Scleritis Versus Episcleritis

Introduction:

Scleritis and episcleritis are two inflammatory conditions affecting the eyes. The white portion of the eye is called the sclera, and the episclera is located exactly on top of it. The integrity and proper functioning of the eye depend heavily on the sclera and episclera. However, severe discomfort and even blindness may result from these tissues becoming red and inflamed. Compared to episcleritis, scleritis is a much more serious condition. This article explains the difference between the two conditions.

What Is Scleritis?

Scleritis is an uncommon condition that affects the eye's sclera and, in certain situations, even the deeper tissues. It is believed to be brought on by an autoimmune reaction, which may be secondary to underlying autoimmune dysregulation, idiopathic, or brought on by trauma or infection. It can cause severe, painful red eyes and occasionally lead to permanently impaired eyesight. Compared to episcleritis, scleritis is a more dangerous condition. In comparison to people with episcleritis, it is more common in women and typically affects patients who are older (40 to 60 years old). Scleritis is divided into two primary varieties: anterior and posterior scleritis.

Anterior Scleritis: This condition affects the sclera in front of the extraocular muscle insertion. Three variations exist.

• Diffuse Anterior—This is the most prevalent form, known as diffuse anterior. It is characterized by extensive anterior sclera inflammation; however, it is benign. Roughly half of the cases of scleritis are caused by it. It normally resolves itself, and it does not threaten eyesight.

• Nodular—The sclera has erythematous, painful, fixed nodules, and there is a 1 in 4 chance of developing necrotizing scleritis. This condition frequently recurs.

• Necrotizing - This is less common, occurring in around fifteen percent of cases, and is characterized by severe discomfort and noticeable scleral damage. It is typically linked to an underlying systemic illness. It is usually linked to more difficulties and worse results. Early and effective therapy is necessary for necrotizing scleritis because standard steroid therapy is typically ineffective. It is divided into two types: necrotising scleritis with corneal inflammation also called sclerokeratitis and necrotising scleritis without inflammation also called scleromalacia perforans.

Posterior Scleritis - Because it affects the backside of the eye and is located further posteriorly, it poses a great challenge to identify. Women are more frequently affected than men. Severe eye pain, retinal detachment, angle closure glaucoma, and vision loss are possible symptoms. Anterior scleritis is a coexisting condition in about one-third of patients with posterior scleritis. Rapid and irreversible vision loss can result from posterior scleritis.

What Is Episcleritis?

Inflammation of the episcleral layer, known as episcleritis, is frequently brought on by dry eye disease. This happens due to insufficient tear lubrication of the eye. Episcleritis lasts for seven to ten days before healing up on its own. Most episcleritis instances are solitary and unrelated to any underlying medical condition. However, in thirty percent of cases, it can be linked to an underlying condition; the episodes will be longer in those circumstances. These include systemic lupus erythematosus (SLE), inflammatory bowel illness, vasculitis, and rheumatoid arthritis.

What Are the Symptoms of Scleritis and Episcleritis?

One of the most noticeable symptoms of episcleritis is the sudden emergence of red, uncomfortable eyes. Pain is very rare, and vision is unaffected. Scleritis, on the other hand, has a more subacute onset and is characterized by a deep, dull pain that is greater at night and interferes with sleep. In extreme cases, it can also cause headaches, photophobia, and vision loss.

Symptoms of Episcleritis:

• Sudden onset.

• Uncomfortable, gritty feeling, or mildly painful eye.

• Episclera will be red and inflamed, often dispersed, but sometimes arranged in a sectoral pattern.

• It can affect one eye or both eyes.

• Enlargement of the episcleral arteries on the surface.

• No thinning of the sclera.

• Watery eyes.

• No issues with eyesight.

Symptoms of Scleritis:

• Slow and gradual onset.

• Deep, dull discomfort and pain normally worsen at night and may radiate to the forehead or jaw.

• Diffused ocular redness.

• Scleral thinning.

• It can be one-sided or two-sided.

• Watery eyes.

• Decrease in vision acuity.

• Photophobia (fear of lights).

• Painful movement of the eyes.

• Fever, vomiting, and headaches can occur as associated symptoms.

What Is the Difference Between Scleritis and Episcleritis?

Scleritis and episcleritis both cause inflammation of the outer layers of the eye, but they differ in a few important ways:

• Incidence - It is fairly common to have episcleritis. It usually appears suddenly. Scleritis, on the other hand, is far more dangerous and less prevalent. It usually manifests more slowly and damages the eye's deep white layer or sclera.

• The Severity of Symptoms - Episcleritis can cause mild discomfort and redness, which frequently forms a wedge-shaped area over the white eye. Occasionally, it may hurt a little more than usual and result in the formation of swollen lumps on the eye's surface. The swollen lumps are called nodules. On the other hand, scleritis can potentially spread and impact the cornea and the episclera. The main difference between scleritis and episcleritis is that scleritis causes severe pain, like a deep 'boring' type of pain in or around the eye. Still, episcleritis causes only discomfort but is not that painful. It is possible for the eye to become watery, sensitive to light, and have blurred vision.

• Treatment Approach - In most cases, episcleritis is a mild condition with no lasting effects. With basic care, it normally goes away on its own in a week or so. Nevertheless, episcleritis can affect one or both eyes and is frequently recurrent. Conversely, scleritis can cause long-term visual loss. It can affect one or both eyes. Since it is frequently linked to other inflammatory diseases like rheumatoid arthritis, systemic drugs like immunosuppressants or corticosteroids are needed for more intensive treatment.

• Complications - If scleritis is not treated or well managed, there is an increased chance of consequences, including corneal thinning and vision loss. Conversely, long-term visual issues or consequences are uncommon with episcleritis.

• Underlying Conditions - While episcleritis can develop spontaneously or in response to external stimuli, scleritis is closely linked to underlying autoimmune illnesses.

Conclusion:

Episcleritis and scleritis are two different eye conditions affecting the sclera and associated structures. Both conditions have different symptoms and require separate treatments. Differentiating the condition is important for proper diagnosis and prompt treatment of sclerosis, or it can lead to severe complications.