Hello and welcome to the zero to finals podcast.

My name is Tom and in this episode I'm going to be talking to you about episcloritis.

And you can find written notes on this topic at zero to finals.com slash episcloritis

or in the ophthalmology section of the second edition of the zero to finals medicine book.

And you can find flashcards and questions to train your knowledge

and help you remember the information for longer at members.0 to finals.com.

So let's get straight into it.

Episcleritis involves benign and self-limiting inflammation of the episclera, which is the outermost layer of the sclera just below the

conjunctiva. Episcleritis is relatively common in young and middle-aged adults.

It's often associated with inflammatory disorders such as rheumatoid arthritis and inflammatory bowel

disease. Episcleritis is not usually caused by infection.

Let's start with the presentation.

Episcleritis usually presents with an acute onset of unilateral symptoms of localized or diffuse redness to the white of the eye,

often with a patch of redness in the lateral sclera, which is the outer part of the white of the eye,

towards the ear, there's usually no pain or maybe a mild discomfort, and there's dilated

episclural vessels. Importantly, there's no photophobia and no discharge from the eye and a normal visual acuity.

Photophobia, discharge or reduced visual acuity are more suggestive of scleritis rather than episcloritis.

Applying phenylephrine eye drops helps to differentiate between episcloritis and scleritis.

Phenalephrine will cause blanching of the episclural vessels, which causes the redness to disappear in episcloritis.

Phenalephrine does not affect the scleral vessels, and so it won't make any difference to the

redness in scleritis.

Finally, let's talk about management.

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