologist due to potential side effects.
Oral NSAIDs: Such as ibuprofen or naproxen, for more severe or persistent cases.
Systemic medications: If episcleritis is associated with an underlying systemic condition, treatment of that condition is crucial. This might involve medications like oral corticosteroids or immunosuppressants, as prescribed by a physician.
Is Communicable
No, episcleritis is not contagious. It cannot be spread from person to person.
Precautions
Avoid rubbing the affected eye: This can worsen the inflammation.
Practice good hygiene: Wash hands frequently to prevent secondary infections.
If you wear contact lenses: Remove them until the episcleritis resolves, or follow your eye doctor's advice.
Protect your eyes from irritants: Avoid smoke, dust, and other potential triggers.
Manage underlying conditions: If episcleritis is linked to a systemic disease, follow your doctor's recommendations for managing that condition.
Follow your doctor's instructions: Regarding medication and follow-up appointments.
How long does an outbreak last?
Episcleritis is typically self-limiting. The duration of an outbreak varies, but it usually lasts from 1 to 3 weeks. Some cases may resolve more quickly, while others can persist for longer. With treatment, the duration can often be shortened.
How is it diagnosed?
Episcleritis is usually diagnosed through a clinical examination by an ophthalmologist or optometrist. The examination typically involves:
Visual acuity testing: To check your vision.
Slit-lamp examination: A specialized microscope is used to examine the structures of the eye, including the episclera.
Phenylephrine test: Instilling phenylephrine eye drops can help differentiate episcleritis from scleritis. In episcleritis, the blood vessels in the affected area will blanch (become white) after phenylephrine is applied, whereas in scleritis, they will not.
Medical history: The doctor will ask about your medical history and any associated symptoms or conditions.
Blood tests: If an underlying systemic condition is suspected, blood tests may be ordered to help identify the cause.
Timeline of Symptoms
The timeline of episcleritis symptoms can vary, but a general progression is as follows:
Initial Stage: Gradual onset of redness, irritation, and mild discomfort in one eye.
Progression: Over a few days, redness and discomfort may increase. Tearing or watery discharge may develop. A nodule may appear in nodular episcleritis.
Peak: Symptoms typically peak within a week or two.
Resolution: Symptoms gradually subside over the following week or two. Redness diminishes, and discomfort decreases.
Complete Resolution: Typically resolves within 1 to 3 weeks without long-term complications. Recurrences are possible.
Important Considerations
Differentiation from Scleritis: It is crucial to distinguish episcleritis from scleritis, a more serious inflammatory condition of the sclera. Scleritis is typically associated with more severe pain, potential vision loss, and a higher association with systemic diseases. An ophthalmologist can differentiate the two conditions.
Underlying Conditions: While many cases of episcleritis are idiopathic, it's important to consider the possibility of an underlying systemic condition, especially if episcleritis is recurrent or severe.
Monitoring: Regular follow-up with an eye doctor is important to monitor the condition and ensure that it is resolving appropriately and to rule out other potential causes.
Self-Treatment: While mild cases may resolve on their own with artificial tears, it's best to consult an eye doctor for proper diagnosis and management. Avoid using over-the-counter steroid eye drops without medical supervision, as they can have serious side effects.