Episcleritis - Causes, Symptoms, Diagnosis, and Treatment

What Is Episcleritis?

The white part of the eye is called the sclera, and there are two transparent layers over it called episclera and conjunctiva. The episclera is a structure that is both fibrous and elastic. It comprises two layers and is joined together in a very loose manner. The outer layer is called the superficial parietal layer, and the inner layer is called the deep visceral layer. The superficial layer is rich in blood vessels and is arranged radially. The deep layer contains blood vessels with various connections originating from the important ophthalmic artery.

The conjunctiva is also a clear part and makes the eye reddish. It might resemble a pink eye. It is a benign condition. Sometimes, it appears as nodules, and this nodular variant is the most common one.

There are two types of episcleritis. They are sectoral and diffusion. The sectoral type involves only one part of the sclera, and when the entire episclera is involved, it is called diffuse.

The inflammation is usually self-limiting. Based on the nature of the episcleritis, it can be categorized as simple and nodular. The nodular type of episcleritis is mostly present as a vascular nodule, and it is often elevated in its tissue region. It will be accompanied by inflammation. The simple type is present without any prominent nodule. But, in the absence of nodules, congestion is known to occur. The simple type occurs suddenly and is acute. The nodular type takes a long time to develop and is very gradual.

What Are the Causes of Episcleritis?

In most cases, episcleritis occurs due to unknown causes. About 30 % of the affected patients are known to be affected by any systemic disorder. It might include the following disorders.

• Gout.

• Psoriatic arthritis.

• Ulcerative colitis.

• Crohn’s disease.

• Rheumatoid arthritis.

• Systemic lupus erythematosus.

• Polychondritis.

• Ankylosing spondylitis.

• Polyarteritis nodosa.

• Temporal arteritis.

• Cogan’s syndrome.

What Are the Symptoms of Episcleritis?

The symptoms vary between the types of episcleritis. In simple episcleritis, the symptoms begin to express after 12 hours. It is known to resolve slowly after two or three days. In nodular type, the redness will be visible only after waking up from bed in the early morning. Recurrence can happen in the same eyes or with different eyes.

The common symptoms between the two types are sensitivity to light, tearing sensation, and sometimes pricking sensation. The pain will be more while winking my eyes. No disturbances to vision are seen. It can heal after a few weeks, but the rate of recurrence is high.

What Are the Risk Factors for Episcleritis?

There are no gender-related health issues. Episcleritis can affect both men and women, but women are known to be affected more than men. The major risk factor is the presence of underlying disorders.

What Is the Pathophysiology of Episcleritis?

The pathophysiology of episcleritis involves non-granulomatous inflammation of the episcleral vascular network. This inflammatory process assumes the activation of resident immune cells. These immune cells include lymphocytes and macrophages. The activated immune cells release inflammatory mediators, leading to vasodilation, increasing vascular permeability, and migration of more white blood cells and macrophages. The process is considered to be self-limiting and lasts between two and 21 days.

How Is It Diagnosed?

A physical examination by a doctor might be necessary for an accurate diagnosis. The exact cause and mechanism of episcleritis are not known. The color of the eyes will be noted. If the eyes are purplish or bluish, then it might indicate scleritis rather than episcleritis.

Slit Lamp Examination:

Disorders in the eye can be difficult to identify and treat. Sometimes, ophthalmologists might be required. A slit lamp is a specialized tool designed to diagnose eye problems. Examining the eyes using this specialized instrument is known as biomicroscopy. This procedure requires some eye preparation before the examination.

To obtain clear results, dilation of the pupil might be necessary. Dilation refers to the enlargement of the pupil size. Eye drops are instilled in the pupil to achieve the dilation. The doctor will make the person sit in a comfortable position and will ask to rest the chin on a stand. This position will be comfortable for the ophthalmologist to visualize the eyes.

The biomicroscopy procedure uses a low-powered microscope attached to a high-intensity lamp. The lamp will have many filters to view the eyes. The latest technology allows the capturing of the eye’s images. It is always good to maintain a record of the images so that they can be used for future reference.

The following parts of the eye can be visualized in this procedure.

• Conjunctiva.

• Eyelids.

• Optic nerve.

• Sclera.

• Iris.

• Lens.

• Retina.

• Cornea.

What Are the Treatment Options?

Episcleritis is not a fatal condition. It gets cured on its own. If the reddish appearance is quite problematic to the individual, they can seek help for quicker treatment options.

Home Remedies:

It is necessary to wear sunglasses whenever one goes outdoors. A cold compress or warm compress can be given to the eyes. Artificial tear drops are known to help cure episcleritis.

Medications:

Before the doctor prescribes the medication, the doctor must look into the patient's medical history. Treatment for systemic disorder is known to cure the condition of episcleritis.

The medications are given to the patient in the form of eye drops. The commonly prescribed drugs are:

• Corticosteroid eye drops can be given to prevent eye damage. It will also provide relief from irritation and redness. These drugs require a recommendation from the doctor. Long-term usage of corticosteroids should be avoided to prevent complications like cataracts and glaucoma.

• Non-steroidal anti-inflammatory drugs might be used to overcome the pain in the eyes. The most commonly used anti-inflammatory drugs are Ibuprofen.

• Artificial tear drops are very helpful in providing lubrication to the eyes. It can also prevent damage from environmental factors. The teardrops should be stored at room temperature. It should be placed away from too much moisture or heat.

How Is the Prognosis Rate?

The prognosis is very good for episcleritis conditions. The healing happens completely within a few weeks. Following the medications, along with the home remedies, can provide a cure and prevent a recurrence.

What Is the Differential Diagnosis of Episcleritis?

The differential diagnosis of episcleritis includes those conditions that appear similar to episcleritis.

• CLARE (Contact lens-associated red eye) has a similar presentation, but because of its history and disease characteristics make it different from episcleritis.

• Acute conjunctivitis will have symptoms like red eyes with discharge, photophobia, itching or burning, and edematous eyelids.

• Phylectenular conjunctivitis exhibits sectoral conjunctival erythema and edema. This condition occurs due to delayed hypersensitivity and is associated with blepharitis.

• Iritis is another condition similar to episcleritis. Specific findings help to distinguish both conditions.

• Scleritis is a condition that should be carefully distinguished from episcleritis.

Conclusion:

Episcleritis is an eye condition that can be resolved completely with treatment. It was noticed that most individuals affected by episcleritis were found to be associated with autoimmune disease. It tends to recur even. Hence, it is important to know about episcleritis and its causes, symptoms, risk factors, pathophysiology, and management. Knowing helps the person to identify the condition early. Early diagnosis leads to effective treatment.