Diseases of the Conjunctiva Practice Questions

Q: A patient presents with chronic redness and discharge from the eye. The image shows the conjunctival findings. What is the most likely diagnosis?

Trachoma. ***Trachoma*** - The image shows **conjunctival injection**, **mucopurulent discharge**, and **follicular conjunctivitis** which are characteristic signs of active trachoma. - This chronic follicular conjunctivitis caused by **Chlamydia trachomatis** serotypes A, B, Ba, and C often leads to scarring and visual impairment. - **WHO classification:** Active trachoma shows follicles on upper tarsal conjunctiva. *Vernal conjunctivitis* - Typically presents with severe **itching**, **cobblestone papillae** on the upper tarsal conjunctiva, and sometimes **Horner-Trantas dots** at the limbus. - The discharge is usually **ropy and mucoid**, not mucopurulent as seen in the image. - Seasonal pattern and bilateral involvement are common. *Bacterial conjunctivitis* - While bacterial conjunctivitis also presents with **mucopurulent discharge** and conjunctival injection, it lacks the characteristic **follicular pattern** seen in trachoma. - Bacterial conjunctivitis is typically **acute and self-limiting**, whereas trachoma is chronic and progressive. - Common organisms include *Staphylococcus aureus*, *Streptococcus pneumoniae*, and *Haemophilus influenzae*. *Phlyctenular keratoconjunctivitis* - Characterized by the formation of **small, localized nodules (phlyctenules)** on the cornea or conjunctiva, often associated with delayed hypersensitivity to microbial antigens like *Mycobacterium tuberculosis*. - While it causes **redness and irritation**, the distinct follicular pattern and diffuse mucopurulent discharge presented in the image are not typical features.

Q: A 22-year-old Air-force test pilot presents after flying a sortie. Eye examination shows:

Subconjunctival hemorrhage. ***Subconjunctival hemorrhage*** - The image clearly shows a localized collection of **blood under the conjunctiva**, appearing as a bright red patch on the white of the eye. - This can be caused by sudden increases in **venous pressure**, such as during straining, coughing, or, in the case of a pilot, due to G-forces experienced during a sortie. *Arcus senilis* - This condition presents as a **grayish-white arc** or ring around the limbus (the edge of the cornea), caused by lipid deposits. - It is typically seen in older individuals but can occur in younger individuals with **hyperlipidemia**. The image does not show such a ring. *Phlyctenular keratoconjunctivitis* - This involves the formation of small, **nodular lesions (phlyctenules)** on the cornea or conjunctiva, often associated with hypersensitivity reactions to bacterial antigens (e.g., tuberculosis). - The image does not display distinct nodules or inflammatory lesions characteristic of this condition. *Hypopyon* - This refers to the accumulation of **pus or inflammatory cells in the anterior chamber** of the eye, appearing as a whitish-yellow fluid level, typically in the lower part of the iris. - The image shows blood on the surface of the sclera, not within the anterior chamber of the eye.

Q: What is correct about the image shown below?

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image exhibits **cobblestone papillae** on the upper tarsal conjunctiva, which are characteristic of vernal keratoconjunctivitis (VKC). - The small white dots on top of the papillae are often **Trantas dots**, another hallmark of active VKC, consisting of degenerated eosinophils and epithelial cells. *Trachoma* - Trachoma is characterized initially by **follicular conjunctivitis** and later by scarring, which can lead to **entropion** and trichiasis, not the large papillae seen here. - While it can cause superior tarsal scarring (Arlt's line) and Herbert’s pits, these features are distinct from the hypertrophied papillae in the image. *Eales disease* - Eales disease is primarily a **retinal vasculitis** affecting the peripheral retina, leading to recurrent vitreous hemorrhage and retinal detachment. - It does not present with conjunctival findings like those shown in the image. *Phlyctenular keratoconjunctivitis* - This condition involves the formation of **phlyctenules** (small, nodular lesions) on the cornea or conjunctiva, often associated with hypersensitivity reactions to bacterial antigens. - It does not present with diffuse cobblestone papillae on the tarsal conjunctiva.

Q: A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Trachoma. ***Trachoma*** - The image shows **conjunctival follicles** and **gritty sensation** in a patient from a slum, which are classic signs of Trachoma caused by *Chlamydia trachomatis*. The everted eyelid typically reveals these characteristic follicles. - Trachoma is prevalent in areas with **poor sanitation** and **limited access to water**, consistent with a "slum" setting. *Vernal conjunctivitis* - Characterized by **giant papillae (cobblestone papillae)** on the upper tarsal conjunctiva, often associated with a history of allergies and intense itching. - While it can cause grittiness, the picture does not show the typical giant papillae, but rather smaller, more numerous follicles. *Eales disease* - This is an **idiopathic inflammatory vaso-occlusive disease** affecting the retinal vessels, primarily in young adult males. - It presents with **recurrent vitreous hemorrhages and retinal detachment**, not primarily with conjunctival findings or grittiness. *Phlyctenular keratoconjunctivitis* - Involves the formation of **phlyctenules** (small, nodular lesions) on the conjunctiva or cornea, often associated with delayed hypersensitivity to microbial antigens, such as *Staphylococcus* or *Mycobacterium tuberculosis*. - While it can cause grittiness and photophobia, the follicular pattern in the image is not typical of phlyctenules.

Q: A 5-year-old child presents with severe itching and ropy discharge. Image shows:

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image exhibits **giant papillae** on the upper tarsal conjunctiva, a hallmark feature of vernal conjunctivitis. - The history of **severe itching** and **ropy discharge** in a child are classic symptoms of this allergic condition. *Ligneous conjunctivitis* - Characterized by the formation of **wood-like, firm, white, or yellowish pseudomembranes** on the conjunctiva, which are not seen here. - This is a rare form of chronic conjunctivitis often associated with **plasminogen deficiency**. *Angular conjunctivitis* - Primarily caused by **_Moraxella lacunata_** and is characterized by chronic conjunctival inflammation predominantly affecting the **outer canthi** (angles of the eye). - It typically presents with localized redness, soreness, and maceration of the skin at the **lateral canthi**, and not the diffuse papillary hypertrophy seen in the image. *Parinaud's conjunctivitis* - A rare unilateral conjunctivitis associated with **lymphadenopathy** caused by various infections, most commonly **cat-scratch disease** (_Bartonella henselae_). - It presents with **granulomas** and **follicles** on the conjunctiva, along with a prominent preauricular or submandibular lymph node, features not consistent with the image or symptoms.

Q: The image shown below depicts:

Pterygium. ***Pterygium*** - The image shows a **triangular growth of conjunctival tissue** extending onto the cornea, which is characteristic of a pterygium. - This growth typically involves **vascularization** and can eventually affect vision by encroaching on the pupillary area. *Bitot's spots* - These are **foamy, white, or silvery patches** on the conjunctiva, often associated with **vitamin A deficiency**. - They are distinct from the fleshy, vascularized growth seen in the image. *Nodular scleritis* - Nodular scleritis presents as a **painful, localized nodule** on the sclera, often red or bluish, due to inflammation of the sclera. - The lesion in the image is a **conjunctival and corneal growth**, not an inflamed scleral nodule. *Pinguecula* - A pinguecula is a **yellowish, benign growth** on the conjunctiva, usually on the nasal side, but it **does not extend onto the cornea**. - The image clearly shows the growth extending past the limbus onto the cornea, differentiating it from a pinguecula.

Q: A five-year-old child presents with recurrent episodes of thick, woody pseudomembranous growths on the conjunctiva that have been difficult to remove. Which condition is shown in the image below?

Ligneous conjunctivitis. ***Ligneous conjunctivitis*** - The image shows a **thick, woody, and pseudomembranous growth** on the conjunctiva, which is characteristic of ligneous conjunctivitis. - This condition is a rare form of chronic pseudomembranous conjunctivitis linked to a deficiency in **plasminogen**, leading to impaired fibrinolysis. *Adenovirus pseudomembrane* - While adenoviral conjunctivitis can cause pseudomembranes, they are typically **thinner** and more easily peelable than the thick, fibrin-rich lesions seen in the image. - Adenoviral infections are usually acute and self-limiting, whereas ligneous conjunctivitis tends to be **chronic and recurrent**. *Vernal conjunctivitis* - Vernal conjunctivitis is an **allergic condition** characterized by **cobblestone papillae** on the upper tarsal conjunctiva and **Trantas dots** at the limbus, which are not depicted in the image. - It often presents with intense itching and a ropy mucous discharge, distinct from the solid mass shown. *Foreign body granuloma* - A foreign body granuloma typically presents as a **localized, firm nodule** and is usually a reaction to a retained foreign material. - The diffuse, extensive, and often bilateral involvement of the conjunctiva as seen here is inconsistent with a typical foreign body granuloma.

Q: A 25-year-old lady presents with itching and excoriation of the skin near inner canthus bilaterally. Sometimes a slight mucopurulent discharge is present in the morning. What is the best treatment for this patient? (Recent NEET Pattern 2016-17)

Oxytetracycline with zinc oxide. ***Oxytetracycline with zinc oxide*** - The patient's symptoms of itching, excoriation near the inner canthus bilaterally, and mucopurulent discharge suggest an **angular blepharoconjunctivitis**, often caused by *Staphylococcus* or *Moraxella*. - **Oxytetracycline is an effective broad-spectrum antibiotic** against these organisms, and **zinc oxide has astringent and mild antiseptic properties** that help in drying out the moist excoriated skin and soothing irritation, making this combination ideal. *Gentamicin with boric acid* - **Gentamicin is an aminoglycoside antibiotic** that can be effective against certain bacterial infections, but it's not the **first-line choice for angular blepharoconjunctivitis** and can have higher rates of allergic reactions. - **Boric acid has weak antiseptic properties** but is generally less effective for the significant excoriation and discharge seen in angular blepharitis compared to zinc oxide. *Gentamicin with zinc oxide* - While **zinc oxide** is beneficial for the skin irritation, **gentamicin** may not be the most appropriate primary antibiotic for the causative organisms of angular blepharitis. - The efficacy against common pathogens of this condition might be superior with alternative antibiotics like tetracyclines. *Oxytetracycline with boric acid* - **Oxytetracycline is a good antibiotic choice** for angular blepharoconjunctivitis. - However, **boric acid is typically less effective than zinc oxide** for the specific excoriation and skin healing required in this condition, as zinc oxide provides better astringent and protective properties for inflamed skin.

Q: A patient presents with red eye. What is correct about the image shown below?

$X=$ Conjunctival congestion, $Y=$ Ciliary congestion. ***Correct: X = Conjunctival congestion, Y = Ciliary congestion*** - Image X demonstrates **conjunctival congestion**, characterized by dilated superficial blood vessels that are more prominent away from the limbus and **reddening in the fornices**, indicating a superficial inflammation like conjunctivitis. - Image Y shows **ciliary congestion (perilimbal injection)**, where prominent deep vessels form a reddish-purple ring around the limbus, suggesting deeper inflammation such as **uveitis, keratitis, or acute angle-closure glaucoma**. *Incorrect: X = Ciliary congestion, Y = Conjunctival congestion* - This option reverses the patterns of vascular dilation shown in images X and Y. - Ciliary congestion (Y) is characterized by a **violaceous flush around the cornea (limbus)**, while conjunctival congestion (X) shows **more diffuse redness that is worse in the fornices**. *Incorrect: X = Phlyctenular keratoconjunctivitis, Y = Angular conjunctivitis* - This option incorrectly identifies specific inflammatory conditions rather than the types of congestion shown. - **Phlyctenular keratoconjunctivitis** involves nodular lesions (phlyctenules) near the limbus, which are not depicted in image X. - **Angular conjunctivitis** causes redness and excoriation primarily at the outer and inner canthi, not the perilimbal pattern seen in image Y. *Incorrect: X = Angular conjunctivitis, Y = Phlyctenular keratoconjunctivitis* - This option reverses the incorrect attributions from the previous option. - Angular conjunctivitis affects the **canthi** (not the diffuse pattern in X), and phlyctenular keratoconjunctivitis involves **nodules on the conjunctiva or cornea** (not the circumcorneal congestion in Y).

Q: All are correct about the lesion shown except:

More common on temporal side as compared to nasal side. ***More common on temporal side as compared to nasal side*** - The image shows a **pterygium**, which is a fleshy, triangular growth of conjunctival tissue on the cornea. Pterygia are **more common on the nasal side** of the eye, typically growing from the nasal conjunctiva towards the cornea. - The statement claims it's more common on the temporal side, which is incorrect and therefore the exception. *Exposure to UV light is a risk factor* - **Chronic exposure to ultraviolet (UV) light** from sunlight is a well-established and major risk factor for the development and progression of pterygium. - This is why pterygium is more prevalent in individuals living in equatorial regions or those with outdoor occupations. *Probe cannot be passed beneath the neck* - A characteristic feature of a pterygium, differentiating it from a pseudopterygium, is that a **probe cannot be passed beneath its neck** (the corneal portion). - This indicates that the pterygium is firmly adherent to the corneal surface, representing an invasive growth. *Conjunctival limbal autograft has the least recurrence rate* - Surgical excision of a pterygium combined with a **conjunctival limbal autograft** (CLAG) is considered one of the most effective techniques to prevent recurrence. - The autograft tissue, containing limbal stem cells, helps repopulate the limbus and discourage further fibrovascular invasion onto the cornea, leading to a significantly lower recurrence rate compared to simple excision.

Question 1

A patient presents with chronic redness and discharge from the eye. The image shows the conjunctival findings. What is the most likely diagnosis?

Accepted Answer

Trachoma

Answer

Vernal conjunctivitis

Answer

Bacterial conjunctivitis

Answer

Phlyctenular keratoconjunctivitis

Question 2

A 22-year-old Air-force test pilot presents after flying a sortie. Eye examination shows:

Accepted Answer

Subconjunctival hemorrhage

Answer

Arcus senilis

Answer

Phlyctenular keratoconjunctivitis

Answer

Hypopyon

Question 3

What is correct about the image shown below?

Accepted Answer

Vernal conjunctivitis

Answer

Trachoma

Answer

Eales disease

Answer

Phlyctenular keratoconjunctivitis

Question 4

A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Trachoma

Answer

Vernal conjunctivitis

Answer

Eales disease

Answer

Phlyctenular keratoconjunctivitis

Question 5

A 5-year-old child presents with severe itching and ropy discharge. Image shows:

Accepted Answer

Vernal conjunctivitis

Answer

Ligneous conjunctivitis

Answer

Angular conjunctivitis

Answer

Parinaud's conjunctivitis

Question 6

The image shown below depicts:

Accepted Answer

Pterygium

Answer

Bitot's spots

Answer

Nodular scleritis

Answer

Pinguecula

Question 7

A five-year-old child presents with recurrent episodes of thick, woody pseudomembranous growths on the conjunctiva that have been difficult to remove. Which condition is shown in the image below?

Accepted Answer

Ligneous conjunctivitis

Answer

Adenovirus pseudomembrane

Answer

Vernal conjunctivitis

Answer

Foreign body granuloma

Question 8

A 25-year-old lady presents with itching and excoriation of the skin near inner canthus bilaterally. Sometimes a slight mucopurulent discharge is present in the morning. What is the best treatment for this patient? (Recent NEET Pattern 2016-17)

Accepted Answer

Oxytetracycline with zinc oxide

Answer

Gentamicin with boric acid

Answer

Gentamicin with zinc oxide

Answer

Oxytetracycline with boric acid

Question 9

A patient presents with red eye. What is correct about the image shown below?

Accepted Answer

$X=$ Conjunctival congestion, $Y=$ Ciliary congestion

Answer

$X=$ Ciliary congestion, $Y=$ Conjunctival congestion

Answer

$X=$ Phlyctenular keratoconjunctivitis, $Y=$ Angular conjunctivitis

Answer

$X=$ Angular conjunctivitis, $Y=$ Phlyctenular keratoconjunctivitis

Question 10

All are correct about the lesion shown except:

Accepted Answer

More common on temporal side as compared to nasal side

Answer

Exposure to UV light is a risk factor

Answer

Probe cannot be passed beneath the neck

Answer

Conjunctival limbal autograft has the least recurrence rate

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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