Episcleritis - With this condition, there is a localized, red raised area on the conjunctiva. The deeper vessels are engorged in the episclera, which is the layer above the white sclera. Pain is often severe and aching in nature. This disease can be recurrent, but is easily treated and is not threatening to sight.
Scleritis - This is a deeper localized inflammation. Pathologically, it consists of a central mass of necrotic collagen with elongated cells. This picture is identical to rheumatoid arthritis. This more severe condition can be threatening to sight. Episcleritis is often treated with topical steroids and can be easily controlled. Scleritis usually requires systemic steroids and recently the use of nonsteroidal and anti-inflammatory drugs (NSAID) has been found helpful. Side effects of steroids are well known. In the eye they can cause cataracts and raised intra-ocular pressure, so NSAID use is increasing. Salicylates (aspirin) have been around for a long time, but new uses have been found for their anti-inflammatory properties. Other groups in this category are phenylalkanoic acids such as Naprosyn, acetic acids such as Indocid or Voltaren. Other groups used are fenamic acids and enolic acids such as Butazolidin and Feldene.
Punctual Occlusion - Patients using corticosteroid drops can prevent a lot of systemic absorption and limit side effects by pressing on the lacrimal sac, between the inner corner of the eye and the bridge of the nose after instilling the drops. This prevents the drop passing down the tear duct where it is readily absorbed. This trick is also very useful for patients using glaucoma drops such as betablockers.
Iritis - This is an eye inflammation that can be acute or sub-acute. It involves the iris, which is the pigmented tract. One variety HKAB27 can be present in arthritis and gastro-intestinal disease. In some patients with ulcerative colitis, an ostomy resolves the ocular disease, however, it may not prevent recurrences of ocular inflammation.
