Taking a Second Look at Episcleritis

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Episcleritis is a relatively common type of red-eye caused by the inflammation of the episcleral tissues. This condition usually impacts women more than men and young adults. While episcleritis is usually not a sign of another disease, it tends to occur in those who suffer from body-wide inflammatory diseases like forehead or eye-related shingles, rheumatoid arthritis, or lupus. Let's take a closer look at episcleritis to learn more about the condition.

What Is Episcleritis?

Episcleritis refers to the inflammation of the episclera. The episclera is a clear layer that is located on top of the sclera. On the outside of the episclera, there is another clear layer called the conjunctiva. 

The inflammation and irritation causes the eye to look irritated and red. In many instances, episcleritis resembles pink eye without the discharge, can often go away on its own, and usually only impacts a small patch of the eye. While it usually causes a red, irritated look, it sometimes results in a raised, slightly yellow area. 

Scleritis

In addition to episcleritis, it’s important to educate your patients on a similar eye condition called “scleritis.” It’s important for them to know that if their eye feels painful, looks red, and/or if their vision becomes blurry, they should immediately seek medical attention. If they do have scleritis, they're more likely to need a more aggressive treatment plan because this condition can lead to permanent eye damage.

Understanding Types and Symptoms of Episcleritis

The main symptom of episcleritis is eye redness; however, there are two primary types of episcleritis:

  • 1. Simple episcleritis: This is a simple form of episcleritis where redness can form in a section and sometimes throughout the eye with minimal discomfort. As the most common type of episcleritis, there are two different types:
  • a. Diffuse episcleritis is when redness appears all over the eye.
  • b. Sectoral episcleritis is when redness appears over only a part of the eye.
  • 2. Nodular episcleritis: In this version your patient may experience slightly raised bumps. These bumps tend to be surrounded by blood vessels that are dilated. Similar to simple episcleritis, nodular episcleritis usually only impacts one area of the eye and may cause discomfort.

Nodular and simple types of episcleritis do have aesthetic differences, but they also share some of the same symptoms, such as:

  • A gritty, prickly, or hot sensation in the eye
  • Bright light sensitivity
  • Tearing

Usually, these symptoms will not hinder or impact your patient’s vision, and they may go away on their own over a few weeks and return several months later. 

What Causes Episcleritis?

At the moment, it's unclear as to the exact causes of the condition. In most cases, there is no single, specific cause that can be found. However, an estimated ⅓ of people who have episcleritis also have a condition that impacts their entire body — or systematic disorder. Common examples of systematic disorders include: 

  • Crohn's disease
  • Lupus
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Rosacea
  • Collagen vascular diseases
  • Gout

In addition, other types of injuries and certain medications may lead to episcleritis.  

What Are the Risk Factors 

Some people are slightly more prone to experience episcleritis than others. Those who may be more susceptible to developing the condition include:

  • Gender. The condition tends to impact women slightly more than it does men.
  • Age. While it can affect children, episcleritis is more common in adults — particularly those between 40 and 50
  • People with infections. In rare instances, certain types of viruses, bacteria, or fungi can either cause or make one more susceptible to developing episcleritis. For example, the shingles (varicella) virus may be a factor.
  • Cancer. In rare instances, episcleritis has been connected to Hodgkin's lymphoma and T-cell leukemia.

Diagnosing & Treating Episcleritis

A diagnosis of episcleritis is usually found in the regular slit lamp exam. For many patients, no medical treatment or intervention is needed because the condition tends to clear up on its own in seven to 10 days. 

However, soothing, lubricating eye drops that cause blood vessel constriction can temporarily reduce the redness. These eye drops, such as tetrahydrozoline, should only be used on certain occasions because consistent use can lead to even more redness, which is called the rebound effect. To treat an episcleritis attack, a non-steroidal, anti-inflammatory drug or corticosteroid drops can be used to make the symptoms go away. 

Home Remedies 

As your patients wait for episcleritis to clear up on its own, there are a few simple things they can do at home to help manage the symptoms. Some common home remedies include:

  • Wearing sunglasses outside.
  • Using artificial tears.
  • Applying a cool compress over the impacted eye.

Questions? Contact Us Today!

For more than 100 years, Keeler has been a leader in the optometric/ophthalmic industry, offering cutting-edge diagnostic equipment and solutions. We offer a vast range of different ophthalmic and optometry supplies and equipment, including: 

We regularly partner with different high-tech ophthalmic solution providers, general medical instrument manufacturers, veterinary diagnostic specialists, and more to provide specialized OEM manufacturing.

About the Author Eugene VanArsdale

Eugene is the Director of Marketing Communications at Keeler Instruments. He has been with Keeler since 1982 and is co-holder of two patents for the company. Eugene has a true passion for the eye care industry and has dedicated himself to understanding the ins and outs of the optometric and ophthalmic equipment market.