Download Episcleritis and Scleritis

Episcleritis and Scleritis
Recommend
 Urgent ophthalmologist referral within 24 hours [1]
Background
 The episclera and sclera is thickened and discoloured
1.
May present with:
 A red sore eye
 Episcleritis and scleritis differ from conjunctivitis in that they usually present as localised tender areas
of inflammation
 Scleritis is more florid and much more painful than episcleritis
 The episcleral and scleral blood vessels are larger than the conjunctival vessels
 There may be a watery discharge
2.
Immediate management: not applicable
3.
Clinical assessment:
 Obtain a comprehensive patient history with particular note:
 medical history – any rheumatoid arthritis or any autoimmune disease, vascular or connective
tissue disease
 family history
 current medications – is the patient taking any medications involving systemic steroids, NSAIDs,
antimetabolites
 Perform standard clinical observations
 Examine both eyes
 starting with visual acuities – vision may be impaired in scleritis [1]
 sclera is thickened and discoloured
 the globe is tender to palpation (with eyelid closed)
4. Management:

Consult MO and discuss further management including whether
 can be treated as per Conjunctivitis (episcleritis)
 evacuation/hospitalisation is needed for Ophthalmologist review (scleritis) within 24 hours
5. Follow up:

If not evacuated/hospitalised, review daily

Consult MO if:
 not improving on each review
 visual acuity deteriorates at any time

See next MO visit
6. Referral / Consultation:
 Consult MO and see next MO clinic as above