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Episcleritis

Episcleritis is a topic covered in the 5-Minute Clinical Consult.

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Basics

  • Episcleritis is irritation and inflammation of the episclera, a thin layer of tissue covering the sclera. It is not an infection.
  • Episcleritis is the localized inflammation of the vascular connective tissue superficial to the sclera.
  • Usually a self-limited condition, typically resolving within 3 weeks
  • Most cases resolve without treatment.
  • 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 (diffuse scleral involvement—more common)
    • Nodular (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/100,000 person-years)

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

Etiology and Pathophysiology

  • Etiology: usually idiopathic, but other causes may be found (either nonimmune or immune)
  • 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:
    • Rheumatoid arthritis
    • Vasculitis
    • Inflammatory bowel disease
    • Ankylosing spondylitis
    • Systemic lupus erythematosus
    • Gout
    • Herpes zoster
    • Hypersensitivity disorders
      • Rosacea
      • Contact dermatitis
      • Penicillin sensitivity
      • Erythema multiforme

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Citation

Stephens, Mark B., et al., editors. "Episcleritis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/all/Episcleritis.
Episcleritis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/all/Episcleritis. Accessed April 20, 2019.
Episcleritis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/all/Episcleritis
Episcleritis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/all/Episcleritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Episcleritis ID - 117584 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117584/all/Episcleritis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -