Anatomy of the eye What are episcleritis and scleritis? It causes redness and inflammation of the eye, often with discomfort and irritation but without other significant symptoms. Scleritis affects the sclera and, sometimes, the deeper tissues of the eye. It is much less common than episcleritis.

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Anatomy of the eye What are episcleritis and scleritis? It causes redness and inflammation of the eye, often with discomfort and irritation but without other significant symptoms. Scleritis affects the sclera and, sometimes, the deeper tissues of the eye. It is much less common than episcleritis. It causes a painful red eye and can affect vision, sometimes permanently.

Episcleritis and scleritis are mainly seen in adults. They can initially look similar but they do not feel similar and they do not behave similarly. Both are slightly more common in women than in men. Both can be associated with other conditions such as rheumatoid arthritis and systemic lupus erythematosus SLE , although this is more likely in the case of scleritis. Episcleritis does not cause scleritis, although scleritis can lead to associated episcleritis.

Episcleritis is a fairly common condition. It tends to come on quickly. It causes redness - often in a wedge shape over the white of the eye - and mild discomfort. A lot of people might have it and never see a doctor about it. It can occasionally be a little more painful than this and can cause inflamed bumps to form on the surface of the eye.

However, it is generally a mild condition with no serious consequences. It usually settles down by itself over a week or so with simple treatment. Episcleritis is often recurrent and can affect one or both eyes. Episcleritis Scleritis is much less common and more serious. It tends to come on more slowly and affects the deep white layer sclera of the eye. It can spread to affect the adjacent layers around the sclera, including the episclera and the cornea.

The eye is likely to be watery and sensitive to light and vision may be blurred. Scleritis can affect vision permanently. It may involve one or both eyes and is often associated with other inflammatory conditions such as rheumatoid arthritis. What causes episcleritis and scleritis? Episcleritis and scleritis are inflammatory conditions.

Both conditions are more likely to occur in people who have other inflammatory conditions, although this is particularly true of scleritis. Scleritis can occasionally be caused by infection with germs such as bacteria, viruses or, rarely, fungi. Who develops episcleritis and scleritis? Episcleritis is most common in adults in their 40s and 50s.

It is slightly more common in women than in men, and in people who have connective disease disease such as rheumatoid arthritis. About 40 people per , per year are thought to be affected. However, this is difficult to estimate accurately because many people do not go to a doctor if they have mild episcleritis. Scleritis is less common, affecting only about 4 people per , per year. It affects a slightly older age group, usually the fourth to sixth decades of life.

It is also slightly more common in women. It is more likely than episcleritis to be associated with an underlying inflammatory condition like rheumatoid arthritis. What are the symptoms of episcleritis? There are two types of episcleritis. The most common type is called diffuse episcleritis and it makes the surface of the eye evenly red, sometimes all over and sometimes in a wedge shape.

This picture shows the typical appearance of diffuse episcleritis: Diffuse episcleritis Image source: Open-i Parentin F et al - see Further reading below The less common type is called nodular episcleritis. It comes on more slowly and causes inflamed swollen bumps or nodules in the episclera. It is more likely than diffuse episcleritis to be associated with an underlying inflammatory condition.

The eyes may water a little and the eye may be a little tender when pressure is applied over the red area. However, vision is unaffected and painkillers are not generally needed. The diffuse type tends to be less painful than the nodular type.

Episcleritis is often a recurrent condition, with episodes occurring typically every few months. Most attacks last days, although in the case of nodular episcleritis this can be a little longer.

What are the symptoms of scleritis? Scleritis causes redness of the eye. It tends to come on more slowly than episcleritis As the redness develops the eye becomes very painful. This is a deep boring kind of pain inside and around the eye. It is typically much more severe than the discomfort of episcleritis. Sometimes the white of the eye has a bluish or purplish tinge. Vision may be blurred, the eye may be watery although there is no discharge and you may find it difficult to tolerate light photophobia.

There are several types of scleritis, depending on what part of the eye is affected and how inflamed the tissues are: Anterior scleritis is divided into: Non-necrotising type most common.

This is divided into: Diffuse anterior scleritis in which the eye is uniformly red. Nodular anterior scleritis in which tender nodules develop. Necrotising type: With inflammation: this is the most severe form of scleritis. It causes severe pain and tenderness and often causes permanent damage to the eye.

Without inflammation: this rare condition is called scleromalacia perforans and is only seen in patients with long-standing rheumatoid arthritis. The eye is not red or painful but the sclera is gradually thinned. This picture shows someone with necrotising scleritis in their left eye. This required strong medication to dampen down their immune system: Necrotising scleritis Image source: Open-i Sambhav K et al - see Further reading below Posterior scleritis is rare and is also painful although your eye may not be red.

Eye movements may be painful and there may be loss of vision. What is the treatment for episcleritis? Episcleritis does not necessarily need any treatment.

If symptoms are mild it will generally settle by itself. Lubricating eye drops or ointment may ease the discomfort whilst symptoms settle. If the eye is very uncomfortable, episcleritis may be treated with non-steroidal anti-inflammatory drugs NSAIDs in the form of eye drops.

If episcleritis does not settle over a week or if the pain becomes worse and your vision is affected, you should see a doctor in case you have scleritis.

What is the treatment for scleritis? If you develop scleritis you should be urgently referred to an eye specialist ophthalmologist. You will usually need to be seen on the same day. The management will depend on what type of scleritis this is and on its severity.

Some doctors treat scleritis with injections of steroid medication into the sclera or around the eye. They can take several weeks to work. Sometimes surgery is needed to treat the complications of scleritis. Necrotising scleritis is treated with oral steroids and immunosuppressants as early as possible. Scleromalacia perforans does not respond well to treatment - research continues to find the best way to manage this rare condition.

What are the possible complications of episcleritis and scleritis? Scleritis can lead to permanent damage to the structure of the eye, including: Thinning of the sclera.


A Red Eye: Scleritis or Episcleritis?

Last reviewed by Dr. Raj MD on August 14th, What is Episcleritis? This medical condition is an inflammation and irritation of the episclera and is benign, or non-cancerous. The episclera is the thin layer of tissue between the sclera, which is the white part of your eye and the conjunctiva, which is the covering of your eye.



It is relatively common, benign and self-limiting. Scleritis is inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment. The blood vessels of the episclera are not easily seen in the non-inflamed eye. There are three plexuses. Mainly arteries, when inflamed they are bright red. Episcleral plexus - straight radially arranged vessels in the superficial episclera.


Episcleritis and Scleritis

Clinical evaluation of clobetasone butyrate eye drops in episcleritis. Br J Ophthalmol. Topical flurbiprofen: an effective treatment for episcleritis? Eye Lond. Clinical characteristics of a large cohort of patients with scleritis and episcleritis. Scleritis and episcleritis.



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