Recurrent Episcleritis: Unveiling The Causes And Systemic Links

Background: Episcleritis is a common, typically benign ocular condition characterized by inflammation of the episcleral tissue. While often self-limiting, recurrent episcleritis may signal underlying systemic disease, including autoimmune conditions and latent tuberculosis (TB), particularly in TB-endemic regions like India. Objective: To investigate the clinical profile, systemic associations, and treatment outcomes in patients presenting with recurrent episcleritis. Methods: A cross-sectional study was conducted over six months at a tertiary care center involving 76 patients diagnosed with recurrent episcleritis. Detailed ocular and systemic evaluations were performed, including Mantoux testing, autoimmune markers, and chest imaging. Patients were followed up for a minimum of two months to assess recurrence and treatment response. Results: The majority of patients were female (61%) and aged between 30–50 years, with a mean age of 43.03±9.06 years. Unilateral (91%) and diffuse (80%) episcleritis were the most common presentations. Systemic associations were identified in 31 patients (41%), of which 26 (34%) were Mantoux positive. Among these, six patients with latent or prior TB-related findings were initiated on anti-tubercular therapy (ATT), resulting in complete resolution with no further recurrences. Conclusion: Recurrent episcleritis may be an ocular manifestation of systemic diseases, especially latent tuberculosis in endemic regions. Routine Mantoux testing and targeted systemic evaluation are critical in such cases. Initiation of ATT in selected patients demonstrated favorable outcomes, reinforcing the need for a multidisciplinary approach in managing recurrent episcleritis.