What is the typical presentation of episcleritis?

• A. Diffuse redness with significant vision loss.
• B. Localized redness, usually painless, with no vision changes.
• C. Severe eye pain with constricted pupils.
• D. Purulent discharge and lid swelling.

Answer: (B)

Episcleritis involves inflammation of the episclera, producing redness from superficial vessels while sparing deeper structures. The hallmark is localized or sectoral redness with minimal or no discomfort and, importantly, preserved visual acuity. This contrasts with conditions that cause deeper inflammation or corneal/uveal involvement, which bring more pain and often vision changes. A helpful clinical cue is that the superficial redness blanchs with a topical vasoconstrictor, highlighting the superficial vessels involved. Given this, the presentation described as localized redness, usually painless, with no changes in vision best fits episcleritis.