Which condition is typically benign, usually painless, and involves localized inflammation of the episcleral vessels?

• A. Episcleritis
• B. Conjunctival chemosis
• C. Keratitis
• D. Uveitis

Answer: (A)

This describes episcleritis, which is inflammation limited to the episcleral vessels. The episclera is the thin layer between the conjunctiva and sclera, so redness is from superficial vessels rather than deeper eye structures. It is typically benign and mild, often with little to no pain and preserved vision. A practical clue is that the redness tends to blanch with a topical vasoconstrictor such as phenylephrine, indicating involvement of superficial episcleral vessels.

In contrast, keratitis involves the cornea and usually causes significant pain, photophobia, tearing, and decreased vision with corneal staining. Uveitis is deeper intraocular inflammation presenting with pain, photophobia, blurry vision, and anterior chamber cells/flare. Conjunctival chemosis is mainly eyelid-subtended swelling of the conjunctiva and may accompany irritation or allergy, but it is not inflammation confined to the episclera.

Most episcleritis cases resolve on their own in a few weeks with supportive care like artificial tears and cold compresses; more persistent or nodular forms may use topical NSAIDs or brief topical steroids under supervision.