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 necessary.
Patients with nodular episcleritis or those with severe and recurrent/persistent diffuse episcleritis may require a limited workup, although the review of systems is unremarkable. 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. Patients with a long history of low back pain or stiffness should be evaluated for ankylosing spondylitis.
Histologic Findings
Histologic findings include nongranulomatous inflammation with perivascular infiltrates and vascular dilatation.
Imaging Studies
Evaluations of the sclera and episclera using anterior segment optical coherence tomography (AS-OCT) have been shown useful in monitoring the effectiveness of therapy. [20] Differentiating scleritis from episcleritis can be helpful. The former demonstrates increased thickness of the sclera and intrascleral hyporeflective areas of edema on AS-OCT. [21]
More recently, a pilot study on the use of AS-OCT in conjunction with anterior segment OCT angiography (AS-OCTA) in differentiating patients with scleritis and episcleritis was conducted. Results show that both combined may be adjunctive tools by differentiating superficial from deep scleral inflammation by assessing the degree of vascularity and tissue thickness of the different tissue layers. [22]
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Localized temporal inflammation in a patient with nodular episcleritis.
