Episcleritis and ankylosing spondylitis: link, symptoms and treatment

Episcleritis refers to inflammation of the transparent layer over your eye, called the episclera. This usually causes redness and discomfort, but no discharge.

Some people with the autoimmune disease ankylosing spondylitis (AS) have episcleritis, although uveitis and iritis are more common eye symptoms. Not everyone with AS suffers from eye inflammation.

This article explores the relationship between episcleritis and AS, how to manage this symptom, and what conditions other than AS can cause it.

AS is a type of arthritis that causes inflammation of the joints and ligaments, especially around the spinal cord. This inflammation can also impact other parts of the body, including your eyes.

The uvea is the ocular layer most commonly affected by AS inflammation. It contains the pigmented part of your eye, including the iris. About half of all people with AS will experience inflammation of the uvea (uveitis) or iris (iritis) at some point.

Inflammation of the sclera (scleritis) and episclera (episcleritis) is also possible but less common.

Scleritis is more often linked to systemic (chronic) health problems than episcleritis. Episcleritis is usually a self-contained symptom that occurs spontaneously. It is not usually linked to chronic health problems, although it can occur with AS.

With AS, episcleritis usually appears as the end stage of uveitis or other more serious eye inflammation. It is important to distinguish whether you have scleritis or episcleritis, as treatment plans for these conditions can be very different.

Between 26 and 36 percent of people with episcleritis are suspected of having a chronic condition that contributes to the symptom.

Possible causes of episcleritis outside of AS include:

If a healthcare professional suspects that an infection or other chronic condition may be contributing to your episcleritis, you may need to perform additional tests or blood work.

Episcleritis often appears in two ways:

  • redness in one section or the whole eye (single)
  • raised bumps surrounded by red, dilated blood vessels in one area of ​​the eye (nodular)

In addition to redness, you may also experience:

  • watery or watery eyes
  • light sensitivity
  • a feeling of heat or grit in the eyes
  • mild pain or discomfort

The impact on your vision with episcleritis is usually minimal, but it can cause some blurring. The discharge usually does not appear with episcleritis.

An ophthalmologist can usually make a diagnosis of episcleritis by performing an examination of your eye, most likely with a slit lamp. This tool gives the doctor a 3D view of your eye to help distinguish the difference between the inner layers.

You will likely receive eye drops before the exam to help the doctor clearly see your eye structure and any irregularities.

For most people, episcleritis is a mild concern that will resolve on its own within a few days. Even then, you should always seek professional advice for eye inflammation. It is important to rule out infection or other serious eye complications.

When discomfort from episcleritis is impacting your quality of life, or if inflammation is a persistent problem, some treatment options include:

If you have one of the chronic conditions, such as AS, that increases your risk of developing episcleritis, it’s also important that you manage your condition effectively.

Learn more about treatment options for AS.

Everything from allergies to infections can make your eyes temporarily red and irritated. Pink eye (conjunctivitis) is a common condition that can be confused with episcleritis due to its similar appearance.

Pink eye is a general diagnosis used for inflammation of the conjunctiva – a mucous membrane over the eye – caused by viruses, bacteria, allergies and other irritants.

While episcleritis and pink eye can appear with redness, burning sensation and sensitivity to light, pink eye usually also appears with:

  • eye discharge
  • itch
  • eyelid swelling

The discharge is perhaps the most distinctive feature between these two. If your eyes are just watery, episcleritis is possible, but thicker or colored discharge makes a diagnosis of pink eye more likely.

Although uveitis is a more common eye complication in people with AS, episcleritis can also occur.

Episcleritis makes one or both eyes red and irritated due to inflammation of the outer layer. It can occur due to an acute health problem such as an infection or as a symptom of a chronic disease.

If you have AS, talk to your doctor about what to watch out for in terms of eye health, or if you have concerning symptoms.

Ocular complications can be treated directly as they arise. However, effectively managing your underlying condition is the best way to prevent or lessen the effects that AS or another chronic condition will have on your eyes.

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About Chris Y. Camp

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