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Episcleritis Clinical Presentation

  • Author: Hampton Roy, Sr, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Mar 03, 2016
 

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.[7, 8, 9]

Collagen-vascular diseases are as follows:

Miscellaneous causes are as follows:

  • Atopy
  • Foreign bodies
  • Chemicals

Infectious disease 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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Additional Contributors

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

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. 2006 May-Jun. 51(3):288-9; author reply 289. [Medline].

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

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

  6. Yadav S, Rawal G. Tubercular Nodular Episcleritis: A Case Report. J Clin Diagn Res. 2015 Aug. 9 (8):ND01-2. [Medline].

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

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

  9. 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].

  10. 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].

  11. 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].

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

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