How does episcleritis differ from scleritis?
The difference is in the depth of the lesion and the consequences. With episcleritis, the superficial vessels become inflamed: the redness is bright pink, mobile, not accompanied by real pain, and vision is not affected. With scleritis, the sclera itself is involved, its vessels are located deeper, and the redness acquires a purple or bluish tint, especially noticeable in daylight. The main distinguishing feature is the nature of the pain: dull, debilitating, worse at night and with eye movement.
- Episcleritis - superficial inflammation, vision is preserved
- Scleritis is a deep inflammation with a risk of complications
- Episcleritis: discomfort and burning, scleritis: severe pain
- Episcleritis can be simple or nodular
- Scleritis is divided into anterior and posterior, with and without necrosis
Causes and connections with common diseases
In about half of people with episcleritis, no cause can be found, and the episode remains isolated. Repeated cases and especially scleritis lead to a search for a systemic disease. Most often these are rheumatoid arthritis, granulomatosis with polyangiitis, lupus, ankylosing spondylitis, inflammatory bowel disease. Less commonly, inflammation is caused by infections: herpes zoster, tuberculosis, syphilis. Episodes can be triggered by injury, eye surgery, gout, or an insect bite.
- Rheumatoid arthritis and other rheumatic diseases
- Systemic vasculitis
- Bechterew's disease and inflammatory bowel diseases
- Gout
- Infections: herpes, tuberculosis, syphilis
- Injuries and surgeries on the eyeball
Symptoms
Episcleritis begins suddenly: within a few hours, a limited red sector appears on the white of the eye, usually in one eye. There may be a slight burning sensation, lacrimation and sensitivity to light, but visual acuity remains the same. Scleritis develops more slowly, over days, and the main thing is pain: it is deep, aching, extends to the temple and half of the face, wakes you up at night and is difficult to relieve with conventional painkillers. With posterior scleritis, the eye may appear almost calm from the outside, but vision is reduced.
- Limited redness in the white of the eye
- Burning, lacrimation, photophobia with episcleritis
- Deep aching pain with scleritis
- Pain with eye movement and pressure
- Purple tint of the sclera
- Decreased vision due to scleritis
Diagnostics
The ophthalmologist examines the eye using a slit lamp in daylight, assessing the depth and color of dilated vessels. The classic technique is instillation of vasoconstrictor drops: with episcleritis, the superficial vessels quickly turn pale and the eye turns white; with scleritis, redness persists. Be sure to check visual acuity, intraocular pressure and examine the fundus to exclude concomitant uveitis. In case of scleritis and repeated episodes of episcleritis, tests for systemic inflammation are prescribed and referred to a rheumatologist.
- Slit lamp examination
- Test with vasoconstrictor drops
- Checking visual acuity and intraocular pressure
- Fundus examination
- C-reactive protein, rheumatoid factor, antinuclear antibodies
- Ultrasound of the eye for suspected posterior scleritis
Treatment
Episcleritis in most cases goes away on its own in one to three weeks, so treatment is aimed at comfort: moisturizing drops, cold compresses, and for severe complaints, a short course of anti-inflammatory drugs as prescribed by a doctor. Scleritis requires serious systemic therapy: non-steroidal anti-inflammatory drugs, if the effect is insufficient - glucocorticoids and drugs that suppress immune inflammation, selected together with a rheumatologist. Vasoconstrictor drops “for redness” in both conditions only mask the picture and, with prolonged use, increase redness. You cannot prescribe hormonal drops yourself.
- Moisturizing drops without preservatives
- Cold compresses for episcleritis
- Anti-inflammatory drugs as prescribed by a doctor
- Systemic therapy for scleritis together with a rheumatologist
- Avoiding eye whitening drops
- Treatment of the underlying systemic disease
