In the white of the eye you may see a red patch which is at times very alarming, in particular when it comes on suddenly. At times the cause is a mild inflammation. Also at times redness is a sign of an infection or of some other eye issue that requires medical attention. To understand episcleritis VS conjunctivitis is to see how although they may look the same they in fact present and are treated differently.
Episcleritis is of the thin tissue that covers the white of the eye. Conjunctivitis affects the inner lining of the eyelids and which also covers the front of the eye. Although both can cause redness and irritation their symptoms and treatment may differ. An eye exam is best for identifying the cause rather than going by what we see.
What Is Episcleritis?
Episcleritis is inflammation of the episclera which is the tissue that lays between the conjunctiva and the sclera. It may cause a well defined red or pink area on the white of the eye. This look is at time referred to as a sectoral red eye which is when the redness is present in a certain section of the eye instead of the whole eye.
People have mild soreness, tenderness, watering or a gritty sensation. Vision usually does not change. Many episodes resolve on their own in days or weeks though symptoms may come back. The episcleritis causes is usually not known. At times recurrent inflammation may be related to an underlying inflammatory disease.
How Is Conjunctivitis Different?
Conjunctivitis is a condition which happens when the conjunctiva becomes inflamed. Viral or bacterial infections, allergies and irritants are triggers. We see that symptoms present as redness, itching, tearing, burning and discharge. Also it is not uncommon for the eyelids to stick together which is most noticeable first thing in the morning.
Compared in the case of episcleritis vs conjunctivitis you cannot just look at how red the eye is. With episcleritis we see localised redness and mild discomfort. In conjunctivitis what is more common is itchiness, discharge or irritation which tends to be over a larger area. But also here symptoms do cross over so that’s not enough for a proper diagnosis.
| Feature | Episcleritis | Conjunctivitis |
| Common appearance | Localised red patch or sectoral red eye | Redness across part or most of the eye |
| Typical discomfort | Mild soreness or tenderness | Itching, burning or gritty irritation |
| Discharge | Usually little or none | Watery or sticky discharge may occur |
| Common causes | Often unknown; sometimes linked to inflammation elsewhere | Viral or bacterial infection, allergy or irritants |
| Contagious? | Not usually | Some forms, particularly viral and bacterial, can spread |
| Usual approach | Often settles without specific treatment | Depends on the cause and symptom severity |
What Causes a Red Patch on the Eye?
Episcleritis causes are at times unknown. In many people the condition comes up for no known reason. In some cases we see diagnosis of an underlying inflammatory disease which may be put forth when the episodes are recurrent or of greater duration than expected.
By contrast with other ocular conditions which may present similarly, conjunctivitis signs may point to a cause. It is common to see itching in cases of allergic conjunctivitis and a watery discharge in that of a viral infection. Thick discharge is a feature of bacterial infection but it is important to note that signs alone are not reliable for diagnosis.
A red eye also results from dry eye, a broken blood vessel in the surface of the eye, a corneal issue or from inflammation at a deeper level of the eye. A sectoral red eye does not always indicate episcleritis. A health care provider should assess if the redness is persistent or unexplained.
When Should You Seek Medical Attention?
Pay note to symptoms which include redness. Severe pain, light sensitivity, blurred or reduced vision, significant swelling or a very dark red eye may be signs of a more serious problem. If these symptoms are present see a medical professional immediately. Also, contact lens wearers who have a painful red eye also need prompt evaluation.
When it comes to episcleritis as opposed to conjunctivitis don’t start on antibiotics or steroid eye drops until you see a health care professional. Antibiotics are not used in viral or allergic conjunctivitis and in fact improper use of steroid drops may cause problems. A health care provider may put you on a treatment plan based on the exam and what they think is the cause.
How Are These Conditions Treated?
Many times mild episcleritis will resolve on its own. A doctor may prescribe lubricating drops or cool compresses for relief. In the case of persistent, recurrent or very painful symptoms evaluation is required and you should follow the doctor’s advice.
Treatment of conjunctivitis is based on it’s cause. In the case of viral conjunctivitis which usually goes away within a few days we may just give support to the eye. Allergic conjunctivitis on the other hand may do better with allergy treatment. Bacterial infections may require a prescription medication after we do a clinical assessment. Also good hand washing, not rubbing the eye, and not sharing towels or eye make up can play a role in the prevention of the spread of infectious conjunctivitis.
| Situation | Appropriate next step |
| Mild redness without pain or vision changes | Arrange advice if the redness persists or its cause is unclear |
| Recurrent localised redness | Book an eye examination to assess possible episcleritis |
| Itching with watery eyes or discharge | Seek advice to identify the type of conjunctivitis |
| Severe pain, light sensitivity or reduced vision | Seek urgent eye care |
| Red, painful eye while wearing contact lenses | Remove the lenses and obtain prompt medical assessment |
Conclusion
Understanding episcleritis vs conjunctivitis helps explain why a red eye may have different causes and require different care. A localised red spot may be a case of episcleritis, while itching and discharge may point to conjunctivitis. Which picture or symptom you see isn’t enough for a diagnosis. An ophthalmologist is the one to determine the cause and to put forward the right care.
For further information, consult these trusted public health resources:
Frequently Asked Questions
1. Is episcleritis more serious than conjunctivitis?
Neither should diagnosis be based on appearance alone. Episcleritis is usually mild and will go away on its own, while conjunctivitis may be due to an infection or allergy. Severe pain or vision changes require prompt evaluation as they may be a sign of another eye problem.
2. Can episcleritis spread to another person?
Episcleritis which is an inflammatory condition does not generally present with contagious symptoms. As for conjunctivitis which is of the viral and bacterial varieties we see transmission through contact with infected hands, towels and other objects.
3. Do all red patches on the eye need treatment?
Not all redness of the skin is due to a condition that requires medicine, however persistent, recurring, or no reason for the redness which is observed does. Pain, light sensitivity or impaired vision require emergency care. A health care professional will be able to tell if you need treatment or just to be watched.
4. When should someone see an eye specialist?
If you have redness that persists, returns, or is accompanied by discomfort or discharge then see a doctor. Go to the emergency room for very painful eye, light sensitivity, sudden vision changes or a painful red eye while you are wearing contact lenses.
References
[1] MedlinePlus, US National Library of Medicine https://medlineplus.gov/ency/article/001019.htm
[2] National Institutes of Health
https://health.nih.gov/health-topics-a-z/conjunctivitis
[3] Moorfields Eye Hospital NHS Foundation Trust https://www.moorfields.nhs.uk/eye-conditions/episcleritis
