Episcleritis Clinical Presentation
- Author: Hampton Roy, Sr, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc more...
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.
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.
Most cases are idiopathic; however, up to one third of cases may have an underlying systemic condition.[7, 8, 9]
Collagen-vascular diseases are as follows:
- Polyarteritis nodosa
Miscellaneous causes are as follows:
- Foreign bodies
Infectious disease causes are as follows:
- Viruses, including herpes simplex and herpes zoster
Other rare causes/associations are as follows:
- T-cell leukemia
- 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
Foster CS, Maza MS. The Sclera. Springer-Verlag; 1994. 96-102.
Watson PG, Hazelman BL. The Sclera and Systemic Disorders. Philadelphia: WB Saunders; 1976.
Lin CP, Shih MH, Su CY. Scleritis. Surv Ophthalmol. 2006 May-Jun. 51(3):288-9; author reply 289. [Medline].
Watson PG. Episcleritis. Current Ocular Therapy. 5th ed. 809.
Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976. 60:163-192. [Medline].
Yadav S, Rawal G. Tubercular Nodular Episcleritis: A Case Report. J Clin Diagn Res. 2015 Aug. 9 (8):ND01-2. [Medline].
Minas TF, Podos SM. Familial glaucoma associated with elevated episcleral venous pressure. Arch Ophthalmol. 1968. 80:202-213. [Medline].
Roy FH. Ocular Differential Diagnosis. 7th ed. Baltimore: Williams & Wilkins; 2002. Vol 1:
Boniuk M. The ocular manifestations of ophthalmic vein and aseptic cavernous sinus thrombosis. Trans Am Acad Ophthalmol Otolaryngol. 1972 Nov-Dec. 76(6):1519-34. [Medline].
Axmann S, Ebneter A, Zinkernagel MS. Imaging of the Sclera in Patients with Scleritis and Episcleritis using Anterior Segment Optical Coherence Tomography. Ocul Immunol Inflamm. 2015 Aug 10. 1-6. [Medline].
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].
Lim L, Suhler EB, Smith JR. Biologic therapies for inflammatory eye disease. Clin Experiment Ophthalmol. 2006 May-Jun. 34(4):365-374. [Medline].