Episcleritis vs Conjunctivitis (Pinkeye) - Knowing the Difference

Episcleritis

It is an inflammatory condition which affects the episcleral tissue between the white part of the eye (the sclera) and the clear mucous membrane lining the inner eyelids and sclera (the conjunctiva). It usually causes soreness, irritation, or a gritty sensation, but, it almost never causes any permanent damage.

Although it occurs at all ages and in both sexes, the condition is seen more frequently in young to middle-aged women. It is very rare in children, especially children under 5 years old. It can occur in both eyes simultaneously, however, it commonly occurs just in one.

Types

There are two forms of this condition:

  • simple – in simple episcleritis, vascular congestion is present in the absence of an obvious nodule;
  • nodular – it is characterized by a discrete, elevated area of inflamed episcleral tissue. Many patients with nodular episcleritis have an associated systemic disease. Also, nodular episcleritis may require anti-inflammatory agents or local corticosteroid drops.

Symptoms

Image credit – https://commons.wikimedia.org/wiki/File:Episcleritis.jpg

Common symptoms include:

  • tearing of the eye;
  • a pink or purple color to the normally white part of the eye;
  • sensitivity to light;
  • eye tenderness;
  • eye pain.

Complications

In some cases, it may develop an inflammation of the sclera which can cause loss of vision and intense pain.

Causes

The cause is usually unknown. However, it may occur with certain diseases, like:

Other causes of the condition include the following underlying conditions:

Diagnosis

The condition is diagnosed with a slit lamp by an eye doctor.

Treatment

It usually clears without treatment. If the appearance bothers you, your doctor may recommend you the following treatment options:

  • cold compresses;
  • nonsteroidal anti-inflammatory drugs, like – ibuprofen (Motrin or Advil) in more severe cases, especially nodular episcleritis;
  • artificial tear eye drops;
  • corticosteroid eye drops.

Prognosis

The condition is a self-limited inflammation which typically causes little or no permanent damage to the eye unless it is associated with an underlying disease like – rheumatoid arthritis.

Conjunctivitis

Conjunctivitis, also known as pinkeye, is an inflammation of the membranes on the inner part of the eyelids and the membranes covering the white parts of the eyes.

It can affect one eye at first, however, it affects both eyes after several hours.

Types

#1 Bacterial

Bacterial conjunctivitis can last up to 10 days without treatment and several days with treatment. It has a large societal impact in terms of missed days of work or school.

Common causes of bacterial conjunctivitis include:

  • touching the eye with dirty hands;
  • using unclean or old makeup which has collected bacteria;
  • sharing personal hygiene objects or other items.

The majority of cases are caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Rare pathogens include Chlamydia and Neisseria spp.

#2 Viral

Image credit – https://sco.wikipedia.org/wiki/File:An_eye_with_viral_conjunctivitis.jpg

Viruses responsible for viral conjunctivitis include:

  • herpes virus — uncommon but more dangerous;
  • adenovirus — the most common.

The infection can last up to 14 days, depending on the severity of the infection. This type of conjunctivitis is very contagious.

It can stem from an upper respiratory infection or cold. In addition, individuals can get viral conjunctivitis via droplets from a sneeze or a cough which land directly on the eye. It can also be transmitted from an infection which spreads from the nose to the eyes.

#3 Allergic

Allergic conjunctivitis is not contagious. Common allergens that can cause allergic conjunctivitis includes:

  • ragweed;
  • grass;
  • tree pollen;
  • animal dander;
  • mold;
  • dust.

Symptoms

Image credit – https://en.wikipedia.org/wiki/Conjunctivitis

Common symptoms include:

  • increased sensitivity to light;
  • a gritty feeling in one or both eyes;
  • pink discoloration of the whites of one or both eyes;
  • swollen eyelids;
  • discharge from one or both eyes;
  • excessive tearing;
  • burning or itching in one or both eyes.

Note – both children and adults can get conjunctivitis and should stay away from school or work until their signs and symptoms clear.

When to Call the Doctor

See your doctor immediately if you have:

  • a newborn baby with pinkeye;
  • eye pain;
  • intense redness in one eye or both eyes;
  • disturbed vision;
  • sensitivity to light.

Causes

There are numerous causes of pinkeye, including:

  • a blocked tear duct;
  • foreign objects in the eye;
  • chlamydia and parasites;
  • chemical injury;
  • allergies;
  • bacterial infections;
  • viruses.

Risk Factors

Risk factors for the condition include:

  • using contact lenses, particularly extended-wear lenses;
  • exposure to someone infected with the bacterial or viral form of pinkeye;
  • exposure to allergens you are sensitive to.

Diagnosis

Image credit – https://www.flickr.com/photos/rvoegtli/2961555067

Your healthcare professional can diagnose the condition by asking questions about your recent health history and symptoms and performing a physical examination of the eyes.

Treatment

Treatment is not typically required for pinkeye since the symptoms usually clear up within several weeks. In some cases, symptom relief can be achieved by using cold packs for the inflammation and artificial tears for the dryness.

Prevention

Good hygiene is important, as it will help to prevent the spread of pinkeye. Some suggestions include:

  • use and care for your contact lenses correctly;
  • don’t share eye cosmetics;
  • ensure that eye ointments and drops, and pillow slips are not shared;
  • wash hands frequently;
  • avoid rubbing your eyes;
  • change pillowcases frequently;
  • keep your fingers away from the eyes;
  • disinfect household surfaces, e.g. countertops and doorknobs;
  • avoid contact with people who have pinkeye.

Bottom Line – Episcleritis vs Conjunctivitis

Image credit – https://commons.wikimedia.org/wiki/File:Episcleritiseye.jpg

Episcleritis refers to inflammation of the episclera, that is a clear layer on top of the white part of the eye, called the sclera. The episodes usually resolve without treatment, however, they can recur.

The inflammation is one of many potential causes of a red eye. Episcleritis is distinguished from conjunctivitis as its radially oriented vessels do not move with the conjunctiva.

Conjunctivitis is a swelling or inflammation of the conjunctiva, the thin transparent layer of tissue which lines the inner surface of the eyelid and covers the white part of the eye. Symptoms may include:

  • sensitivity to light;
  • swelling of the eyelids;
  • discharge, causing the eyelids to stick together in the morning;
  • irritation in one or both eyes;
  • redness in the whites of the eyes.
References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1042707/
https://www.tandfonline.com/doi/full/10.3109/09273948.2013.854394
https://www.hindawi.com/journals/criopm/2017/5742673/