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Episcleritis

Published by Bupa's health information team, April 2009.

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

Episcleritis is an inflammation of the episclera, the thin layer of tissue overlaying the white of your eye (sclera).

It's a relatively common condition that can affect one or both eyes. It affects men and women equally, and usually happens when you are in your 40s or 50s.

• About episcleritis
• Symptoms of episcleritis
• Complications of episcleritis
• Causes of episcleritis
• Diagnosis of episcleritis
• Treatment for episcleritis
• Questions and answers
• Related topics
• Sources

About episcleritis

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

There are two types of episcleritis.

• Simple episcleritis. This is the most common type of episcleritis. The inflammation is usually mild and comes on quickly. It lasts for about seven to 10 days, completely going after two to three weeks. People with simple episcleritis 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 the eye and there may be a raised area or lumps on the surface. It's frequently related to an underlying health condition such as rheumatoid arthritis or lupus.

Symptoms of episcleritis

Your affected eye(s) will feel sore with a dull ache, and may be tender. When you look at your eye in a mirror, you may notice that an area of the white of your eye looks red and bloodshot. Also, you may find that your eye is watering for no obvious reason and that your eyes are more sensitive to light than usual. Vision isn't normally 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.

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

In most instances, episcleritis has no known cause. However, in a third of cases it's related to an underlying health condition. This is usually a disease that affects the bones, cartilage, tendon or other connective tissues of the body, such as:

• rheumatoid arthritis
• systemic lupus erythematosus
• ankylosing spondylitis
• inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
• gout

It can also be caused by infectious diseases due to bacteria, for example Lyme disease or syphilis, or a virus, for example 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 healthcare professional who examines eyes, tests sight and dispenses glasses and contact lenses) will be able to diagnose episcleritis.

Your GP may also carry out further tests, such as a blood test, if he or she suspects that your episcleritis is related to an underlying health condition.

If your condition is particularly painful or doesn't respond to treatment, you may be referred to an ophthalmologist. An ophthalmologist is a doctor who specialises in eye health.

Treatment for episcleritis

Episcleritis usually clears up on its own and doesn't normally require any treatment.

However, artificial tears, can be useful in relieving symptoms. Always read the patient information leaflet that comes with your medicine.

If your symptoms are severe or you have nodular episcleritis, your GP may prescribe a non-steroidal anti-inflammatory drug (NSAID), such as flurbiprofen (eg Froben). This will help to relieve your symptoms and reduce inflammation. However, if your condition hasn't improved after two or three days of taking the medicine, your GP may refer you to an ophthalmologist.

Occasionally, if your condition is severe or you have had it for a long time, you may be prescribed steroid eye drops, such as dexamethasone (eg Maxidex). These will help to relieve symptoms 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.

Any underlying conditions that have been found as a result of having episcleritis will also be treated.

Related topics

• Crohn's disease
• Gout
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Rheumatoid arthritis
• Shingles
• Syphilis
• Systemic lupus erythematosus
• Ulcerative colitis

Sources

• Episcleritis. GP Notebook. www.gpnotebook.co.uk, accessed 11 December 2008
• Episcleritis. eMedicine. www.emedicine.com, accessed 11 December 2008
• Collier J, Longmore M, Scally P. Oxford handbook of clinical specialities. 6th ed. Oxford: Oxford University Press, 2003:496
• Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:937
• Khaw PT, Elkington AR. ABC of eyes. London: BMJ Publishing Group, 2002:8
• Joint Formulary Committee. British National Formulary. 55 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:633

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009