Southwest, FL | Red Eye Due to Episcleritis | Cataract & Refractive Institute of Florida
Dr Croley: Hello and welcome to case of the day. I'm Dr Croley, and today we're going to discuss a patient who came in today, with a particular eye problem and a little bit unusual that doesn't happen very often, but this person complained of a painful red eye and they had actually what's called episcleritis. So episcleritis is not an eye infection. Though, It can look like it cause the eye is red and inflamed, but it's an inflammation, and so what happens in episcleritis, we'll go over that, but first we need to know what we're talking about. So the first thing is, is that the white part of your eye is called a sclera. And then over top of that sclera is a coating called the conjunctiva. In between those two layers is the episclera and there's some really fine tissue just between, on top of the sclera and underneath the conjunctiva.
Dr Croley: When people get the pink eye, or conjunctivitis, the outer coating of the conjunctiva that contains most of the blood vessels, gets infected and their eye gets red, and it could look similar to episcleritis. But typically with a regular conjunctivitis, you don't have pain. And with an episcleritis you do have pain, so that's one distinguishing factor. And usually the episcleritis is more localized to a portion of the eye, not the whole eye being red and inflamed.
Dr Croley: There's two types of episcleritis. The most common type that I see is called nodular episcleritis. And this patient had nodular episcleritis, where there's a little nodule underneath the conjunctiva with a lot of blood vessels and rounded that are inflamed. And then there's either a diffuse, or simple episcleritis where there's not a nodule, it's just an area that's inflamed, and so like I said, this is an inflammation.
Dr Croley: So there are certain diseases that are associated with having episcleritis. So any auto immune type disease, and that patient can also develop episcleritis, which is an inflammation. So the most common type of autoimmune diseases, rheumatoid arthritis associated with episcleritis, but it could be lupus, it could be colitis, ulcerative colitis, Crohn's disease, a variety of different types of inflammatory diseases like ankylosing spondylitis. And so all the itises, sort of have a similar characteristics so they can be associated together.
Dr Croley: Typically speaking, this is a self-limited disease, and some websites and information you may look up say it's a several limiting benign disease, but that's not always the case. I have another patient that I'm following here as well who has a episcleritis, and now has it in both eyes and has been worked up for rheumatoid and autoimmune diseases up North and has been on systemic medicines for that but isn't really sure she's on the right medicine. And we've been treating her now for a couple of months, and as soon as we tried to taper off the medicine it flares back up and now it's gone to the other eye, and she recently saw the rheumatologist here locally had all the blood work done is going back to see the rheumatologist, to decide if she has a type of autoimmune disease, which probably would be rheumatoid arthritis in her case. And she probably may need systemic treatment to calm down her episcleritis.
Dr Croley: So how do we treat episcleritis? The most common treatment is corticosteroids or prednisone or cortisone eyedrops. And then can be also, nonsteroidal anti inflammatory medicines, which are like Advil type medicines or Motrin that are in eyedrop form. And so we can sometimes use that as well or a combination of both. Usually, like I said, it does go away in a self limited. In some cases people can get it, and a year or two later get it again because it can recur just like any autoimmune type disease. And like I said, in most cases it's not chronic, like this one patient, who just keeps having trouble. So, if you have any questions about episcleritis you can always contact us through the website. I'll be happy to try to answer any questions. If not, may God grant you with healthy eyes and great vision.