- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: February 27, 2025
At Blue Fin Vision® Eye Clinic on London’s prestigious Harley Street, we often encounter patients with various eye conditions, including episcleritis and scleritis. While these two conditions may sound similar and share some characteristics, they are distinct entities with different implications for eye health. In this comprehensive guide, we’ll explore the key differences between episcleritis and scleritis, focusing on their causes, symptoms, and treatments.
Understanding Episcleritis and Scleritis
Before delving into the differences, let’s briefly define each condition:
Episcleritis is an inflammatory condition affecting the episclera, the thin layer of tissue between the conjunctiva and the sclera (the white part of the eye). It’s generally a benign condition that often resolves on its own.
Scleritis, on the other hand, is a more serious inflammatory condition that affects the sclera itself. It can be painful and potentially sight-threatening if left untreated.
Causes: What Triggers These Conditions?
Understanding the causes of episcleritis and scleritis is crucial for proper diagnosis and treatment.
Episcleritis Causes
Episcleritis often occurs without any identifiable cause. However, it can be associated with:
- Mild infections
- Environmental irritants
- Hormonal changes
- Autoimmune disorders (in some cases)
Scleritis Causes
Scleritis is frequently linked to underlying systemic conditions, including:
- Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
- Vasculitis (e.g., granulomatosis with polyangiitis)
- Infections (e.g., tuberculosis, herpes zoster)
In some cases, scleritis can occur without an identifiable cause, but this is less common than with episcleritis.
Symptoms: Recognising the Signs
The symptoms of episcleritis and scleritis can be similar, but there are key differences that help in distinguishing between the two conditions.
Episcleritis Symptoms
- Mild redness in one or both eyes
- Slight discomfort or irritation
- Mild tenderness when touching the eye
- Watery eyes
- Photophobia (light sensitivity) in some cases
Importantly, episcleritis typically does not cause significant pain or affect vision.
Scleritis Symptoms
- Severe, deep eye pain (often described as a boring pain)
- Intense redness, often with a bluish or purplish hue
- Extreme tenderness to touch
- Photophobia
- Tearing
- Blurred vision
- In some cases, decreased visual acuity
The pain associated with scleritis is often more severe than that of episcleritis and may even wake patients from sleep.
Treatment: Managing Episcleritis and Scleritis
The treatment approaches for episcleritis and scleritis differ significantly due to the varying severity and potential complications of each condition.
Episcleritis Treatment
Episcleritis often resolves on its own within a few weeks. However, if treatment is needed, options include:
- Artificial tears for lubrication
- Cold compresses for comfort
- Topical non-steroidal anti-inflammatory drugs (NSAIDs)
- Oral NSAIDs in some cases
- Mild topical corticosteroids (used cautiously and under medical supervision)
Scleritis Treatment
Scleritis requires more aggressive treatment to prevent potential vision loss. Treatment options include:
- Oral NSAIDs for mild cases
- Oral corticosteroids for more severe cases
- Immunosuppressive drugs for refractory cases or those associated with systemic diseases
- Biologic agents in some cases
- Treatment of any underlying systemic conditions
It’s crucial to note that scleritis treatment often requires close collaboration between an ophthalmologist and a rheumatologist or other specialists to manage any associated systemic conditions.
Diagnosis: How We Distinguish Between Episcleritis and Scleritis
At Blue Fin Vision® Eye Clinic in London, our expert ophthalmologists use various methods to accurately diagnose and differentiate between episcleritis and scleritis:
- Comprehensive eye examination: Using a slit lamp to examine the eye’s structures in detail.
- Medical history review: To identify any underlying conditions or potential triggers.
- Ocular ultrasonography: Particularly useful for diagnosing posterior scleritis.
- Blood tests: To check for underlying autoimmune conditions, especially in cases of scleritis.
One key diagnostic technique is the use of phenylephrine eye drops. In episcleritis, these drops will cause the blood vessels to constrict, reducing the redness. In scleritis, the redness persists even after applying these drops.
Potential Complications
Understanding the potential complications of each condition underscores the importance of accurate diagnosis and prompt treatment.
Episcleritis Complications
Episcleritis rarely leads to complications. However, recurrent episodes may occur, and in some cases, it may progress to scleritis.
Scleritis Complications
Scleritis can lead to several serious complications if left untreated:
- Corneal thinning or ulceration
- Uveitis
- Glaucoma
- Cataracts
- Retinal detachment
- Vision loss
These potential complications highlight the importance of early diagnosis and aggressive treatment of scleritis.
Living with Episcleritis or Scleritis
For patients diagnosed with either condition, following the treatment plan and attending regular follow-ups is crucial. At Blue Fin Vision® Eye Clinic, we provide ongoing support and management to ensure the best possible outcomes for our patients.
Why Choose Blue Fin Vision® for Eye Care?
At Blue Fin Vision® Eye Clinic on Harley Street, London, we offer:
- Expert diagnosis: Our experienced ophthalmologists use state-of-the-art technology for accurate diagnosis.
- Personalised treatment plans: We tailor our approach to each patient’s unique needs.
- Comprehensive care: We address not just the symptoms but also any underlying causes.
- Advanced treatments: Access to the latest therapies and treatment modalities.
- Ongoing support: Regular follow-ups and support to manage your condition effectively.
Conclusion
While episcleritis and scleritis may seem similar at first glance, they are distinct conditions with different implications for eye health. Episcleritis is generally a benign, self-limiting condition, while scleritis requires prompt and often aggressive treatment to prevent potential vision loss.
If you’re experiencing any symptoms of eye redness, pain, or discomfort, don’t hesitate to contact our Harley Street clinic. At Blue Fin Vision® Eye Clinic, we’re committed to providing the highest standard of care for all eye conditions, ensuring your vision and eye health are protected.
Remember, when it comes to your eye health, early intervention is key. Trust the experts at Blue Fin Vision® to provide comprehensive, compassionate care for all your eye health needs.
