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 only an area of painless injection.
Photophobia and watery discharge may be noted.
Physical
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 nodular episcleritis.
Other ocular findings that may be found in episcleritis include anterior uveitis and ocular hypertension. [4, 5]
Causes
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:
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Polyarteritis nodosa
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Seronegative spondyloarthropathies - Ankylosing spondylitis, inflammatory bowel disease, reactive arthritis, psoriatic arthritis
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Wegener granulomatosis
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Juvenile idiopathic arthritis
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:
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Fungi
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Parasites
Complications
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]
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Localized temporal inflammation in a patient with nodular episcleritis.
