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Episcleritis: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Episcleritis is an inflammation of the connective tissue that forms the outer surface of the sclera. It is usually bilateral, usually benign, and occurs approximately 2 times more often in women over 40. Episcleritis is clinically classified into simple diffuse and nodular types. Simple diffuse episcleritis occurs in 80% of cases, nodular - in 20%.
[ Causes of Episcleritis
The causes of episcleritis are very diverse. Previously, the most common causes of episcleritis were tuberculosis, sarcoidosis, syphilis. Currently, the leading role in the development of episcleritis is played by streptococcal infection, pneumococcal pneumonia, inflammation of the paranasal sinuses, any inflammatory focus, metabolic diseases - gout, collagenoses. Some authors point to a connection between the occurrence of scleritis due to rheumatism and polyarthritis. Pathological processes in scleritis develop according to the type of bacterial allergy, sometimes have an autoimmune nature, which causes their persistent recurrent course. Trauma (chemical, mechanical) can also be the cause of sclera diseases. In endophthalmitis, panophthalmitis, there may be secondary damage to the sclera.
Symptoms of Episcleritis
Episcleritis often develops in the areas between the eyelids, appears suddenly, causing lacrimation, pain, photophobia and redness. In diffuse episcleritis, the edge of hyperemia is poorly defined and gradually disappears among normal tissue. The affected sclera has a color from pale to bright red. Hyperemia soon takes on a lilac or purple hue. The episclera swells, so that this area seems somewhat elevated. Touching it causes minor pain, there are also independent, but not very strong pains. The vessels of the episclera are significantly dilated, but their radial course is not changed.
Symptoms of nodular episcleritis are similar to those of diffuse episcleritis, but the inflammatory processes are accompanied by the formation of nodules 2-3 mm in diameter, hard or soft to the touch. The conjunctiva above it is mobile. Sometimes several nodules develop, merging with each other. Episcleritis lasts on average 2-3 weeks, but can last from 5 days to many months. Nodular episcleritis usually lasts longer than its simple variety. Most often, the course of episcleritis is chronic and recurrent. Relapses and remissions of episcleritis alternate over several years, the damaged areas often gradually bypass the entire circumference of the eye. Disintegration and ulceration of the episcleral infiltrate, which consists of lymphocytes with an admixture of epithelioid and giant cells, is never observed. Often both eyes are affected.
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Treatment of episcleritis
The outcome of episcleritis is almost always favorable; episcleritis goes away without a trace without treatment.
In case of recurrent course and occurrence of pain, corticosteroids are applied locally (eye drops dekanos, maxides, oftan-dexamethasone, eye ointment hydrocortisone-POS) or non-steroidal anti-inflammatory drugs in the form of drops (naklof) 3-4 times a day. In case of persistent course, non-steroidal anti-inflammatory drugs are prescribed orally.