Episcleritis and Scleritis
Episcleritis:
Refers to the common and usually benign
Condition, characterized by inflammation of the
episclera which lies between the conjunctiva and sclera.
It's usually an idiopathic condition, but occasionally
occurs in the context of underlying disease or
exogenous inflammatory stimuli.
Clinical Features:
Acute onset of red eye and discomfort/mild pain
No associated ocular symptoms
Normal vision
Treatment:
Treatment is usually not required, because it is a self-
limited condition.
The use of topical non-steroidal anti-inflammatory
drugs can be helpful.
If the episode is more severe, a short course of topical
steroids is required.
Scleritis:
Anterior Scleritis:
Localized
i. Nodular
ii. Non-nodular
Diffuse
Posterior Scleritis
Refers to severe inflammation that affect the sclera.
This rare condition is usually associated with systemic
disease.
Clinical Features:
Anterior Scleritis:
Sub-acute onset of:
Red eye
Severe boring eye pain often radiating to forehead,
brow and jaw.
Associated with watering, photophobia and gradual
decrease in vision.
50% of cases are bilateral.
Occasionally associated with systemic manifestations
(fever, vomiting, headache)
Posterior Scleritis:
Uncommon
2/3 of cases are unilateral
Most common symptoms are pain and visual
impairment.
Fundus findings:
Optic disc swelling
Macular edema
Choroidal folds
Exudative retinal detachment
Choroidal detachment.
Note: some cases of anterior Scleritis are associated
with posterior Scleritis.
Treatment:
Oral NSAIDs
Oral steroids
Sub-conjunctival injection of steroids
Immune-suppressive agents such as methotrexate
in severe non-responding cases.