**Question:** A 27-year-old male presents to the emergency with severe pain behind his right eye for the last 30 minutes. He states that his right eye has also been 'watering excessively' for the last two hours. The man has had similar episodes over the last few weeks, but this time the pain is significantly worse which has prompted him to present to the ER. The vitals are normal and ophthalmic examination demonstrates conjunctival injection and miosis of the right pupil. A CT scan of the brain and ESR are unremarkable. Which is the initial treatment of this patient?

A. Ophthalmic steroid therapy
B. Ophthalmic analgesic therapy
C. Systemic steroid therapy
D. Systemic nonsteroidal anti-inflammatory therapy

**Correct Answer:**

**Core Concept:**
The patient is experiencing ocular pain and excessive tearing, which may indicate an ocular inflammation or infection. The correct approach to manage this condition would involve addressing the ocular symptoms while ruling out a more systemic cause.

**Why the Correct Answer is Right:**

Initial treatment for the patient should focus on alleviating ocular symptoms while excluding a more systemic cause. In this scenario, the correct choice is B (Ophthalmic analgesic therapy), as it addresses the pain and excessive tearing directly related to the eye and its structures, while also considering a potential ocular inflammation or infection.

**Why Each Wrong Option is Invalid:**

A (Ophthalmic steroid therapy) and C (Systemic steroid therapy) could potentially exacerbate the ocular inflammation or infection and may not directly address the patient's symptoms.

D (Systemic nonsteroidal anti-inflammatory therapy) is not specific to ocular symptoms and could have systemic side effects that are not beneficial in this case.

**Clinical Pearls:**

1. Always consider the possibility of ocular inflammation or infection when observing patients presenting with ocular pain, excessive tearing, and normal vitals.
2. In cases of suspected ocular inflammation or infection, begin with local ocular treatment to address symptoms while further evaluating the patient.
3. It is essential to rule out a more systemic cause for the patient's symptoms by either CT scan (as shown in the question) or by considering further diagnostic tests as per the clinical presentation.