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Updated: Nov 22, 2023

-Common, benign, self-limited cause of red eye, due to inflammation of the episcleral tissues.

-2 forms of this condition: nodular and simple.

-Nodular: discrete, elevated area of inflamed episcleral tissue.

-Simple: vascular congestion in the absence of an obvious nodule.


-Fibroelastic structure consisting of 2 layers loosely joined together.

-The outer parietal layer, with the vessels of the superficial episcleral capillary plexus, is the more superficial layer.

-The superficial vessels appear straight and are arranged in a radial fashion.

-The deeper visceral layer contains a highly anastomotic network of vessels.

-Both of the vessel networks originate from the anterior ciliary arteries, which stem from the muscular branches of the ophthalmic artery.

-The episclera lies between the superficial scleral stroma and Tenon’s capsule.


-Mostly idiopathic.

-26-36% of patients have an associated systemic disorder.

-Collagen vascular diseases (RA most common), Vasculitides, Dermatologic disease, metabolic disease and atopy.


-Vascular congestion occurs in the superficial episcleral plexus.

-The episclera as well as Tenon’s capsule become infiltrated with inflammatory cells.



-Redness (pain rare)

-Nodular: redness noted when patient wakes up in the morning

-Area of diffuse or sectoral, bright red or pink bulbar injection

-Eyelid edema, conjunctival chemosis may be present

-Use a narrow slit beam to differentiate episcleritis from scleritis

-Nodular scleritis: inner reflection, which rests on the sclera and visceral layer, will remain undisturbed while the outer reflection will be displaced forward by the episcleral nodule

-Scleritis: both of the light beams will be displaced forward

-Nodule in episcleritis is freely mobile over the scleral tissue that lies underneath


-RF, ANA, Serum Uric acid, ESR, CBC with differential counts, VDRL/FTA-ABS.


-Conjunctivitis, phlyctenular conjunctivitis, scleritis, pingueculitis



-Reassuring the patient

-Weak topical steroids

-Oral NSAIDs⁣

Image from Rajan Eye Care Hospital

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