episcleritis
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Introduction
Inflammation of the episcleral connective tissue.
Etiology
- allergy
- rheumatoid arthritis*
- spondyloarthropathy
- vasculitis
- ANCA-associated vasculitis
- granulomatosis with polyangiitis (70% cANCA positive)
- ANCA-associated vasculitis
* minority of patients[2]
Clinical manifestations
- unilateral red eye, eye irritation, & tearing[2]
- superficial dilated blood vessels with white sclera visible between dilated vessels
- dilation of blood vessels resolves with 2.5% phenylephrine
- occasionally painful
- occasional photophobia
- rarely results in a discharge
- uncommonly associated with visual changes[2]
Differential diagnosis
- scleritis
- more commonly associated with eye pain & photophobia
- more commonly associated with red eye, eye irritation & tears[2]
- edema of the sclera, violaceous discoloration of the globe
- dilation of deeper blood vessels does not easily resolve with 2.5% phenylephrine[3]
- uveitis typically causes severe eye pain & photophobia
- ciliary flush
- conjunctivitis
- pain uncommon
- conjunctiva grossly injected
- diffuse eye redness vs localized redness with episcleritis
- tearing &/or mucus discharge uusual[3]
- watery discharge with viral conjunctivitis
- preauricular lymphadenopathy is commonly present with viral conjunctivitis
Management
- generally self-limited, resolving within several weeks[2]
- NSAIDS for symptom relief[2]