Hello and welcome to Case of the Day! I’m Dr. Croley. Today we’re gonna discuss a patient who came in today with a particular eye problem, and a little bit unusual; it doesn’t happen very often. But this person complained of a painful red eye, and they had actually what’s called episcleritis.
So episcleritis is not an eye infection, though it can look like it because the eye is red and inflamed, but it’s an inflammation. So what happens in episcleritis, we’ll go over that, but first we need to know what we’re talking about.
So the first thing is that the white part of your eye, it’s called the sclera, and then over top of that sclera is a coating called the conjunctiva. In between those two layers is the episclera. That’s some really fine tissue just between on top of the sclera and underneath the conjunctiva.
When people get a pink eye, or a conjunctivitis, the outer coating of the conjunctiva that contains most of the blood vessels gets infected and their eye gets red and it could look similar to episcleritis. But typically with a regular conjunctivitis, you don’t have pain. And with an episcleritis, you do have pain. So that’s one distinguishing factor. Usually, the episcleritis is more localized to a portion of the eye, not the whole eye being red and inflamed.
There’s two types of episcleritis. The most common type that I see is called nodular episcleritis. And this patient had nodular episcleritis, where there’s a little nodule underneath the conjunctiva with a lot of blood vessels around it that are inflamed. And then there’s either diffuse or simple episcleritis where there’s not a nodule; there’s just an area that’s inflamed.
Like I said this is an inflammation, so there are certain diseases that are associated with having episcleritis. Any autoimmune type disease, that patient can also develop episcleritis, which is an inflammation. The most common type of autoimmune disease is rheumatoid arthritis, associated with episcleritis, but it could be lupus, it could be colitis, ulcerative colitis, Crohn’s disease, a variety of different types of inflammatory diseases, like ankylosing spondylitis, and so all the “itises” sort of have similar characteristics so they can be associated together.
Typically speaking, this is a self-limited disease. Some websites and information you may look up say it’s a self-limiting benign disease but that’s not always the case. I have another patient that I’m following, here as well, who has episcleritis and now has it in both eyes and has been worked up for rheumatoid and autoimmune diseases up North and has been on systemic medicines for that but isn’t really sure she’s on the right medicine. We’ve been treating her now for a couple of months. As soon as we try to taper off the medicine, it flares back up and bounced on to the other eye and she recently saw a rheumatologist here locally and had her blood work done and is going back to see the rheumatologist to decide if she has a type of autoimmune disease which is probably rheumatoid arthritis, in her case, and she probably may need systemic treatment to calm down her episcleritis.
So, how do we treat episcleritis? The most common treatment is corticosteroids or prednisone and cortisone eye drops and can also be non-steroidal anti-inflammatory medicines, which are like Advil type medicines or Motrin that are in eye drop form. We can sometimes use that as well or a combination of both.
Usually, like I said, it does go away and is self-limited. In some cases people can get it and a year or two later, get it again because it can recur just like any autoimmune type disease. And like I said in most cases, it’s not chronic, like this one patient who just keeps having trouble.
So, if you have any questions about episcleritis, you can always contact us through the website. I’ll be happy to try to answer any question. If not, may God bless you with healthy eyes and great vision.