Episcleritis vs scleritis
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Episcleritis is usually sectoral, mild, and self-limited; scleritis is deeper, more painful, and more vision-threatening.
- Deep boring pain, tenderness, violaceous hue, or pain on eye movement raises concern for scleritis.
- Visual symptoms or severe pain are out of keeping with simple episcleritis.
- Escalate promptly when the inflammation appears deep or the pain is significant.
Common causes
- Simple episcleritis.
- Nodular episcleritis.
- Diffuse or nodular anterior scleritis.
- Associated systemic inflammatory disease in deeper inflammation.
Red flags (must not miss)
- Deep boring pain or pain radiating to face or brow.
- Pain with eye movement or waking at night.
- Reduced vision or marked photophobia.
- Violaceous or diffuse deep injection rather than superficial sectoral redness.
Use OptoGuide™ to guide this decision during consult.
What to check
- Pain severity and character.
- Sectoral versus diffuse injection pattern.
- Tenderness and depth of vessel appearance.
- Visual acuity and anterior chamber status.
- History of systemic inflammatory disease or previous episodes.
When to refer
- Prompt ophthalmology referral for suspected scleritis.
- Routine or local management only when the picture is clearly simple episcleritis.
- Escalate if vision is affected or the pain is not mild.
Initial management
- Use pain severity and vessel depth to separate superficial from deep inflammation.
- Do not label a very painful red eye as episcleritis without strong evidence.
- Document acuity, pain pattern, and appearance of injection before referral.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.