Consultant Ophthalmologist,
Cataract & Refractive Surgeon

BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

Episcleritis

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What's going on?

The connective tissue layer between the sclera and the conjunctiva is inflamed. The condition may be idiopathic or, rarely, related to a connective tissue or autoimmune disorder. It may be localised and nodular (raised nodules lifting the overlying conjunctiva) or flat. Rarely, the episcleritis is diffuse, affecting all the visible episclera. Patients may feel some slight discomfort.

If I examine the patient what will I find?

Localised redness of the conjunctiva, which may appear slightly elevated. The adjacent cornea will be clear with no fluorescein staining.

What if I've diagnosed it?

There is usually no need for referral if the diagnosis is clear.

If you are concerned that the patient has a scleritis (see below) refer soon/urgently.

What will the hospital do?

Often no treatment is necessary. Occasionally, a short course of topical steroids will be given.

What do I need to do?

Reassure the patient that the condition will resolve without treatment. Any discomfort may be treated with lubricant drops or oral non-steroidal anti-inflammatory drugs (NSAIDs).

What to tell the patient

Reassure them that this is a benign condition and recurrent episodes do not cause any long-term damage.

Problems that may arise, and how to deal with them

If the hospital has given the patient steroid drops, ensure that it is a short course and not a prolonged treatment. Patients may find that after they taper off and finally stop the drops, the condition recurs. If this happens, it is inadvisable to give further steroids as complications may arise from long-term use.

Unfortunately, this is a recurrent condition.