Episcleritis

Introduction

Episcleritis is an inflammation of the thin layer of tissue (called the episclera) that lies in front of the firm white part of the eye (the sclera). It is a relatively common condition that often affects just one eye, but it can affect both eyes in around one third of cases.

It also tends to affect women more than men and it occurs more frequently among those in their 40s and 50s.

If you have episcleritis, you will likely experience some eye redness and possibly some eye discomfort and irritation. These symptoms often appear quickly, but they usually improve without treatment within 7 to 10 days.

Episcleritis can return – often doing so every few months – but it rarely has any long-lasting effect on the health of your eyes.

Symptoms

Try checking your symptoms with our AI-powered symptom checker.

Eye redness is the main symptom you are likely to experience. This redness generally affects only one eye, but around one in three people find that both eyes are affected.

You may experience other symptoms, including:

  • a mild ache or burning sensation
  • eye feels tender to touch
  • eye watering

If you have episcleritis, your vision is unlikely to be affected.

There are two types of episcleritis:

  • simple episcleritis – this is the most common type of episcleritis. It tends to come on quickly, making the surface of the eye look red. This redness is sometimes in the shape of a triangle or can affect the whole eye.
  • nodular episcleritis – this is a rarer type of episcleritis. It comes on more slowly and causes red, swollen bumps (nodules) on the surface of the eyeball.

Causes

The exact cause of episcleritis is still not fully understood, but it is more likely to happen in people with an underlying inflammatory condition, such as:

A small proportion of cases of episcleritis are associated with higher than normal levels of a substance called uric acid (as sometimes seen in gout) and the skin condition rosacea.

More rarely, episcleritis may be caused by an infectious disease. This includes:

  • herpes zoster virus - the virus that causes chickenpox and shingles
  • herpes simplex virus - the virus that causes cold sores and genital herpes
  • lyme disease
  • syphilis
  • hepatitis B

Episcleritis can also be caused by injury to the eye.

Diagnosis

Your doctor may diagnose episcleritis after asking you questions about your symptoms, eye health, general health, medical history, family history of diseases, and other questions about your health and lifestyle.

Your doctor is also likely to examine your eyes. Depending on the severity and the type of your symptoms and the response to treatment, your doctor may refer you to an eye specialist (ophthalmologist).

If your doctor thinks that your symptoms are related to another underlying disease, they may perform additional tests including blood tests.

Treatment

As a condition that usually clears up on its own, episcleritis often requires no treatment. If your symptoms are mild, your doctor may say that you don’t need to do anything other than wait for the condition to settle by itself.

If you are experiencing some discomfort in your eyes, your doctor may recommend eye drops, ointment, and/or applying a cold compress to your eye to help ease the discomfort.

In more severe cases your doctor may prescribe eye drops containing non-steroidal anti-inflammatory drugs (NSAIDs) or, more rarely, steroids to help calm the inflammation.

If you have episcleritis that won’t go away (your symptoms do not improve after 7 days), the episcleritis pain becomes worse, and/or your vision becomes affected, it is important to see your doctor in case your symptoms are due to a more serious eye condition called scleritis

Outlook

Episcleritis of the eye is usually a mild condition which heals on its own within 7 to 10 days, and without causing any long-term complications or affecting your vision.

However, you may find that the condition comes back in the future, and this may be in the same eye or in your other eye.

If your symptoms are associated with an underlying inflammatory disease, you may find that the condition progresses in the same way as the underlying disease.

In such cases, working with a specialist to manage your underlying condition can be a good way to reduce the risk of episcleritis returning in the future.

To find answers to any other health questions you might have, visit our Health A-Z.

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