In patients with episcleritis, decreased vision occurred in 2%, anterior uveitis was present in 11%, glaucoma developed in 4%, cataract formed in 2%, and specific disease association was uncovered in 32%. [ncbi.nlm.nih.gov]

Note the malar rash that is also present. ( Courtesy of Richard P. [basicmedicalkey.com]

February 07, 2018 / Tim Murphy Emergency physicians will see many patients presenting with a "red eye" throughout their career. [tamingthesru.com]

Management depends on the specific diagnosis, and every year a new list of potential associations or atypical presentations is reported. For a successful outcome, it is important that these presentations are recognized. [journals.lww.com]

• Fatigue

  Now let me go into detail as I am very confused now. 7 months ago I became very ill....leg weakness, muscle twitches, extreme fatigue, and severe vertigo. [medhelp.org]

  Some systemic associations may include life-threatening aortitis (up to 10%), inflammatory bowel disease, pericarditis, abdominal pain, fatigue, weight loss, arthralgia, myalgia, fever, headache, and urticaria. [webeye.ophth.uiowa.edu]

• Collapse

  Scleritis can be differentiated from episcleritis by using phenylephrine or neo-synephrine eye drops, which causes blanching (collapsing of blood vessel causing a reduction in redness) of the blood vessels in episcleritis, but not in scleritis. [differencebetween.com]

• Recurrent Inflammation

  Definition of Episcleritis: Episcleritis is defined as the benign recurrent inflammation of episclera and tenon’s capsule. [epomedicine.com]

• Burning Pain

  corneal vascularization, corneal ulceration NSAIDs, topical/oral/IV steroids, immunosuppressives, surgery Keratoconjunctivitis sicca Dry eye, burning, pain, blurred vision, pruritus, foreign-body sensation, mucous threads and crusting about the eyelids [aafp.org]

• Rhinorrhea

  She denied any hearing loss, diplopia, fever, cough, rhinorrhea, otorrhea, tinnitus, and vomiting. [webeye.ophth.uiowa.edu]

• Vascular Disease

  In patients with collagen vascular disease, measures targeted at the underlying disease itself can achieve control of the episcleritis. [eyewiki.aao.org]

  It can, however, present in a wide variety of conditions causing ocular surface inflammation, including connective tissue or vascular disease (such as lupus or rheumatoid arthritis), infection, rosacea, gout, or allergy. [mersi.com]

  Aetiology Idiopathic inflammation of the vascular connective tissue layer that lies between the sclera and conjunctiva Predisposing factors Up to one third of cases (especially nodular variety) associated with systemic disorders, e.g. collagen vascular [college-optometrists.org]

  A significant percentage of patients with concurrent scleritis and collagen vascular disease die within 5 years. [emedicine.medscape.com]

• Eye Pain

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

  In very severe cases of scleritis, eye surgery must be performed to repair damaged corneal tissue. For less severe cases, non-steroidal anti-inflammatory drugs, such as ibuprofen, are given to relieve the pain. [differencebetween.com]

  Symptoms of Scleritis and Episcleritis A red or violet, slightly raised patch on the white of the eye, usually only a fraction of an inch in diameter Sharp, severe eye pain that intensifies when the eye is moved Dull, aching pain in one or both eyes, [healthcommunities.com]

  pain on eye movement Pathophysiology Common pathological features include scleral oedema and inflammation, often with a zonal granulomatous (can also necrose) reaction that may be localised or diffuse. [dundeemedstudentnotes.wordpress.com]

  Although clinical presentation was similar, with conjunctival injection noted in majority, eye pain and headache were more common with SC. Markers of inflammation were elevated in 7/15 SC and 6/15 EP. [acrabstracts.org]

• Scleral Disease

  Ocular Examination The ocular examination in scleral diseases must include an episcleral and scleral examination and a general ophthalmologic examination. [aao.org]

  Shoughy, MD, FRCS (Glasg.), The Eye Center and The Eye Foundation for Research in Ophthalmology: Scleritis Episcleritis Optical coherence Tomography Additional relevant MeSH terms: Scleritis Scleral Diseases Eye Diseases [clinicaltrials.gov]

  Progression of scleral disease. Ophthalmology. 1991 ;98: 467 – 471. [Crossref], [Web of Science ®], [Google Scholar] ]. 4.2. Tests Blood and radiographic tests are seldom helpful and are mainly used to diagnose associated autoimmune conditions. [tandfonline.com]

  Destructive corneal and scleral disease associated with rheumatoid arthritis. Medical and surgical management. Cornea. 1995;14:408–17. 9. Waheed NK, Miserocchi E, Foster CS. Ocular concerns in juvenile rheumatoid arthritis. [aafp.org]

• Blurred Vision

  […] eye movement, photophobia Decreased visual acuity, loss of color vision, central scotoma, afferent pupillary defect, swollen optic nerve IV steroids with positive MRI findings Exophthalmos Irritable and gritty eyes, double or blurred vision, photophobia [aafp.org]

  vision Pain affecting the jaw or cranial bones around the eye Scleritis and Episcleritis Prevention There is no way to prevent episcleritis or scleritis. [healthcommunities.com]

  Blurred vision and bland watering of the eye is seen due to inflammation of the tissues. A Red patch which may be slightly raised is commonly noted in cases of scleritis. [differencebetween.net]

  Symptoms include pain, tearing, photophobia, gradual blurring of vision. [webeye.ophth.uiowa.edu]

  The patients don't come in complaining of blurred vision, they come in complaining of irritation, redness, and itching." One trick Dr. de Luise uses for differentiating between the two is using a drop of phenylephrine in the eye. [eyeworld.org]

• Blepharitis

  Red Eye Diagnosis 9 Blepharitis Dry Eye Conjunctivitis Subconjunctival Haemorrhage Episcleritis And Scleritis Corneal Causes Of Red Eye Iritis Endophthalmitis Test Questions 3. [ophthalmologytraining.com]

  Other conditions that have symptoms similar to scleritis include: episcleritis, which is an inflammation of superficial vessels in the outermost layer of the eye (episclera) blepharitis, which is an inflammation of the outer eye lid viral conjunctivitis [healthline.com]

  Episcleritis frequently occurs in the setting of dry eye syndrome and blepharitis and attention to these two underlying issues is likely to be of benefit. [eyewiki.aao.org]

  […] reactivation of SLE that was thought to be in remission. 16 External ocular manifestations include keratoconjunctivitis sicca, conjunctivitis, uveitis, episcleritis, scleritis, keratitis, and a discoid lupus rash over the eyelids that is often confused with blepharitis [aafp.org]

• Chemosis

  Eyelid edema and conjunctival chemosis may be present. Symptoms Patients with episcleritis will report the acute or gradual onset of diffuse or localized eye redness, usually unilateral. [eyewiki.aao.org]

  Because of the close connection between the sclera and Tenon’s capsule, inflammation of the posterior sclera can extend to the orbit and cause proptosis, chemosis, lid swelling and retraction in upgaze. [touchophthalmology.com]

  […] defect, swollen optic nerve IV steroids with positive MRI findings Exophthalmos Irritable and gritty eyes, double or blurred vision, photophobia, increased tearing, orbital pressure Protruding globe, widened palpebral fissures, conjunctival injection and chemosis [aafp.org]

Designed for quick point-of-care reference, the book features numerous full-color photographs and bulleted how-to instructions for workup and treatment of each disorder. [books.google.com]

Workup Most episcleritis does not require a workup. Gather a careful review of systems (ROS) to rule out the very slight possibility that a patient’s episcleritis represents a forme fruste systemic autoimmune disease. [entokey.com]

Management Often a full systematic workup with blood tests and X rays may be required to exclude the potential underlying causes described above. Co-management with another physician (rheumatologist) may be advocated. [peterheyworth.com]

[…] have some form of ocular inflammation whether you want to call it episcleritis, scleritis, uveitis or pan-uveitis - it all depends on the exact findings but all are similar in that they can have multiple possible causes and a properly directed medical workup [medhelp.org]

Systemic Disease Workup Diagnostic Test Remarks Complete blood count Elevated white cell count in infections Basic metabolic panel Evaluate for vasculitis-related renal disease Erythrocyte sedimentation rate Nonspecific inflammation C-reactive protein [reviewofoptometry.com]

CONCLUSIONS: Selective vs. non-selective COXIs were equally efficacious for the treatment of chronic non-infectious, non-necrotizing scleritis and episcleritis. [ncbi.nlm.nih.gov]

treatment 9.2 [3.0–28.7]) compared to the nonsmoking group. [nature.com]

Scleritis Scleritis almost always requires treatment with systemic medications. [aao.org]

Episcleritis is typically self-limited and does not require acute treatment. Authored by Jimmy Summers, MD Posted by Tim Murphy, MD [tamingthesru.com]

Treatment of mild cases may include using artificial tears and cool compresses. [ibdrelief.com]

Prognosis Scleritis: Scleritis can have a bad prognosis. Episcleritis: With episcleritis prognosis is often good. Image Courtesy: “Scleritis” by Kribz – Own work. [differencebetween.com]

Episcleritis is more common in females than in males, although the difference is not statistically significant. [7, 8] Prognosis The prognosis of episcleritis is favorable. Patient Education Episcleritis is usually self-limited. [emedicine.medscape.com]

The ocular prognosis of scleritis associated with connective tissue or vasculitic disease varies depending on the specific entity. [aao.org]

Scleritis - prognosis When scleritis originates from a systemic disorder, its course tends to follow that of the underlying problem. [patient.info]

[…] misdiagnosed Affects women twice as often as men 1/3 rd patients are under 40 yrs of age at presentation Patients over 50 yrs: at inc. risk of harbouring systemic disease and suffering visual loss 2/3 rd cases have unilateral involvement Guarded visual prognosis [slideshare.net]

etiology include subacute/chronic complaints and absence of fever, infectious parameters, or sinusitis. [ajnr.org]

An associated systemic disease is present in approximately 40% to 57% of patients with scleritis; 30% to 48% have an associated connective tissue or vasculitic disease, 5% to 10% an infectious etiology, and 2% have atopy, rosacea, or gout ( Table 2 ). [aao.org]

Therefore, we conducted this study to evaluate and analyze our experience of the clinical features and etiologies of scleritis and episcleritis in Southern Taiwan. 2. [e-tjo.org]

Etiology and Pathophysiology Scleritis and episcleritis are inflammatory conditions causing congestion of the deeper 2 of the 3 vascular layers (conjunctival, episcleral, and scleral plexuses) overlying the avascular sclera. [basicmedicalkey.com]

Etiology: The most common underlying disorder for scleritis or episcleritis is rheumatic arthritis. [differencebetween.net]

METHODS:: Secondary analysis was performed on data from the Northern California Epidemiology of Uveitis Study. [jhu.pure.elsevier.com]

Epidemiology Scleritis usually presents between the ages of 30 and 50 years and is twice as common in women compared to men. 1 Forty-four percent of patients presenting with scleritis to specialty health centers were found to have an associated systematic [basicmedicalkey.com]

Types of Episcleritis: Diffuse episcleritis Nodular episcleritis Epidemiology: Common in females compared to males Common in young adults Etiology: Non-specific immune response to irritants Idiopathic (mostly) Rheumatoid arthritis (RA) Sjogren’s syndrome [epomedicine.com]

Many patients with nodular episcleritis have an associated systemic disease. [6] Epidemiology Diffuse episcleritis (84% of cases) is more common than nodular scleritis (16% of cases), and the mean age of all patients with episcleritis is 47.4 years. [ [emedicine.medscape.com]

[…] takes longer to resolve. [1] Although rare, some cases may progress to scleritis. [11] However, in general, episcleritis does not cause complications in the eye. [11] Smoking tobacco delays the response to treatment in patients with episcleritis. [12] Epidemiology [en.wikipedia.org]

This article reviews the pathophysiology and clinical features of the different variants of episcleritis and scleritis, and also discusses current and emerging treatment modalities, including the biological agents and the putative role of periocular corticosteroid [eurekaselect.com]

Episcleritis Background Inflammation of the episclera (thin fibroelastic structure that lies between the conjunctiva and sclera) Usually mild and self-limiting Pathophysiology and aetiology Most cases are idiopathic Up to a third of patients have an underlying [dundeemedstudentnotes.wordpress.com]

Some cases may be caused by exogenous inflammatory stimuli. [3, 4, 5] Pathophysiology The pathophysiology is poorly understood. [emedicine.medscape.com]

Etiology and Pathophysiology Scleritis and episcleritis are inflammatory conditions causing congestion of the deeper 2 of the 3 vascular layers (conjunctival, episcleral, and scleral plexuses) overlying the avascular sclera. [basicmedicalkey.com]

Pathophysiology The hypothesized pathophysiology is non-granulomatous inflammation of the superficial vascular network of the episclera that leads to vascular dilatation and perivascular infiltration [ 1 Sainz De La Maza, M, Molina N, Gonzalez-Gonzalez [tandfonline.com]

There is no way to prevent episcleritis or scleritis. [healthcommunities.com]

Treating underlying autoimmune conditions that might cause scleritis is also important in preventing future problems with the sclera. [healthline.com]

Prevention: There is no way one can prevent these diseases apart from cleanliness of the eye. The inflammation can only be reduced by application of local eye drops which have anti-inflammatory content in it. [differencebetween.net]

How do I prevent episcleritis and scleritis? These inflammatory conditions cannot be directly prevented. [dartonsurgery.nhs.uk]