Which statement best describes episcleritis?

• A. An infectious conjunctivitis with purulent discharge
• B. A benign, usually painless localized ocular inflammation of the episcleral vessels
• C. A painful inflammatory condition affecting the cornea
• D. A glaucomatous process

Answer: (B)

Episcleritis is a benign, usually painless localized inflammation of the episcleral vessels. Clinically, this presents as redness of the eye that is often sectoral or diffuse, with only mild irritation and preserved vision; there is typically little or no discharge and minimal photophobia. This differentiates it from infectious conjunctivitis, which commonly has purulent discharge and more conspicuous mucous production. If pain is deep, persistent, or there is significant tenderness, or vision changes occur, think about scleritis or keratitis rather than episcleritis, since those conditions involve deeper eye structures and are more serious. Scleritis presents with a deep, severe eye pain that can wake the patient and may threaten vision, while keratitis causes marked pain, photophobia, tearing, and corneal staining. A practical diagnostic aid is the phenylephrine blanching test: in episcleritis the superficial episcleral vessels blanch with the drops, helping distinguish it from scleritis where deeper vessels do not blanch. Management is typically supportive and self-limited, with reassurance, artificial tears, and possibly topical NSAIDs; steroids may be used if inflammation is persistent or recurrent, under medical supervision. If recurrences occur or there are systemic associations suspected, evaluate for underlying conditions.