A clinical study of episcleritis and scleritis

Abstract

Purpose: Episcleritis and scleritis, considered as different forms of the same spectrum of disease, are clinically distinct, having different prognosis and requiring different management. They participate in a variety of systemic diseases, particularly in connective tissue disorders. As they are uncommon disorders, documentation of clinical experience with them is limited. In this study, the clinical profile and associated disorders of episcleritis and scleritis were studied. Methodology: Detailed clinical history was taken in every patient relating to ocular and systemic disorders. Ocular and systemic examinations were done in all patients. Essential investigations pertaining to the cases were done. The patients were followed up throughout the course of the study for a variable period. Results: One-fourth of episcleritis cases were of nodular type. All the six cases of scleritis were of anterior type. Episcleritis showed a peak age incidence in the third decade of life, whereas scleritis in the fourth decade. Episcleritis occurred slightly more commonly in females than males. Scleritis showed equal sex distribution. Fifty-five percent of episcleritis patients presented within 3rd week of onset of symptoms, whereas majority of scleritis patients presented during 3rd week of onset. Twenty five percent of episcleritis patients had recurrent disease. One out of 20 cases of episcleritis and one out of six cases of scleritis patients had an associated systemic disorder. In 45% of episcleritis patients, artificial tears were sufficient for treatment. In 15% of cases oral nonsteroidal anti-inflammatory drug (NSAID) was required for controlling their episcleral inflammation. In 5 out of 6 cases of scleritis, oral NSAID was sufficient for controlling inflammation. None of the episcleritis patients had a decreased best corrected visual acuity (BCVA). Whereas one-third of scleritis patients had a fall in BCVA. Conclusion: Episcleritis is a benign, self-limiting, and recurrent disorder which typically affects young adults. Scleritis of whatever variety is a serious condition and usually affects the older age group. Episcleritis patients do not develop any sight-threatening complications. Whereas a half of scleritis patients develop ocular complications, which are usually severe and sight threatening. In majority of episcleritis patients, topical medication will suffice. All patients with scleritis must be treated with systemic anti-inflammatory medications.