Comments
An open comment form is an open door. This screen is where you decide what came through it, and the goal is to spend as little time here as possible.

The queue
Counts across the top split the queue into All, Pending, Approved, Spam and Trash. Pending is the only one that needs you; the rest are archives.
Each entry shows the commenter, the time, the post it belongs to, and the comment itself - not a truncated preview. You can judge without clicking through, which is the difference between moderating forty comments in five minutes and abandoning the queue for a week.
Per comment: Unapprove, Reply, Spam and Move to Trash. Replying here posts your reply on the site as a threaded response - you do not need to open the post.
Marking something as Spam does more than hide it. The filter learns from what you mark, so the same pattern is caught by itself next time.
Before anything reaches this screen
Most of what a public form attracts never appears in the queue, because the spam filter scores each submission first. It weighs language and alphabet, bare domains and shortened links, known spam phrasing in several languages, flattery templates, look-alike characters, random-looking names, bot fingerprints, and repetition of comments already seen.
Optional external checks - StopForumSpam and Akismet - can be layered on top under Spam Protection, linked from the top of this screen.
If something obvious slips through, mark it as spam rather than deleting it. Deletion removes the evidence; marking teaches the filter.
Deciding how strict to be
Under Settings → General → Discussion you choose whether comments are open at all, whether they need approval before appearing, and whether a commenter's first approved comment earns them automatic approval afterwards.
That last option is the one worth understanding. On a site with regular readers it cuts the queue to near zero while keeping first-time commenters held for review. On a site that gets occasional drive-by traffic it does very little.
Related
- Settings Panel - comment rules live under General → Discussion
- Posts Panel - comments are attached to the post they were left on