Episcleritis

one of the common infections in ophthalmology

1. Epi scleritis Jenan Muhammed ESIC &PGIMSR

2. Contents Definition Epidemiology Etiology Pathology Types Clinical picture Differential diagnosis Management

3. definition Episcleritis is a benign inflammation of deep subconjuctival connective tissue in including superficial scleral lamellae. Frequently affects both eyes

4. Epidemiology Age- seen in young adults Sex- twice common in females

5. etiology Idiopathic Systemic disease- asso with Gout, Rosacea , Psoriasis,CT tissue disordes – RA Hypersensitivity Rn - Endogenous tubercular or staphylococcal toxin Infectious Episcleritis - HZV, Syphilis, Lyme disease, tuberculosis

6. pathology Histologically – dense lymphocytic infiltration with non granulomatous inflammation Characterized by vascular dilatation Episcleral n Subconjunctival tissues

7. Normal sclera Episcleritis Scleritis

8. Types Simple- Sectoral or Diffuse redness of one or both eyes due to engorgement of large episcleral vessels in radial direction. Mild to mod tenderness over area of episcleral injection

9. Nodular- Circumscribed pink or purple nodule of dense leucocytic infiltration ,2-3 mm from limbus Hard, tender immovable (at most can be moved slightly over underlying sclera, with conjunctiva moving freely over it)

10. Symptoms Redness Little or no pain Ocular discomfort- gritty, foreign body, burning Mild photophobia Lacrimation Sometimes severe neuralgia

11. management Mild- lubricants, topical NSAIDs Moderate to severe- Mild topical steroids- fluorometholone QID If unsuccessful – oral NSAIDs (ibuprofen 400 mg oral 3 or 4 times a day, Indomethacin 25 mg TID, aspirin)