Episcleritis is an inflammation of the episcleral plate of the eye. Clinically manifested by unilateral redness, moderate discomfort in the eye area, local soreness, lacrimation. In the process of diagnosis, visual examination, visometry, tonometry, refractometry, computer perimetry, biomicroscopy using a slit lamp are used. Laboratory diagnostics are used to identify possible underlying pathology. Treatment of episcleritis is conservative, consists in the appointment of non-steroidal anti-inflammatory drugs, moisturizing and antibacterial drops. In the absence of complaints, therapy is not required. The prognosis is favorable.
Episcleritis is an inflammatory disease of the eyeball, in which the episcleral membrane is affected. The episclera is the surface layer of the scleral capsule of the eye, has a loose structure and rich blood supply (contains two vascular networks – superficial and deep). Episcleritis can occur in two forms – simple and nodular.
The simple form occurs more often in young people, nodular, as a rule, affects patients older than 50 years. Episcleritis is characterized by a recurrent course. The disease almost never turns into true scleritis. It is often combined with autoimmune disorders in the body. The lesion is usually one-sided, but it can also be two-sided. Pathology is found everywhere in practical ophthalmology.
Causes of episcleritis
The pathogenesis of episcleritis is not fully elucidated. It is known that the inflammatory reaction spreads to the episclera from the circulatory system. Risk factors for the development of episcleritis include the ingress of a foreign body into the eyeball, the effect of various chemicals on the eyes, the presence of polyvalent allergies. The disease often occurs as an ophthalmological complication in:
- rheumatoid arthritis;
- systemic lupus erythematosus;
- ulcerative colitis;
- Crohn’s disease;
- Lyme disease;
- tuberculosis and others.
In some pathologies (Crohn’s disease, ulcerative colitis), an inflammatory reaction on the episclere may appear somewhat earlier than the symptoms of the underlying disease, which complicates diagnosis.
Symptoms of episcleritis
With episcleritis, patients complain of unilateral redness, a feeling of heaviness in the eye area, soreness, lacrimation. The decrease in visual acuity is uncharacteristic. Simple episcleritis is the most common type of pathology, accompanied by sectoral, rarely diffuse hyperemia. It usually goes away on its own within two weeks.
The nodular form is characterized by a limited protruding hyperemic nodule, which resolves within up to four weeks. With biomicroscopy using a slit lamp, an ophthalmologist reveals the absence of swelling of the sclera. Due to frequent recurrences of episcleritis, the surface layers of the sclera begin to rearrange into parallel rows, as a result, the scleral shell becomes more transparent.
To diagnose episcleritis, an ophthalmologist also uses the following examination methods: visual examination, visometry, tonometry, refractometry, computer perimetry. Of the additional methods, laboratory blood tests are prescribed: specific samples (Mantoux test, Wasserman reaction, HIV infection test), fluorography, and also determine the immune status. Taking into account the fact that episcleritis is a complication of various diseases, consultations of other specialists are necessary for accurate diagnosis and treatment – a rheumatologist, an infectious disease specialist, an endocrinologist, an allergist.
Treatment of episcleritis
Treatment of episcleritis is only conservative – medication and physiotherapy. Basic therapy is aimed at correcting the underlying pathology. In the absence of patient complaints, special drug therapy for episcleritis is not required. In the presence of complaints, nonsteroidal anti-inflammatory drugs in the form of drops are usually prescribed (frequent instillations with short-term intermittent courses are recommended), moisturizing drops. If necessary, use antibiotics. Physiotherapy procedures include the appointment of UHF therapy to the eye area.
Prognosis and prevention
The prognosis depends on the underlying disease, more often favorable. Measures for the prevention of pathology involve the use of eye protectors when working in chemical industries, timely detection and appointment of competent therapy for chronic diseases, regular preventive examinations, compliance with personal hygiene rules and strengthening of the immune system.