Synopsis
Differentiate superficial episcleral inflammation from potentially destructive scleral disease, recognise atypical presentations, and arrange the appropriate urgency of ophthalmic and systemic assessment.
- Episcleritis affects superficial tissue and usually causes mild discomfort with preserved vision; scleritis affects the deeper scleral coat.
- Episcleritis is commonly self-limiting over seven to ten days, although recurrence should prompt reconsideration of associated disease.
- Scleritic pain can be deep, radiating and severe enough to disturb sleep, but important exceptions occur.
Key red flags
Severe deep pain radiating towards the brow or jaw, disturbing sleep or worsening with eye movement suggests scleral inflammation.
Investigation priorities
Assess ocular function and identify associated sight-threatening findings.
Management branches
Assessment supports uncomplicated episcleritis with normal vision and no concerning corneal or intraocular findings.
- Explain that symptoms commonly resolve within seven to ten days and offer cold compresses or artificial tears for comfort.
- Discuss whether clinical review is needed for troublesome discomfort, avoiding unexamined steroid treatment or assumptions about oral NSAID suitability.
Key medicines
Carmellose sodium for comfort in uncomplicated episcleritisOne to two drops into the affected eye as needed, using a suitable 0.5% or 1% formulation and the manufacturer's opening-expiry instructions.