Diseases of the Conjunctiva Practice Questions

Q: Conjunctival mucosal overgrowth over the cornea is known as

Pterygium. ***Pterygium*** - A **pterygium** is a triangular growth of **conjunctival tissue** that extends from the conjunctiva onto the **cornea**. - It often develops on the nasal side of the eye and is associated with **UV exposure**. *Pinguecula* - A **pinguecula** is a yellowish, slightly raised thickening of the **conjunctiva** that does not extend onto the cornea. - It is a **degenerative condition** of the conjunctiva, often found interpalpebrally. *Vernal keratoconjunctivitis* - This is a **chronic, bilateral allergic inflammation** of the conjunctiva, often associated with seasonal allergies. - It is characterized by **large papillae** on the upper tarsal conjunctiva and can involve the cornea, but not as a growth of conjunctival tissue over it. *Herbert's pits* - **Herbert's pits** are characteristic scars found at the **limbus** after the resolution of **Trachoma**, specifically after the healing of limbal follicles. - They are depressions caused by follicular necrosis and do not represent conjunctival overgrowth.

Q: Which of the following indicates activity of anterior uveitis?

Cells in anterior chamber. ***Cells in anterior chamber*** - The presence of **inflammatory cells** (leukocytes) floating in the **aqueous humor** is a direct sign of active inflammation in the anterior uvea. - These cells cause the **Tyndall effect** (flare) when a slit lamp beam is passed through the anterior chamber, indicating active uveitis. *Circumcorneal congestion* - This is a symptom of **uveitis** but doesn't specifically indicate the *activity* of the inflammation. It's a general sign of inflammation in the anterior segment. - It results from dilation of the **perilimbal blood vessels**, which can persist even when the inflammation is subsiding. *Keratic precipitate* - These are **deposits of inflammatory cells** on the posterior corneal surface. While seen in uveitis, they represent the *sequelae* of inflammation rather than active, ongoing cellular activity in the aqueous. - They can be present even in quiescent phases of the disease, making them less indicative of current activity compared to live cells in the anterior chamber. *Corneal edema* - **Corneal edema** can occur in severe anterior uveitis but is not a primary indicator of active inflammation. It usually signifies compromise of the corneal endothelium due to prolonged or severe inflammation. - It is a less direct measure of the ongoing inflammatory process than the presence of cellular activity in the anterior chamber.

Q: Which of the following is a feature of vernal keratoconjunctivitis?

Papillary hypertrophy. ***Papillary hypertrophy*** - This is a hallmark feature of **vernal keratoconjunctivitis (VKC)**, particularly the presence of large, **cobblestone papillae** on the upper tarsal conjunctiva. - The papillary reaction is due to inflammation and infiltration of the conjunctival stroma with lymphocytes, plasma cells, and eosinophils, leading to raised bumps. - VKC is a chronic, bilateral allergic condition typically affecting children and young adults, with seasonal exacerbations. *Follicular hypertrophy* - **Follicular hypertrophy** is characterized by dome-shaped, avascular elevations formed by hyperplasia of lymphoid tissue, commonly seen in **viral conjunctivitis** and **chlamydial conjunctivitis**. - It is not typically seen in VKC, which is an allergic condition with a papillary rather than follicular response. *Pseudomembrane formation* - **Pseudomembrane formation** is a coagulum of inflammatory exudates and necrotic epithelial cells that loosely adheres to the conjunctiva and can be peeled off without bleeding, often seen in severe **adenoviral conjunctivitis**. - This feature is not characteristic of vernal keratoconjunctivitis. *Membrane formation* - **True membrane formation** involves a fibrinous exudate that is firmly adherent to the conjunctiva, and removal causes bleeding. It is seen in **bacterial conjunctivitis** (particularly diphtheria) and **Stevens-Johnson syndrome**. - Unlike papillary hypertrophy in VKC, membrane formation represents severe inflammatory or infectious processes.

Q: Arlt's line is seen in?

Trachoma. ***Trachoma*** - Arlt's line is a **subtarsal fibrous white line** seen on the upper tarsal conjunctiva, resulting from repeated episodes of inflammation and scarring in **trachoma**. - This scarring can lead to **entropion** and **trichiasis**, causing corneal abrasion and potential blindness. *Vernal catarrh* - Characterized by giant papillae (cobblestone papillae) on the upper tarsal conjunctiva and **Horner-Trantas dots** at the limbus. - It is an allergic condition, and while it causes conjunctival changes, it does not typically result in Arlt's line. *Allergic conjunctivitis* - Presents with itching, redness, tearing, and sometimes mild conjunctival swelling or papillae. - It is an acute or chronic allergic reaction and does not cause the specific scarring pattern known as Arlt's line. *Bacterial conjunctivitis* - Typically presents with **purulent discharge**, redness, and lid crusting. - While it causes acute inflammation, it usually resolves without the chronic scarring that leads to Arlt's line unless it is a severe, recurrent infection.

Q: Pterygium is

A fibrovascular growth. ***A fibrovascular growth*** - A pterygium is characterized by its **triangular shape** with the apex typically pointing towards the pupil, representing a growth of both fibrous tissue and blood vessels. - It arises from the **conjunctiva** and extends onto the **cornea**, which is its defining feature. - This describes **what it is** structurally—the most direct and specific answer to the question. *An infectious condition* - Pterygium is not caused by infectious agents like bacteria, viruses, or fungi. It is primarily linked to **chronic UV exposure** and environmental irritants. - While it can become secondarily inflamed, this is not due to an underlying infection. *A neoplastic condition* - A pterygium is a **benign growth** and is not cancerous or considered a neoplasm. - While it involves abnormal tissue proliferation, it does not have the invasive or metastatic potential characteristic of neoplastic conditions. *A degenerative condition of the conjunctiva* - While pterygium does involve **elastotic degeneration** of conjunctival collagen with UV-induced changes, this describes its **pathogenesis** (how it forms). - The question asks "what pterygium **is**" rather than its mechanism—the **fibrovascular growth** is the more complete structural definition. - Simply calling it degenerative doesn't capture the characteristic **extension onto the cornea**, which is pterygium's defining clinical feature.

Q: Ramu, a 10-year-old patient, presents with itching in his eye, foreign body sensation, and ropy discharge since several months, with symptoms more prominent in summer. What is the most probable diagnosis?

Vernal conjunctivitis. ***Vernal conjunctivitis*** - **Vernal conjunctivitis** (or allergic conjunctivitis) is characterized by **itching**, foreign body sensation, and a **ropy, tenacious discharge**, which are all present in Ramu's case. - The symptoms are typically **seasonal**, often worsening during warmer months (summer), matching the patient's presentation. *Fungal keratoconjunctivitis* - This condition often presents with a history of **ocular trauma** involving vegetable matter or contact lens use, which is not mentioned here. - Clinical signs typically include a **corneal ulcer**, often with feathery margins and satellite lesions, alongside eye discomfort, rather than predominantly ropy discharge and itching. *Viral conjunctivitis* - Viral conjunctivitis typically presents with **watery discharge**, conjunctival hyperemia, and often a history of an **upper respiratory tract infection**. - While it can cause foreign body sensation and redness, the prominent **ropiness of the discharge** and **seasonal recurrence** described are less characteristic of viral etiology. *Trachoma* - Trachoma is a chronic infectious eye disease caused by *Chlamydia trachomatis*, leading to severe scarring of the conjunctiva and can cause blindness. - It is often associated with poor hygiene and crowded living conditions, and typically presents with **conjunctival scarring**, **trichiasis**, and potentially corneal opacities, which differ from Ramu's chronic allergic presentation.

Q: Maxwell Lyon's sign is a feature of:

Allergic conjunctivitis. ***Allergic conjunctivitis*** - **Maxwell-Lyons sign** (also known as **Maxwell Lyon's sign**) refers to the presence of **shield-shaped or giant cobblestone papillae** on the **upper tarsal conjunctiva**, characteristic of **vernal keratoconjunctivitis (VKC)**. - VKC is a severe form of **chronic allergic conjunctivitis** primarily affecting young males in warm climates. - Other features of VKC include **Trantas' dots** (limbal collections of eosinophils), **Horner-Trantas dots**, thick ropy discharge, and corneal complications like shield ulcers. - This sign is indicative of a significant **allergic inflammatory reaction** in the eye. *Trachoma* - Trachoma is a **chronic follicular conjunctivitis** caused by *Chlamydia trachomatis* and is characterized by scarring and eventual blindness. - Key signs include **conjunctival scarring**, **Herbert's pits** (healed limbal follicles), **Arlt's line** (horizontal conjunctival scar), and **trichiasis**, not Maxwell-Lyons sign. *Acanthamoeba keratitis* - This is a rare but severe **corneal infection** associated with contact lens use, characterized by intense pain, a **ring infiltrate** in the cornea, and resistance to treatment. - It does not present with upper tarsal papillae or other signs of allergic conjunctivitis. *Epidemic keratoconjunctivitis* - Epidemic keratoconjunctivitis is a highly contagious **adenovirus infection** (serotypes 8, 19, 37) causing acute conjunctivitis with **subepithelial infiltrates** in the cornea. - It features **follicular conjunctivitis**, preauricular lymphadenopathy, and watery discharge, not giant papillae, as it is a viral, not an allergic, condition.

Q: A 12-year-old boy presents with recurrent attacks of conjunctivitis for the last 2 years, characterized by intense itching and ropy discharge. The diagnosis is likely to be:

Vernal conjunctivitis. ***Vernal conjunctivitis*** - **Vernal keratoconjunctivitis (VKC)**, commonly called **vernal conjunctivitis**, is a chronic, bilateral inflammation of the conjunctiva, most common in young boys, characterized by intense itching and thick, **ropy discharge**. - It is a **type 1 hypersensitivity reaction** and often exhibits seasonal recurrence, improving in colder months, which aligns with the "recurrent attacks for the last 2 years" given the patient's age. *Phlyctenular conjunctivitis* - **Phlyctenular conjunctivitis** is characterized by the formation of small, raised nodules (**phlyctenules**) on the conjunctiva or cornea, often associated with a delayed hypersensitivity response to bacterial antigens like **tuberculosis** or **Staphylococcus**. - It typically presents with **irritation**, **photophobia**, and **lacrimation**, but not the ropy discharge or predominant severe itching seen in this boy. *Viral conjunctivitis* - **Viral conjunctivitis** is highly contagious and often presents with **redness**, **watery discharge**, and sometimes an associated **upper respiratory infection**. - While it can cause itching and redness, the discharge is typically watery, not ropy, and the long-term recurrent nature with ropy discharge is less characteristic of viral etiologies. *Trachoma* - **Trachoma**, caused by **Chlamydia trachomatis**, is a chronic infectious eye disease leading to inflammation, follicular conjunctivitis, and ultimately scarring that can cause **blindness**. - It is prevalent in developing countries and typically presents with a mucopurulent discharge and characteristic follicles, but the intense itching and ropy discharge in a 12-year-old in a recurrent pattern are not its primary defining features.

Q: Which of the following is not true of acute conjunctivitis?

Topical antibiotics are the mainstay of treatment. ***Topical antibiotics are the mainstay of treatment*** - This is **NOT true** because **viral conjunctivitis** accounts for approximately **80% of acute conjunctivitis cases** and **does not respond to antibiotics**. - Most acute conjunctivitis is **self-limiting** and resolves spontaneously within 1-2 weeks. - **Bacterial conjunctivitis** may benefit from topical antibiotics, but they are not the "mainstay" since most cases are viral. - Treatment focus should be on supportive care, cool compresses, and artificial tears. *Vision is not affected* - This statement **is true**; acute conjunctivitis primarily affects the **conjunctiva** and typically **does not impair visual acuity**. - Vision remains **normal** in uncomplicated cases. - Any significant vision loss would suggest **keratitis**, **uveitis**, or other more serious conditions. *Corneal infiltration occurs* - This statement **is generally true** for certain types of viral conjunctivitis, particularly **epidemic keratoconjunctivitis (EKC)** caused by adenovirus. - **Subepithelial infiltrates** can develop in the cornea, especially 1-2 weeks after onset, causing decreased vision and foreign body sensation. - However, in simple acute bacterial conjunctivitis, corneal involvement is uncommon unless it progresses to keratoconjunctivitis. *Pupil remains unaffected* - This statement **is true**; the pupil's size and reactivity are governed by the iris and ciliary body, which are **not involved** in conjunctivitis. - Any pupillary abnormalities (irregular pupil, poor reaction) would indicate **anterior uveitis** or **intraocular inflammation**, not simple conjunctivitis.

Question 1

Conjunctival mucosal overgrowth over the cornea is known as

Accepted Answer

Pterygium

Answer

Vernal keratoconjunctivitis

Answer

Pinguecula

Answer

Herbert's pits

Question 2

Which of the following indicates activity of anterior uveitis?

Accepted Answer

Cells in anterior chamber

Answer

Circumcorneal congestion

Answer

Keratic precipitate

Answer

Corneal edema

Question 3

Which of the following is a feature of vernal keratoconjunctivitis?

Accepted Answer

Papillary hypertrophy

Answer

Follicular hypertrophy

Answer

Pseudomembrane formation

Answer

Membrane formation

Question 4

Arlt's line is seen in?

Accepted Answer

Trachoma

Answer

Bacterial conjunctivitis

Answer

Vernal catarrh

Answer

Allergic conjunctivitis

Question 5

Pterygium is

Accepted Answer

A fibrovascular growth

Answer

A neoplastic condition

Answer

An infectious condition

Answer

A degenerative condition of the conjunctiva

Question 6

Phlyctenular conjunctivitis is primarily associated with which of the following underlying causes?

Accepted Answer

Mycobacterium tuberculosis infection

Answer

Hypersensitivity to specific allergens

Answer

Staphylococcus aureus infection

Answer

Post viral infection

Question 7

Ramu, a 10-year-old patient, presents with itching in his eye, foreign body sensation, and ropy discharge since several months, with symptoms more prominent in summer. What is the most probable diagnosis?

Accepted Answer

Vernal conjunctivitis

Answer

Fungal keratoconjunctivitis

Answer

Viral conjunctivitis

Answer

Trachoma

Question 8

Maxwell Lyon's sign is a feature of:

Accepted Answer

Allergic conjunctivitis

Answer

Acanthamoeba keratitis

Answer

Trachoma

Answer

Epidemic keratoconjunctivitis

Question 9

A 12-year-old boy presents with recurrent attacks of conjunctivitis for the last 2 years, characterized by intense itching and ropy discharge. The diagnosis is likely to be:

Accepted Answer

Vernal conjunctivitis

Answer

Viral conjunctivitis

Answer

Phlyctenular conjunctivitis

Answer

Trachoma

Question 10

Which of the following is not true of acute conjunctivitis?

Accepted Answer

Topical antibiotics are the mainstay of treatment

Answer

Vision is not affected

Answer

Pupil remains unaffected

Answer

Corneal infiltration occurs

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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