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Episcleritis

Episcleritis is inflammation of the episclera. This is the thin layer of tissue that sits between the white of your eye (sclera) and the transparent layer that covers your eye (conjunctiva).

About episcleritis

Episcleritis can affect one or both of your eyes. Episcleritis can affect women more than men and most commonly occurs between the ages of 40 and 50.

There are two types of episcleritis.

  • Simple episcleritis. This is the most common type of episcleritis. Inflammation is usually mild and will come on quickly. It lasts for about seven to 10 days and clears up completely within two to three weeks. You can have bouts of the condition, typically every one to three months. The cause is often not known.
  • Nodular episcleritis. This is often more painful than simple episcleritis and lasts longer. The inflammation is usually confined to one part of your eye and you may have a raised area or lumps on the surface of your eye. It’s sometimes related to an underlying health condition, such as rheumatoid arthritis or systemic lupus erythematosus.


Illustration showing the sclera and episclera of the eye

Symptoms of episcleritis

Symptoms of episcleritis include:

  • a red and bloodshot area in the white of your eye
  • sore tender eye(s) with a dull ache or burning sensation
  • a watering eye
  • sensitivity to light

Episcleritis shouldn’t affect your vision.

If you have nodular episcleritis, you may have one or more small lumps or raised areas on the white of your eye. You may find that these lumps can move on the surface of your eyeball.

You probably won’t need to see your GP if you have these symptoms as you can usually manage them at home. However, if they get worse or don’t improve within three weeks, see your GP or optometrist for advice. An optometrist is a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses.

Complications of episcleritis

A possible complication of episcleritis is anterior uveitis (also called iritis). This is when the front of your eye, often the coloured part (iris), becomes inflamed. About one in 10 people with episcleritis develop anterior uveitis but it’s usually mild.

Causes of episcleritis

The exact reasons why you may develop episcleritis aren’t fully understood at present. However, some patients may have an underlying health condition such as:

Other, less common, associated conditions include certain types of cancer, skin diseases, immune deficiency disorders and, rarely, insect bites.

Diagnosis of episcleritis

Your GP or optometrist will ask about your symptoms and examine you.

It’s unlikely you will need any tests but if you have severe episcleritis or it keeps coming back, your GP may ask you to have a blood test to find out if episcleritis is related to an underlying health condition.

If you have a lot of pain or you don’t respond to treatment, your GP may refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery).

Treatment for episcleritis

Episcleritis usually clears up on its own within about 10 days and doesn’t normally require any treatment.

Medicines

You might find artificial tears (eg hypromellose) useful to relieve your symptoms. This is an over-the-counter medicine that you can buy from a pharmacy. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your symptoms are severe or last more than three weeks, your doctor may prescribe:

  • a non-steroidal anti-inflammatory drug (NSAID), such as flurbiprofen – this will help to relieve pain and swelling and reduce inflammation
  • steroid eye drops, such as dexamethasone – these will help to reduce inflammation and speed up your recovery but there are some risks associated with using steroid eye drops, so you will need to be monitored closely by your doctor

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

During your diagnosis, if your doctor finds that you have an underlying health condition you will also require treatment for this. He or she may refer you to another specialist such as a rheumatologist (a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues) for treatment.

 

Produced by Rachael Mayfield-Blake, Bupa Health Information Team, October 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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