Etiology, Clinical Features, and Management of Episcleritis

Introduction

Episcleritis is a benign, self-limiting inflammatory condition of the episclera, the vascular connective tissue between the conjunctiva and sclera. It is often idiopathic but can be associated with systemic diseases such as rheumatoid arthritis or lupus.

Etiology

The exact cause of episcleritis remains unknown. However, some common associations include:

• Idiopathic cases
• Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
• Infections (e.g., herpes simplex, tuberculosis)
• Allergic reactions

Clinical Features

Episcleritis is characterized by acute redness of the eye, typically in one sector, without significant pain or vision impairment.

Common Symptoms:

• Mild discomfort or irritation
• Localized redness (often sectoral)
• Absence of discharge
• No visual disturbances

Differential Diagnosis: Episcleritis vs. Scleritis

Feature	Episcleritis	Scleritis
Pain Level	Mild discomfort	Severe pain
Redness	Localized, sectoral	Diffuse, deep red
Response to Phenylephrine	Blanching occurs	No blanching

Management

Most cases of episcleritis resolve spontaneously within 1-2 weeks. However, symptomatic treatment can include:

• Lubricating eye drops for comfort
• Cold compresses
• Topical NSAIDs for mild inflammation
• Oral NSAIDs in recurrent or severe cases

Conclusion

Episcleritis is a common, self-limiting ocular condition that requires minimal intervention. Differentiating it from scleritis is crucial to prevent mismanagement and ensure appropriate care.