7 Powerful Tips for Managing Scleritis Episcleritis: A Comprehensive Guide

Two inflammatory eye disorders that affect the ocular surface are scleritis episcleritis. If left untreated, scleritis, a more serious ailment that affects the sclera, the white area of the eye, can result in excruciating pain, redness, and even vision loss. Contrarily, episcleritis affects the episclera, the thin layer of tissue between the sclera and the conjunctiva, and is more frequently associated with milder signs and symptoms like redness and itching. Anti-inflammatory treatments are normally used to treat both illnesses, but in severe cases of scleritis, immunosuppressant medications may be required to decrease the inflammation.

Definition of Scleritis Episcleritis

Difference between scleritis and episcleritis

Scleritis

The strong, white outer covering of the eye, the sclera, becomes inflamed in the more severe condition of scleritis. A number of underlying disorders, including herpes simplex, and autoimmune diseases including lupus and rheumatoid arthritis, can bring it on. Scleritis symptoms include intense eye discomfort, redness, and tenderness, as well as light sensitivity and blurred vision. Additionally, the illness may cause the eye to swell or become watery. Scleritis can cause the sclera to scar in extreme cases, which can impair vision.

Episcleritis

On the other hand, episcleritis is a less serious illness that affects the episclera, the delicate tissue layer that covers the sclera. It is more frequent in young people and is often brought on by an allergy or infection. Episcleritis signs and symptoms include light sensitivity, redness, and mild to moderate pain. Usually, the disease is self-limiting and goes away on its own within a few days to a week.

Posterior scleritis

Scleritis, is an inflammation of the sclera, including posterior scleritis (the white part of the eye). It is regarded as a rare variety of scleritis and is characterized by intense eye pain, redness, and pressure. If neglected, it can result in severe visual loss. Corticosteroids, either oral or injectable, and other immunosuppressive medications, are frequently used throughout treatment. Sometimes, surgery may be necessary. If you experience the signs and symptoms of scleritis, you should consult an ophthalmologist immediately because vision loss can be avoided with early treatment.

Investigations

Scleritis investigations

Investigations for scleritis may involve a thorough eye exam, which may include tests for visual acuity, visual field, and the retina and optic nerve. In order to look for underlying systemic disorders that may be connected to scleritis, laboratory tests such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may also be performed. To determine the severity of the inflammation and rule out other illnesses, imaging procedures such as an ultrasound or CT scan of the eye may be performed. In some circumstances, a biopsy of the afflicted tissue may be performed to confirm the diagnosis.

Investigations for episcleritis

A complete eye exam that may include a visual acuity test, a slit-lamp examination, and a Schirmer test may be part of an investigation for episcleritis. Further examinations, such as blood testing or imaging, may be advised in accordance with the findings of these tests to rule out underlying disorders.
To relieve symptoms, your ophthalmologist may also suggest using warm compresses on the affected eye, artificial tears, or non-steroidal anti-inflammatory eye drops. Your ophthalmologist may occasionally additionally recommend alternative immunomodulatory treatments or oral non-steroidal anti-inflammatory drugs.

associated diseases

Scleritis can be associated with several other diseases, including

  • Rheumatoid arthritis: People with rheumatoid arthritis and other autoimmune diseases are more likely to develop scleritis.
  • Lupus erythematosus: Scleritis can develop in lupus patients, an autoimmune condition that affects a number of different body organs.
  • Wegener’s granulomatosis: This uncommon autoimmune condition can result in blood vessel inflammation, which can cause scleritis.
  • Relapsing polychondritis: This uncommon autoimmune condition affects the body’s cartilage and can lead to scleritis.
  • Other infectious and inflammatory disorders: In addition to infections like tuberculosis, syphilis, and herpes zoster, other inflammatory diseases including sarcoidosis and Behçet’s disease can also lead to scleritis.

Episcleritis is often associated with other conditions such as:

  • Rheumatoid arthritis: Episcleritis is a rheumatologic condition that affects people with rheumatoid arthritis frequently.
  • Inflammatory bowel disease (IBD): Patients with IBD, such as ulcerative colitis or Crohn’s disease, may develop episcleritis.
  • Other autoimmune disorders: Lupus, sarcoidosis, and Wegener’s granulomatosis are a few examples of other autoimmune diseases that episcleritis may be linked to.
  • Diseases: Episcleritis can also be brought on by infections like TB or herpes simplex.

management

management of scleritis

The underlying cause and the degree of the condition will determine how to treat scleritis. Reducing inflammation and pain, maintaining vision, and avoiding complications are among the objectives of treatment.

Medical management

  • Non-steroidal anti-inflammatory medicines (NSAIDs) are frequently employed to lessen discomfort and inflammation.
  • In moderate to severe situations, steroids (oral or intraocular) are frequently utilized.
  • Patients with a systemic disease related to their condition or who don’t react to previous treatments may be prescribed immunosuppressive medications such as methotrexate, azathioprine, mycophenolate, and cyclophosphamide.
  • Antibiotics or antiviral medications may be given in cases of concomitant infectious illness.

Surgical management

  • Surgery may be needed to repair or remove damaged tissue in severe cases.
  • In cases of associated uveitis or corneal damage, a referral to a corneal specialist may be necessary

management of episcleritis

The management of episcleritis depends on the severity and duration of symptoms, as well as the presence of any underlying conditions. The main goals of management are to alleviate symptoms and prevent recurrences.

The following are some common management strategies for episcleritis:

  • Warm compresses applied to the afflicted eye and artificial tears or non-steroidal anti-inflammatory drops (such as diclofenac or ketorolac) can assist to reduce inflammation and ease symptoms.
  • Oral medications: Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be administered in more severe cases or when topical treatment is ineffective. Immunosuppressive medications such as methotrexate, azathioprine, or mycophenolate may be administered when the episcleritis is linked to an underlying autoimmune condition.
  • Management of underlying illnesses: If rheumatoid arthritis or inflammatory bowel disease are associated with episcleritis, managing such conditions is crucial to preventing recurrences of episcleritis.
  • Close monitoring: To keep an eye out for any changes in symptoms or the course of the ailment, the patient should schedule routine follow-up consultations with the ophthalmologist.

complications

Complications of Scleritis

Scleritis can have several complications if left untreated or if treatment is not effective. Some possible complications include:

  • Vision loss: Scleritis can harm the cornea and retina of the eye, which can result in vision loss.
  • Blindness: Scleritis can cause blindness in severe situations.
  • Scarring: Scleral inflammation can result in scarring, which can distort the shape of the eye and impair eye mobility.
  • Glaucoma: Scleritis can increase intraocular pressure, which can result in glaucoma and vision loss.
  • Orbital complications: Scleritis can induce swelling and inflammation in the tissues surrounding the eye, which can cause double vision and eye movement abnormalities.
  • Scleritis can result in blepharitis, dry eyes, and other ocular surface conditions.
  • Facial nerve paralysis can result from scleritis, which can inflame the facial nerves that control facial movement.

complications of episcleritis

Episcleritis is generally a benign condition that resolves on its own within several weeks. However, in some cases, it can lead to complications.

The following are some potential complications of episcleritis:

  • Recurrent occurrences: Some people may have recurrent bouts of episcleritis, which can cause discomfort and chronic inflammation.
  • Scleritis: Scleritis, a more severe form of eye inflammation that affects the sclera, can occasionally develop from episcleritis under unusual circumstances (the thick, white outer coat of the eyeball). If neglected, scleritis can result in vision loss and cause pain, redness, and increased sensitivity to light.
  • Underlying Disease: As previously mentioned, effective therapy of an underlying condition, such as rheumatoid arthritis or inflammatory bowel disease, is required to stop the recurrence of episcleritis.
  • Vision loss: Episcleritis can, in rare instances, lead to vision loss, however, this is more likely to happen in conjunction with scleritis than with episcleritis alone.

Conclusion

The sclera, or the white component of the eye, is affected by inflammatory diseases called scleritis and episcleritis. If left untreated, scleritis, a more serious disorder that affects the deeper layers of the sclera, can cause vision loss and blindness. On the other hand, episcleritis is a less serious type of scleral inflammation that only affects the sclera’s outermost layers and often manifests as lesser symptoms. Both illnesses are known to be connected to autoimmune disorders, and early detection and treatment are crucial to avoid life-threatening complications.

FAQ

Which is worse scleritis or episcleritis?

Scleritis is not as common as Episcleritis but is a more serious condition because the inflamed vessels are deeper in the eye.

How can you tell the difference between scleritis and episcleritis?

Episcleral and scleral examination in daylight is sometimes the only way to distinguish episcleritis from scleritis, as the natural color of the sclera is not distorted. In episcleritis, the eye appears pink to red; in scleritis, the eye has a deep bluish-red or violaceous tinge.

How do you treat episcleritis?

Oral NSAIDs (nonsteroidal anti-inflammatory drugs), typically 800 mg ibuprofen three times daily, are the mainstay of treatment for episcleritis. Alternative medications include indomethacin 25mg to 75 mg twice daily or flurbiprofen 100 mg three times daily.

Can episcleritis turn into scleritis?

Episcleritis does not progress to scleritis. Episcleritis is inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign, and self-limiting.

Is episcleritis caused by stress?

Episclera is a highly vascular tissue that lies above the sclera and beneath the conjunctiva. Episcleritis is an inflammatory response likely caused by oxidative stress, which causes tissue inflammation

Dr Sadia Ayaz
Dr Sadia Ayaz

I am an ophthalmologist and eye surgeon

Articles: 47

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