A Red Eye: Scleritis or Episcleritis?

When differentiating episcleritis from scleritis, clinicians often use the phenylephrine blanching technique: blanching congested conjunctival and superficial episcleral blood vessels with either the 2.5% or the 10% concentration.1-4 When the deep episcleral plexus does not blanch, the diagnosis is usually scleritis. If the redness does disappear, it’s episcleritis.

 More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis

Scleritis is a painful, sight-threatening, inflammatory condition of the sclera. It typically presents with an acutely red and painful eye and can be associated with decreased visual acuity. Inflammation of the periorbital soft tissues and ophthalmoplegia are not typically associated with posterior scleritis

 Scleritis: When a Red Eye Raises a Red Flag

This painful inflammation is often an indicator of more serious health concerns.

 The Red Eye in the Rheumatology Patient

It is important to remember that the most frequent cause of red eye in rheumatoid arthritis is dry eye. Episcleritis and scleritis can occur in RA but it is much less common. When thinking about dry eye the obvious cause to a rheumatologist is Sjogren Syndrome, but it important to exclude other causes which include previous radiation, hepatitis C, HIV, sarcoidosis, amyloidosis, IgG4 disease and graft versus host disease.

Conjunctivitis vs Scleritis

Oh the "red eye". Diagnosing scleritis is gonna be hard for the non-ophtho. Some clues though, scleritis often has a very dull, boring pain and when you push on the eye, they will come off the table on you. The injection also will not blanch completely when you put neosynephrine in the eye (if you even have that available). Sometimes it is nodular and you will see a nodular granulomatous reaction on the conj.

Episcleritis

Episcleritis is inflammation of the episclera, which is the thin vascular outer coating of the eye wall, the sclera. Episclera lies underneath the more superficial layers of conjunctiva and other connective tissues. Unlike the more severe disease scleritis, episcleritis is a benign condition and is usually not associated with other systemic inflammatory diseases.

My Patient Has Scleritis...Now What?

For many clinicians, the diagnosis and treatment of scleritis can be daunting tasks. This troubling condition frequently requires an arduous course of treatment and brings significant risk for destruction of ocular structures and permanent vision loss. The diagnosis of scleritis is based primarily on clinical observation and the patient’s presenting constellation of symptoms. Pain will be the hallmark,

Scleritis and Episcleritis

Episcleritis and scleritis are inflammation of the deeper layers of the eye, the vascular episclera, and the avascular sclera. Episcleritis presents with segmental eye redness, discomfort but not severe pain, and no vision loss. Scleritis can have overlying episcleritis, but also has a violaceous hue, is painful, and may cause vision loss.

Current Approach for the Diagnosis and Management of Noninfective Scleritis

Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of scleritis.

Episcleritis Patient Case Study

Episcleritis is a benign inflammatory condition of the external eye, specifically the episcleral tissues, which form the membrane between the conjunctiva and the sclera. It is a relatively common, recurrent, but self-limited acute red eye presentation.

Eyes are red, still hurts when pressed? The doctor judges this disease based on typical symptoms

"Scleral inflammation is an inflammatory disease of the sclera. The typical symptom is pain when pressing the eyeball." Feng Qingyang said that scleritis can also cause redness, ocular edema, decreased vision, photophobia and tearing...

Scleritis Often Diagnosed by Ophthalmologists, But Rheumatologists Help Determine Systemic Causes

Eye pain is sometimes so bad at night, it can cause trouble sleeping, says rheumatologist Elyse Rubenstein, MD, Providence Saint John’s Health Center, Santa Monica, Calif. Headaches and photophobia are other possible symptoms of scleritis.