Episcleritis

Basics

  • Episcleritis is irritation and inflammation of the episclera, a thin layer of vascular connective tissue between the conjunctiva and sclera.
  • Usually a benign self-limited condition, typically resolving without treatment within 3 weeks
  • Topical lubricants and/or topical corticosteroid treatment may relieve symptoms while awaiting spontaneous resolution.

Description

  • Edema and injection confined to the episcleral tissue
  • Two types
    • Simple episcleritis: diffuse scleral involvement—more common
    • Nodular episcleritis: focal area(s) of involvement—less common

Epidemiology

Slight female predominance (~60–65%)

Incidence

  • May occur at any age
  • Peak incidence in 40s to 50s
  • Community incidence not well known (~20 to 50 cases per 100,000 person-years)

Prevalence
Not historically well-known; a recent community study found a prevalence of 53 cases per 100,000 persons.

Etiology and Pathophysiology

  • Etiology: usually idiopathic, but up to one-third of the patients can have systemic autoimmune conditions (1)
  • Pathophysiology:
    • Nonimmune (e.g., dry eye syndrome, with histology showing widespread vasodilation, edema, lymphocytic infiltration)
    • Immune (systemic vasculitis or rheumatologic disease)

Commonly Associated Conditions

  • Usually not associated with another condition
  • Less commonly associated conditions include the following: In rare cases, episcleritis can be the initial symptom of a systemic condition.
    • Rheumatoid arthritis
    • Vasculitis
    • Inflammatory bowel disease
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Systemic lupus erythematosus
    • Gout
    • Herpes zoster
    • Hypersensitivity disorders
      • Rosacea
      • Contact dermatitis
      • Penicillin sensitivity
      • Erythema multiforme
  • It can be an uncommon manifestation of other ocular infectious conditions.

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