Episcleritis

Episcleritis is an inflammation of the episclera, the vascular connective tissue layer between the sclera and conjunctiva. The condition is usually idiopathic, but around one in three of cases associated with systemic disorders such as rheumatoid arthritis and inflammatory bowel disease.

It is usually self-limiting and does not affect vision, but patients can experience redness, aching and tenderness of one or both eyes. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating episcleritis. It provides recommendations for non-pharmacological management and pharmacological treatment, and outlines when referral is appropriate.

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What is episcleritis?

Episcleritis is an inflammation of the episclera, the tissue that lies just under the outer skin of the white of the eye. Commonest between the ages of 40 to 60, it usually affects just one eye but both eyes are affected in a quarter to a half of cases. In about one in three of cases there is a background of inflammation elsewhere in the body, for example rheumatoid arthritis or inflammation of the bowel.

The condition begins without warning and patients experience redness, aching and tenderness of one or both eyes. The vision is not affected. Episcleritis often disappears in a week to ten days. In some patients, it may return again later. The optometrist will reach a diagnosis based on the exact type of inflammation, which distinguishes this condition from conjunctivitis (inflammation of the outer skin of the eye) and scleritis (inflammation of the white part of the eyeball).

How is episcleritis managed?

Cold compresses may relieve the symptoms, as may artificial tears in eye drop form. If the inflammation is more severe, steroid eye drops may be prescribed, and sometimes anti-inflammatory tablets are needed also.

After the second recurrence, the optometrist may refer the patient for investigation by the ophthalmologist.

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Last updated

Episcleritis - 9 January 2026
The aetiology and predisposing factors sections have been updated to include epidemiological data on episcleritis subtypes and further information on the associations with systemic disorders and infections. The pharmacological management section has been amended to highlight the need for caution when using oral non-steroidal anti-inflammatory drugs in those at higher risk of adverse drug reactions or side effects. This section also advises consideration of more potent topical steroids for more severe presentations of episcleritis.

Version 14
Date of search 09.10.25
Date of revision 30.10.25
Date of publication 09.01.26
Date for review 08.10.27
© The College of Optometrists