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Stephen C Foster - One of the best experts on this subject based on the ideXlab platform.
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clinical considerations of Episcleritis and scleritis
2012Co-Authors: Maite Sainz De La Maza, Joseph Tauber, Stephen C FosterAbstract:Episcleritis is a benign disease that presents as an uncomfortable red eye, sometimes with tearing and mild photophobia. Pain, if any, is mild and localized to the eye. Episcleritis rarely causes significant adverse ocular sequelae and is infrequently associated with systemic disease. Unlike Episcleritis, scleritis is a severe inflammatory disease that can be progressively destructive, sometimes leading to loss of vision or loss of the eye. It presents with deep, severe pain, often radiating to the forehead, the jaw, and the sinuses. Scleritis is often associated not only with ocular complications (keratitis, uveitis, glaucoma, and cataract if anterior or fundus abnormalities if posterior), but also with immune-mediated systemic diseases, some of them potentially lethal.
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diagnostic approach of Episcleritis and scleritis
2012Co-Authors: Maite Sainz De La Maza, Joseph Tauber, Stephen C FosterAbstract:The approach to the patient with scleritis should include five phases. The first phase includes the investigation of the illness through the interview and physical examination of the patient. The second phase consists of the selection of blood, urine, and imaging studies that are needed to investigate the possibilities raised in the first phase. In the third phase, the decision is made as to whether a tissue biopsy is likely to add useful information to the diagnosis or to the therapy. The fourth phase integrates the clinical findings with tests and biopsy results, leading to a specific diagnosis. In the fifth phase, a therapeutic plan is initiated and the response is observed.
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multifocal nodular Episcleritis and scleritis with undiagnosed hodgkin s lymphoma
Ophthalmology, 2003Co-Authors: Manoj M Thakker, Victor L. Perez, Alexandre Moulin, Sandra Lora Cremers, Stephen C FosterAbstract:Abstract Purpose To report the case of a patient with undiagnosed Hodgkin's lymphoma who presented with coexistent unilateral nodular Episcleritis and scleritis. Design Interventional case report and literature review Methods Review of clinical history, laboratory findings, histology of episcleral and cervical lymph node biopsies, and follow-up. Results A 20-year-old female presented with a 5-month history of redness and pain in her left eye, with associated symptoms of dyspnea, malaise, and fever. The patient was found to have multifocal nodular Episcleritis and scleritis that was not responsive to topical steroids or systemic nonsteroidal anti-inflammatory treatment. Laboratory tests subsequently revealed evidence of systemic inflammation, and radiologic studies showed extensive mediastinal and cervical adenopathy. A cervical lymph node biopsy showed Reed–Sternberg cells and a chronic lymphocytic infiltrate consistent with nodular sclerosing Hodgkin's lymphoma. Histopathologic analysis of an episcleral nodule revealed a necrotizing granuloma with vasculitis. Systemic chemotherapy was instituted for the Hodgkin's disease; this therapy abolished the nodular scleritis. Conclusions This case raises the possibility of concurrent undiagnosed systemic vasculitis with only an ocular manifestation with Hodgkin's lymphoma, either as a coincidence or as a paraneoplastic syndrome. Moreover, it emphasizes the important role of tissue biopsy in establishing diagnosis and directing treatment. © 2003 by the American Academy of Ophthalmology.
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severity of Episcleritis and systemic disease association
Ophthalmology, 1999Co-Authors: Esen K Akpek, William G Christen, Canan Gurdal, Stephen C FosterAbstract:Abstract Objective To analyze patient characteristics and correlate between the site and severity of the inflammation and ocular and/or systemic disease association in a cohort of patients with Episcleritis. Design Retrospective case series. Methods Medical records of 100 patients with Episcleritis were reviewed. Data were analyzed using a customized database software. Results The age range at presentation was 18 to 76 years (mean, 43; median, 44). Sixty-nine percent of the patients were female. Thirty-two (32%) patients had bilateral involvement. The Episcleritis was nodular in 23 eyes (16%). Half of the patients had a concurrent eye disease. Associated systemic disease was found in 36 patients (36%). In two patients, Episcleritis preceded a systemic vasculitic disease (Wegener granulomatosis and Cogan syndrome). Ocular complications included uveitis (11.4%), corneal involvement (15%), and glaucoma (7.8%). No significant correlation of the site and severity of inflammation to the presence of associated systemic or ocular diseases was found. The mean follow-up was 16.5 months. Twenty-eight patients experienced recurrence of Episcleritis during the follow-up. Half of the patients required treatment with oral nonsteroidal anti-inflammatory drugs. Conclusions Episcleritis is usually a benign, self-limited disease, but it should not be trivialized since it may be associated with systemic disease and ocular complications. A careful review of systems should be performed in all patients presenting with Episcleritis, and this should be repeated at least annually during the follow-up. A thorough eye examination is obviously essential to detect and treat ocular complications.
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diagnostic approach to Episcleritis and scleritis
1994Co-Authors: Stephen C Foster, Maite Sainz De La MazaAbstract:Scleral inflammation gives rise to a spectrum of conditions, ranging from a trivial, self-limiting episode to a vision-threatening necrotizing process. Clinical differentiation of these conditions is important because they follow different courses and have different prognostic significance. Several classifications have been proposed on the basis of clinical, clinicopathological, and etiological aspects. The most frequently used is based on the anatomical site of the inflammation and on the clinical appearance of the disease at presentation (Table 3.1). This classification, proposed by Watson and Hayreh,l has proved to be satisfactory because it enables one to assign most patients to a particular category and subcategory at the initial clinical examination, with almost no changes over the course of the disease. Two main groups can be differentiated: Episcleritis and scleritis (Figs. 3.1 and 3.2; see color insert). Episcleritis is a benign recurrent disease with little systemic disease association, whereas scleritis not only can cause great pain, loss of vision, and in some cases destruction of the eye, but also may portend an underlying, potentially lethal systemic disease (Table 3.2). There are distinct clinical patterns that help to distinguish Episcleritis from scleritis. There are also distinguishing features that may help uncover the underlying systemic diseases. Early detection and characterization of the scleral and systemic disease leads to early treatment, which can improve both ocular and systemic prognoses. This chapter provides specific guidelines for a diagnostic approach in patients with Episcleritis and scleritis.
Maite Sainz De La Maza - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Episcleritis and Scleritis
The Sclera, 2012Co-Authors: Maite Sainz De La Maza, Joseph Tauber, C. Stephen FosterAbstract:The treatment of Episcleritis can usually be strictly supportive, although in some instances systemic nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated. Diffuse and nodular scleritis can usually be effectively treated in the same way, that is, with NSAIDs. If NSAID therapy fails, systemic corticosteroid therapy is indicated, provided there are no contraindications to this approach. If the scleritis continues to recur with each attempt to discontinue steroid therapy after 6 months of treatment, immunomodulatory therapy (IMT) or biologic response modifiers (BRM) should be considered. The same applies for patients who develop serious steroid-induced side effects. Patients with an established, potentially lethal systemic vasculitis as the cause of scleritis (e.g., polyarteritis nodosa or granulomatosis with polyangiitis (Wegener)), and patients with necrotizing scleritis, always require treatment with IMT or BRM.
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clinical considerations of Episcleritis and scleritis
2012Co-Authors: Maite Sainz De La Maza, Joseph Tauber, Stephen C FosterAbstract:Episcleritis is a benign disease that presents as an uncomfortable red eye, sometimes with tearing and mild photophobia. Pain, if any, is mild and localized to the eye. Episcleritis rarely causes significant adverse ocular sequelae and is infrequently associated with systemic disease. Unlike Episcleritis, scleritis is a severe inflammatory disease that can be progressively destructive, sometimes leading to loss of vision or loss of the eye. It presents with deep, severe pain, often radiating to the forehead, the jaw, and the sinuses. Scleritis is often associated not only with ocular complications (keratitis, uveitis, glaucoma, and cataract if anterior or fundus abnormalities if posterior), but also with immune-mediated systemic diseases, some of them potentially lethal.
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diagnostic approach of Episcleritis and scleritis
2012Co-Authors: Maite Sainz De La Maza, Joseph Tauber, Stephen C FosterAbstract:The approach to the patient with scleritis should include five phases. The first phase includes the investigation of the illness through the interview and physical examination of the patient. The second phase consists of the selection of blood, urine, and imaging studies that are needed to investigate the possibilities raised in the first phase. In the third phase, the decision is made as to whether a tissue biopsy is likely to add useful information to the diagnosis or to the therapy. The fourth phase integrates the clinical findings with tests and biopsy results, leading to a specific diagnosis. In the fifth phase, a therapeutic plan is initiated and the response is observed.
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Clinical characteristics of a large cohort of patients with scleritis and Episcleritis.
Ophthalmology, 2011Co-Authors: Maite Sainz De La Maza, Nicolas Molina, Luis Alonso Gonzalez-gonzalez, Priyanka P. Doctor, Joseph TauberAbstract:Objective To evaluate the demographic characteristics, clinical features, ocular complications, and disease associations of patients with scleritis and Episcleritis; as well as to delineate the risk factors for decreased vision in patients with scleritis. Design Retrospective case series. Participants Five hundred patients with scleritis and 85 patients with Episcleritis. Methods The electronic health records of 500 patients with scleritis and 85 patients with Episcleritis seen at 2 tertiary referral centers were reviewed and their clinical features were studied. Main Outcome Measures Clinical features (pain, scleral inflammation), ocular complications (decrease in vision, anterior uveitis, peripheral ulcerative keratitis, ocular hypertension), and disease associations. Results In a series of 585 patients, 500 patients had scleritis (85.5%) and 85 patients had Episcleritis (14.2%). Ocular complications were more frequent overall in patients with scleritis versus in those with Episcleritis (45.0% vs. 19.0%), including decrease in vision (15.8% vs. 2.3%), anterior uveitis (26.4% vs. 16.5%), peripheral ulcerative keratitis (7.4% vs. 0%), and ocular hypertension (14.2% vs. 3.5%; P P P P = 0.042), degree of scleral inflammation of more than 2+ (range, 0–4+; OR, 3.60; P P = 0.033), ocular hypertension (OR, 3.19; P P P Conclusions Scleritis is associated more often with ocular complications than Episcleritis, and necrotizing scleritis is the type of scleritis most often associated with ocular complications and disease association. Risk factors for decrease in vision in patients with scleritis include necrotizing scleritis, posterior scleritis, scleral inflammation of more than 2+, anterior uveitis, ocular hypertension, and associated infectious disease. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Severity of Scleritis and Episcleritis
Ophthalmology, 1994Co-Authors: Maite Sainz De La Maza, Nada S. JabburAbstract:Purpose: Inflammation of the wall of the eyeball may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. This study was undertaken to evaluate the ocular complications and systemic disease associations of the different types of scleritis and Episcleritis. Methods: Ocular complications and specific disease association were evaluated in 266 patients (358 eyes) with different types of scleritis (diffuse, nodular, necrotizing, scleromalacia perforans, and posterior) and Episcleritis (simple and nodular). Results: In patients with scleritis, decrease in vision occurred in 37%, anterior uveitis was present in 42%, peripheral ulcerative keratitis developed in 14%, glaucoma occurred in 13%, cataract formed in 17%, fundus abnormalities appeared in 6%, and specific disease association was uncovered in 57%. These findings were most commonly associated with necrotizing scleritis. In patients with Episcleritis, decreased vision occurred in 2%, anterior uveitis was present in 11%, glaucoma developed in 4%, cataract formed in 2%, and specific disease association was uncovered in 32%. These findings were similar in simple and nodular Episcleritis. Conclusions: In a patient with scleritis, examination of visual acuity, anterior uvea, cornea, lens, intraocular pressure, and fundus must be performed in every follow-up visit, and a meticulous approach for detection of a specific associated disease must be undertaken since the first visit. Scleritis is more severe than Episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and Episcleritis provides valuable prognostic information.
Vivien M Tham - One of the best experts on this subject based on the ideXlab platform.
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assessment of the accuracy of using icd 9 codes to identify uveitis herpes zoster ophthalmicus scleritis and Episcleritis
JAMA Ophthalmology, 2016Co-Authors: Matthew A Pimentel, Durga S Borkar, Vivien M Tham, Aleli C Vinoya, Aileen Uchida, Erica N Browne, Priya M Janardhana, Nisha R AcharyaAbstract:Importance With the increased use of data from electronic medical records for research, it is important to validate International Classification of Diseases , Ninth Revision ( ICD-9 ) codes for their respective diagnoses. Objective To assess the accuracy of using ICD-9 codes to identify ocular inflammatory diseases. Design, Setting, and Participants Retrospective secondary database analysis. The setting was Kaiser Permanente Hawaii, an integrated managed care consortium that serves approximately 15% of the general Hawaiian population. Participants were patients with ICD-9 diagnosis codes that might be associated with a diagnosis of ocular inflammation seen at Kaiser Permanente Hawaii between January 1, 2006, and December 31, 2007. The data collection and analysis took place from January 2011 to August 2015. Main Outcomes and Measures The main outcome was the positive predictive value (PPV) of ICD-9 codes for identifying specific types of ocular inflammatory disease. The PPVs were calculated by determining the ratio of the confirmed cases found by medical record review to the total number of cases identified by ICD-9 code. Results Of the 873 patients identified by a comprehensive list of ICD-9 codes for ocular inflammatory diseases, 224 cases were confirmed as uveitis after medical record review. Using a set of uveitis-specific codes and eliminating patients with a history of ocular surgery, the overall PPV for uveitis was 61% (95% CI, 56%-66%). The PPVs for individual uveitis codes ranged from 0% to 100%, and 11 uveitis codes had a PPV exceeding 80%. Herpes zoster ophthalmicus and scleritis/Episcleritis ICD-9 codes had PPVs of 91% (95% CI, 86%-95%) and 60% (95% CI, 54%-66%), respectively. Conclusions and Relevance Our results suggest that using ICD-9 codes alone to capture uveitis and scleritis/Episcleritis diagnoses is not sufficient in the Kaiser Permanente Hawaii healthcare system, although there were specific uveitis codes with high PPVs. However, the electronic medical record can reliably be used to identify herpes zoster ophthalmicus cases. Medical record review, as was done in this study, is recommended to elucidate diagnoses for uveitis and scleritis/Episcleritis.
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incidence of scleritis and Episcleritis results from the pacific ocular inflammation study
American Journal of Ophthalmology, 2013Co-Authors: Gelareh Homayounfar, Natalie Nardone, Durga S Borkar, Vivien M Tham, Travis C Porco, Wayne T A Enanoria, John V Parker, Aleli C Vinoya, Aileen Uchida, Nisha R AcharyaAbstract:Purpose To ascertain the incidence of scleritis and Episcleritis in a Hawaiian population and describe variations by age, sex, and race. Design Retrospective, population-based cohort study. Methods All electronic medical records for enrollees in Kaiser Permanente Hawaii (n = 217 061) from January 1, 2006 to December 31, 2007 were searched for International Classification of Diseases, 9th Edition (ICD-9) codes associated with ocular inflammation. Chart review was conducted to verify a clinical diagnosis of scleritis or Episcleritis. Confirmed cases were used to calculate incidence rates per 100 000 person-years. Ninety-five percent confidence intervals (CI) were calculated for each incidence rate, including age-, sex-, and race-specific rates, using bias-corrected Poisson regression. To assess for confounding, a multivariate analysis adjusting for age, sex, and race was also performed. Results Of 217 061 eligible patients, 17 incident scleritis cases and 93 incident Episcleritis cases were confirmed. The overall incidence rates of scleritis and Episcleritis were 4.1 (95% CI: 2.6-6.6) and 21.7 (95% CI: 17.7-26.5) cases per 100 000 person-years, respectively. Women were overrepresented among scleritis patients ( P = .049). Pacific Islanders were the most underrepresented racial group among cases of scleritis and Episcleritis ( P = .006, P = .001). Blacks had the highest incidence of scleritis ( P = .004). Conclusions These results provide a population-based estimate of the incidence of scleritis and Episcleritis in a diverse population and highlight differences in patients' demographic characteristics. Differences in incidence by sex and race raise questions about genetic and environmental influences on the development of these conditions.
Nisha R Acharya - One of the best experts on this subject based on the ideXlab platform.
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assessment of the accuracy of using icd 9 codes to identify uveitis herpes zoster ophthalmicus scleritis and Episcleritis
JAMA Ophthalmology, 2016Co-Authors: Matthew A Pimentel, Durga S Borkar, Vivien M Tham, Aleli C Vinoya, Aileen Uchida, Erica N Browne, Priya M Janardhana, Nisha R AcharyaAbstract:Importance With the increased use of data from electronic medical records for research, it is important to validate International Classification of Diseases , Ninth Revision ( ICD-9 ) codes for their respective diagnoses. Objective To assess the accuracy of using ICD-9 codes to identify ocular inflammatory diseases. Design, Setting, and Participants Retrospective secondary database analysis. The setting was Kaiser Permanente Hawaii, an integrated managed care consortium that serves approximately 15% of the general Hawaiian population. Participants were patients with ICD-9 diagnosis codes that might be associated with a diagnosis of ocular inflammation seen at Kaiser Permanente Hawaii between January 1, 2006, and December 31, 2007. The data collection and analysis took place from January 2011 to August 2015. Main Outcomes and Measures The main outcome was the positive predictive value (PPV) of ICD-9 codes for identifying specific types of ocular inflammatory disease. The PPVs were calculated by determining the ratio of the confirmed cases found by medical record review to the total number of cases identified by ICD-9 code. Results Of the 873 patients identified by a comprehensive list of ICD-9 codes for ocular inflammatory diseases, 224 cases were confirmed as uveitis after medical record review. Using a set of uveitis-specific codes and eliminating patients with a history of ocular surgery, the overall PPV for uveitis was 61% (95% CI, 56%-66%). The PPVs for individual uveitis codes ranged from 0% to 100%, and 11 uveitis codes had a PPV exceeding 80%. Herpes zoster ophthalmicus and scleritis/Episcleritis ICD-9 codes had PPVs of 91% (95% CI, 86%-95%) and 60% (95% CI, 54%-66%), respectively. Conclusions and Relevance Our results suggest that using ICD-9 codes alone to capture uveitis and scleritis/Episcleritis diagnoses is not sufficient in the Kaiser Permanente Hawaii healthcare system, although there were specific uveitis codes with high PPVs. However, the electronic medical record can reliably be used to identify herpes zoster ophthalmicus cases. Medical record review, as was done in this study, is recommended to elucidate diagnoses for uveitis and scleritis/Episcleritis.
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incidence of scleritis and Episcleritis results from the pacific ocular inflammation study
American Journal of Ophthalmology, 2013Co-Authors: Gelareh Homayounfar, Natalie Nardone, Durga S Borkar, Vivien M Tham, Travis C Porco, Wayne T A Enanoria, John V Parker, Aleli C Vinoya, Aileen Uchida, Nisha R AcharyaAbstract:Purpose To ascertain the incidence of scleritis and Episcleritis in a Hawaiian population and describe variations by age, sex, and race. Design Retrospective, population-based cohort study. Methods All electronic medical records for enrollees in Kaiser Permanente Hawaii (n = 217 061) from January 1, 2006 to December 31, 2007 were searched for International Classification of Diseases, 9th Edition (ICD-9) codes associated with ocular inflammation. Chart review was conducted to verify a clinical diagnosis of scleritis or Episcleritis. Confirmed cases were used to calculate incidence rates per 100 000 person-years. Ninety-five percent confidence intervals (CI) were calculated for each incidence rate, including age-, sex-, and race-specific rates, using bias-corrected Poisson regression. To assess for confounding, a multivariate analysis adjusting for age, sex, and race was also performed. Results Of 217 061 eligible patients, 17 incident scleritis cases and 93 incident Episcleritis cases were confirmed. The overall incidence rates of scleritis and Episcleritis were 4.1 (95% CI: 2.6-6.6) and 21.7 (95% CI: 17.7-26.5) cases per 100 000 person-years, respectively. Women were overrepresented among scleritis patients ( P = .049). Pacific Islanders were the most underrepresented racial group among cases of scleritis and Episcleritis ( P = .006, P = .001). Blacks had the highest incidence of scleritis ( P = .004). Conclusions These results provide a population-based estimate of the incidence of scleritis and Episcleritis in a diverse population and highlight differences in patients' demographic characteristics. Differences in incidence by sex and race raise questions about genetic and environmental influences on the development of these conditions.
Lyndell L Lim - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of Episcleritis and scleritis in urban Australia
Clinical & experimental ophthalmology, 2020Co-Authors: Louisa P. Thong, Sophie Rogers, Colby Hart, Anthony J. Hall, Lyndell L LimAbstract:IMPORTANCE The epidemiology of Episcleritis and scleritis in Australia is largely unknown. BACKGROUND To determine the incidence, prevalence and clinical characteristics of Episcleritis and scleritis in Melbourne. DESIGN Retrospective longitudinal study. PARTICIPANTS Patients aged ≥18 years with Episcleritis or scleritis seen at the Royal Victorian Eye and Ear Hospital from November 2014 to October 2015. METHODS Medical record review confirmed clinical diagnosis and characteristics. Incidence and prevalence were calculated using estimates of the adult population in areas of Melbourne with ≥30 ocular presentations/year to the emergency department. MAIN OUTCOME MEASURES Diagnosis of active Episcleritis or scleritis, aetiology, ocular complications and treatments. RESULTS From a general population of 3 408 068, we confirmed 149 new and 23 pre-existing cases of active Episcleritis, and 35 new and 23 pre-existing cases of active scleritis. Incidence per 100 000 person-years was 4.4 (95% confidence interval [CI] 3.7-5.1) for Episcleritis and 1.0 (95% CI 0.7-1.4) for scleritis, while 12-month prevalence was 5.1 (95% CI 4.3-5.9) and 1.7 (1.3-2.2) per 100 000 persons, respectively. Systemic disease was associated with 10% of Episcleritis compared with 34% of scleritis (P
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epidemiology of Episcleritis and scleritis in urban australia
Clinical and Experimental Ophthalmology, 2020Co-Authors: Louisa P. Thong, Sophie Rogers, Colby Hart, Anthony J. Hall, Lyndell L LimAbstract:IMPORTANCE The epidemiology of Episcleritis and scleritis in Australia is largely unknown. BACKGROUND To determine the incidence, prevalence and clinical characteristics of Episcleritis and scleritis in Melbourne. DESIGN Retrospective longitudinal study. PARTICIPANTS Patients aged ≥18 years with Episcleritis or scleritis seen at the Royal Victorian Eye and Ear Hospital from November 2014 to October 2015. METHODS Medical record review confirmed clinical diagnosis and characteristics. Incidence and prevalence were calculated using estimates of the adult population in areas of Melbourne with ≥30 ocular presentations/year to the emergency department. MAIN OUTCOME MEASURES Diagnosis of active Episcleritis or scleritis, aetiology, ocular complications and treatments. RESULTS From a general population of 3 408 068, we confirmed 149 new and 23 pre-existing cases of active Episcleritis, and 35 new and 23 pre-existing cases of active scleritis. Incidence per 100 000 person-years was 4.4 (95% confidence interval [CI] 3.7-5.1) for Episcleritis and 1.0 (95% CI 0.7-1.4) for scleritis, while 12-month prevalence was 5.1 (95% CI 4.3-5.9) and 1.7 (1.3-2.2) per 100 000 persons, respectively. Systemic disease was associated with 10% of Episcleritis compared with 34% of scleritis (P < .001). Ocular complications were seen in 3% (6/184) of Episcleritis eyes and 44% (32/72) of scleritis eyes, with the commonest being anterior uveitis (12/72) and ocular hypertension (14/72). At presentation, scleritis patients were commonly treated with oral non-steroidal anti-inflammatory drugs (60%) and prednisolone (19%). By 12 months, 24% of scleritis patients required immunosuppressants. CONCLUSIONS AND RELEVANCE Rates of Episcleritis and scleritis in our single-centre Australian study were low. Episcleritis was usually benign, whereas scleritis had increased ocular complications and systemic disease.