Episcleritis and Scleritis

Episcleritis and Scleritis

Both episcleritis and scleritis cause inflammation, but they’re actually pretty different from one another.

Episcleritis and scleritis both involve inflammation of the outer covering of the eye, but their symptoms, severity and treatment are quite different. The cause of these conditions is often unknown, but they can be associated with inflammatory or auto-immune diseases of the body.

Episcleritis is inflammation of the tissue between the conjunctiva (the clear tissue with blood vessels on the surface of the eye) and the sclera (the white part of the eye). This usually includes inflammation, or redness, of the conjunctiva. It is usually found on only a part of the surface of the eye, not the whole eye. Often, no cause for this condition can be identified, but it is sometimes associated with rheumatoid arthritis, lupus, herpes zoster (shingles), and other inflammatory disorders of the body. The symptoms and signs of episcleritis include redness, swelling, tenderness, irritation and light sensitivity. Episcleritis rapidly improves with a corticosteroid (anti-inflammatory) eye drop and oral medication is rarely necessary. Over the counter “get the red out” drops can improve the appearance temporarily, but they don’t improve the condition itself.

Scleritis is more severe in all respects. It is an inflammation of the deeper tissue, the white part of the eye, and can cause destruction of the tissue and even loss of vision. It is less common than episcleritis, and occurs most often in females aged 30-50. It’s often associated with auto-immune disorders, or inflammation of the body, including rheumatoid arthritis, lupus erythematosus, polyarteritis nodosa and granulomatosis with polyangiitis (Wegener’s Syndrome). It is rarely infectious in origin and about 50% of cases have an unidentified cause. The signs and symptoms include severe, piercing pain, redness, tearing and light sensitivity. The pain is much more severe than episcleritis—it is a deep ache which may interfere with appetite and sleep, and the redness is usually deeper and darker in color. The inflammation may be localized like episcleritis, but also can include the entire globe of the eye.

There are three types of scleritis: diffuse, nodular and necrotizing:

  • The diffuse type is more spread out, and generally occurs on the front part of the eye.
  • The nodular type is seen as a raised red nodule.
  • The necrotizing type is seen as an area without blood vessels, where the tissue can thin and erode, even causing a perforation, or hole, in the eye, and the eye can be lost.

Nearly 15% of patients with scleritis can lose vision in one year, and nearly 30% in three years. The most severe type can also be a sign of underlying blood vessel inflammation in the body. Scleritis requires treatment with oral corticosteroids like prednisone, or IV steroids like methylprednisolone, often for an extended period of time. Treatment with immunosuppressants in coordination with a rheumatologist may also be necessary. Severe globe-threatening cases of scleritis may also require a graft of the sclera to save the eye.

The doctors at Sterling Vision are skilled at determining and treating the causes of red eyes and will coordinate treatment with other physicians as necessary to ensure the optimum level of care. Most causes of red eye are not scleritis or even episcleritis, but a red eye is something to have checked in a timely manner to maintain the safety and health of your eyes and vision.