eMedicine Specialties > Ophthalmology > Sclera

Episcleritis: Differential Diagnoses & Workup

Author: Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: Jun 18, 2009

Differential Diagnoses

Conjunctivitis, Viral
Keratoconjunctivitis, Superior Limbic
Scleritis

Workup

Laboratory Studies

  • All patients should undergo a thorough history, including a review of systems. Results of this review and findings from the physical examination are used to determine the need for specific laboratory studies. In most patients with mild self-limited disease, laboratory studies are not useful.
  • Some patients with an unremarkable review of systems may benefit from a limited workup. This includes patients with nodular episcleritis or those with severe and recurrent/persistent simple episcleritis. Useful laboratory studies in this group of patients include serum uric acid, complete blood count with differential, antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, Venereal Disease Research Laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-ABS) test, and chest x-ray.

Histologic Findings

Histologic findings include nongranulomatous inflammation with perivascular infiltrates and vascular dilatation.

More on Episcleritis

Overview: Episcleritis
Differential Diagnoses & Workup: Episcleritis
Treatment & Medication: Episcleritis
Follow-up: Episcleritis
References

References

  1. 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].

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

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

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

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

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

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

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

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

  10. 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].

Further Reading

Keywords

simple episcleritis, nodular episcleritis, episcleral tissue, inflammation, conjunctiva, sclera

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.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

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.

CME Editor

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

James P Gills, MD, Founder, St Luke's Cataract and Laser Institute; Professor, Department of Ophthalmology, University of South Florida College of Medicine
James P Gills, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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