Single-page without differential diagnosis table
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]
Overview
Episcleritis is an acute, recurrent, benign inflammatory condition of the episclera, loose connective tissue lying superficial to the sclera. It has been recognized for more than a century and a number of recent studies have provided information about its clinical features, aetiology, and management. Episcleritis is overwhelmingly a disease of adults with a broad age range at presentation; childhood involvement is distinctly uncommon.1–3 The sex distribution varies between published series but those series that describe an association with rheumatic diseases tend to have a female preponderance. Episcleritis is uncommon and the exact incidence of episcleritis is difficult to know but, of 9600 new referrals to two eye departments in Glasgow between 1966 and 1974, only eight (0.08%) were due to scleral inflammation.4 In the same paper of 4210 patients with rheumatoid arthritis, only 0.17% had episcleritis at any stage of their disease. Diffuse episcleritis is more common than nodular episcleritis (78:16 in one series).5 Episcleritis is far commoner than the series in the medical literature would suggest. The majority of patients with episcleritis have mild evanescent disease that usually does not require ophthalmological intervention and treatment.6
Historical Perspective
- [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
- In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
- In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
Classification
- [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
- [group1]
- [group2]
- [group3]
- Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Clinical Features
The onset of episcleritis is usually acute and associated with discomfort as the presenting symptom. The pain is usually mild discomfort and localized to the eye, rather than boring in nature and associated with severe headache as is typical of scleritis. Some episodes of episcleritis may be entirely pain free. There may be associated foreign body sensation and The hallmark signs of episcleritis are oedema and inflammation of the episclera and injection and dilatation of the episcleral blood vessels. The sclera and subtarsal conjunctiva are not involved but the conjunctiva overlying the inflamed area is always affected. There is no scleral swelling or necrosis and the intraocular structures are typically not involved. Unless there is other coexistent ocular pathology the visual acuity is normal. Episcleritis is divided into diffuse and nodular types . In diffuse episcleritis there is diffuse swelling and oedema of a sector of the episclera in around two-thirds of patients or of the whole eye in around one-third of patients. In diffuse episcleritis the redness varies in intensity, but is always red or pink (rather than the bluish, brawny red colour seen in diffuse scleritis), and the episcleral vessels, although engorged, retain their characteristic radial orientation. The best way of appreciating the colour of episcleritis and in particular differentiating it from scleritis is not to use the slit lamp but to examine the eye using natural light or an incandescent lamp. The eye is generally not tender to touch. In nodular episcleritis , the oedema and infiltration is localized to one part of the globe. A raised nodule forms within the episcleral tissue. It is bright red to pink in colour and often has overlying or surrounding vascular irregularity. The nodule may be tender to touch and is usually mobile. There is generally only one nodule at any one time and the nodules do not undergo necrosis. Careful slit lamp examination of the episclera, sclera, and the blood vessels is essential to differentiate episcleritis from scleritis.In patients with episcleritis there is oedema of the episclera and dilatation of the conjunctival vessels. There is no oedema of the underlying sclera. The lack of scleral involvement is often easiest to appreciate using red-free light and after blanching the superficial conjunctival vessels with phenylephrine 10%. After an attack of episcleritis the eye returns completely to normal, but after repeated attacks over a long period of time there may be some mild scleral thinning.
epiphora.
Differentiating [disease name] from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop [disease name].
- [Disease name] is more commonly observed among patients aged [age range] years old.
- [Disease name] is more commonly observed among [elderly patients/young patients/children].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected with [disease name] than [gender 2].
- The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
Race
- There is no racial predilection for [disease name].
- [Disease name] usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop [disease name].
Risk Factors
- Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
Diagnosis
Diagnostic Criteria
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- [Disease name] is usually asymptomatic.
- Symptoms of [disease name] may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- There are no [imaging study] findings associated with [disease name].
- [Imaging study 1] is the imaging modality of choice for [disease name].
- On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
- [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].