What Are Scleritis and Episcleritis?

Scleritis and episcleritis are inflammations of the protective outer layers of tissue that form the eyeball’s shell. The deepest layer is the sclera, known commonly as the white of the eye. The transparent tissue covering the sclera is the episclera, which in turn is covered by a fine membrane called the conjunctiva.

Inflammation of the episclera—or episcleritis—often resembles a localized form of conjunctivitis, but episcleritis is not accompanied by the watery or pus-filled discharge typical of conjunctivitis (pinkeye). Episcleritis is usually a minor disorder that does not permanently damage the eye and generally resolves on its own within a week or two. Its presence occasionally indicates an underlying disease such as rheumatoid arthritis.

Scleritis, a less common but more serious disease, most often occurs in association with an underlying systemic or autoimmune disorder, usually in people between the ages of 30 and 60.

What Causes Scleritis and Episcleritis?

  • The cause of episcleritis and scleritis is unknown.
  • Both episcleritis and scleritis may be associated with a systemic disorder; that is, one affecting other organ systems in the body. Such disorders include autoimmune rheumatoid diseases (rheumatoid arthritis, scleroderma, systemic lupus erythematosus), inflammatory bowel disease and tuberculosis.
  • Herpes zoster involving the eye can lead to scleritis.

Symptoms of Scleritis and Episcleritis

  • A red or violet, slightly raised patch on the white of the eye, usually only a fraction of an inch in diameter
  • Sharp, severe eye pain that intensifies when the eye is moved
  • Dull, aching pain in one or both eyes, often worse at night (severe in some cases)
  • Aversion or increased sensitivity to light (photophobia)
  • Blurred vision
  • Pain affecting the jaw or cranial bones around the eye

Scleritis and Episcleritis Prevention

  • There is no way to prevent episcleritis or scleritis.
  • Corticosteroid eye drops may relieve the symptoms faster.

Scleritis and Episcleritis Diagnosis

  • Patient history and an eye examination by an ophthalmologist are required.
  • An ultrasound of the eyeball may be conducted.
  • A blood tests and general physical examination by a medical doctor may be required to look for and treat an associated underlying disease.

How to Treat Scleritis and Episcleritis

  • In episcleritis, steroids in eyedrop or ointment form may be prescribed to reduce inflammation.
  • The course of scleritis often parallels the activity and treatment of the associated systemic disorder. Corticosteroids, in tablet or eyedrop form, may reduce inflammation in some patients. Cycloplegic drugs may be administered to dilate the pupil, which may prevent scarring and alleviate pain somewhat. Immunosuppressive drugs may be prescribed in more severe cases.
  • Surgery may be required for scleritis if the sclera has perforated.

When to Call a Doctor

  • If you suspect you have either scleritis or episcleritis, consult an ophthalmologist immediately.


Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 30 Jan 2012

Last Modified: 30 Jan 2012