October 13, 2010

USMLE 2 Question 7

A 35 year old with no history of a rheumatoid disorder presents with mild photophobia and sectoral hyperemia. Topical neosynephrine is administered but the engorged vessels do not blanch.

a) orbital pseudotumor
b) uveitis
c) episcleritis
d) scleritis
e) conjunctivitis

The correct answer is C

Episcleritis-an inflammatory condition of the episclera. Usually sectoral and self limiting. The eye is often tender and mildly photophobic.

2.5% neosynephrine topically can be used diagnostically: the conjunctival vessels blanch but the episcleral vessels remain engorged in episcleritis as opposed to conjunctivitis where most vessels blanch.

Sectoral hyperemia, is distinguished from conjunctivitis by radially oriented vessels that do not move with the conjunctiva. Episcleritis is self-limited, although topical non-steroidal anti-inflammatory medications such as flurbiprofen or diclofenac may hasten resolution. In contradistinction to scleritis, episcleritis is not usually related to systemic rheumatoid disease.

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