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Episcleritis

Episcleritis is an inflammatory eye disease, that affects the episcleral tissue, located between sclera and conjunctiva.

This disease proceeds predominantly in a mild form, but with frequent relapses. In some cases it can be healed by itself. It is impossible to determine the true prevalence of this ocular pathology, because many people with episcleritis prefer not to resort to the help of professional ophthalmologist. According to many researchers, Episcleritis is more widespread among women.

Causes of episcleritis

Currently, the exact causes of this disease are not known. About one-third of the cases is observed in users with various systemic diseases. At the same time 11% of these users have an increased content of uric acid in the blood.

Episcleritis often occurs against a background of such diseases as:

  • Systemic lupus erythematosus;

  • Rheumatoid arthritis;

  • Seronegative spondyloarthropathy (psoriatic or reactive arthritis, Crohn's disease, nonspecific ulcerative colitis, ankylosing spondylitis, etc.);

  • Polyarteritis nodosa;

  • Various forms of allergic diseases;

  • Gout;

  • Presence of a foreign body in the eye;

  • Reaction to eye irritation caused by chemicals;

  • Some infectious diseases of viral (herpes), fungous or bacterial (Lyme disease, tuberculosis, syphilis) nature.

In the fewer cases, episcleritis occurs against a background of adrenal insufficiency, Wiskott-Aldrich syndrome, paraproteinemia, t-cell leukemia.

Clinical picture

 

There are two basic forms of episcleritis: nodular and simple. Simple episcleritis is more common type of this eye disease. It is usually manifested by diffuse or local (limited) eye reddening and moderate pain sensations. Nodular form of the disease is accompanied by severe pain and has long clinical course. It appears on the eyeball as a small bulge – a nodule, circled by hyperemic (reddened) tissues.

There are no forms of episcleritis, that transform to scleritis. Episcleritis is characterized by chronic course with remission and exacerbation periods. The symptoms of exacerbation of inflammatory process usually last for one or two weeks. After that, their activity is reduced, and the disease goes into it's latent stage, that lasts from one to three months.

The inflammation can has different intensity. The most severe course of episcleritis with frequent and prolonged exacerbations is usually observed in people with various systemic diseases of connective tissue. Such persons can experience an  intensification of symptomatology of episcleritis   in autumn and in spring as well as after severe stress and hormonal changes.

During the period of exacerbation many people complain of eye discomfort, noticeable reddening of the sclera and photophobia. In some cases, the appearance of limpid discharge from the conjunctiva  can be observed.

Diagnostics

It is necessary to become acquainted with case history of the patient to identify all the causes, that could lead to the development of episcleritis. Sometimes it can be very important to conduct not only an ophthalmologic, but also a laboratory (test for syphilis, the determination of rheumatoid factor, antinuclear antibodies, uric acid level, conducting of detailed general analysis of blood with the calculation of leukocyte formula and ESR) and instrumental (fluorography, radiography)  researches.

 

Treatment

In most cases, the treatment of episcleritis is not conducted. Only if you experience an expressed symptomatology of this disease, it is necessary to use moisturizing eye drops, based on the effect of artificial tear. Sometimes, it can be prescribed to use special eye drops or ointments with corticosteroids, that have an expressed antiinflammatory effect, as a course of medical treatment. Their long-term and frequent use at episcleritis is contraindicated because they contribute to the development of glaucoma. Besides, the use of corticosteroid preparations in some persons can cause further exacerbations of the inflammatory process in episcleral tissue in itself.

If treatment does not give a positive effect, the doctor can recommend the systemic use of nonsteroidal antiinflammatory agents (in the form of pills or injections). Sunglasses should be worn in the case of severe photophobia. In order to prevent further progression of episcleritis (and the occurrence of relapses), it is very important to identify and eliminate all the causes of it's development.