Episcleritis

1. See Also
   1. Sclera
   2. Scleritis
2. Pathophysiology
   1. Inflammation of connective tissue under Conjunctiva
3. Causes
   1. Idiopathic in most cases
      1. Contrast with Scleritis which is often a manifestation of connective tissue disease
   2. Allergy may underly many cases
   3. Uncommon other causes
      1. Connective tissue disease
      2. Acne Rosacea
      3. Atopic Patient
4. Symptoms
   1. More mild eye discomfort than in Scleritis
      1. Red eye with gritty, uncomfortable sensation
   2. Sudden onset of symptoms (gradual onset in Scleritis)
   3. No blurred vision (contrast with Scleritis)
   4. Mild photophobia
   5. Mild eye tearing
5. Signs
   1. No change in visual acquity
   2. Pupils equal and reactive to light
   3. Focal (single sector) of raised white area with blood vessels radiating out
      1. Dilated episcleral blood vessels
      2. Episcleral Edema
6. Signs: Slit Lamp Exam
   1. Superficial Localized Edema over Sclera
   2. No Scleral thickening or other involvement
   3. Scleritis blanches with topical Phenylephrine 2.5% (contrast with Scleritis which does not blanch)
7. Differential Diagnosis
   1. Scleritis
   2. Conjunctivitis
8. Course
   1. Resolves spontaneously within days
9. Management
   1. No treatment needed (resolves spontaneously)
   2. Ocular NSAID
10. References
    1. Goldstein in Yanoff (1999) Ophthalmology, p. 13.1
    2. Ruddy (2001) Kelley's Rheumatology, Saunders, p. 396
    3. Nakla (1998) Gastroenterol Clin North Am 27:697-711