Episcleritis

Published by Bupa's Health Information Team, January 2011.

This factsheet is for people who have episcleritis, or who would like information about it.

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

About episcleritis

Episcleritis is a relatively common condition that can affect one or both of your eyes. Episcleritis affects women more than men and most commonly occurs between ages 40 and 50.

There are two types of episcleritis.

• Simple episcleritis. This is the most common type of episcleritis. Inflammation is usually mild and comes on quickly. It lasts for about seven to 10 days and clears up completely after 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 frequently related to an underlying health condition, such as rheumatoid arthritis or lupus.

Symptoms of episcleritis

Symptoms of episcleritis include:

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

Your vision shouldn’t be affected.

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.

If you have any of these symptoms, see your GP.

Complications of episcleritis

A complication of episcleritis is iritis. This is when the coloured part of your eye (iris) becomes inflamed. About one in 10 people with episcleritis develop mild iritis.

Causes of episcleritis

Doctors don’t fully understand why episcleritis develops. However, certain health conditions make episcleritis more likely. These are usually diseases that affect the bones, cartilage, tendons or other connective tissues of the body, such as:

• rheumatoid arthritis
• ankylosing spondylitis
• lupus (systemic lupus erythematosus)
• inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
• gout
• bacterial or viral infection such as Lyme disease, syphilis or shingles

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

Diagnosis of episcleritis

Your GP or optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses) will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may carry out further tests, such as a blood test, to find out if episcleritis is related to an underlying health condition.

If your condition is particularly painful or doesn’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.

Artificial tears (eg hypromellose) can be useful in relieving symptoms. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Medicines

If your symptoms are severe or last a long time your doctor may prescribe the following.

• 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. However, 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.

Any underlying conditions that have been found as a result of you having episcleritis will also require treatment. You may be referred 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.

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

For sources and links to further information, see Resources.