Is Episcleritis caused by stress?

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This blog post will explore whether Episcleritis is caused by stress and cover topics like what is Episcleritis and what are the symptoms associated with this condition. 

We will also explore the various risk factors that make it likely that this condition will develop in a person and other factors that play a part in the development of this condition. 

We will also explore how this condition is diagnosed by a medical professional and the various treatment interventions available for this condition.

Is Episcleritis caused by stress?

Due to the limited amount of empirical evidence and lack of research surrounding the relationship between the development of Episcleritis as a result of stress there is no conclusive evidence as to whether it is actually caused by stress or not. 

However, there are many physicians who believe that in some cases, the episcleritis attacks have been associated with bouts of stress. 

This particular speculation was made early in the 1980s by a doctor in New Orleans, USA known as Dr. Curtis Margo. He published his observations in the Journal Archives of Ophthalmology in 1984.

According to his observation of one of his patients who came in for treating an attack of Episcleritis. Margo noted that the individual had a medical examination for surgery during this particular attack and persisted until the exam period was over after which the condition resided on its own. 

Margo also noted that his patient kept a record of his attacks and found that he recorded 6 attacks and each episode began five to six days before a stressful event such as job interviews and paper presentations in the same eye.

Now Margo in his speculation also noted that he has not heard of any cases where emotional stress was a cause of Episcleritis; however, he has brought forward the various developments in the psychosomatic manifestations of medical conditions during the time. 

He concluded that,

“…Although the temporal relationship between the onset and resolution of episcleritis and stressful life events in our patient does not absolutely prove a psychosomatic cause, it suggests that stress plays a role in pathogenesis.”

As interesting as his initial observations have been, there seems to be a lack of clinical studies done based on his speculation after the fact.

Thus, there is no conclusive evidence to say for sure that this condition is brought on by stress; however, stress might play a role. 

What is episcleritis?

Episcleritis is a medical condition which is observed as an inflammation of your episclera.

The Episclear is a clear layer on top of the white part of your eye that separates the wall on the eyeball or the white part of the eye, known as the Sclera, from exposure. 

This inflammation manifests in the eye looking red and irritated and often looks like a pink eye but without discharge. 

Episcleritis occurs when the tiny blood vessels in the episclera get irritated or inflamed, making your eyes look bloodshot and red and this usually happens in one eye- in most cases- but can also occur in both. 

There are two types of episcleritis:

Simple type of Episcleritis which which is observed in 70% of patients and has two subtypes:

  • Sectoral Episcleritis : The redness appears over part of your eye- say one corner of the white part of your eye. Diffuse Episcleritis: The redness appears over all the white areas of your eye. 

Nodular type of Episcleritis where a tiny bump (or nodule) forms on your eye is observed in approximately 30% of patients. This kind of Episcleritis is more uncomfortable and can cause more distress to the individual affected. 

What are the symptoms?

The main and most observable symptom of Episcleritis is the redness of your eye on the white parts called the Sclera. 

This redness occurs more commonly on one eye however it might occur in both eyes occasionally. 

Now, depending on the type of Episcleritis that you have, symptoms can differ. 

If you have the simple type of Episcleritis, you will either have redness in one section of your eye or through out the eye with minimal discomfort 

If you have been affected by the nodular type of episcleritis you will be affected with slightly raised bumps surrounded by dilated blood vessels which will cause the redness, usually in one area of the eye with moderate to severe discomfort, 

For both kinds of Episcleritis you might also experience the following symptoms:

  • tearing
  • sensitivity to bright light
  • a hot, prickly, or gritty sensation in the eye
  • Burning sensation in some cases. 

Usually, these symptoms usually don’t affect your vision, however, if you experience soreness or pain in your eye, you might have something else so it is advisable for you to seek out medical help. 

Usually the condition disappears on its own after a few days and does not cause any permanent damage to the eye. 

A curious thing about this condition is that it can come back after intervals of time have passed. It can switch from eye to eye or repeat in the same eye. 

It is not threatening but you can seek out medical support if you’d like to and espeicallywhen you experience it and the condition does not go away after a week.

What causes episcleritis?

There is not enough research that pinpoints the cause of Episcleritis so the exact cause of episcleritis is unknown. 

However, some clinical studies and observation has found that the condition tends to occur more often in people with inflammatory and autoimmune diseases affects their entire body (doctors call this a systemic disorder).

In fact, it has been estimated by researchers that 26% to 36% of patients have a systemic disorder that is responsible for the development of episcleritis. Such disorders include:

  • Rheumatoid arthritis
  • Inflammatory bowel disease
  • Lupus
  • Crohn’s disease
  • Gout
  • Rosacea
  • Collagen vascular diseases

In some rare cases, infections caused by bacteria or fungi or viruses can also cause this particular condition. For example, in the case of Covid-19 infection caused by the coronavirus, Episcleritis is one of the symptoms that appear.

The varicella virus, which causes shingles, may also play a factor in some manifestations of episcleritis. 

In other extremely rare cases, episcleritis has been linked to T-cell leukaemia and Hodgkin’s lymphoma. However, these cases have been rarely observed and studied. 

Other causes of the condition can include:

  • Medications that is applied to the eye
  • External injury caused by trauma 
  • Vigorous rubbing
  • Accidental application of chemicals and substance. 
  • Eye strain due to dim lighting

Various risk factors can also be linked to this condition and make it more likely for people to be affected by this condition. 

These risk factors include:

  • Gender where clinical observation finds that women are more affected than men. 
  • Age. While this condition can affect children, it’s most common in adults, especially those between 40 and 50 years of age. 

How is Episcleritis diagnosed?

If you have this condition and it is causing you distress and discomfort, it is advisable that you go seek out medical attention. 

Your eye doctor will give you a thorough eye exam to diagnose your condition and they will most likely start by looking at the colour of your eyes. 

If the discoloration is more of a bluish purple, rather than red, they might diagnose you with scleritis instead which is a more severe form of inflammation. 

You might also be given a slit eye exam where the doctor will examine the front of your inflamed eye using a device called the slit lamp to take a look at your inflammation and abnormalities. 

What are the treatments available for Episcleritis?

Usually Episcleritis often goes away on its own. However, if the appearance and discomfort bothers you, or it keeps coming back,it is advisable that you seek out medical treatment for the condition. 

Depending on the severity of your condition and the type of your episcleritis your doctor will prescribe you various medications to soothe the irritation and bring down the inflammation such as:

  • corticosteroid eye drops
  • artificial tear eye drops
  • nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin)
  • treating an underlying inflammatory condition

If the inflammation is severe, they also may prescribe a nonsteroidal anti-inflammatory drug either to be taken orally in the form of a pill or as a cream you apply to your eyes.

In case the inflammation is severe and painful, your doctor might also prescribe a mild steroid eye drop. 

While you wait for the condition to clear up and get better and as you apply the medication that has been prescribed, you can try a few things you can do to manage symptoms such as:

  • applying a cool compress over your eyes with your eyes closed
  • applying artificial tear eye drops
  • wearing sunglasses outside

If your condition is recurring frequently you and your doctor might also ave to explore other possible causes as to the case of this condition. 

Conclusion

This blog post has explored whether Episcleritis is caused by stress and covers topics like what is Episcleritis and what are the symptoms associated with this condition. 

We have also explored the various risk factors that make it likely that this condition will develop in a person and other factors that play a part in the development of this condition. 

We have also looked into how this condition is diagnosed by a medical professional and the various treatment interventions available for this condition.

FAQ related to episcleritis caused by stress

What triggers episcleritis?

There is not much evidence that pinpoint triggers of episcleritis which makes it seem like there is no apparent cause.

However, your condition can be linked to an underlying systemic inflammatory condition such as rosacea, lupus or rheumatoid arthritis. 

In some cases it can also be triggered by external trauma or injury. 

Is episcleritis a symptom of Covid?

Based on various scientific literature reviews, one of the first presenting sign of COVID-19 is Episcleritis or an inflammatory condition of the eye which manifests as red eye. 

Can episcleritis last for years?

Episcleritis does not usually last more than a few days however,  the condition can reappear over the course of months. It usually does not have any significant long-term consequences and it does not affect vision. 

Is episcleritis an autoimmune disease?

Episcleritis is an inflammation of the episclera- a tissue above the white part of the eyeball, It is not an autoimmune disease however, it might be a common symptoms of an underlying autoimmune disease. 

References

Christiano. D. Episcleritis. Healthline. 18th September 2018. Retrieved on 12th Dec 2021. https://www.healthline.com/health/episcleritis

Nelson.A.What Is Episcleritis? WebMD. 8th December 2020. Retrieved on 12th Dec 2021. https://www.webmd.com/eye-health/what-is-episcleritis

Margo, C. E. (1984). Recurrent Episcleritis and Emotional Stress. Archives of Ophthalmology, 102(6), 821–824. doi:10.1001/archopht.1984.0104003

Schonberg S, Stokkermans TJ. Episcleritis. [Updated 2021 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534796/

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