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__NOTOC__
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{{Episcleritis}}
{{SI}}
{{CMG}};{{AE}}
{{CMG}};{{AE}}{{RBS}}


{{SK}}  
{{SK}}  


==Overview==
==Overview==
 
'''Episcleritis''' is an acute, recurrent, benign inflammatory condition
==Historical Perspective==
of the loose connective tissue lying superficial to the sclera and deeper to the conjunctiva.
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
Inflammation of the episclera is classified by its location and severity using the system devised by Watson.<ref name="pmid1268179">{{cite journal| author=Watson PG, Hayreh SS| title=Scleritis and episcleritis. | journal=Br J Ophthalmol | year= 1976 | volume= 60 | issue= 3 | pages= 163-91 | pmid=1268179 | doi= | pmc=1042706 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1268179  }} </ref>
 
{| class="wikitable"
OR
! colspan="2" |Classification of Episcleritis
 
|-
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
|Episcleritis
 
|
OR
* Diffuse
 
* Nodular
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
|}
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
The exact pathogenesis of Episcleritis is not fully understood.
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
Episcleritis has been associated with a large number systemic morbidities. The commoner systemic conditions associated with episcleritis are atopy [[Rheumatoid arthritis]], [[Spondyloarthritis]], [[Inflammatory bowel disease]], [[Systemic lupus erythematosus]], [[Relapsing polychondritis]], [[Gout]]. Rarely it may be associated with [[IgA nephropathy]], [[Lyme disease]] and drug reaction to pamidronate.


OR
[[Rosacea|Acne rosacea]] is the commonest ocular comorbid condition with
 
episcleritis and is typically seen in patients with eyelid and corneal
Common causes of [disease] include [cause1], [cause2], and [cause3].
involvement. The ocular disease often precedes dermatological manifestations.
 
Episcleritis is also frequently seen as part of the spectrum of
OR
[[Allergic conjunctivitis|atopic keratoconjunctivitis]] and dry eye syndrome.
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 
==Differentiating Episcleritis from Other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
Episcleritis is overwhelmingly a disease of adults affecting a wide range of age groups; pediatric age group involvement is rare.<ref name="Akpek 1999 pp. 729–731">{{cite journal | last=Akpek | first=E | title=Severity of episcleritis and systemic disease association | journal=Ophthalmology | publisher=Elsevier BV | volume=106 | issue=4 | date=1999-04-01 | issn=0161-6420 | pmid=10201593 | doi=10.1016/s0161-6420(99)90157-4 | pages=729–731}}</ref> The sex distribution varies between published
 
series but those series that describe an association with rheumatic diseases tend to have a female preponderance. Episcleritis is uncommon and the exact etiology of episcleritis is difficult to ascertain.  
OR
Diffuse episcleritis is more common than nodular episcleritis.<ref name="Sainz de la Maza Jabbur Foster 1994 pp. 389–96">{{cite journal | last=Sainz de la Maza | first=M | last2=Jabbur | first2=NS | last3=Foster | first3=CS | title=Severity of scleritis and episcleritis. | journal=Ophthalmology | volume=101 | issue=2 | year=1994 | issn=0161-6420 | pmid=8115160 | pages=389–96}}</ref>The majority of patients with episcleritis have mild evanescent disease that usually does not require ophthalmological intervention and treatment.
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
There are no established risk factors for Episcleritis.


OR
==Clinical Presentation==
The onset of episcleritis is usually acute and the patient presents with discomfort rather than severe pain .The pain if present in Episcleritis is usually a  mild discomfort and localized to the eye, rather than the typical boring pain associated with severe headache in scleritis.


The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
Rarely, episcleritis may be associated foreign body sensation and epiphora. The hallmark signs of episcleritis are oedema and inflammation of the episclera and injection and dilatation of the episcleral blood vessels. The sclera and subtarsal conjunctiva are not involved but
the conjunctiva overlying the inflamed area is always affected. There is no scleral swelling or necrosis and the intraocular structures
are typically not involved. The visual acuity is normal as long as there is no co-morbidity.  


OR
In diffuse episcleritis there is diffuse swelling and
oedema of a sector of the episclera in around two-thirds of patients
or of the whole eye in around one-third of patients. The redness varies in intensity, but is always red or pink
(rather than the bluish, brawny red colour seen in diffuse scleritis),
and the episcleral vessels, although engorged, retain their characteristic radial orientation.<ref name="Akpek 1999 pp. 729–731">{{cite journal | last=Akpek | first=E | title=Severity of episcleritis and systemic disease association | journal=Ophthalmology | publisher=Elsevier BV | volume=106 | issue=4 | date=1999-04-01 | issn=0161-6420 | pmid=10201593 | doi=10.1016/s0161-6420(99)90157-4 | pages=729–731}}</ref>


Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
The eye is generally not tender to touch. In nodular episcleritis , the oedema and infiltration is
localized to one part of the globe. A raised nodule forms within
the episcleral tissue. It is bright red to pink in colour and often has overlying or surrounding vascular irregularity. The nodule may be
tender to touch and is usually mobile. There is generally only one nodule at any one time and the nodules do not undergo necrosis.


OR
Careful slit lamp examination of the episclera, sclera, and the blood vessels is essential to differentiate episcleritis from scleritis.
 
In patients with episcleritis there is oedema of the episclera and
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
dilatation of the conjunctival vessels. There is no oedema of the underlying sclera. The lack of scleral involvement is often easiest
to appreciate using red-free light and after blanching the superficial conjunctival vessels with phenylephrine 10%. After an attack of episcleritis the eye returns completely to normal,
but after repeated attacks over a long period of time there
may be some mild scleral thinning.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
There is insufficient evidence to recommend routine screening for Episcleritis.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Episcleral inflammation adjacent to the cornea can lead to mild peripheral corneal infiltrate or oedema, and
 
the peripheral cornea can be left thinned or vascularized. Recurrent attacks of episcleritis over a long time can cause mild scleral thinning, which is of no consequence to the integrity of the eye. The most common complications seen in patients with episcleritis are related to the use of long-term topical corticosteroids.
OR
The use of long-term topical corticosteroids can lead to Cataract, ocular hypertension, and steroid-induced glaucoma. Rarely, topical corticosteroids may also induce herpetic
 
keratitis. These treatment-related complications are the commonest causes of visual loss in patients with episcleritis.
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
When diagnosed clinically, a small number of
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
serological tests to ascertain associative autoimmune diseases like [[rheumatoid arthritis]] or [[Systemic lupus erythematosus|systemic lupus
 
erythematosus]] may be useful.
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR


The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
Anterior segment fluorescein angiography in episcleritis reveals
a normal vascular pattern but the flow rate is generally faster than
normal and the whole transit of dye may be completed within two
to three seconds.<ref name="Meyer 1988 pp. 533–546">{{cite journal | last=Meyer | first=Paul A R | title=Patterns of blood flow in episcleral vessels studied by low-dose fluorescein videoangiography | journal=Eye | publisher=Springer Nature | volume=2 | issue=5 | year=1988 | issn=0950-222X | doi=10.1038/eye.1988.104 | pages=533–546}}</ref>


OR
High definition anterior segment ultrasound helps in differentiating episcleritis from scleritis but is rarely
 
necessary clinically.
There are no established criteria for the diagnosis of [disease name].
 
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
 
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].
 
===Electrocardiogram===
There are no ECG findings associated with [disease name].
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===X-ray===
There are no x-ray findings associated with [disease name].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===CT scan===
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===MRI===
There are no MRI findings associated with [disease name].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Episcleritis is a self-limiting disease, thus it doesn't frequently require any treatment. If the symptoms are severe to require treatment, [[topical steroids]] generally
 
provide rapid symptomatic relief and have proven benefit over
OR
topical [[Non-steroidal anti-inflammatory drug|non-steroidal anti-inflammatory treatment]] and topical
 
lubricants.
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].
 
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
 
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
 
OR


Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
Systemic treatment with oral non-steroidal antiinflammatory
drugs such as cyclo-oxygenase inhibitors, may be
required for episcleritis. In general any systemic disease should be
treated on its merits and the episcleritis treated as necessary.
Any local ocular disease, such as [[Rosacea|acne rosacea]], atopy, or
[[keratoconjunctivitis sicca]] that may be causing or contributing to
the episcleritis, should be treated aggressively.


==References==
==References==

Latest revision as of 20:50, 3 March 2018

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List of terms related to Episcleritis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]

Synonyms and keywords:

Overview

Episcleritis is an acute, recurrent, benign inflammatory condition of the loose connective tissue lying superficial to the sclera and deeper to the conjunctiva.

Classification

Inflammation of the episclera is classified by its location and severity using the system devised by Watson.[1]

Classification of Episcleritis
Episcleritis
  • Diffuse
  • Nodular

Pathophysiology

The exact pathogenesis of Episcleritis is not fully understood.

Causes

Episcleritis has been associated with a large number systemic morbidities. The commoner systemic conditions associated with episcleritis are atopy Rheumatoid arthritis, Spondyloarthritis, Inflammatory bowel disease, Systemic lupus erythematosus, Relapsing polychondritis, Gout. Rarely it may be associated with IgA nephropathy, Lyme disease and drug reaction to pamidronate.

Acne rosacea is the commonest ocular comorbid condition with episcleritis and is typically seen in patients with eyelid and corneal involvement. The ocular disease often precedes dermatological manifestations. Episcleritis is also frequently seen as part of the spectrum of atopic keratoconjunctivitis and dry eye syndrome.

Epidemiology and Demographics

Episcleritis is overwhelmingly a disease of adults affecting a wide range of age groups; pediatric age group involvement is rare.[2] The sex distribution varies between published series but those series that describe an association with rheumatic diseases tend to have a female preponderance. Episcleritis is uncommon and the exact etiology of episcleritis is difficult to ascertain. Diffuse episcleritis is more common than nodular episcleritis.[3]The majority of patients with episcleritis have mild evanescent disease that usually does not require ophthalmological intervention and treatment.

Risk Factors

There are no established risk factors for Episcleritis.

Clinical Presentation

The onset of episcleritis is usually acute and the patient presents with discomfort rather than severe pain .The pain if present in Episcleritis is usually a mild discomfort and localized to the eye, rather than the typical boring pain associated with severe headache in scleritis.

Rarely, episcleritis may be associated foreign body sensation and epiphora. The hallmark signs of episcleritis are oedema and inflammation of the episclera and injection and dilatation of the episcleral blood vessels. The sclera and subtarsal conjunctiva are not involved but the conjunctiva overlying the inflamed area is always affected. There is no scleral swelling or necrosis and the intraocular structures are typically not involved. The visual acuity is normal as long as there is no co-morbidity.

In diffuse episcleritis there is diffuse swelling and oedema of a sector of the episclera in around two-thirds of patients or of the whole eye in around one-third of patients. The redness varies in intensity, but is always red or pink (rather than the bluish, brawny red colour seen in diffuse scleritis), and the episcleral vessels, although engorged, retain their characteristic radial orientation.[2]

The eye is generally not tender to touch. In nodular episcleritis , the oedema and infiltration is localized to one part of the globe. A raised nodule forms within the episcleral tissue. It is bright red to pink in colour and often has overlying or surrounding vascular irregularity. The nodule may be tender to touch and is usually mobile. There is generally only one nodule at any one time and the nodules do not undergo necrosis.

Careful slit lamp examination of the episclera, sclera, and the blood vessels is essential to differentiate episcleritis from scleritis. In patients with episcleritis there is oedema of the episclera and dilatation of the conjunctival vessels. There is no oedema of the underlying sclera. The lack of scleral involvement is often easiest to appreciate using red-free light and after blanching the superficial conjunctival vessels with phenylephrine 10%. After an attack of episcleritis the eye returns completely to normal, but after repeated attacks over a long period of time there may be some mild scleral thinning.

Screening

There is insufficient evidence to recommend routine screening for Episcleritis.

Natural History, Complications, and Prognosis

Episcleral inflammation adjacent to the cornea can lead to mild peripheral corneal infiltrate or oedema, and the peripheral cornea can be left thinned or vascularized. Recurrent attacks of episcleritis over a long time can cause mild scleral thinning, which is of no consequence to the integrity of the eye. The most common complications seen in patients with episcleritis are related to the use of long-term topical corticosteroids. The use of long-term topical corticosteroids can lead to Cataract, ocular hypertension, and steroid-induced glaucoma. Rarely, topical corticosteroids may also induce herpetic keratitis. These treatment-related complications are the commonest causes of visual loss in patients with episcleritis.

Diagnosis

When diagnosed clinically, a small number of serological tests to ascertain associative autoimmune diseases like rheumatoid arthritis or systemic lupus erythematosus may be useful.

Anterior segment fluorescein angiography in episcleritis reveals a normal vascular pattern but the flow rate is generally faster than normal and the whole transit of dye may be completed within two to three seconds.[4]

High definition anterior segment ultrasound helps in differentiating episcleritis from scleritis but is rarely necessary clinically.

Treatment

Medical Therapy

Episcleritis is a self-limiting disease, thus it doesn't frequently require any treatment. If the symptoms are severe to require treatment, topical steroids generally provide rapid symptomatic relief and have proven benefit over topical non-steroidal anti-inflammatory treatment and topical lubricants.

Systemic treatment with oral non-steroidal antiinflammatory drugs such as cyclo-oxygenase inhibitors, may be required for episcleritis. In general any systemic disease should be treated on its merits and the episcleritis treated as necessary. Any local ocular disease, such as acne rosacea, atopy, or keratoconjunctivitis sicca that may be causing or contributing to the episcleritis, should be treated aggressively.

References

  1. Watson PG, Hayreh SS (1976). "Scleritis and episcleritis". Br J Ophthalmol. 60 (3): 163–91. PMC 1042706. PMID 1268179.
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  3. Sainz de la Maza, M; Jabbur, NS; Foster, CS (1994). "Severity of scleritis and episcleritis". Ophthalmology. 101 (2): 389–96. ISSN 0161-6420. PMID 8115160.
  4. Meyer, Paul A R (1988). "Patterns of blood flow in episcleral vessels studied by low-dose fluorescein videoangiography". Eye. Springer Nature. 2 (5): 533–546. doi:10.1038/eye.1988.104. ISSN 0950-222X.


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