Which statement about episcleritis is true?

• A. It is typically more painful than scleritis
• B. It often presents with sectoral redness that blanches with phenylephrine
• C. It is less common than scleritis
• D. It is more likely to cause secondary glaucoma

Answer: (B)

Episcleritis involves the superficial vessels of the episclera and usually presents with mild, sectoral redness and irritation, with little pain. The key practical clue is that the redness often blanches when you apply topical phenylephrine, because the dilated superficial episcleral vessels constrict with this alpha-adrenergic agonist. This blanching helps distinguish it from deeper scleral inflammation (scleritis), where the redness reflects deeper vessels and the pain is typically much more pronounced, and the redness often does not blanch as readily.

Other statements don’t fit the typical picture: pain in episcleritis is not greater than in scleritis; scleritis is the more painful, more vision-threatening condition. Regarding frequency, episcleritis is more common than scleritis, not less common. And while scleritis can be associated with complications like secondary glaucoma, episcleritis is not typically linked to glaucoma.