Diseases of the Conjunctiva Practice Questions

Q: Gold standard procedure to reduce recurrence of pterygium after surgical excision is

Conjunctival autograft. ***Conjunctival autograft*** - **Conjunctival autografting** involves transplanting a piece of healthy conjunctiva from the superior bulbar conjunctiva to the bare scleral bed after pterygium excision, acting as a barrier to fibrovascular proliferation. - This technique has consistently shown the **lowest recurrence rates** in comparative studies, making it the **gold standard** for preventing pterygium recurrence due to its high success rate and safety profile. *Thiotepa* - **Thiotepa** is an **antimetabolite** that inhibits DNA synthesis and cell proliferation, used topically post-excision to reduce recurrence by suppressing fibroblast activity. - While it can lower recurrence rates compared to simple excision, its efficacy is generally **less than conjunctival autografting**, and it carries risks of corneal toxicity and limbal stem cell deficiency. *Amniotic membrane grafting* - **Amniotic membrane grafting** involves placing processed amniotic membrane over the scleral bed, which has anti-inflammatory, anti-scarring, and pro-epithelialization properties. - It is an effective option, especially for **large pterygia** or for patients at high risk of recurrence, but its recurrence rates are generally **not as low as those achieved with conjunctival autografting**, and the graft can sometimes detach. *B- radiation* - **Beta-radiation** (strontium-90) is a form of adjuvant therapy applied to the scleral bed immediately after pterygium excision to inhibit fibroblast proliferation and reduce recurrence. - It is effective but associated with potential complications such as **scleral melt**, corneal scarring, and cataract formation, making it a less preferred option than conjunctival autografting, especially in primary cases.

Q: Treatment of gonococcal ophthalmia neonatorum does not include:

IV bacitracin. ***IV bacitracin*** - **Bacitracin is NEVER administered intravenously** due to significant nephrotoxicity risk. - It has **no role** in the treatment of gonococcal ophthalmia neonatorum, neither systemically nor as standard topical therapy. - This is the **correct answer** to what is NOT included in treatment. *Topical bacitracin* - While topical bacitracin **can be used as adjunct therapy** in neonatal conjunctivitis, it is not the primary or preferred topical agent. - Standard topical therapy typically uses **erythromycin or tetracycline ointment** rather than bacitracin. - However, it may still be employed in some treatment protocols, making it part of potential treatment options. *Ceftriaxone IM* - **Ceftriaxone 50 mg/kg IM (maximum 125 mg) as a single dose** is the **first-line systemic treatment** for gonococcal ophthalmia neonatorum. - This provides adequate bactericidal levels against *Neisseria gonorrhoeae* and prevents complications including corneal perforation and systemic dissemination. - This is **definitely included** in standard treatment protocols. *Topical atropine* - **Atropine** is a cycloplegic agent with **no antibacterial activity**. - It is NOT part of the standard treatment protocol for gonococcal ophthalmia neonatorum. - While it might be considered if severe iritis develops as a complication, it is not a routine component of treatment.

Q: A 22-year-old Air-force test pilot presents after flying a sortie. He reports no pain or vision changes. Eye examination reveals a localized red patch on the sclera. What is the most likely diagnosis?

Subconjunctival hemorrhage. ***Subconjunctival hemorrhage*** - A **localized red patch on the sclera** with no pain or vision changes, especially after activities that can increase venous pressure (like flying a sortie or straining), is characteristic of a **subconjunctival hemorrhage**. - It results from the rupture of small blood vessels beneath the conjunctiva, causing blood to pool. *Hyphema* - This involves blood in the **anterior chamber of the eye**, usually visible as a fluid level and often causing pain or blurred vision. - It typically results from **trauma** and is not described as a localized red patch on the sclera. *Keratitis* - **Keratitis** is inflammation of the cornea, causing pain, redness, photophobia, and often blurred vision. - The patient has no pain or vision changes, and the presentation is a localized scleral patch, not diffuse corneal involvement. *Allergic conjunctivitis* - Presents with **redness**, itching, tearing, and often bilateral involvement, sometimes with discharge. - The description of a solitary, localized red patch without other allergic symptoms makes this diagnosis unlikely.

Q: Not a feature of ligneous conjunctivitis:

Bacterial origin. ***Bacterial origin*** - Ligneous conjunctivitis is a rare genetic disorder caused by a **plasminogen deficiency**, not a bacterial infection. - The membranes are formed by the deposition of **fibrin** due to impaired fibrinolysis. *Wood-like membranes* - This is a hallmark feature of ligneous conjunctivitis, describing the **firm, thick, and confluent pseudomembranes** that develop on the conjunctiva. - These membranes are due to excessive **fibrin deposition** that cannot be effectively cleared. *Plasminogen deficiency* - Ligneous conjunctivitis is associated with a **genetic defect in plasminogen**, an enzyme crucial for fibrinolysis. - The deficiency leads to the impaired breakdown of fibrin, resulting in the characteristic membranes. *Recurrent nature* - The disease is known for its **recurrent formation of membranes**, even after surgical removal. - This recurrence is due to the underlying persistent **plasminogen deficiency**.

Q: A 25-year-old male presents with recurrent bilateral conjunctival hyperemia and a gritty sensation. Likely diagnosis?

Vernal keratoconjunctivitis. ***Vernal keratoconjunctivitis*** * This is the correct diagnosis as it perfectly matches the clinical presentation: **young male patient** (VKC has male predominance, especially in adolescents/young adults), **recurrent course** (VKC is a chronic allergic condition with seasonal exacerbations), and **bilateral involvement** with gritty sensation. * VKC is a **severe form of allergic conjunctivitis** characterized by **bilateral conjunctival hyperemia**, intense itching, gritty sensation, photophobia, and mucoid discharge. The recurrent bilateral nature in a young male is pathognomonic. *Herpes keratitis* * Usually presents as **unilateral eye pain**, redness, and a characteristic **dendritic ulcer** on the cornea (seen with fluorescein staining), which is not described here. * Caused by herpes simplex virus and typically has an acute presentation rather than recurrent bilateral conjunctival symptoms. Can lead to significant vision loss if untreated. *Episcleritis* * Characterized by **localized sectorial redness** in one eye, often in a radial pattern, and is usually **mild and self-limiting**. * Typically causes minimal discomfort and does not commonly present with gritty sensation or recurrent bilateral involvement as the primary feature. *Bacterial conjunctivitis* * Typically presents with **purulent discharge** (thick yellow-green pus) and matting of eyelids, which is not mentioned in this patient's symptoms. * While it causes redness and grittiness, it's usually **acute and unilateral or sequential bilateral** (one eye then the other), and resolves with topical antibiotics within days, unlike the recurrent chronic nature described here.

Q: Which of the following findings is typically NOT seen in a patient with allergic conjunctivitis?

Purulent discharge. ***Purulent discharge*** - **Purulent discharge** (thick, yellowish, or greenish) is characteristic of **bacterial conjunctivitis** and is usually absent in allergic conjunctivitis. - Allergic conjunctivitis typically presents with a **clear or watery discharge**. *Watery discharge* - **Watery discharge** is a very common symptom of **allergic conjunctivitis**, often accompanied by itching and redness. - It results from the inflammatory response and increased lacrimation due to allergen exposure. *Itching* - **Ocular itching** is the hallmark symptom of allergic conjunctivitis and is considered its most distinctive feature. - It is caused by the release of **histamine** and other inflammatory mediators from mast cells in response to allergens. *Bilateral eye redness* - **Bilateral conjunctival redness** (hyperemia) is a frequent finding in allergic conjunctivitis. - This is due to **vasodilation** in response to the inflammatory process affecting both eyes, as airborne allergens often affect both simultaneously.

Q: A 25-year-old female presents with bilateral eye redness, a burning sensation, and dry eyes. The Schirmer test shows reduced tear production. What is the most likely diagnosis?

Dry eye syndrome. ***Dry eye syndrome*** - The combination of **bilateral eye redness**, **burning sensation**, **dry eyes**, and **reduced tear production** on the **Schirmer test** are classic symptoms of dry eye syndrome. - This condition results from insufficient tear quantity or quality, leading to ocular surface irritation. *Allergic conjunctivitis* - While it causes **red eyes** and **burning**, it is typically associated with **itching**, which is not mentioned in the presentation. - Reduced tear production is not a primary feature; instead, there may be increased watery discharge. *Blepharitis* - This condition involves inflammation of the **eyelid margins** and is characterized by crusting, irritation, and sometimes dryness due to dysfunction of the meibomian glands. - While a burning sensation can occur, the primary finding of **reduced tear production** on the **Schirmer test** points away from isolated blepharitis. *Episcleritis* - Characterized by **localized redness** and discomfort, but typically does not involve a burning sensation or generalized dryness. - There is no reduction in tear production associated with episcleritis.

Q: A 10-year-old boy presents with itching, redness, and tearing in his eyes, particularly during spring. What is the most likely diagnosis?

Vernal keratoconjunctivitis. ***Vernal keratoconjunctivitis*** - This condition characteristically presents in **children and young adults**, often with a seasonal recurrence (spring) and symptoms of **itching, redness, and tearing**. - It is a severe form of **allergic conjunctivitis** with hallmark signs including **Trantas dots** (white limbal dots) and **cobblestone papillae** on the upper tarsal conjunctiva. *Bacterial conjunctivitis* - Typically presents with a **purulent discharge**, matting of the eyelids (especially in the morning), and is usually not seasonal. - It is often associated with a **bacterial infection**, rather than an allergic response. *Acute iritis* - Manifests with **eye pain, photophobia**, and circumcorneal redness, but typically without the marked **itching** or seasonal recurrence seen here. - It involves inflammation of the **iris and ciliary body**, distinguishable from conjunctival inflammation. *Dry eye syndrome* - Characterized by a gritty sensation, burning, and sometimes paradoxical tearing, but it is less common in childhood and usually lacks the prominent **itching** and strong seasonal component. - This condition is due to inadequate tear production or excessive tear evaporation, not an allergic response.

Q: Which medication is commonly used to treat bacterial conjunctivitis?

Moxifloxacin. ***Moxifloxacin*** - **Moxifloxacin** is a **fourth-generation fluoroquinolone** antibiotic, effective against a broad spectrum of bacteria, including common conjunctivitis pathogens. - It is often prescribed as **ophthalmic drops** for bacterial conjunctivitis due to its good penetration and efficacy. *Acyclovir* - **Acyclovir** is an **antiviral agent** primarily used to treat infections caused by the **herpes simplex virus (HSV)** and **varicella-zoster virus (VZV)**, not bacteria. - It would be indicated for **herpetic keratitis** or **zoster ophthalmicus**, not bacterial conjunctivitis. *Prednisolone* - **Prednisolone** is a **corticosteroid** used to reduce inflammation; it does not have antibacterial properties. - While it can alleviate inflammation, using it alone for bacterial conjunctivitis can worsen the infection by suppressing the immune response. *Timolol* - **Timolol** is a **beta-blocker** primarily used to treat **glaucoma** by reducing intraocular pressure. - It has no role in treating infections such as bacterial conjunctivitis.

Q: Which of the following statements about conjunctival lesions is NOT true?

Surgery is treatment of choice. ***Surgery is treatment of choice*** - While surgery can be used to treat conjunctival lesions, it is not always the **treatment of choice**, especially for smaller, asymptomatic lesions like **pinguecula** which may only require observation and lubrication. - Many conjunctival lesions, such as uncomplicated **pterygium** or **pinguecula**, are managed conservatively unless they cause significant symptoms, vision impairment, or cosmetic concerns. *Arise from any part of conjunctiva* - **Conjunctival lesions** can indeed arise from various parts of the conjunctiva, including the palpebral, bulbar, and forniceal conjunctiva. - For example, **pterygium** typically arises from the bulbar conjunctiva, while **pinguecula** also originates in the bulbar conjunctiva, specifically in the interpalpebral fissure. *Can cause Astigmatism* - Larger **conjunctival lesions**, particularly a **pterygium** that encroaches onto the cornea, can induce or alter astigmatism. - The growth of the lesion can change the **curvature of the cornea**, leading to optical distortion and astigmatism. *UV exposure is risk factor* - **Ultraviolet (UV) light exposure** is a well-established risk factor for the development of many conjunctival lesions, including **pterygium** and **pinguecula**. - Chronic UV exposure leads to **elastotic degeneration** of the conjunctival collagen and is thought to play a key role in the pathogenesis of these growths.

Question 1

Gold standard procedure to reduce recurrence of pterygium after surgical excision is

Accepted Answer

Conjunctival autograft

Answer

Thiotepa

Answer

Amniotic membrane grafting

Answer

Beta-radiation

Question 2

Treatment of gonococcal ophthalmia neonatorum does not include:

Accepted Answer

IV bacitracin

Answer

Topical bacitracin

Answer

Ceftriaxone IM

Answer

Topical atropine

Question 3

A 22-year-old Air-force test pilot presents after flying a sortie. He reports no pain or vision changes. Eye examination reveals a localized red patch on the sclera. What is the most likely diagnosis?

Accepted Answer

Subconjunctival hemorrhage

Answer

Hyphema

Answer

Keratitis

Answer

Allergic conjunctivitis

Question 4

Not a feature of ligneous conjunctivitis:

Accepted Answer

Bacterial origin

Answer

Wood-like membranes

Answer

Plasminogen deficiency

Answer

Recurrent nature

Question 5

A 25-year-old male presents with recurrent bilateral conjunctival hyperemia and a gritty sensation. Likely diagnosis?

Accepted Answer

Vernal keratoconjunctivitis

Answer

Herpes keratitis

Answer

Episcleritis

Answer

Bacterial conjunctivitis

Question 6

Which of the following findings is typically NOT seen in a patient with allergic conjunctivitis?

Accepted Answer

Purulent discharge

Answer

Watery discharge

Answer

Itching

Answer

Bilateral eye redness

Question 7

A 25-year-old female presents with bilateral eye redness, a burning sensation, and dry eyes. The Schirmer test shows reduced tear production. What is the most likely diagnosis?

Accepted Answer

Dry eye syndrome

Answer

Allergic conjunctivitis

Answer

Blepharitis

Answer

Episcleritis

Question 8

A 10-year-old boy presents with itching, redness, and tearing in his eyes, particularly during spring. What is the most likely diagnosis?

Accepted Answer

Vernal keratoconjunctivitis

Answer

Bacterial conjunctivitis

Answer

Acute iritis

Answer

Dry eye syndrome

Question 9

Which medication is commonly used to treat bacterial conjunctivitis?

Accepted Answer

Moxifloxacin

Answer

Acyclovir

Answer

Prednisolone

Answer

Timolol

Question 10

Which of the following statements about conjunctival lesions is NOT true?

Accepted Answer

Surgery is treatment of choice

Answer

Arise from any part of conjunctiva

Answer

Can cause Astigmatism

Answer

UV exposure is risk factor

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

On this page

Practice by Chapter

Want unlimited practice?