13d • General discussion
Small findings. Big clinical significance.
By Dr Ashvira Moodley.
Today’s patient presented with a sectoral red eye associated with mild discomfort and irritation, but notably without significant discharge, photophobia, or visual disturbance. On slit lamp examination, the inflamed vessels blanched with topical phenylephrine — a positive phenyl test — supporting a diagnosis of episcleritis rather than scleritis.
Episcleritis is a relatively common, benign, and often self-limiting inflammation of the episcleral tissue. Patients typically present with:
• Sectoral or diffuse redness
• Mild tenderness or irritation
• Little to no pain
• Normal visual acuity
One of the most useful clinical pearls in differentiating episcleritis from scleritis is the phenylephrine blanching test:
- Superficial episcleral vessels blanch with phenylephrine
- Deeper scleral vessels remain injected in scleritis
This distinction is important because while episcleritis is usually benign and manageable with supportive treatment or topical anti-inflammatory therapy, scleritis can be vision-threatening and may be associated with underlying systemic autoimmune disease.
A good reminder that careful examination of the “simple red eye” can make all the difference.
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Small findings. Big clinical significance.
