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Episcleritis - Causes, Symptoms, Diagnosis, and Treatment

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Episcleritis - Causes, Symptoms, Diagnosis, and Treatment

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Episcleritis is an inflammation of the episclera. Read this article to know more about the symptoms, causes, diagnosis, and treatment.

Written by

Dr. Lochana .k

Medically reviewed by

Dr. Akshay Uday Nayak

Published At March 2, 2022
Reviewed AtJanuary 29, 2024

What Is Episcleritis?

The white part of the eye is called the sclera, and there are two transparent layers over it called episclera and conjunctiva. Episclera is a structure that is both fibrous and elastic in nature. It comprises two layers and is joined together in a very loose manner. The outer layer is called the superficial parietal layer, and the inner layer is called the deep visceral layer. The superficial layer is rich in blood vessels and is arranged in a radial manner. The deep layer contains blood vessels with various connections originating from the important ophthalmic artery.

Conjunctiva is also a clear part and makes the eye reddish in color. It might resemble a pink eye. It is a benign condition. Sometimes, it appears as nodules, and this nodular variant is the most common one.

There are two types of episcleritis. They are sectoral and diffusion. The sectoral type involves only one part of the sclera, and when the entire episclera is involved, it is called diffuse.

The inflammation is usually self-limiting. Based on the nature of the episcleritis, it can be categorized as simple and nodular. The nodular type of episcleritis is mostly present as a vascular nodule, and it is often elevated in its tissue region. It will be accompanied by inflammation. The simple type is present without any prominent nodule. But, in the absence of nodules, congestion is known to occur. The simple type occurs suddenly and is acute in nature. The nodular type takes a long time to develop and is very gradual.

What Are the Causes of Episcleritis?

In most cases, episcleritis occurs due to unknown causes. About 30% of the affected patients are known to be affected by any systemic disorder. It might include the following disorders.

What Are the Symptoms of Episcleritis?

The symptoms vary between the types of episcleritis. In simple episcleritis, the symptoms begin to express after 12 hours. It is known to resolve slowly after two or three days. In nodular type, the redness will be visible only after waking up from bed in the early morning. Recurrence can happen in the same eyes or with different eyes.

The common symptoms between the two types are sensitivity to light, tearing sensation, and sometimes pricking sensation. The pain will be more while winking my eyes. No disturbances to vision are seen. It can heal after a few weeks, but the rate of recurrence is high.

What Are the Risk Factors for Episcleritis?

There are no gender-related health issues. Episcleritis can affect both men and women, but women are known to be affected more than men. The major risk factor is the presence of underlying disorders.

How Is It Diagnosed?

A physical examination by a doctor might be necessary for an accurate diagnosis. The exact cause and mechanism of episcleritis are not known. The color of the eyes will be noted. If the eyes are purplish or bluish in color, then it might indicate scleritis rather than episcleritis.

Slit Lamp Exam:

The disorders in the eye would be difficult to identify and treat. Sometimes, the help of ophthalmologists might be required. Slit-lamp is a specialized tool designed to diagnose the problems of the eyes. The examination of eyes using this specialized instrument is known as biomicroscopy. This procedure requires some preparation in the eyes before the examination.

To obtain clear results, dilation of the pupil might be necessary. Dilation refers to the enlargement of the pupil size. In order to achieve the dilation of the pupil, eye drops are instilled. The doctor will make you sit in a comfortable position and will ask you to rest the chin on a stand. This position will be comfortable for the ophthalmologist to visualize your eyes.

The procedure of biomicroscopy will use a low-powered microscope attached to a high-intensity lamp. The lamp will have many filters to view the eyes. The latest technology allows capturing of the eye’s images. It is always good to maintain a record of the images so that they can be used for future references.

The following parts of the eye can be visualized in this procedure.

  • Conjunctiva.

  • Eyelids.

  • Optic nerve.

  • Sclera.

  • Iris.

  • Lens.

  • Retina.

  • Cornea.

What Are the Treatment Options?

Episcleritis is not a fatal condition. It gets cured on its own. If the reddish appearance is quite problematic to the individual, they can seek help for quicker treatment options.

Home Remedies:

It is necessary to wear sunglasses whenever you go outdoors. A cold compress can be given to the eyes. Artificial tear drops are known to help in the cure for episcleritis.

Medications:

Before the doctor prescribes the medication, it is mandatory for the doctor to look into the patients' medical history. Treatment for systemic disorder is known to cure the condition of episcleritis.

The medications are given to the patient in the form of eye drops. The commonly prescribed drugs are:

  • Corticosteroid eye drops can be given to prevent eye damage. It will also provide relief from irritation and redness. These drugs require a recommendation from your doctor. Long-term usage of corticosteroids should be avoided to prevent complications like cataracts and glaucoma.

  • Non-steroidal anti-inflammatory drugs might be used to overcome the pain in the eyes. The commonly used anti-inflammatory drugs are Ibuprofen.

  • Artificial tear drops are very helpful in providing lubrication to the eyes. It can also prevent damage from environmental factors. The teardrops should be stored at room temperature. It should be placed away from too much moisture or heat.

How Is the Prognosis Rate?

Prognosis is very good for episcleritis conditions. The healing happens completely within a few weeks. Following the medications, along with the home remedies, can provide a cure and prevent a recurrence.

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Frequently Asked Questions

1.

Can Stress Cause Episcleritis?

Episcleritis is the inflammation of the episclera, the clear layer on the top of the white part of the eye called the sclera. This inflammation is likely caused by oxidative stress (disproportion between antioxidants and free radicals in the body), which results in tissue inflammation. 

2.

Does Episcleritis Ever Go Away?

Episcleritis is a common condition that generally does not cause any long-term issues. It often goes away within a few weeks on its own, but certain treatment options are available to speed up the process.

3.

Can Episcleritis Result in Blindness?

Generally, episcleritis does not affect vision or cause any permanent damage to the eyes. It does not hurt much but can be irritating. So if a person is having sore or painful eyes, he might have something else.

4.

Is Episcleritis a Severe Condition?

Episcleritis is a self-limiting, benign condition that does not have long-term consequences. Usually, it is a mild condition that settles down over a week by itself. Hence it is not a severe condition, and often complete resolution is achieved without any treatment.

5.

Can Dry Eyes Cause Episcleritis?

It is estimated that episcleritis patients are more likely to suffer from dry eye syndrome in comparison to non-episcleritis patients. Treatment of dry eye syndrome has proven to be helpful in episcleritis. Hence it can be said that episcleritis is associated with dry eye syndrome.

6.

Who Is at Risk of Getting Episcleritis?

Episcleritis is common in females when compared to males. People of ages between 40 to 50 years old are more prone to develop episcleritis. The incidence of episcleritis is estimated to be one in 1000. Hence it is a common condition.

7.

Are Eye Drops Help in Episcleritis?

Usually, episcleritis does not require any treatment, but lubricating eye drops can help soothe irritation and redness. Eye drops constrict blood vessels of the eye hence temporarily reducing the redness.

8.

Can Allergy Cause Episcleritis?

In some patients, episcleritis is found to be associated with systemic diseases. It can be present in various conditions causing inflammation of the ocular surface, including allergy, infection, gout, and rheumatoid arthritis. Hence allergy can cause episcleritis.

9.

Which Doctor Treats Episcleritis?

Episcleritis is the inflammation of the episclera, causing the eyes to look red and irritated. It is often seen and treated by eye specialists known as ophthalmologists or even general physicians unless the problem is severe. 

10.

How to Treat Episcleritis?

The mainstay of the treatment for episcleritis is oral NSAIDs (nonsteroidal anti-inflammatory drugs) such as Ibuprofen. Alternative medications include Indomethacin. If any associated underlying condition is present, then it should be treated. 

11.

How to Diagnose Episcleritis?

To diagnose episcleritis, an eye exam is done to check for any changes in the color of the eyes. A slip lamp exam is also done that gives a 3D view of the front of the eyes to check for any eye abnormalities.

12.

When Should One Consult a Doctor for Episcleritis?

Episcleritis often goes away on its own in a few days. However, a doctor needs to be consulted if the symptoms of episcleritis last for more than two weeks. Follow-up care is important for treatment and safety.

13.

Is Episcleritis Associated With Autoimmune Disease?

Episcleritis is said to be associated with autoimmune disorders such as lupus and rheumatoid arthritis. Lupus is a condition in which the immune system attacks its own cells and affects the skin, joints, kidneys, blood cells, heart, brain, and lungs.

14.

How to Treat Episcleritis at Home?

A cold compress can be used to get some relief from episcleritis symptoms. An over-the-counter medication such as Ibuprofen can be taken to treat the condition. Eye drops also help in providing relief from symptoms. Also, affected people should wear sunglasses when going out to prevent aggravating the symptoms.
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Dr. Akshay Uday Nayak
Dr. Akshay Uday Nayak

Ophthalmology (Eye Care)

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