Episcleritis

Episcleritis is a benign, self-limited inflammation of the thin episcleral tissue that lies between the clear conjunctiva and the tough white sclera. It usually appears suddenly as a bright red or salmon-pink patch on the white of one eye, often without significant pain or visual loss. Two main clinical patterns exist: simple (diffuse or sectoral) and nodular, in which a small, tender nodule forms in the inflamed area. Most attacks resolve on their own within two to three weeks, but recurrences are common, especially in middle-aged women [1]. While the condition itself rarely threatens vision, it can be a sentinel sign of an underlying systemic disease such as rheumatoid arthritis or inflammatory bowel disease [2].

The hallmark symptom is sectoral eye redness that may feel mildly gritty or tender when you blink. Other common features include tearing, warmth, and light sensitivity, yet significant eye pain or blurred vision are unusual. Symptoms often peak within 12 hours of onset and improve over several days [3]. Because redness typically blanches with over-the-counter vasoconstrictor drops and there is no discharge, episcleritis can usually be distinguished from conjunctivitis at home, though a professional exam is important for first-time episodes [1].

Up to 70 % of cases are idiopathic, meaning no cause is identified. Among the remainder, autoimmune and connective-tissue disorders dominate: rheumatoid arthritis, lupus, psoriatic arthritis, inflammatory bowel disease, rosacea, and vasculitides have all been linked [2]. Infections such as herpes zoster, syphilis, Lyme disease, and tuberculosis are rare but important triggers. Epidemiologic data show a female-to-male ratio of roughly 2 : 1 and a peak incidence between ages 40 – 60 [1]. Stress, hormonal fluctuations, and environmental irritants may precipitate flares in susceptible individuals.

An eye-care professional confirms the diagnosis with a slit-lamp examination. Blanching of superficial vessels after instillation of 2.5 % phenylephrine supports episcleritis and helps rule out deeper, vision-threatening scleritis [3]. Routine laboratory work-up is not required for isolated, first-time simple episcleritis, but recurrent or nodular disease often prompts targeted testing (e.g., rheumatologic panel, Lyme serology) to uncover systemic associations [2].

Because the condition is usually self-limiting, management focuses on comfort: frequent preservative-free artificial tears, cool compresses, and oral non-steroidal anti-inflammatory drugs (NSAIDs) as needed [1]. Short courses of mild topical corticosteroid drops (e.g., loteprednol) or topical NSAIDs may speed resolution, especially for nodular disease [3]. When episcleritis coexists with a systemic autoimmune disorder, controlling the underlying condition is critical and may require collaboration with a rheumatologist.

Most patients can maintain normal activities during a flare, but limiting screen time, using tinted lenses for light sensitivity, and applying chilled lubricating drops can ease discomfort [1]. Because triggers are unpredictable, prevention centers on systemic health: keep autoimmune disease under good control, protect eyes from irritants, and schedule prompt follow-up if redness returns. Red-eye alarms such as severe pain or reduced vision warrant urgent care to exclude more serious causes [4].

Emerging imaging studies are refining how clinicians differentiate episcleritis from early scleritis. High-resolution anterior-segment OCT and in-office ultrasound biomicroscopy can now visualize depth of inflammation in vivo, aiding triage and treatment decisions [2]. A 2024 narrative review synthesizing 40 years of literature reports renewed interest in biologic agents (e.g., anti-TNF therapies) for recalcitrant nodular episcleritis linked to systemic rheumatologic disease [5].

If you notice recurrent redness or a raised episcleral nodule, schedule an appointment with a board-certified ocular inflammation/uveitis specialist. Referrals can originate from your primary-care doctor or general optometrist, but wait times vary. You can also connect directly with the right specialist through Kerbside to streamline care and secure rapid access to advanced imaging and tailored therapy plans.