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episcleritis
Inflammation of the episcleral connective tissue.
Etiology:
1) allergy
2) rheumatoid arthritis*
3) spondyloarthropathy
- enteropathic arthritis*
4) vasculitis
- ANCA-associated vasculitis
- granulomatosis with polyangiitis (70% cANCA positive)
* minority of patients [2]
Clinical manifestations:
1) unilateral red eye, eye irritation, & tearing [2]
2) superficial dilated blood vessels with white sclera visible between dilated vessels
- dilation of blood vessels resolves with 2.5% phenylephrine
3) occasionally painful
4) occasional photophobia
5) rarely results in a discharge
6) uncommonly associated with visual changes [2]
Differential diagnosis:
- scleritis
- more commonly associated with eye pain & photophobia
- more commonly associated with red eye, eye irritation & tears [2]
- edema of the sclera, violaceous discoloration of the globe
- dilation of deeper blood vessels does not easily resolve with 2.5% phenylephrine [3]
- uveitis typically causes severe eye pain & photophobia
- ciliary flush
- conjunctivitis
- pain uncommon
- conjunctiva grossly injected
- diffuse eye redness vs localized redness with episcleritis
- tearing &/or mucus discharge uusual [3]
- watery discharge with viral conjunctivitis
- preauricular lymphadenopathy is commonly present with viral conjunctivitis
Management:
- generally self-limited, resolving within several weeks [2]
- NSAIDS for symptom relief [2]
Related
episclera
scleritis
General
scleral disease
inflammation
References
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Medical Knowledge Self Assessment Program (MKSAP) 11,16,17,18,19.
American College of Physicians, Philadelphia 1998,2012,2015,2018,2022
- NEJM Knowledge+ Ophthalmology