FFinalistSouthampton · 2027
Ophthalmology
AKT · Ophthalmology/Cornea & ant. segment

Episcleritis

Benign inflammation of the episclera (usually idiopathic, self-limiting)

Overview

Benign, self-limiting inflammation of the episclera. A localised red eye with mild or no pain and normal vision; the redness blanches with topical phenylephrine (superficial vessels). Reassurance ± lubricants/NSAID; the key skill is distinguishing it from sight-threatening scleritis.

Recognise

  • Sectoral or diffuse redness with mild discomfort/grittiness, NOT severe pain
  • Normal vision; no photophobia or discharge; superficial vessels BLANCH with phenylephrine
  • Mostly idiopathic; a minority have associated systemic inflammatory disease

Red flags

  • Severe boring pain, visual loss, or non-blanching deep redness → reconsider scleritis

Differentials & how to tell them apart

Scleritissevere boring pain that wakes the patient, deep non-blanching violaceous redness, often systemic disease
Conjunctivitisdischarge and diffuse injection of the whole conjunctiva
Anterior uveitisphotophobia, AC cells, small pupil, reduced vision
Episcleritis — sectoral superficial injection

Episcleritis — sectoral superficial injection

Imrankabirhossain / CC BY-SA 4.0 — Wikimedia Commons

Investigations

Clinical ± phenylephrine blanch test. No routine systemic work-up unless recurrent.

Management

Reassurance + lubricants (NSAID if symptomatic) — self-limiting

  1. 1Reassure (self-limiting, not harmful). Cold compresses/artificial tears. Topical/oral NSAID or, if more severe, a short course of topical steroid.Gate: Confirm it is episcleritis (mild pain, blanches with phenylephrine) and not scleritis (severe pain, non-blanching) before reassuring — recurrent disease may need a systemic screen
  2. 2Recurrent/persistent → ophthalmology and consider a systemic association.
Reassurance ± lubricants/cold compress — most resolve spontaneously
Topical/oral NSAID; short topical steroid if severe — for symptomatic relief in more troublesome cases

Key points

Comfortable, blanching, vision normal = episcleritis (benign). It is the benign mimic of scleritis — phenylephrine sorts them.

Monitor & prognosis

Self-resolves over 1–2 weeks.

Excellent.

Source: NICE CKS Red eye; College of Optometrists CMG