Taking a Second Look at Episcleritis

Episcleritis is a relatively common type of red-eye caused by the inflammation of the episcleral tissues. This condition usually impacts women more than men and young adults. While episcleritis is usually not a sign of another disease, it tends to occur in those who suffer from body-wide inflammatory diseases like forehead or eye-related shingles, rheumatoid arthritis, or lupus. In this article we are taking a closer look at the what causes this condition and how to treat.

What is episcleritis?

Episcleritis refers to the inflammation of the episclera. The episclera is a clear layer that is located on top of the sclera. On the outside of the episclera, there is another clear layer called the conjunctiva. 

The inflammation and irritation causes the eye to look inflamed and red. In many instances, episcleritis resembles pink eye without the discharge, can often go away on its own, and usually only impacts a small patch of the eye. While it usually causes a red, irritated look, it can occasionally result in a raised, slightly yellow area. 

Scleritis

In addition to episcleritis, it’s important that patients are educated on a similar eye condition called “scleritis.” If the eye is painful, looks red, and/or if their vision becomes blurry, they should immediately seek medical attention. If they do have scleritis, they're more likely to need a more aggressive treatment plan because this condition can lead to permanent eye damage.

Understanding types and symptoms of episcleritis

The main symptom of episcleritis is eye redness; however, there are two primary types of episcleritis:

1. Simple episcleritis: this is a simple form of episcleritis where redness can form in a section and sometimes throughout the eye with minimal discomfort. As the most common type of episcleritis, there are two different types:

a. Diffuse episcleritis is when redness appears all over the eye

b. Sectoral episcleritis is when redness appears over only a part of the eye

2. Nodular episcleritis: in this version, patients may experience slightly raised bumps. These bumps tend to be surrounded by blood vessels that are dilated. Similar to simple episcleritis, nodular episcleritis usually only impacts one area of the eye and may cause discomfort. Nodular and simple types of episcleritis do have aesthetic differences, but they also share some of the same symptoms, such as:

  • A gritty, prickly, or hot sensation in the eye
  • Bright light sensitivity
  • Tearing

Usually, these symptoms will not hinder or impact a patient’s vision, and they may go away on their own over a few weeks, but may also return several months later. 

What causes episcleritis?

At the moment, it's unclear as to the exact causes of the condition. In most cases, there is no single, specific cause that can be found. However, an estimated ⅓ of people who have episcleritis also have a condition that impacts their entire body — or systematic disorder. Common examples of systematic disorders include: 

  • Crohn's disease
  • Lupus
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Rosacea
  • Collagen vascular diseases
  • Gout

In addition, other types of injuries and certain medications may lead to episcleritis.  

What are the risk factors 

Some people are more prone to experience episcleritis than others. Factors that may make an individual more susceptible to developing the condition include:

  • Gender - the condition tends to impact women more than men.
  • Age - while it can affect children, episcleritis is more common in adults, particularly those between 40 and 50
  • People with infections - in rare instances, certain types of viruses, bacteria, or fungi can either cause or increase the chances of developing episcleritis. For example, the shingles (varicella) virus may be a factor
  • Cancer - in rare instances, episcleritis has been connected to Hodgkin's lymphoma and T-cell leukemia

Diagnosing & treating episcleritis

A diagnosis of episcleritis is usually found in the regular slit lamp exam. For many patients, no medical treatment or intervention is needed because the condition tends to clear up on its own in 7 to 10 days. 

However, soothing, lubricating eye drops that cause blood vessel constriction can temporarily reduce the redness. These eye drops, such as tetrahydrozoline, should be used infrequently because consistent use can lead to even more redness, known as 'the rebound effect'. To treat an episcleritis attack, a non-steroidal, anti-inflammatory drug or corticosteroid drops can be used to tackle the symptoms. 

Home remedies 

Whilst waiting for episcleritis to clear up on its own, there are a few simple things that can be done to help manage the symptoms. Some common home remedies include:

  • Wearing sunglasses outside
  • Using artificial tears
  • Applying a cool compress over the impacted eye

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