Episcleritis and Optical Nerve Damage - Related?

[sabing]

About 7 years ago in a routine physical the doctor noticed a prominent cup in my left eye and referred me to an opthamologist.  In my first appointment they took images and found damage to the optic nerve (I never really got more information than that.)  For the past 7 years I have been seen every 6 months as a "glaucoma suspect" but I have no family history of glaucoma and have had normal pressures every time they are checked. Also my visual fields have not noted any changes.  I just keep being told I'm fine but they are categorizing this way and want to keep seeing me.  My original doctor left last year so I switched to another hospital to the glaucoma expert there and he was baffled as to why they had "diagnosed" me that way.  But he still hasn't gotten the records so he hasn't seen the nerve.  So that's my first confusion.

Then last month I had pain and redness in my eye and ended up going to the triage doctor at the original hospital and was diagnosed with Episcleritis.  He mentioned that it could be associated with vascular disease but was probably nothing.  So too much online research later I'm wondering if these two could be at all related to some underlying vascular problem and if taking birth control could be a problem.  Or if they are totally unrelated. And if so, then what may be the other possibilities for this "glaucoma suspect" diagnosis.  Thanks.

[John C Hagan III, MD, FACS, FAAO]

The two conditions are not related and are co-incidental. Episcleritis is an inflammation on the surface of the eye, it is not an infection. It is not dissimiliar to tennis elbow and bursitis of the shoulder. A very small percentage of the cases are associated with collagen vascular disease such as rheumatoid arthritis. It has a tendency to reoccur, often is triggered by sunlight exposure and clears up quickly with steroid drops.

Glaucoma suspect is a resonable diagnosis in someone that has a large dimple "cup" in the middle of the optic nerve. We make a ratio of the diameter of the optic nerve to the diameter of the cup. 90% plus of the population have cup to disk ratios of 40% or less. People with cup to disc ratios over 50% are generally considered glaucoma suspects and need special tests. Be grateful you didn't turn out to have glaucoma. Your large cup will make glaucoma more difficult to diagnose in the future.

A person can also be a glaucoma suspect based on positive family history, thin cornea, high intraocular pressure, suspicious cup/disk ratio, abnormal pigment on the cornea, abnormal pigment on the lens (pseudoexfoliation), abnormal visual fields or abnormal filtering angles.

JCH III MD

[John C Hagan III, MD, FACS, FAAO]

You are welcome.

JCH III MD

[sabing]

Thank you.  That was much clearer about both issues than anything I've gotten from anyone else.  Your help is much appreciated.