Episcleritis Clinical Presentation

  • Author: Hampton Roy Sr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 2, 2012
 

History

All patients should undergo a thorough history, including a review of systems.

Many patients complain of acute onset of mild-to-moderate discomfort, although some may notice an area of painless injection.

Photophobia and watery discharge may be noted.

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Physical

A diffuse or localized injection of the bulbar conjunctiva is often present.

A watery discharge is observed in some patients.

A freely moveable nodule may be present in nodular episcleritis.

Corneal findings are uncommon and include dellen formation as well as peripheral corneal infiltrates.

An associated anterior uveitis may occur in as many as 10% of patients.

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Causes

Most cases are idiopathic; however, up to one third of cases may have an underlying systemic condition.[6, 7, 8]

Collagen-vascular diseases are as follows:

Miscellaneous causes are as follows:

  • Gout
  • Atopy
  • Foreign bodies
  • Chemicals

Infectious diseases causes are as follows:

Other rare causes/associations are as follows:

  • T-cell leukemia
  • Paraproteinemia
  • Paraneoplastic syndromes - Sweet syndrome, dermatomyositis
  • Wiskott-Aldrich syndrome
  • Adrenal cortical insufficiency
  • Necrobiotic xanthogranuloma
  • Progressive hemifacial atrophy
  • Following transscleral fixation of posterior chamber intraocular lens
  • Insect bite granuloma
  • Malpositioned Jones tube
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Contributor Information and Disclosures
Author

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Foster CS, Maza MS. The Sclera. Springer-Verlag; 1994:96-102.

  2. Watson PG, Hazelman BL. The Sclera and Systemic Disorders. Philadelphia: WB Saunders; 1976.

  3. Lin CP, Shih MH, Su CY. Scleritis. Surv Ophthalmol. May-Jun 2006;51(3):288-9; author reply 289. [Medline].

  4. Watson PG. Episcleritis. In: Current Ocular Therapy. 5th ed. 809.

  5. Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976;60:163-192. [Medline].

  6. Minas TF, Podos SM. Familial glaucoma associated with elevated episcleral venous pressure. Arch Ophthalmol. 1968;80:202-213. [Medline].

  7. Roy FH. Ocular Differential Diagnosis. Vol 1. 7th ed. Baltimore: Williams & Wilkins; 2002.

  8. Boniuk M. The ocular manifestations of ophthalmic vein and aseptic cavernous sinus thrombosis. Trans Am Acad Ophthalmol Otolaryngol. Nov-Dec 1972;76(6):1519-34. [Medline].

  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;[Medline].

  10. Lim L, Suhler EB, Smith JR. Biologic therapies for inflammatory eye disease. Clin Experiment Ophthalmol. May-Jun 2006;34(4):365-374. [Medline].

 
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