Contributor: Gordon K. Klintworth
Episcleritis is usually a benign, self-limiting condition that does not affect vision. Most frequently the anterior episclera is involved with a recurrent, spontaneous, non-infectious inflammation with pain or ocular discomfort and focal dilatation of episcleral blood vessels. It may subside spontaneously within days or persist for weeks despite anti-inflammatory therapy. The cause of most cases of episcleritis is unknown, but infrequently it is associated with a systemic disease (rheumatoid arthritis, Wegener granulomatosis, relapsing polychondritis, systemic lupus erythematosus, inflammatory bowel disease, Churg-Strauss syndrome, Behçet disease, cranial arteritis, Cogan syndrome, ankylosing spondylitis, Reiter syndrome, psoriatic arthritis [arthritis - psoriatic], rosacea, atopy, gout, thyroid disease). Persons with active rheumatoid arthritis may present to an ophthalmologist with episcleritis, which can recur. Males and females are equally affected and most cases begin in the fifth decade. Simple episcleritis [episcleritis - simple] does not usually progress to scleritis and in contrast to nodular episcleritis [episcleritis - nodular] or scleritis it is infrequently associated with rheumatoid arthritis. Nodular scleritis, decreased vision, anterior uveitis [uveitis - anterior], glaucoma, and cataract are sometimes sequelae. Histologically, the inflammation is nongranulomatous and is characterized by vascular dilatation, perivascular lymphocytic infiltration, and the accumulation of proteinaceous fluid in the extracellular spaces. In non-recurrent cases, healing occurs without scarring.