Episcleritis

Zahoor pp
238
 Episclera
Thin layer of connective tissue
lying between sclera and
conjunctiva.
Episcleritis-
Benign,recurrent, inflammation of
episclera involving the overlying tenon's
capsule but not involving sclera.
Introduction
• Common in young adult
• Twice common in females than males
Etiology
• Idiopathic -
• Systemic disease -gout,rosacea,psoriasis and
connective tissue diseases.
• Hypersensitivity reaction to endogenous
tubercular or streptococcal toxin
• Infectious-Herpeszoster,lymes disease syphilis,TB.
Pathology
• Histology- localised lymphocytic infiltration of
episcleraltissue
• Congestion of overlying conjunctiva and tenon's
ccapsule
Clinical features
• Symptoms-
• Redness
• Mild occular discomfort- gritty feeling
• Foreign body sensation
• Burning sensation
• Mild photophobia and lacrimation
Signs
• Types of episcleritis

• 1)Simple.(diffuse) 2)Focal(nodular)
Simple/ diffuse episcleritis
• 75% cases
• Sectorial or diffuse inflammation of episclera
• Engorged episcleral vessels - large and run radialy
under conjunctiva.
• Involved area bright red or pink
Nodular/focal episcleritis
• Pink or purple flat nodule surrounded by injection

• Situated 2-3mm away from limbus

• Nodule is firm and tender
• Moves separately from sclera
• Conjunctiva also moves freely
Clinical course
• Limited course-10 days -3 weeks
• Resolve spontaneously
• Recurrance common
• Occur in bouts
• Episcleritis periodica.
Differential diagnosis
• Scleritis

• Conjunctivitis

• Inflammed pinguela

• Swelling and congestion due to foreign

body obstruction in bulbar cconjuctiva.
Treatment
• NSAIDS
• Ketorolac 0.3 %

• Topical mild corticosteriodal eye drops

Fluromethelone,Lotepredanol
Treatment
• Topical artificial tears-0.5%carboxy methyl
cellulose

• Coldcompression

• Systemic NSAIDS-
• Flurbiprofen(300mg OD) Indomethacin25 mg
TID)