When should I refer a patient with episcleritis to an ophthalmologist?

Refer a patient with episcleritis to an ophthalmologist if:

• Symptoms persist despite primary care management, to rule out other diagnoses and prevent rare complications such as sight-threatening keratitis.
• There is diagnostic uncertainty or if the appropriate diagnostic equipment (such as slit-lamp examination) is not available in primary care.
• There is severe eye pain, significant reduction in vision, or suspicion of more serious ocular inflammation such as uveitis, which requires urgent referral.
• There is any clinical feature suggestive of a serious cause of red eye or associated systemic disease that may require specialist management.

In general, episcleritis is a benign, self-limiting condition often managed in primary care, but referral is warranted if symptoms do not improve, if the diagnosis is unclear, or if there are signs of more serious ocular involvement requiring specialist assessment and treatment ¹,²,³.