Makindo Medical Notes

Related Subjects: |Episcleritis |Scleritis |Assessing a Red eye |Acute Angle Closure Glaucoma |Allergic and Infective Conjunctivitis |Anterior and Posterior Uveitis

Topical application of phenylephrine turns the inflamed episclera white but has no effect on the redness of scleritis

About

• Benign self-limiting condition of uncertain aetiology,
• Inflammation of the Episcleral membrane which covers the sclera

Aetiology

• Typically no cause found

Clinical

• Acute onset redness and discomfort rather than pain, usually focal
• Much less severe than scleritis
• Some mild eye discomfort and irritation
• Mild redness around the conjunctiva
• Pupil, cornea and visual acuity normal

Investigations

• Topical application of phenylephrine turns the inflamed episclera white but has no effect on the redness of scleritis

Differentials

• Scleritis: pain wakes the patient from sleep and the globe is tender to gentle pressure through the closed eyelid
• Conjunctivitis: redness tends to be more generalised and the tarsal conjunctiva (evert the lower eyelid) is involved
• Pterygium (when inflamed): raised nasal pterygium, with localised redness, possibly with some punctate conjunctival staining with fluorescein

Management

• Try frequent (hourly) preservative-free lubricating drops or gels/ointments
• Minimise exposure to sun, wind and air-conditioning
• Oral NSAIDs may be helpful
• Non urgent referral to an ophthalmologist if recurrent or concerns
• Topical NSAIDs or topical steroids may be required