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 person-years.
ETIOLOGY AND PATHOPHYSIOLOGY
- Etiology: usually idiopathic, but up to 1/3 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
- One-third of the cases have a systemic autoimmune disease (2):
- 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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Citation
Domino, Frank J., et al., editors. "Episcleritis." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/0.3/Episcleritis.
Episcleritis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/0.3/Episcleritis. Accessed July 25, 2025.
Episcleritis. (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/0.3/Episcleritis
Episcleritis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/0.3/Episcleritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Episcleritis
ID - 117584
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/0.3/Episcleritis
PB - Wolters Kluwer
ET - 34
DB - Medicine Central
DP - Unbound Medicine
ER -