Episcleritis refers to inflammation of the clear coating over your eye, called the episclera. This usually causes redness and discomfort but no discharge.
Some people with the autoimmune disease ankylosing spondylitis (AS) experience episcleritis, though uveitis and iritis are more common eye symptoms. Not everyone with AS experiences eye inflammation.
This article explores the relationship between episcleritis and AS, how to manage this symptom, and what other conditions besides AS can cause it.
AS is a type of arthritis that causes inflammation in your joints and ligaments, especially around the spinal cord. This inflammation can impact other parts of the body, too, including your eyes.
The uvea is the eye layer most commonly impacted by inflammation from AS. It contains the pigmented part of your eye, including the iris. Roughly half of all people with AS will experience inflammation of the uvea (uveitis) or the iris (iritis) at some point.
Inflammation of the sclera (scleritis) and episclera (episcleritis) is also possible but less common.
Scleritis is more often linked to systemic (chronic) health conditions than episcleritis. Episcleritis is usually a stand-alone symptom that happens spontaneously. It is generally not related to chronic health concerns, although it can occur with AS.
With AS, episcleritis usually appears as the end phase of uveitis or other more severe eye inflammation. It’s important to distinguish whether you have scleritis or episcleritis because the treatment plans for these conditions can be quite different.
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Possible causes of episcleritis outside of AS include:
- rheumatoid arthritis
- lupus
- Crohn’s disease
- ulcerative colitis
- psoriatic arthritis
- Behcet’s disease
- Cogan syndrome
- Lyme disease
- cat scratch fever
- syphilis
- some herpes virus infections
If a healthcare professional suspects that an infection or other chronic condition may be contributing to your episcleritis, you may need additional testing or blood work.
Episcleritis often appears in two ways:
- redness in one section or the entire eye (simple)
- raised bumps surrounded by red, dilated blood vessels in one area of the eye (nodular)
Along with redness, you may also experience:
- tearing or watery eyes
- sensitivity to light
- a hot or gritty feeling in your eye
- mild pain or discomfort
The impact to your vision with episcleritis is usually minimal, but it could cause some blurriness. Discharge does not usually appear with episcleritis.
An eye doctor can usually make a diagnosis of episcleritis by performing an examination of your eye, most likely with a slit lamp. This tool gives the doctor a 3D view of your eye to help distinguish the difference between internal layers.
You will likely receive eye drops before the exam to help the doctor clearly see your eye’s structure and any irregularities.
For most people, episcleritis is a mild concern that will resolve on its own in a matter of days. Even so, you should always seek a professional opinion when experiencing eye inflammation. It’s important to rule out infection or other serious eye complications.
When discomfort due to episcleritis is impacting your quality of life, or if inflammation is an ongoing issue, some treatment options include:
- refrigerated artificial tear eye drops
- topical corticosteroid eye drops like fluorometholone 0.1% or loteprednol etabonate 0.5%
- prednisolone acetate 1% four times a day for more severe inflammation
- oral over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
- topical NSAIDs like diclofenac 0.1% and ketorolac 0.5%
If you have one of the chronic conditions, such as AS, that increases your chances of developing episcleritis, it’s also important that you effectively manage your condition.
Learn more about treatment options for AS.
Everything from allergies to infections can make your eyes temporarily red and irritated. Pink eye (conjunctivitis) is a common condition that can be confused with episcleritis due to its similar appearance.
Pink eye is a blanket diagnosis used for inflammation of the conjunctiva — a mucous membrane over the eye — caused by viruses, bacteria, allergies, and other irritants.
While both episcleritis and pink eye can appear with redness, a burning sensation, and sensitivity to light, pink eye usually also appears with:
- eye discharge
- itching
- swelling of the eyelids
Discharge is perhaps the most distinguishing feature between these two. If you eyes are simply watering, episcleritis is possible, but thicker or colored discharge makes a diagnosis of pink eye more likely.
While uveitis is a more common eye complication in people with AS, episcleritis can also occur.
Episcleritis makes one or both of your eyes red and irritated due to inflammation of the outer layer. It can arise due to an acute health concern like infection or as a symptom of a chronic condition.
If you have AS, talk with your doctor about what to watch for in terms of your eye health or if you are experiencing any troubling symptoms.
Eye complications can be treated directly as they arise. However, managing your underlying condition effectively is the best way to prevent or lessen the effects that AS or another chronic condition will have on your eyes.