Episcleritis

Change Language German

Symptoms

  • Acute onset of eye redness and mild pain, unilateral or bilateral
  • Frequently recurring episodes
  • Mostly self-limiting within a few days

Findings

  • Redness usually sectorally limited (rarely diffuse), often in the palpebral fissure
  • Enlarged episcleral vessels (displaceable with cotton swabs)
  • Sometimes nodular changes (-> nodular episcleritis), may be staining

Work-up

  • Phenylephrine test: Administer 1 drop of Phenylephrine 2.5%, evaluate after 10-15min
    • if redness persists: Scleritis
    • if redness disappears: Episcleritis

Differential Diagnoses

  • Scleritis: typically severe pain, Phenylephrine test (see above)
  • Anterior uveitis / iridocyclitis
  • Conjunctivitis

Treatment

  • Primary lubricating therapy
  • For moderate to severe episcleritis: systemic NSAIDs (e.g. Froben (flurbiprofen), Voltaren (diclofenac), Ibuprofen orally etc.), alternatively: topical NSAIDs (e.g., Yellox (bromfenac) gtt 2x/day for up to 4 days after regression)
  • If no response: topical steroids (e.g., FML (fluorometholone) 3x/day)
    • Caution: possible rebound phenomenon with steroid use; administer only if no response to NSAIDs
  • systemic work-up only in exceptional cases!

Sources

  • EyeWiki Episcleritis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)