Red Eye But No Pain? How to Tell If It’s Episcleritis (And What to Do)

What Is Episcleritis?

Episcleritis is inflammation of the episclera, the thin vascular layer between the white of the eye (sclera) and the clear conjunctiva. It is usually mild, non-infectious, and self-limiting, often resolving in 7–10 days without treatment.

Key Facts (American Academy of Ophthalmology [AAO]):
✔ Not contagious and rarely affects vision.
✔ More common in women (ages 20–50).
✔ Often idiopathic (no clear cause) but may be linked to autoimmune conditions (e.g., rheumatoid arthritis, lupus).

Types (AAO & Mayo Clinic)

1. Simple (Diffuse) Episcleritis (Most Common):
   • Mild, sectoral redness (often pink or salmon-colored).
   • No nodules; resolves faster.
2. Nodular Episcleritis:
   • Localized, raised, tender nodule.
   • Longer recovery (2–3 weeks).

Symptoms (National Eye Institute [NEI]):

✔ Redness (localized or diffuse, usually one eye).
✔ Mild irritation or burning (no severe pain).
✔ Watering but no discharge.
✔ No light sensitivity (unlike uveitis).

Not Present in Episcleritis:

• Vision changes.
• Severe pain (suggests scleritis, a deeper inflammation).

Diagnosis (AAO Guidelines):

1. Slit-Lamp Exam:
   • Dilated blood vessels blanch with phenylephrine drops (distinguishes from scleritis).
2. Rule Out Systemic Causes:
   • Blood tests (e.g., rheumatoid factor, ANA) if recurrent.
3. Differential Diagnosis:
   • Conjunctivitis, scleritis, or foreign body.

Treatment (AAO & UpToDate):

1. Mild Cases (Often Self-Resolving):

Artificial tears (for comfort).
Cool compresses.

2. Moderate/Severe or Recurrent Cases:

• Topical NSAIDs (e.g., ketorolac drops).
• Oral NSAIDs (e.g., ibuprofen) for nodular type.
• Steroid drops (short-term, if persistent).

Avoid: Unnecessary antibiotics (not infectious).

Prevention (AAO):

✔ Manage underlying conditions (e.g., rheumatoid arthritis).
✔ Avoid eye rubbing.
✔ Use humidifiers in dry environments.

Red Flags: When to See a Doctor (NEI):

Seek care if:

• Severe pain (possible scleritis).
• Vision changes (blurring, floaters).
• Recurrence >2–3 times/year (may indicate autoimmune disease).
• No improvement in 10 days.