How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?

The episclera lies on top of the sclera. The majority of patients with episcleritis do not have a systemic disease, although patients with rheumatoid arthritis are more prone to develop episcleritis.

Episcleritis must be distinguished from scleritis, which is also associated with rheumatoid arthritis. About 40% of patients with scleritis have an associated immune-mediated illness such as RA, ANCA-associated vasculitis, IBD, or spondyloarthritis.

Scleritis is painful. With episcleritis, the eye feels irritated but the discomfort is not usually described as pain. The superficial vessels of the episclera will constrict with a drop of phenylephrine, which is often used to dilate the eye. Scleral vessels are too deep to be affected by phenyleph...