A 'deep boring pain' is most commonly associated with which ocular finding?

• A. Acute angle closure glaucoma
• B. Anterior scleritis
• C. Episcleritis
• D. Acanthamoeba keratitis

Answer: (B)

Deep, boring eye pain is a classic sign of scleral inflammation, most strongly associated with anterior scleritis. The discomfort is deep and persistent, often worsened by eye movement, and the exam typically shows scleral injection with tenderness to palpation of the globe (sometimes with a ciliary flush). This pattern helps distinguish scleritis from conditions that cause similar redness or pain but with different features: episcleritis generally presents with milder, superficial redness and little pain; acute angle-closure glaucoma causes intense, throbbing pain often with halos, headache, nausea, and a hard eye with a mid-dilated pupil; corneal infections like Acanthamoeba keratitis produce severe pain tied to corneal surface involvement and characteristic keratitis findings. Thus the deep, boring pain points to anterior scleritis.