Objective: To describe the characteristics and systemic disease associations of episcleritis in childhood. Design: Retrospective, observational case series. Participants: Twelve children diagnosed with episcleritis between duly 1981 and June 1998. Methods/Testing: Complete eye and systemic evaluations. Main Outcome Measures: Characteristics of episcleritis and presence and nature of concurrent systemic disease. Results: The 12 children (10 boys and 2 girls) ranged in age from 13 months to 16 years. Five children had bilateral simple episcleritis, one had bilateral nodular episcleritis, and six had unilateral simple episcleritis. The eye examination was otherwise normal and recovery was uneventful in all cases. Six of the nine children older than 5 years of age had one of the following rheumatologic diseases: systemic lupus erythematosus, juvenile rheumatoid arthritis, spondyloarthropathy, inflammatory bowel disease, rheumatic fever, or polyarteritis nodosa. All three children younger than 5 years of age had simple episcleritis, an antecedent viral illness, and presented within 2 months of each other. Conclusions: Episcleritis is a rare occurrence in childhood, especially in children younger than 5 years of age. In older children, it is frequently associated with rheumatologic disease.