Episcleritis

What is episcleritis?

Episcleritis is the medical name for inflammation (swelling), irritation and reddening of your episclera. Blood vessels in the eye get bigger, making it look red or pink. Episcleritis often affects only one eye but can affect both.

Your episclera is a layer of clear tissue that covers the white part of your eyes (sclera). It’s in between your sclera and the lining of your eyelids (the conjunctiva).

Who does episcleritis affect?

Episcleritis can affect anyone. But it usually happens more often in women and people assigned female at birth (AFAB) between the ages of 47 and 60.

How common is this condition?

Each year in the United States, about 41 in 100,000 people are diagnosed with episcleritis.

Are there types of episcleritis?

There are two types of episcleritis. One is called simple episcleritis. You may have a limited red area in your eye (sectoral) or an area of redness may cover most of your eye (diffuse).

Episcleritis may start suddenly, which your healthcare provider will call “acute onset.” In simple episcleritis, your eye might get worse at 12 hours and then get better over two to three days.

Another type is nodular episcleritis. This type has a raised lump (nodule) of inflammation in your episclera. Nodular episcleritis often starts gradually rather than suddenly.

What are the signs and symptoms of episcleritis?

Signs and symptoms of episcleritis may include:

• Reddening and irritation of the whites of your eyes.
• Inflammation (swelling) of your eyes.
• Tearing (watering) of your eyes.
• Eye discomfort, but not actual pain.

What causes episcleritis?

In many cases, episcleritis has no known cause (it’s idiopathic). In other cases, episcleritis may be associated with inflammatory and immune system disorders. These types of diseases include:

• Rheumatoid arthritis. This is a type of arthritis where your immune system attacks the tissue lining your joints. Rheumatoid arthritis affects joints on both sides of your body.
• Lupus. Also known as systemic lupus erythematosus, lupus is an autoimmune disease that causes swelling and pain throughout your body. It can cause joint pain, skin issues and problems with organs.
• Inflammatory bowel disease (IBD). A group of disorders that cause pain and swelling in your intestines. If it lasts a long time (is chronic), it can damage the tissue.
• Rosacea. This condition primarily affects the skin on your face, causing redness that’s tough to get rid of. It can also cause problems with your eyes.
• Behçet’s disease. This is a chronic condition caused by inflammation of the blood vessels (vasculitis).

Some infections may cause episcleritis. These include:

• Lyme disease. This condition is caused by a bacterium (singular of bacteria). It’s transmitted by a tick bite.
• Syphilis. This is a sexually transmitted infection (STI) that can damage your health significantly.
• Herpes infections.
• Cat scratch fever, also called cat scratch disease. This infection is caused by a bacterium in cat saliva.

Sometimes healthcare providers note other factors — like stress, allergies and hormonal fluctuations — when a person has episcleritis. But they aren’t necessarily triggers of episcleritis.

What tests will be done to diagnose episcleritis?

Your eye care provider will most likely be able to diagnose episcleritis with an eye exam. They’ll also ask you about your health history, especially about any immune system disorders.

Your provider may need additional tests, like lab tests of your blood and/or imaging tests, to find out if you have an immune system or inflammatory disorder.

How is episcleritis treated?

Your provider may prescribe eye drops that contain corticosteroids. Your provider may also suggest using a nonsteroidal anti-inflammatory drugs (NSAIDs).

Using eye drops or NSAIDs can make the condition clear up more quickly.

If you have an issue with your immune system along with episcleritis, your provider will work with a rheumatologist to ensure that you get the treatment you need.

How can I reduce my risk of developing episcleritis?

Since there’s often no way of telling what’s causing episcleritis, there’s no real way to prevent it from happening.

What can I expect if I have episcleritis?

If you have episcleritis, the outlook is generally good. It’s not uncommon, though, for episcleritis to come back more than once.

If you have simple episcleritis, it’ll probably clear up on its own in two to three weeks. The eye drops or NSAIDs help your symptoms go away sooner.

There’ve been infrequent reports of complications from using steroids to treat episcleritis. These complications may include glaucoma or cataract development.

How do I take care of myself if I have episcleritis?

You can use cool compresses and chill your eye drops to make your eyes feel better.

If your provider agrees, you can take NSAIDs for the discomfort and inflammation.

When should I see my healthcare provider about episcleritis?

You should see or talk to your healthcare provider at the beginning of an episcleritis episode, especially if you’ve never had this kind of thing happen before.

If you find that the efforts you’re making to manage episcleritis aren’t working, or if things get worse, you should see your healthcare provider immediately.

What is the difference between episcleritis and scleritis?

While your eyes become red with both episcleritis and scleritis, there are ways in which the conditions differ. Episcleritis is different from scleritis in at least two ways. Episcleritis isn’t painful while scleritis is very painful. Also, episcleritis doesn’t cause sensitivity to light (photophobia).

Another difference is that episcleritis doesn’t lead to loss of vision, but scleritis can damage your sight.

Episcleritis doesn’t lead to scleritis, but you can often have episcleritis if you have scleritis. (You don’t get scleritis when you have episcleritis.)

What is the difference between episcleritis and conjunctivitis?

Episcleritis and conjunctivitis (pink eye) may seem very similar, with your eyes becoming red. The red area is more restricted in episcleritis than in pink eye. Pink eye also causes your eyes to water more and produces discharge. There’s no discharge with episcleritis and it isn’t contagious.

A note from Cleveland Clinic

Your eyes are important to you. You’ve probably had times when your eyes have been red or bothered you. It’s a good idea to have an appointment with your healthcare provider for a diagnosis if you notice eye redness or swelling, or have discomfort. Many conditions start with red eyes or eye discomfort. Episcleritis isn’t dangerous or contagious, but other conditions that look like episcleritis can be more severe. Contact your provider if you have pain or blurred vision.