American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is indicated by the presence of redness, irritation, and tearing but not significant ocular pain?

1. Episcleritis

2. Conjunctivitis

3. Uveitis

4. Keratitis

The correct answer is: Episcleritis

The presence of redness, irritation, and tearing alongside minimal or no significant ocular pain suggests a diagnosis of episcleritis. This condition is characterized by inflammation of the episclera, a thin layer of tissue that covers the white part of the eye (sclera). The redness observed is usually sectoral and can be accompanied by mild discomfort, but it is generally not associated with the level of pain commonly seen in conditions like keratitis or uveitis. In contrast, conjunctivitis typically presents with redness, irritation, and tearing but is often associated with more pronounced discharge and discomfort in relation to the underlying cause, whether infectious or allergic. Uveitis involves inflammation of the uveal tract and is usually associated with significant pain, photophobia, and visual changes. Keratitis, which involves inflammation of the cornea, often leads to severe pain, visual disturbances, and is frequently accompanied by other symptoms like light sensitivity. Thus, the distinguishing feature of episcleritis is the mild nature of the symptoms compared to the more severe pain and visual symptoms experienced in the other conditions listed.