Anterior Segment
Episcleritis
Also known as: episcleritis, episcleral inflammation, simple episcleritis, nodular episcleritis, red eye episclera, sectorial redness, episcleral vessel injection, scleral redness
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Inflammation of the episclera — the superficial vascular layer between the conjunctiva and the sclera. Usually idiopathic and self-limiting. Two types: simple (diffuse or sectorial) and nodular. Therapeutically endorsed optometrists may manage simple episcleritis in clinic with topical NSAID or topical fluorometholone. Scleritis must always be excluded.
Recognition
Symptoms: what patients report
- Unilateral or bilateral redness, often sectorial.
- Mild discomfort or aching — notably less severe than scleritis.
- Mild foreign-body sensation.
- Lacrimation.
- Photophobia is usually absent or mild.
- Discharge, marked itching, and sticky lids are usually absent.
- No significant pain on eye movement.
- No visual disturbance.
Signs: what the examination shows
- Sectorial or diffuse episcleral hyperaemia — vessels visible as radial 'red spoke' pattern.
- Bright red or salmon-pink colour (paler in scleritis).
- Vessels blanch with topical phenylephrine 2.5% (distinguishes from scleritis).
- No papillae, follicles, or mucopurulent discharge to suggest conjunctivitis.
- Nodular episcleritis: a raised, mobile, tender nodule on the episclera.
- No scleral oedema or scleral thinning.
- No anterior chamber activity.
- Normal visual acuity.
What OptoGuide™ covers for episcleritis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Episcleritis — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Management of Scleritis in Older Adults. Butler L, Tomkins-Netzer O, Reiser O, Niederer RL. Drugs & Aging. 2024;41(4):287-302.
- Approach to Eye Pain: Differential Diagnosis and Work Up for the Neurologist. Robblee J, Patel JN. Current Neurology and Neuroscience Reports. 2025;25(1):48.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.