Summary Inflammatory eye conditions notes

Inflammation

Episcleritis
Idiopathic inflammation of the vascular connective tissue sheath between the sclera and
conjunctiva
Can be nodular or diffuse
Symptoms:
 Acute
 Painless (important to allow differential)
 Mostly unilateral
 Irritation (due to nodule)
 Usually recurrent
*features are mild so if px describes more significant pain likely not episcleritis
Signs:
 Hyperaemia (sectoral or diffuse)
 VA unaffected
 No signs of inflammation *
Majorty of cases are self limiting (7 – 10 days)
 Provide artificial tears for discomfort
 Cold compress
 If persisting after week 7 day course of a soft steroid (FML 0.1%, Betamethasone
0.1%, predforte 0.5% bds) – IP
 If persists after 1 week- refer to HES, may require increased dose and need
investigation for systemic cause in recurring cases
*check IOP before steroid and weekly
can also advise a systemic NSAID if necessary

scleritis
severe inflammatory disease of the sclera, anterior (90%) or posterior, idiopathic or linked to
systemic inflammatory disease.

Symtpoms:
 Pain- severe (perform motility, will usually be worse on eye movement)
 Ache on brow and forehead
 Unilateral or bilateral
 Redness
 Blurred vision
 Gradual onset
 Photophobia

Anterior
 Non necrotising
o Diffuse- no nodule
o Nodular- fixed nodule
 Necrotising
o With inflammation- hyperaemia
o Without inflammation – dark blue/grey avascular patches but no hyperaemia