EPISCLERITIS AND SCLERITIS
DEFINITION OF EPISCLERITIS AND SCLERITIS
Episcleritis and scleritis are inflammatory conditions affecting the outer layers of the eye, often linked to autoimmune disorders, infections, or systemic inflammation. Both conditions cause redness, discomfort, and eye pain, but they differ in severity.
- Episcleritis is a mild, self-limiting inflammation of the episclera (a thin layer between the sclera and conjunctiva).
- Scleritis is a serious, deep inflammation of the sclera (the white outer layer of the eye), which can lead to vision-threatening complications if left untreated.
RISK FACTORS OF EPISCLERITIS AND SCLERITIS
- Autoimmune diseases
- Infections
- Ocular trauma or surgery
- Chronic inflammation
- Toxic exposure
EPISCLERITIS SYMPTOMS
usually in one section of the eye
no significant pain
but eye not severely painful
but not deeply red
Why it’s misleading: The eyes may actually produce too many reflex tears in response to dryness
Tears lack proper composition, so they don’t lubricate effectively
SCLERITIS SYMPTOMS
can wake patients from sleep
to jaw, brow, or temple
(violaceous hue) that does not blanch with phenylephrine
photophobia
or eye complications if untreated
EPISCLERITIS TREATMENT TYPES
Observation – Often resolves on its own within 1–2 weeks
Supportive care:
Cold compresses
Lubricating artificial tears (preservative-free)
Avoiding eye strain or irritants
Topical corticosteroids:
e.g., Prednisolone acetate 1%, used short term to reduce inflammation
Must be monitored by an eye doctor (risk of increased eye pressure)
e.g., Ibuprofen, Naproxen – for pain control and inflammation
less common due to limited efficacy
Recurrent or severe episcleritis should be referred for evaluation of underlying systemic conditions (e.g., autoimmune diseases, rosacea, gout, herpes zoster).
SCLERITIS TREATMENT TYPES
Systemic NSAIDs:
First-line for mild, non-necrotizing anterior scleritis
e.g., Indomethacin, Ibuprofen, or Naproxen
Oral corticosteroids:
e.g., Prednisone starting at 40–60 mg/day with taper
Used if NSAIDs are not effective or for posterior/necrotizing types
For refractory cases or when associated with autoimmune diseases:
Methotrexate, Azathioprine, Mycophenolate mofetil
Biologics (e.g., Rituximab, Infliximab) in severe or resistant cases
Managed by an ophthalmologist + rheumatologist team
Pain management for severe cases
Antibiotics or antivirals if infectious scleritis is suspected (rare, but serious)
Recurrent or severe scleritis should be referred for evaluation of underlying systemic conditions (e.g., autoimmune diseases, rosacea, gout, herpes zoster).
FAQS
Episcleritis is a mild, usually painless inflammation of the episclera, the thin layer of tissue just above the white part of the eye (sclera).
Scleritis is a deeper, more severe inflammation of the sclera itself and can be painful, vision-threatening, and associated with autoimmune diseases.
Episcleritis:
Mild redness, often in one area
Mild discomfort or irritation
No vision changes
No severe pain
- Scleritis
Severe, deep eye pain (may radiate to brow or jaw)
Eye tenderness
Red or violaceous discoloration
Blurry vision, tearing, light sensitivity
- Episcleritis is often idiopathic (no known cause) but may be linked to mild systemic conditions like rosacea, gout, or viral infections.
Scleritis is commonly associated with autoimmune diseases such as:
Rheumatoid arthritis
Lupus
Granulomatosis with polyangiitis
Sjögren’s syndrome
No, neither episcleritis nor scleritis is contagious. They are not caused by infections in most cases (except in rare cases of infectious scleritis)
Episcleritis typically does not cause permanent damage.
Scleritis, if left untreated, can cause:
Vision loss
Thinning or perforation of the sclera
Retinal or optic nerve damage
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