Episcleritis presents with the following signs and symptoms:

• Watery eyes
• Inflammation and irritation 
• Redness 
• Pain with or without burning sensation 
• Development of bloodshot in the white area of the eyes
• Development of pink to purplish color in the white area of the eyes

• Inflammation

  Nida Sen EPISCLERITIS Episcleritis is a self-limiting, generally benign inflammation of the episclera. [entokey.com]

  Secondary CORE Category: Intraocular Inflammation and Uveitis / Noninfections (Autoimmune) Uveitis Keywords / Main Subjects: Episcleritis; scleritis; conjunctival inflammation Diagnosis: Episcleritis Description of Image: This patient is a 24–year-old [morancore.utah.edu]

  Management Main aim is to minimise inflammation and reduce any damage Topical NSAIDs and corticosteroids may be used. [dundeemedstudentnotes.wordpress.com]

  Classification episcleritis scleritis Simple Anterior scleritis -nodular type -diffuse type -necrotizing with inflammation -necrotizing without inflammation (Scleromalacia Perforan) Nodular Posterior scleritis 73. [slideshare.net]

  The optometrist will reach a diagnosis based on the exact type of inflammation, which distinguishes this condition from conjunctivitis (inflammation of the outer skin of the eye) and scleritis (inflammation of the white part of the eyeball). [college-optometrists.org]

• Pain

  Scleritis vs Episcleritis Pearls Scleritis is characterized by significant pain, pain with eye movement, vision loss, and vessels that do not blanch with phenylephrine. Episcleritis is typically less painful with no vision loss. [tamingthesru.com]

  Severe pain and scleral tenderness. Severe vasculitis as well as infarction and necrosis with exposure of the choroid may result. Rarely, necrotising scleritis can occur without inflammation (scleromalacia perforans). [dundeemedstudentnotes.wordpress.com]

  Episcleritis Scleritis • Abrupt -Days to weeks • Redness without irritation • Mild ocular discomfort -Burning, FB sensation, irritation • Localized • Insidious – over several days • Pain, tenderness to palpation, radiate • Worse at night+awake Clinical [slideshare.net]

  Lantz This image shows the left eye of a 42-year-old white female patient who reported that her eye had become red and painful the previous day. [clspectrum.com]

• Severe Pain

  Pain Most describe severe boring/piercing eye pain over several days may radiate to surrounding facial areas may awaken the patient in the night (cf episcleritis) Tender on movement and palpation Usually not helped by analgesia Tearing may occur secondary [dundeemedstudentnotes.wordpress.com]

  Many individuals are asymptomatic, but some do experience minor discomfort and in rare cases severe pain (Goldstein and Tessler 2009 ; Pearlstein 2011 ). In cases of severe pain, it is more likely scleritis than episcleritis. [link.springer.com]

  Differential diagnosis • Sectoral acute, anterior scleritis – moderate to severe pain with deep vessel inflammation of the sclera, and tender globe on palpation • Sectoral keratitis – moderate to severe pain with corneal opacity or foreign body Examination [pulsetoday.co.uk]

  It is distinguished from scleritis by lack of photophobia and lack of severe pain. The condition is self-limited. [msdmanuals.com]

  Patients suffering from scleritis may complain of severe pain in the affected eye which sometime radiates to the adjacent face. They also may have blurry vision and photophobia. [tamingthesru.com]

• Relapsing Polychondritis

  These include collagen-vascular diseases (rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, systemic lupus erythematosus, reactive arthritis (formerly Reiter’s syndrome), relapsing polychondritis, ankylosing spondylitis, [eyewiki.aao.org]

  Causes of scleritis: Systemic autoimmune diseases such as rheumatoid arthritis, Wegener granulomatosis, seronegative spondyloarthropathies, relapsing polychondritis, systemic lupus erythematosus (SLE). [accessmedicine.mhmedical.com]

  polychondritis, systemic lupus erythematosus),[8] psoriatic arthritis, ankylosing spondylitis, Cogan syndrome, rosacea, gout,[5] atopy,[7] Crohn's disease, and ulcerative colitis.[9][6] 59 percent of patients with relapsing polychondritis have either [en.wikipedia.org]

• Falling

  […] in BCVA, whereas three (50%) patients with scleritis had a fall in BCVA. [tnoajosr.com]

  Clinical types of Episcleritis Simple Episcleritis Common type Intermittent attacks of moderate-to-severe inflammation Attacks recur at 1- to 3-month intervals Episodes last 7-10 days, and most resolve after 2-3 weeks More common episodes in the spring or fall [krishnaeyecentre.com]

  Some patients note that episodes are more common in the spring or fall. The precipitating factor is rarely found, but attacks have been associated with stress, allergy, trauma, and hormonal changes. [emedicine.medscape.com]

  Individuals, who frequently fall prey to recurrent bouts of episcleritis, are put on NSAIDs for faster relief from the symptoms. [symptoma.com]

  […] proteoglycans (decorin, biglycan and aggrecan) • Elastin and glycoproteins (fibronectin) • Fibroblast lie along collagen bundles • Supply by long posterior ciliary nerves at anterior sclera • More translucent when thinning occurs or the water content changes, falling [slideshare.net]

• Erythema

  Topical vasoconstrictors (eg, tetrahydrozoline, brimonidine tartrate 0.025%) to improve appearance are optional; however, regular use can worsen erythema due to rebound. Click here for Patient Education NOTE: This is the Professional Version. [msdmanuals.com]

  […] associated conditions include the following: Rheumatoid arthritis Vasculitis Inflammatory bowel disease Ankylosing spondylitis Systemic lupus erythematosus Gout Herpes zoster Hypersensitivity disorders Rosacea Contact dermatitis Penicillin sensitivity Erythema [unboundmedicine.com]

  Topical vasoconstrictors (eg, tetrahydrozoline, brimonidine tartrate 0.025%) to improve appearance are optional; however, regular use can worsen erythema due to rebound. [merckmanuals.com]

  Cardiorespiratory examination was normal and there was no erythema marginatum rash, subcutaneous nodules or choreiform movements. Her bloods showed neutrophilia of 14.98x10 9 and CRP of 209mg/L. [nzma.org.nz]

  Bilateral interstitial keratitis, erythema nodosum and atrial fibrillation as presenting signs of polyarteritis nodosa. American Journal of Ophthalmology Case Reports. 2020;18:100619. doi: 10.1016/j.ajoc.2020.100619 Pasadhika S, Rosenbaum JT. [verywellhealth.com]

• Arthritis

  Systemic Disease Associations Noninfectious Infectious Other Connective Tissue Disease Herpes zoster ophthalmicus Gout Rheumatoid arthritis Herpes simplex keratitis Rosacea Juvenile rheumatoid arthritis Acanthamoeba keratitis Foreign body reaction Drugs [entokey.com]

  These include collagen-vascular diseases (rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, systemic lupus erythematosus, reactive arthritis (formerly Reiter’s syndrome), relapsing polychondritis, ankylosing spondylitis, [eyewiki.aao.org]

  This also implies that brucellosis as a rule is an underlying triggering infection associated with reactive arthritis. [ncbi.nlm.nih.gov]

  Sclera progressively thins revealing the underlying darker uveal tissue No effective treatment but perforation is rare Scleritis left eye: Diffuse sectorial scleritis in a patient with rheumatoid arthritis. [ophthalmologytraining.com]

  In particular, patients with rheumatoid arthritis are at a much higher risk than the general population. Also more common in women. [dundeemedstudentnotes.wordpress.com]

• Photophobia

  They rarely experience discharge or photophobia. [statpearls.com]

  Symptoms are moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia... read more by lack of photophobia and lack of severe pain. The condition is self-limited. [merckmanuals.com]

  It is distinguished from scleritis by lack of photophobia and lack of severe pain. The condition is self-limited. [msdmanuals.com]

  They also may have blurry vision and photophobia. [tamingthesru.com]

• Eye Pain

  pain with tenderness to palpation of the eye, with or without violet discoloration of the sclera, an ophthalmologic consult is warranted! [amboss.com]

  Severe, boring eye pain often radiating to head and neck that worsens with eye movement. [accessmedicine.mhmedical.com]

  But, it may occur with certain diseases, such as: Herpes zoster Rheumatoid arthritis Sjögren syndrome Syphilis Tuberculosis Symptoms include: A pink or purple color to the normally white part of the eye Eye pain Eye tenderness Sensitivity to light Tearing [baptistjax.com]

  After approximately 6 days, the symptoms of eye pain, hyperemia, and edema disappeared gradually. Then, after radiotherapy was performed three times, he again developed episcleritis in his left eye. [ncbi.nlm.nih.gov]

  Excerpt: " A 45-year-old woman presents with 1 day of increasing eye pain, eye redness, and difficulty in seeing. On exam there was scleral injection and exquisite globe tenderness (Figure 16-1). [web.archive.org]

• Conjunctival Injection

  Injection p = 0.0018 and Day 7: Total Score p = 0.01, Conjunctival Injection p = 0.014, Episcleral Injection p = 0.027). [ncbi.nlm.nih.gov]

  Improvement in conjunctival injection during the first 7 days 50% of the O group and 75% of the P group improved (Significant). [bestbets.org]

  Fact Explanation Diffuse or localized bulbar conjunctival injection. Due to the engorgement of the superficial episcleral plexus. Diffuse or localized bulbar conjunctival injection. Due to the engorgement of the superficial episcleral plexus. [medicaljoyworks.com]

  Diffuse or localized bulbar conjunctival injection. Due to the engorgement of the superficial episcleral plexus [1]. Watery discharge. It correlates with corneal changes but may also indicate a necrotizing process [2]. A mobile nodule in the sclera. [explainmedicine.com]

• Visual Impairment

  Living with Visual Impairment 21. What Tests May the Doctor Order? Downloaded on 28.3.2023 from https://www.degruyter.com/document/doi/10.1515/9781478021209-042/html [degruyter.com]

  Texas School for the Blind and Visually Impaired. Archived from the original on September 29, 2009. Retrieved December 11, 2009. ^ "Blepharitis". The Lecturio Medical Concept Library. 28 September 2020. Retrieved 5 July 2021. ^ "Conjunctivitis". [en.wikipedia.org]

  Treatment-related complications are the most common cause of visual impairment in these patients (hence the need to recognise the benign nature of this disease and not to overtreat). [patient.info]

• Excessive Tearing

  Episcleritis causes the eye to appear reddened, with symptoms similar to conjunctivitis, but without discharge or excessive tearing. Women are typically affected by episcleritis more frequently than men. [herbalremedies.com]

  Excessive tearing 4. Which of the following best describes the frequency of bilateral corneal opacities in patients with confirmed ocular disease in this case series? A. 13% B. 20% C. 35% D. 80% 5. [wwwnc.cdc.gov]

• Confusion

  It is often confused with conjunctivitis (pink eye). What treatments are there for episcleritis? Episcleritis often reflects the inflammation in a person’s IBD. [ibdrelief.com]

  It can be confused with conjunctivitis but in the case of episcleritis only a sector of the white of the eye becomes injected. Sometimes small nodules may be present in the centre of the injected area. [irishhealth.com]

  From its earliest description, confusion existed between episcleritis and scleritis [2]. Incidence is less than 1/1000. It is more common in women and those between 40 and 50 years of age [3]. [tandfonline.com]

  This is the most common point of confusion for most patients who have been afflicted by inflammation of the eye wall, and unfortunately, also for many eye care specialists who see these patients when their disease presents for the first time. [mersi.com]

A thorough physical examination of the eye to study the signs and symptoms of episcleritis will be done. Physical examination will be enough to diagnose the condition. However, if the condition keeps recurring after intermittent intervals then blood test would be required to diagnose the presence of any underlying disease condition. Apart from these, no specialized tests are necessary to diagnose episcleritis.

• Colitis

  Google Scholar | Crossref | Medline | ISI Lakatos, L., Mester, G., Erdelyi, Z., David, G., Pandur, T., Balogh, M. et al. ( 2006 ) Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis [dx.doi.org]

  […] ulcerative colitis: results of a population-based study. [ncbi.nlm.nih.gov]

  Bilateral episcleritis - with ulcerative colitis This young scholar had recurrent episcleritis - bilateral - with flare-ups in his ulcerative colitis. Googling " ulcerative colitis and episcleritis " will produce several pertinent articles. [webeye.ophth.uiowa.edu]

  The inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are the two diseases most commonly associated with episcleritis but again I stress that most people develop the condition for no known reason. [irishhealth.com]

In majority of the cases, episcleritis gets resolved on its own and does not require any specialized treatment plan. However, if the inflammation is severe and the patient is in great discomfort then certain eye drops may be administered to provide quick relief.

The goal of pharmacotherapy in the treatment of episcleritis is to reduce relative morbidity and avert complications [8]. Generally corticosteroid eye drops that act as artificial tears are prescribed for relieving the signs and symptoms of episcleritis [9]. The use of oral cyclooxygenase inhibitors has been found to effectively reduce signs of inflammation in episcleritis [10].

For patients with nodular episcleritis, a more rigorous treatment regime may be required due to development of severe signs and symptoms. Non–steroidal anti–inflammatory drugs are useful in relieving symptoms of nodular episcleritis.

In patients with underlying disease conditions, treatment is also initiated to keep the disease condition under control. This would help to prevent recurrent bouts of episcleritis.

The prognosis of the disease condition is favorable and symptoms often fade away by themselves without any treatment [6]. However, with treatment symptoms resolve sooner and patients can recover faster.

Complications

Episcleritis is not a life threatening condition and gets better without any treatment regime. However, in rare cases the condition can give rise to some kind of complications. Current literature has suggested that episcleritis can give rise to scleritis which is characterized by inflammation and irritation accompanied by redness of the sclera of the eyes.

Complications can develop in those individuals who have suffered from recurrent attacks of episcleritis and had to resort to steroid treatment for several years. In such cases, the following secondary complications can develop:

• Cataract
• Anterior uveitis [7]
• Ocular hypertension
• Rebound inflammation as a result of withdrawal effects of steroid drugs.
• Steroid–induced glaucoma

The exact cause that triggers inflammation and redness of the episclera region of the eyes is yet to be known. However, in many cases it is thought to occur as a secondary complication to many disease conditions [3]. Episcleritis occurs in association with the following medical conditions:

• Tuberculosis
• Herpes zoster
• Syphilis
• Rheumatoid arthritis
• Sjogren syndrome 
• Menstruation [4]
• Infectious conditions such as Lyme disease, shingles or syphilis
• Inflammatory bowel diseases
• Gout 
• Ankylosing spondylitis

Episcleritis is an inflammatory disease of the eyes, more commonly affecting the young and middle aged population. It has been estimated that about 70% of women are affected with this condition [5]. The exact prevalence rate of this disease is not available as most of the patients do not seek any medical help.

Episcleritis is of two types: Simple and nodular. Simple episcleritis is more common that nodular and is less severe and painful. The following are the characteristics of simple episcleritis:

• Recurrent intermittent bouts that occur at every 1 – 3 months intervals. The condition lasts for as long as 7 to 10 days. 
• Patients who suffer from simple episcleritis as a secondary result to other underlying condition, often experience more severe symptoms and the condition takes more than normal time to heal.
• When episcleritis occurs spontaneously and not as a result of any underlying condition then hormonal changes and stress are known to trigger the development of this eye disease.

Nodular episcleritis is a more severe form than the former type. The attacks are more painful, severe and last longer. Individuals with nodular episcleritis always have an underlying systemic disease which is the major causative factor.

So far no guidelines have been given for preventing the onset of episcleritis. The onset of complications can be prevented by timely treatment of the condition and also by proper management of the underlying disease conditions.

Episcleritis is a condition characterized by inflammation and redness of the episclera. The episclera is a thin tissue layer situated between the conjunctiva and sclera [1]. The redness and inflammation of the eyes mimic the signs and symptoms of conjunctivitis; however, in episcleritis there is no discharge from the eyes. It is a common condition affecting several individuals across the globe. The cause of such a condition is not known in many cases.

Episcleritis is a mild condition and often usually resolves by itself requiring no rigorous treatment regime [2]. Women are more affected than men and it strikes both middle aged and young individuals.

Definition

Episcleritis presents with redness and inflammation of the episclera region of the eyes. Infection is not the cause of episcleritis and the condition either occurs spontaneously or due to certain underlying conditions. Middle aged women are at an increased risk of contracting this disease condition.

Cause

The exact cause that triggers the development of episcleritis is unknown. However, individuals with disease such as herpes zoster, tuberculosis, rheumatoid arthritis, syphilis and Sjogren syndrome are known to develop this eye condition.

Symptoms

Symptoms of episcleritis include inflammation and redness in the eyes, irritation, pain, eye tenderness and sensitivity to light. Certain individuals may also develop a pink to purplish color in the white region of the eye. Development of blood shot in the eyes and watery eyes are some of the other symptoms of episcleritis.

Diagnosis

A thorough examination of the eyes is the only diagnosis that is available for detecting episcleritis. Individuals, who have recurrent attacks of this condition, are taken for a blood test to analyze the underlying cause.

Treatment

Majority of the cases of episcleritis usually go away without any treatment. However, with corticosteroid eye drops symptoms resolve faster and patients recover quickly. Individuals, who frequently fall prey to recurrent bouts of episcleritis, are put on NSAIDs for faster relief from the symptoms.

1. Watson PG, Hazelman BL. The Sclera and Systemic Disorders. Philadelphia: WB Saunders; 1976.
2. Watson PG. Episcleritis. In: Current Ocular Therapy. 5th ed. 809
3. Roy FH. Ocular Differential Diagnosis. Vol 1. 7th ed. Baltimore: Williams & Wilkins; 2002.
4. Rajoo SG, Gandhewar J. Recurrent episcleritis in relation to menstruation: a case report. Cornea. 2011; 30(9):1035-6 
5. Honik G, Wong IG, Gritz DC. Incidence and prevalence of episcleritis and scleritis in Northern California. Cornea. 2013; 32(12):1562-6 
6. Héron E, Gutzwiller-Fontaine M, Bourcier T. Scleritis and episcleritis: diagnosis and treatment. Rev Med Interne. 2014; 35(9):577-85 
7. Sainz de la Maza M, Molina N, Gonzalez-Gonzalez LA. Clinical characteristics of a large cohort of patients with scleritis and episcleritis.Ophthalmology. 2012; 119(1):43-50 (ISSN: 1549-4713)
8. Lim L, Suhler EB, Smith JR. Biologic therapies for inflammatory eye disease. Clin Experiment Ophthalmol. May-Jun 2006; 34(4):365-374.
9. Williams CP, Browning AC, Sleep TJ. A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis. Eye. Sep 2004.
10. Kolomeyer AM, Ragam A, Shah K, Do BK, Shah VP, Chu DS. Cyclo-oxygenase inhibitors in the treatment of chronic non-infectious, non-necrotizing scleritis and episcleritis. Ocul Immunol Inflamm. 2012; 20(4):293-9