The episclera is a layer lining the eye that lies below the conjuctiva and above the sclera. it is superficial.
When it is inflamed, the eye becomes red but vision is not affected. Oral or topical nonsteroidal anti-inflammatory drugs may relieve symptoms, but often no specific treatment is prescribed and symptoms resolve spontaneously. Rheumatoid arthritis is often associated with episcleritis.
Scleritis inflammation of the sclera, the layer below the episclera, causes a red, painful eye. The pain is deep, severe, and aching in character compared with the superficial scratchiness caused by conjunctivitis or episcleritis. A few patients get an associated uveitis. Vision can be affected, and scleritis should be treated by an ophthalmologist. Treatment involves management of the underlying condition and may require corticosteroids and immunosuppressive drugs. Approximately 60 percent of patients with scleritis have no associated systemic disease, 30 percent have rheumatoid arthritis, and the remainder have one of a variety of less common diseases. These include, systemic lupus erythematosus, vasculitis (particularly Wegener's granulomatosis),
INFLAMMATORY BOWEL DISEASE, ANKYLOSING SPONDYLITIS, and relapsing polychondritis. In patients with severe rheumatoid arthritis, nodules can occur in the sclera and inflammation can cause the sclera to become thin. if scleral inflammation in rheumatoid arthritis is not controlled, the sclera can become so thin that the globe of the eye perforates and blindness results. This is, fortunately, very rare.
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