Diseases of the Conjunctiva Practice Questions

Q: Inclusion conjunctivitis is caused by which of the following pathogens?

Chlamydia trachomatis. **Explanation:** **Chlamydia trachomatis (Option A)** is the correct answer. Inclusion conjunctivitis is a form of chlamydial conjunctivitis caused by **serotypes D through K**. It primarily presents in two forms: **Adult Inclusion Conjunctivitis (AIC)**, which is a sexually transmitted infection resulting in chronic follicular conjunctivitis, and **Neonatal Inclusion Conjunctivitis (Ophthalmia Neonatorum)**, which occurs 5–14 days after birth via transmission through an infected birth canal. **Why other options are incorrect:** * **Chlamydia psittaci (Option B):** This pathogen causes Psittacosis (parrot fever), a zoonotic respiratory infection. It is not a standard cause of human inclusion conjunctivitis. * **Herpes simplex virus (Option C):** HSV typically causes follicular conjunctivitis associated with dendritic keratitis or vesicular skin lesions, rather than the classic "inclusion" clinical picture. * **Neisseria gonorrhoeae (Option D):** This causes a hyperacute, purulent conjunctivitis characterized by profuse "creamy" discharge and a high risk of corneal perforation. In neonates, it appears much earlier (2–5 days) than Chlamydia. **High-Yield Clinical Pearls for NEET-PG:** * **Cytology:** The hallmark of Chlamydial infection is the presence of **Halberstaedter-Prowazek (HP) inclusion bodies** (intracytoplasmic) on Giemsa stain. * **Clinical Sign:** In adults, it presents as large, "soft" follicles, most prominent in the **inferior fornix**. * **Treatment:** The drug of choice for AIC is **Oral Azithromycin** (1g single dose) or Doxycycline. For neonates, **Oral Erythromycin** is used to prevent associated chlamydial pneumonia. * **Note:** Serotypes **A, B, Ba, and C** cause Trachoma, whereas **D–K** cause Inclusion Conjunctivitis.

Q: Which of the following are features of vernal keratoconjunctivitis?

Tantra's Spots. **Explanation:** **Vernal Keratoconjunctivitis (VKC)**, also known as "Spring Catarrh," is a bilateral, recurrent, external ocular inflammation primarily affecting young boys in hot, dry climates. It is a Type I and Type IV hypersensitivity reaction. **Why Option D is Correct:** **Trantas’ Spots** (also known as Horner-Trantas spots) are a hallmark clinical feature of the limbal or mixed form of VKC. They are small, white, elevated dots found at the limbus, consisting of **eosinophils and degenerated epithelial cells**. Their presence is highly diagnostic for active VKC. **Analysis of Incorrect Options:** * **A. Papillary hypertrophy:** While VKC is characterized by papillae (specifically large, "cobblestone" or "pavement stone" papillae on the superior tarsal conjunctiva), the question asks for a specific feature. In many exams, Trantas' spots are considered the more pathognomonic sign compared to generalized papillary hypertrophy, which can occur in other forms of conjunctivitis. * **B. Follicular hypertrophy:** This is characteristic of **Viral** or **Chlamydial** conjunctivitis. VKC is a papillary disease, not a follicular one. * **C. Herbert's pits:** These are scarred, depressed remnants of limbal follicles and are pathognomonic for **Trachoma** (Stage IV), not VKC. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in males aged 5–15 years. * **Symptoms:** Intense itching (hallmark), ropy discharge, and photophobia. * **Corneal Involvement:** Look for **Shield Ulcers** (sterile, indolent) and **Maxwell-Lyons sign** (ropy discharge). * **Treatment:** Mast cell stabilizers (Prophylaxis), Topical Steroids (Acute phase), and Cyclosporine/Tacrolimus for steroid-sparing effects.

Q: Which of the following are features of vernal keratoconjunctivitis?

Tantra's Spot. **Explanation:** **Vernal Keratoconjunctivitis (VKC)**, also known as "Spring Catarrh," is a bilateral, recurrent, external ocular inflammation primarily affecting young boys in hot, dry climates. It is a Type I and Type IV hypersensitivity reaction. **Why Option D is Correct:** **Trantas’ Spots** (often referred to as Horner-Trantas spots) are a hallmark clinical feature of the limbal variant of VKC. They are small, white, elevated dots found at the limbus, consisting of degenerated epithelial cells and **eosinophils**. Their presence is highly diagnostic for active VKC. **Analysis of Incorrect Options:** * **A. Papillary hypertrophy:** While VKC is characterized by papillae (specifically large "cobblestone" or "pavement stone" papillae on the upper tarsal conjunctiva), the question asks for a specific feature. In many contexts, Trantas' spots are considered more pathognomonic for the limbal form. * **B. Follicular hypertrophy:** Follicles are typical of **Viral** or **Chlamydial** conjunctivitis. VKC is a papillary disease, not a follicular one. * **C. Herbert’s pits:** These are scarred-down remnants of limbal follicles found specifically in **Trachoma**. They are not associated with allergic conjunctivitis. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in males (4:1 ratio), aged 5–15 years. * **Symptoms:** Intense itching (hallmark), ropy discharge, and photophobia. * **Shield Ulcer:** A sterile, transverse oval corneal ulcer found in the upper half of the cornea in severe VKC cases. * **Maxwell-Lyons Sign:** A thin film of fibrin (pseudomembrane) covering the giant papillae. * **Cytology:** Conjunctival scraping will show an abundance of **eosinophils**.

Q: The finding seen in the image is:

Herbert's pits. ***Herbert's pits*** - These are pathognomonic signs of **cicatricial trachoma**, representing shallow, depressed scars located at the superior corneoscleral junction (limbus). - They are formed by the resolution and scarring of **limbal follicles**, which are characteristic of the active inflammatory stage of trachoma. *Horner-Trantas spots* - These are small, white, gelatinous nodules seen at the limbus, composed of degenerated eosinophils and epithelial cells. - They are a characteristic finding in **vernal keratoconjunctivitis (VKC)**, an allergic eye condition, and are not seen in trachoma. *Pannus* - Pannus refers to the growth of fibrovascular tissue from the limbus onto the peripheral cornea. - While a **superior pannus** is a common finding in trachoma, the specific depressions shown in the image are Herbert's pits, not the pannus itself. *Arlt's line* - This is a horizontal line of scar tissue found on the **tarsal conjunctiva** of the upper eyelid. - It is another sign of cicatricial trachoma but is located on the inner surface of the eyelid, not at the limbus as seen in the image.

Q: A young person with recurrent seasonal conjunctivitis presents with itchiness and eye-watering. What is the most likely cell involved in the immediate phase of this condition?

Mast cells. ***Mast cells*** - Seasonal allergic conjunctivitis is a classic Type I **hypersensitivity** reaction (IgE-mediated). The immediate phase is mediated by the degranulation of **mast cells** resident in the conjunctiva. - Upon allergen exposure, cross-linking of surface-bound IgE causes mast cells to release potent preformed mediators, notably **histamine**, which directly causes the immediate onset of **pruritus** (itchiness) and vascular leakage (watering).*Eosinophils* - Eosinophils are primarily associated with the **late-phase** allergic response, recruited to the site hours after the initial reaction. - They contribute to chronic inflammation and tissue damage by releasing major basic protein and other toxic mediators.*Neutrophils* - Neutrophils are the hallmark of **acute inflammation** and are typically abundant in **bacterial infections**, which is not the primary mechanism of this seasonal condition. - While present in some inflammatory states, they are not the primary effector cell governing the immediate symptoms of Type I hypersensitivity.*Lymphocyte* - Lymphocytes, particularly T helper type 2 (Th2) cells, are crucial for promoting the B cell synthesis of **IgE** (sensitization phase). - They drive the overall adaptive immune response but do not mediate the rapid, immediate release of mediators responsible for the acute symptoms.

Q: Acute hemorrhagic conjunctivitis is caused by which of the following combinations?

Coxsackie A and Enterovirus 70. ### **Explanation: Acute Hemorrhagic Conjunctivitis (AHC)** **Acute Hemorrhagic Conjunctivitis (AHC)** is a highly contagious, self-limiting viral infection characterized by rapid onset, lid edema, and pathognomonic **subconjunctival hemorrhages**. #### **1. Why Option A is Correct** The primary etiological agents for AHC are **Enterovirus 70 (EV-70)** and **Coxsackievirus A24 (CA24)** variant. These are small RNA viruses belonging to the *Picornaviridae* family. * **Enterovirus 70** was the first identified cause during the 1969 pandemic. * **Coxsackie A24** is responsible for several subsequent large-scale outbreaks worldwide. #### **2. Why Other Options are Incorrect** * **Options B, C, and D:** These include **Coxsackie B**. While Coxsackievirus B is a common cause of myocarditis, pleurodynia (Bornholm disease), and meningitis, it is **not** a recognized cause of acute hemorrhagic conjunctivitis. The ocular tropism is specific to the **A24 variant** of Coxsackie A. --- ### **High-Yield Clinical Pearls for NEET-PG / INI-CET** * **Incubation Period:** Extremely short, typically **12 to 48 hours**. * **Clinical Hallmark:** Multiple **petechial hemorrhages** on the bulbar conjunctiva that may coalesce to form a large subconjunctival hemorrhage. * **Neurological Association:** A rare but serious complication of **Enterovirus 70** is a **polio-like paralysis** (radiculomyelitis), which can occur several weeks after the conjunctivitis resolves. * **Differential Diagnosis:** * **Epidemic Keratoconjunctivitis (EKC):** Caused by **Adenovirus (Serotypes 8, 19, 37)**. It presents with prominent pseudomembranes and corneal involvement (subepithelial infiltrates) but less frequent hemorrhage compared to AHC. * **Management:** Supportive treatment only (cold compresses, lubricants); antibiotics are used only to prevent secondary bacterial infection.

Q: A 25 -year-old patient presents with localized redness in right eye as shown below. On instillation of 10% phenylephrine there is quick blanching of the vessels. What is the diagnosis?

Nodular episcleritis. **Correct: Nodular episcleritis** - The image shows **localized redness** and congestion of the episcleral vessels, which **blanch with 10% phenylephrine**, indicating superficial involvement of the episclera. - This presentation, particularly the blanching with phenylephrine, is classic for **episcleritis**, and the localized, raised appearance suggests a nodular form. - The **phenylephrine blanching test** is the key diagnostic feature that distinguishes episcleritis from deeper scleral inflammation. *Incorrect: Angular conjunctivitis* - This typically presents with **redness and irritation** localized to the **canthi** (corners) of the eye, often associated with crusty discharge. - While it causes redness, it doesn't usually form a distinct nodule and its vessels generally do not respond as dramatically to phenylephrine as episcleral vessels. *Incorrect: Nodular scleritis* - Scleritis involves the **deeper scleral layer**, causing **severe pain** and often a **violaceous hue** to the redness, which **does not blanch with 10% phenylephrine**. - This is the most important differential diagnosis; the positive phenylephrine blanching test rules out scleritis. - It is a more serious condition than episcleritis and typically requires systemic treatment. *Incorrect: Scleromalacia perforans* - This is a **rare, severe form of necrotizing scleritis without inflammation**, predominantly seen in patients with **long-standing rheumatoid arthritis**. - It involves gradual thinning and disappearance of scleral tissue, leading to exposure of the underlying uvea, which is not consistent with the acute, localized redness shown in the image.

Q: What is the diagnosis shown in the image?

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image shows a **thick, ropy white discharge** (mucus plaque) on the lower conjunctiva, which is a classic sign of **vernal keratoconjunctivitis (VKC)**. - VKC is a chronic, bilateral allergic inflammatory disease, more common in young males, presenting with severe itching, photophobia, and the characteristic discharge as seen here, often associated with a **cobblestone appearance** of the upper tarsal conjunctiva. *Trachoma* - Trachoma is characterized by conjunctival inflammation, leading to **follicle formation** on the upper tarsal conjunctiva and later scarring (Arlt's line) and inversion of the eyelids (**trichiasis**). - The discharge in trachoma is typically mucopurulent, but not the thick, ropy white plaque seen in the image. *Atopic keratoconjunctivitis* - Atopic keratoconjunctivitis (AKC) is a chronic allergic inflammation that typically affects **older patients with a history of atopic dermatitis**. - While AKC can present with mucoid discharge and papillary changes, it is more commonly associated with **lower tarsal involvement**, lid margin inflammation, and occurs in an older age group compared to VKC. *Phlyctenular keratoconjunctivitis* - Phlyctenular keratoconjunctivitis is characterized by the appearance of small, localized, **nodular lesions (phlyctenules)** on the conjunctiva or cornea, often associated with delayed-type hypersensitivity reactions to bacterial antigens (e.g., Mycobacterium tuberculosis, Staphylococcus aureus). - While it involves conjunctival inflammation, it typically does not present with the thick, ropy mucus plaques characteristic of VKC.

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.

Question 1

Regarding spring catarrh, all of the following are true, except:

Accepted Answer

Limbus conjunctival thickening

Answer

Cobblestone appearance of conjunctiva

Answer

Common in spring months

Answer

Sodium cromoglycate is a form of therapy

Question 2

Inclusion conjunctivitis is caused by which of the following pathogens?

Accepted Answer

Chlamydia trachomatis

Answer

Chlamydia psittaci

Answer

Herpes simplex virus

Answer

Neisseria gonorrhoeae

Question 3

Which of the following are features of vernal keratoconjunctivitis?

Accepted Answer

Tantra's Spots

Answer

Papillary hypertrophy

Answer

Follicular hypertrophy

Answer

Herbert's pits

Question 4

Which of the following are features of vernal keratoconjunctivitis?

Accepted Answer

Tantra's Spot

Answer

Papillary hypertrophy

Answer

Follicular hypertrophy

Answer

Herbert's pits

Question 5

The finding seen in the image is:

Accepted Answer

Herbert's pits

Answer

Arlt's line

Answer

Pannus

Answer

Horner-Trantas spots

Question 6

A young person with recurrent seasonal conjunctivitis presents with itchiness and eye-watering. What is the most likely cell involved in the immediate phase of this condition?

Accepted Answer

Mast cells

Answer

Eosinophils

Answer

Neutrophils

Answer

Lymphocyte

Question 7

Acute hemorrhagic conjunctivitis is caused by which of the following combinations?

Accepted Answer

Coxsackie A and Enterovirus 70

Answer

Coxsackie B and Enterovirus 70

Answer

Coxsackie A, Coxsackie B and Enterovirus 70

Answer

Coxsackie A and Coxsackie B

Question 8

A 25 -year-old patient presents with localized redness in right eye as shown below. On instillation of 10% phenylephrine there is quick blanching of the vessels. What is the diagnosis?

Accepted Answer

Nodular episcleritis

Answer

Angular conjunctivitis

Answer

Nodular scleritis

Answer

Scleromalacia perforans

Question 9

What is the diagnosis shown in the image?

Accepted Answer

Vernal conjunctivitis

Answer

Trachoma

Answer

Phlyctenular keratoconjunctivitis

Answer

Atopic keratoconjunctivitis

Question 10

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

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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