Welcome to Case of the Day!
Today, we’re going to discuss a patient who came in with a particular eye problem, which is a little bit unusual and doesn’t happen very often. This person complained of a painful red eye, and what they had actually is called episcleritis.
Episcleritis is not an eye infection; though it can look like it because the eye is red and inflamed, it is an inflammation. We’re going to go over what happens in episcleritis, but first, we need to know what we’re talking about.
The white part of your eye is called the sclera, and over the top of the sclera is a coating called the conjunctiva. Between those two layers is the episclera, a very fine tissue. When people get pink eye or conjunctivitis, the outer coating of the conjunctiva that contains most of the blood vessels gets infected, and their eye gets red, which looks similar to episcleritis. However, with regular conjunctivitis, you don’t have pain. With episcleritis, you do have pain. So that’s one distinguishing factor. Usually, episcleritis is more localized to a portion of the eye, not the whole eye being red and inflamed.
There are two types of episcleritis. The most common type is nodular episcleritis, which is what this patient has. In nodular episcleritis, there is a little nodule underneath the conjunctiva with a lot of blood vessels around it that are inflamed. Then there’s either diffused or simple episcleritis where there’s not a nodule; it’s just an area that’s inflamed.
As mentioned, episcleritis is an inflammation. There are certain diseases that are associated with episcleritis. A patient with an autoimmune disease can also develop episcleritis, which is an inflammation. The most common type of autoimmune disease associated with episcleritis is rheumatoid arthritis, but it could be lupus, ulcerative colitis, Crohn’s disease, and a variety of inflammatory diseases like ankylosing spondylitis. All the “itises” sort of have similar characteristics, so they can be associated together.
Typically speaking, episcleritis is a self-limited disease, and some websites and information you may look up say it’s a self-limiting benign disease, but that’s not always the case. Dr. Croley had another patient with episcleritis and now has it in both eyes and has been worked up for rheumatoid and autoimmune diseases up north. The patient has been on systemic medicines for that, but she isn’t really sure she’s on the right medicine, and we’ve been treating her now for a couple of months. As soon as we tried to taper off the medicine, it flared back up and now went to the other eye. She recently saw the local rheumatologist, had all the blood work done, and is going back to see the rheumatologist to decide if she has an autoimmune disease, which probably would be 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 or cortisone eyedrops, and then can also be non-steroidal anti-inflammatory medicines, which are like Advil-type medicines or Motrin that are in eyedrop form, and so we can sometimes use that as well, or a combination of both. Usually, episcleritis does go away and is self-limited. In some cases, people can get it and get it again in a year or two because it can recur, just like any autoimmune-type disease. In most cases, it’s not chronic.
If you have any questions about episcleritis, you can always contact us through our website. Dr. Croley will be happy to try to answer any questions. If not, may God grant you with healthy eyes and great vision.
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