Episcleritis Clinical Presentation

Updated: Feb 04, 2022
  • Author: Ellen N Yu-Keh, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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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 only an area of painless injection.

Photophobia and watery discharge may be noted.



The diagnosis of episcleritis is mainly based on clinical findings.

Slit-lamp examination reveals edema of the episcleral tissue and injection of superficial episcleral vessels.

The injection may be diffuse in diffuse episcleritis or localized and associated with a nodule in nodular episcleritis. The injection in episcleritis blanches with instillation of 10% phenylephrine ophthalmic drops, but not in scleritis.

Localized temporal inflammation in a patient with Localized temporal inflammation in a patient with nodular episcleritis.

Other ocular findings that may be found in episcleritis include anterior uveitis and ocular hypertension. [4, 5]



Most cases are idiopathic; however, up to one third of cases may have an underlying systemic condition, [12, 13, 14] particularly connective tissue or vasculitic diseases.

Collagen-vascular diseases associated with episcleritis include the following:

Other noninfectious conditions associated with episcleritis include HLA-B27 associated, [15] Behcet disease, and sarcoidosis. [16] Gout, atopy, and acne rosacea have also been associated with episcleritis.

Foreign bodies may cause episcleritis.

Episcleritis may also be associated with infectious causes, including the following:

  • Bacteria, including tuberculosis, Lyme disease, syphilis, and cat-scratch disease
  • Viruses, including herpes simplex and herpes zoster; Episcleritis can also be seen in patients with Covid-19. [17, 18]
  • Fungi
  • Parasites


Episcleritis was found to be complicated by anterior uveitis in 16% of cases based on a large study from a tertiary referral study. Other complications included ocular hypertension and cataract progression. [4] However, the latter two complications were seen only in patients with episcleritis based on a population-based study. [19]