Episcleritis vs Scleritis — SCE Rheumatology MCQ

Correct answer: D — Episcleritis is usually self-limiting and treated symptomatically; scleritis usually needs systemic anti-inflammatory therapy, escalating to glucocorticoids or immunosuppression when required.

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as D · D = shown as E

Episcleritis is superficial, generally benign and self-limiting. Uncomplicated cases can be managed with reassurance and artificial tears; persistent troublesome inflammation may warrant an ophthalmologist-supervised short course of topical corticosteroid or an oral NSAID. Scleritis is deeper, typically much more painful and potentially sight-threatening. RA-associated scleritis therefore generally requires systemic therapy, beginning with an oral NSAID where appropriate and escalating to systemic glucocorticoids, a conventional DMARD or biologic therapy for severe, necrotising, recurrent or refractory disease. It should also prompt assessment of systemic RA activity or vasculitis. Options B and C reverse or erase this important distinction. Option D overtreats uncomplicated episcleritis, while option E is incorrect because antibiotics have no role in non-infectious episcleritis and topical treatment alone is generally inadequate for scleritis.

Reference: Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. Journal of Clinical Medicine. 2021;10:2118. https://pubmed.ncbi.nlm.nih.gov/34068884/