Episcleritis Uncovered: A Thorough Review of Current Research
DOI:
https://doi.org/10.12775/JEHS.2024.70.55740Keywords
episcleritis, eye redness, ocular inflammation, conjunctivitis, scleritisAbstract
Episcleritis is an inflammatory condition affecting the episclera of the eye, which is the tissue between the sclera and conjunctiva. It manifests as unilateral or bilateral redness and discomfort. Despite its typically benign course, it may signal underlying systemic disorders, necessitating comprehensive evaluation and personalized management. While most cases are idiopathic, autoimmune diseases and infections may play contributory roles. Epidemiological studies reveal a predilection for young to middle-aged females, with episcleritis being less common in children. Diagnostically, characteristic features include sectoral redness and mild discomfort, distinguishing it from conjunctivitis and scleritis. Treatment primarily focuses on symptomatic relief, utilizing topical steroids, oral NSAIDs, and artificial tears. The prognosis is generally favourable, with spontaneous resolution within weeks; however, recurrent,
or chronic cases may necessitate further evaluation for underlying systemic conditions. This comprehensive review aims to elucidate etiology, epidemiology, diagnosis, management strategies, prognosis of episcleritis, and clinical nuances, drawing upon recent literature from 1976 to the present. By consolidating contemporary knowledge, this review provides valuable insights for clinicians on how to treat this ocular condition effectively.
References
Schonberg S, Stokkermans TJ. Episcleritis. StatPearls. Treasure Island (FL)2024.
McGavin DD, Williamson J, Forrester JV, Foulds WS, Buchanan WW, Dick WC, et al. Episcleritis and scleritis. A study of their clinical manifestations and association with rheumatoid arthritis. Br J Ophthalmol. 1976;60(3):192-226.
Whitcup SM. Whitcup and Nussenblatt's Uveitis: Elsevier; 2020. 252-8 p.
Akpek EK, Uy HS, Christen W, Gurdal C, Foster CS. Severity of episcleritis and systemic disease association. Ophthalmology. 1999;106(4):729-31.
Watson PG, Hayreh SS. Scleritis and episcleritis. Br J Ophthalmol. 1976;60(3):163-91.
Pavesio CE, Meier FM. Systemic disorders associated with episcleritis and scleritis. Curr Opin Ophthalmol. 2001;12(6):471-8.
Reddy AK, Kolfenbach JR, Palestine AG. Ocular manifestations of rheumatoid arthritis. Curr Opin Ophthalmol. 2022;33(6):551-6.
Sainz de la Maza M, Foster CS, Jabbur NS. Scleritis associated with systemic vasculitic diseases. Ophthalmology. 1995;102(4):687-92.
Aldebasi TM, Alasiri AA, Alnahdi MA, Alfarhan A. Tubercular Episcleritis: A Review of Literature. Middle East Afr J Ophthalmol. 2022;29(1):51-5.
Sanjay S, Handa A, Kawali A, Shetty R, Bhakti Mishra S, Mahendradas P. Scleritis and Episcleritis following Coronavirus Disease (COVID-19) Vaccination. Ocul Immunol Inflamm. 2023;31(6):1184-90.
Mendez Mangana C, Barraquer Kargacin A, Barraquer RI. Episcleritis as an ocular manifestation in a patient with COVID-19. Acta Ophthalmol. 2020;98(8):e1056-e7.
Zagorski Z, Biziorek B, Haszcz D. [Ophthalmic manifestations in Lyme borreliosis]. Przegl Epidemiol. 2002;56 Suppl 1:85-90.
Alnahdi MA, Alasiri AA, Aldebasi TM. Recurrent Tubercular Episcleritis. Middle East Afr J Ophthalmol. 2021;28(2):140-2.
Yadav S, Rawal G. Tubercular Nodular Episcleritis: A Case Report. J Clin Diagn Res. 2015;9(8):ND01-2.
Jabs DA, Mudun A, Dunn JP, Marsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol. 2000;130(4):469-76.
Carreno E, Olivas-Vergara OM. Systemic Vasculitis and Its Association with the Eye. Ophthalmologica. 2023;246(3-4):174-80.
McCluskey PJ, Watson PG, Lightman S, Haybittle J, Restori M, Branley M. Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology. 1999;106(12):2380-6.
Honik G, Wong IG, Gritz DC. Incidence and prevalence of episcleritis and scleritis in Northern California. Cornea. 2013;32(12):1562-6.
Homayounfar G, Nardone N, Borkar DS, Tham VM, Porco TC, Enanoria WT, et al. Incidence of scleritis and episcleritis: results from the Pacific Ocular Inflammation Study. Am J Ophthalmol. 2013;156(4):752-8.
Read RW, Weiss AH, Sherry DD. Episcleritis in childhood. Ophthalmology. 1999;106(12):2377-9.
Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. J Clin Med. 2021;10(10).
Sainz de la Maza M, Molina N, Gonzalez-Gonzalez LA, Doctor PP, Tauber J, Foster CS. Clinical characteristics of a large cohort of patients with scleritis and episcleritis. Ophthalmology. 2012;119(1):43-50.
Sainz de la Maza M, Jabbur NS, Foster CS. Severity of scleritis and episcleritis. Ophthalmology. 1994;101(2):389-96.
Perray L, Ungerer L, Chazal T, Monnet D, Brezin A, Terrier B. [Scleritis and episcleritis]. Rev Med Interne. 2023;44(12):646-55.
Heron E, Gutzwiller-Fontaine M, Bourcier T. [Scleritis and episcleritis: diagnosis and treatment]. Rev Med Interne. 2014;35(9):577-85.
Daniel Diaz J, Sobol EK, Gritz DC. Treatment and management of scleral disorders. Surv Ophthalmol. 2016;61(6):702-17.
Cuchacovich TM, Pacheco P, Merino G, Gallardo P, Gatica H, Valenzuela H, et al. [Clinical features and response to systemic treatment of primary and secondary episcleritis and scleritis resistant to local treatment]. Rev Med Chil. 2000;128(11):1205-14.
Tappeiner C, Walscheid K, Heiligenhaus A. [Diagnosis and treatment of episcleritis and scleritis]. Ophthalmologe. 2016;113(9):797-810.
White GE. Episcleritis and scleritis. Optom Clin. 1991;1(4):79-87.
Caimmi C, Crowson CS, Smith WM, Matteson EL, Makol A. Clinical Correlates, Outcomes, and Predictors of Inflammatory Ocular Disease Associated with Rheumatoid Arthritis in the Biologic Era. J Rheumatol. 2018;45(5):595-603.
Williams CP, Browning AC, Sleep TJ, Webber SK, McGill JI. A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis. Eye (Lond). 2005;19(7):739-42.
Turgut F, Dingerkus V, Tappeiner C, Becker M. [Diagnostic and Therapeutic Management of Episcleritis and Scleritis]. Klin Monbl Augenheilkd. 2023;240(5):725-38.
Berchicci L, Miserocchi E, Di Nicola M, La Spina C, Bandello F, Modorati G. Clinical features of patients with episcleritis and scleritis in an Italian tertiary care referral center. Eur J Ophthalmol. 2014;24(3):293-8.
Smith JR, Mackensen F, Rosenbaum JT. Therapy insight: scleritis and its relationship to systemic autoimmune disease. Nat Clin Pract Rheumatol. 2007;3(4):219-26.
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Copyright (c) 2024 Ewa Błaszczak, Jakub Wójcik, Martyna Dydyk, Aleksander Małachowski, Piotr Malinowski, Urszula Kopczyńska, Cezary Kopczyński, Kinga Gurdak, Martyna Dyrek, Aleksandra Partyka
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