![]() Kembara Xtra - Medicine - Episcleritis Introduction An irritation and inflammation of the episclera, which is a thin layer of tissue that covers the sclera, is referred to as episcleritis. This is not an infection of any kind. A localized inflammation of the vascular connective tissue that is superficial to the sclera is referred to as episcleritis. often a self-limiting condition, often clearing up on its own without therapy within three weeks Symptoms may be alleviated using topical lubricants and/or treatment with topical corticosteroid medication while waiting for the condition to clear up on its own. Edema and injection localized to the episcleral tissue only Two different forms of edema and injection - Simple (diffuse scleral involvement—more prevalent) - Nodules (areas of involvement that are more localized and less frequent) Epidemiology Slightly more women than men (between 60 and 65%) Incidence It is possible to have this disease at any age, but it is most common in people in their forties and fifties. The community incidence is unknown, but it is estimated to be between 20 and 50 cases per 100,000 person-years. Prevalence Not widely known throughout history; a recent assessment of the community indicated that there is a prevalence of 53 cases for every 100,000 people. Causes and effects: etiology and pathophysiology Etiology: idiopathic in most cases, however alternative reasons, either immunological or nonimmune, may be discovered. The pathophysiology of: - Nonimmune (for example, dry eye syndrome, which shows up on histology as extensive vasodilation, edema, and lymphocytic infiltration) - Immune (systemic vasculitis or rheumatologic illness) Conditions Associated With It Usually Doesn't Go Hand-in-Hand With Any Other Issues The following are some of the conditions that are associated with it, but they are less common: – Vasculitis – Inflammatory bowel disease – Rheumatoid arthritis Ankylosing spondylitis, systemic lupus erythematosus, gout, herpes zoster, and hypersensitivity disorders are some of the diseases that can be caused by hypersensitivity. ○ Rosacea Erythema multiforme, erythrodermic contact dermatitis, and penicillin hypersensitivity Diagnosis Episcleritis is a clinical diagnosis. When presenting the history, it is important to look for any contributing causes, recurrent episodes, or linked systemic diseases. Eye pain is typically nonexistent, and when it does occur, it is typically light and confined to the affected eye. There is a possibility of very light crying. The Patient's Clinical Examination It is important to evaluate the patient's visual acuity; blurred vision is quite uncommon in episcleritis, and the occurrence of this symptom should raise suspicions of another disorder, such as scleritis. The normally white sclera will take on a pink or reddish color in this condition. Localized areas of hyperemia Tenderness over the involved area may be present but is typically absent. Pupils that are the same size and are reactive. Superficial episcleral vascular dilatation. Episcleral edema that is either diffuse or focal, depending on the kind of episcleritis. Tenderness over the involved area. The topical use of phenylephrine causes a blanching of the superficial episcleral vascular hyperemia. Caution A referral to an ophthalmologist should be considered necessary in the event of recurrent episodes, difficulty verifying the diagnosis, or a worsening of symptoms. Differential Diagnosis Scleritis Bacterial conjunctivitis Viral conjunctivitis Herpes (ulcerative) keratitis Superficial keratitis Increased intraocular pressure (ocular hypertension) Herpes (ulcerative) keratitis Superficial keratitis Results From the Laboratory The majority of patients diagnosed with episcleritis do not require any additional laboratory testing or diagnostic examinations. Management Providing symptomatic alleviation is often the primary focus of treatment for episcleritis. The goal is to reduce inflammation, which will, in turn, alleviate any discomfort or suffering that the patient is experiencing (5). First Line The initial treatment for symptomatic episcleritis often consists of applying a topical lubricant to the affected eye, such as artificial tears. Second Line Topical corticosteroids are helpful in cases where discomfort cannot be adequately controlled by more traditional treatment methods. — Four doses of 0.1% fluorometholone each day; if they are ineffective, increase the number of times taken. - Prednisolone 0.5–1% eye drops Oral NSAIDs are a potential treatment option for refractory episcleritis. Ophthalmology referral is recommended in the following situations: if corticosteroid eye drops are being prescribed; if episodes keep occurring; if the diagnosis is unclear; or if symptoms are getting worse. In extremely unusual cases, episcleritis might develop into scleritis. Extra Medical Interventions It has not been demonstrated that topical NSAIDs offer a significant advantage over the use of artificial tears. When episcleritis is caused by a viral infection, treatment with the proper antiviral medication is recommended. Episcleritis often resolves on its own within 21 days and does not typically call for follow-up care because of its short duration. The majority of patients will not experience any issues related to their eyes and will make a full recovery. A Complicated Situation Rarely, there are complications that are associated. There is a possibility of anterior uveitis occurring in 4–16% of patients. A vision impairment may manifest itself in 0% to 4% of instances. There have been reports of ocular hypertension in between 0 and 3.5% of cases.
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