QuestionSBA
QuestionChoice
A foreign body may cause irritation and lead to inflammation of the eye; however, this history does not suggest trauma to the eye
32626
d
Foreign body
QuestionChoice
Scleritis is a generalised inflammation of the sclera itself and is strongly associated with systemic disease, commonly vasculitis and rheumatoid arthritis. Ocular movements are painful, and often headache and photophobia are present. As the vessels of the sclera are deeper, they will not blanch on probing. Management is guided by underlying cause and ranges from steroids and topical NSAIDs to immunosuppressive therapy such as cyclophosphamide and rituximab
32623
a
Scleritis
QuestionChoice
Episcleritis is inflammation below the conjunctiva and often associated with an inflammatory nodule. As these vessels are more superficial, they will move and blanch on probing with a phenylephrine soaked cotton bud
32624
b
Episcleritis
QuestionChoice
Patients with acute closed angle glaucoma usually present with nausea and vomiting. However, they rarely have visual complaints, and only about 25% will have a headache and a painful red eye
32627
e
Acute closed angle glaucoma
QuestionChoice
This is harmless bleeding of blood behind the conjunctiva and is often associated with the use of anticoagulants. It is usually more alarming than anything else and would not normally cause pain and therefore is not the most likely diagnosis here
32625
c
Subconjunctival haemorrhage
Concept
Chapter
# Summary

Scleritis and episcleritis are ocular conditions characterized by inflammation of the sclera and the episclera respectively. Both conditions present with red eye. However, scleritis is associated with severe pain, pain on ocular movement and nonblanching vessels, and may be associated with systemic illnesses such as rheumatoid arthritis. Episcleritis, on the other hand, has milder symptoms and often resolves without intervention. Key investigations for scleritis include urine dipstick, FBC, CRP, U&Es, LFT and autoimmune serology. Management strategies include NSAIDs for mild scleritis and corticosteroids for severe or necrotising scleritis.

# Definition

Scleritis is a severe inflammation of the sclera, and episcleritis is an inflammation of the episclera, the layer underneath the conjunctiva.


# Aetiology

Scleritis may be associated with systemic illnesses such as rheumatoid arthritis or granulomatosis with polyangiitis.

# Signs and Symptoms

[lightgallery]
[lightgallery1]

## Scleritis

- Red eye
- Severe pain in the orbit
- Pain on eye movement
- Bluish tinge to the white of the eye in severe or necrotising scleritis
- Systemic symptoms in ~50% of patients

## Episcleritis

- Sectoral redness
- Tenderness over the inflamed area
- Milder pain compared to scleritis
- Episcleral vessels move or blanch when pressed with a cotton bud



# Investigations

## For Scleritis:

- Urine dipstick to identify renal disease
- FBC, CRP, U&Es, LFT to identify anaemia of chronic disease, neutrophilia, renal function
- Autoimmune serology
- Phenylephrine eye drops - these blanch the conjunctival and episcleral vessels but not the scleral vessels. So if there is no blanching this is suggestive of scleritis

# Management

Management of episcleritis is mostly supportive with the majority of cases self-resolving within weeks. Artifical tears may be used for symptomatic relief.

## For Scleritis:

- NSAIDs such as fluriprofen PO 100 mg TDS for mild cases
- Corticosteroids such as oral prednisolone or pulsed IV methylprednisolone for severe or necrotising cases
- Steroid-sparing therapies for long-term treatment

# Prognosis

Less than 5% of patients lose useful vision long-term; however, vision deteriorates in 25% of patients in the years following scleritis and some patients develop cataracts.

# References

- [Scleritis](https://eyewiki.aao.org/Scleritis)
- [EpiScleritis](https://eyewiki.aao.org/Episcleritis)
948
Picture
The typical appearance of scleritis.
707
Scleritis.png
images/vt2js7jf1665036171708.jpg
images/vt2js7jf1665036171708_256.jpg
images/vt2js7jf1665036171708_512.jpg
VXoKLYgBOohuhIaXd3h4hwJqNHA2
Picture
The typical appearance of episcleritis.
809
Episcleritis.jpeg
images/l5y41r4b1665036171708.jpg
images/l5y41r4b1665036171708_256.jpg
images/l5y41r4b1665036171708_512.jpg
mTgOFYYAh5iZhIiFeXiIiGB0B2Rn
997
Episcleritis and Scleritis
Topic
16
Ophthalmology
6525
Scleritis presents with severe eye pain, redness, and is often associated with systemic conditions like rheumatoid arthritis.
A 56-year-old man presents to the Emergency Department with headache, photophobia and a very painful, red eye that has gradually worsened over the past two days. He reports no noticeable discharge from the eye. His past medical history includes diabetes, high cholesterol and rheumatoid arthritis. On examination, the entire sclera is bright red, and there is discomfort on eye movements. On probing with a phenylephrine soaked cotton bud, the redness does not change.

What is the most likely diagnosis?
a