Nodular/diffuse episcleritis

Specialty: Ophthalmology.

• sectoral episcleral inflammation
• non-painful scleral redness
• epiescleritis

Why it occurs

• Idiopathic simple or diffuse episcleritis (benign and self-limited inflammation of the superficial episcleral tissue)
• Idiopathic nodular episcleritis (associated with the formation of a mobile, well-defined and hyperemic nodule)
• Underlying systemic inflammatory disease (associated with rheumatoid arthritis, systemic lupus erythematosus, seronegative spondyloarthropathies, inflammatory bowel disease or gout)
• Systemic latent infections (tuberculosis, syphilis, Lyme disease)
• Ocular rosacea with superficial scleral involvement

Initial workup

Biomicroscopic examination with a slit lamp evaluating the affected vascular plexus (the superficial episcleral vessels have a radial arrangement, they are mobile when moving the conjunctiva with a moistened cotton swab and they whiten or contract after the instillation of 10% phenylephrine eye drops, unlike the deep scleral vessels); Rule out systemic autoimmune pathology through general analysis (Rheumatoid factor, antinuclear antibodies - ANA, antineutrophil cytoplasmic antibodies - ANCA, uric acid and RPR/VDRL luetic serology).

Standard management

• Fluorometholone — 0.1% eye drops, 1 drop every 6 hours for 7-10 days with a progressive tapering pattern; Topical corticosteroid with low ocular penetration, ideal for superficial episcleral inflammatory processes
• Ibuprofen — 600 mg orally every 8 hours for 5-7 days if necessary to control the inflammatory and painful component in nodular episcleritis
• Refrigerated artificial tears without preservatives (apply every 4 hours to reduce eyelid friction).