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 for 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 is 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 person-years.

Etiology and Pathophysiology

Etiology: It is 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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