Diseases of the Conjunctiva Practice Questions

Q: All of the following are causes of acute red eye EXCEPT:

Acute macular oedema. ***Acute macular oedema*** - **Macular edema** primarily affects **central vision** and does not typically cause the visible **redness** associated with acute inflammation of the ocular surface or anterior segment. - It involves **fluid accumulation** in the **macula** (the central part of the retina), which is a posterior segment issue and does not present as a red eye. *Conjunctivitis* - **Inflammation** of the **conjunctiva** (the membrane lining the eyelid and sclera) commonly leads to **vasodilatation** and **redness** of the eye. - Often accompanied by **discharge**, **itching**, or a **gritty sensation**. *Acute glaucoma* - An acute rise in **intraocular pressure** (IOP) can cause significant eye **redness** due to **conjunctival injection** and **ciliary flush**. - Other symptoms include **severe eye pain**, **blurred vision**, and **halos around lights**. *Keratitis* - **Inflammation** of the **cornea** typically results in marked **redness**, often with a **ciliary flush** (perilimbal injection) due to perilimbal vascular engorgement. - Associated with **eye pain**, **photophobia**, and potential **vision loss**.

Q: Which of the following is true about pterygium?

Conjunctival invasion making a flap over cornea. ***Conjunctival invasion making a flap over cornea*** - A **pterygium** is characterized by the growth of **fibrovascular tissue** from the conjunctiva onto the cornea. - This growth typically forms a **triangular flap**, with its apex extending towards the center of the corneal surface. *Fatty deposition of sclera* - This description is more indicative of **pinguecula**, which is a **yellowish, fatty deposit** on the conjunctiva, usually on the nasal side, but it does not invade the cornea. - Unlike pterygium, a **pinguecula** remains confined to the conjunctiva and does not grow across the limbus onto the cornea. *Inflammation of cornea* - While a pterygium can sometimes cause irritation or inflammation, its primary characteristic is a **degenerative growth of tissue**, not primarily an inflammatory condition of the cornea itself. - **Keratitis** refers to inflammation of the cornea, which can have various causes, but it is not the defining feature of pterygium. *Dead epithelial debris accumulation* - The accumulation of dead epithelial debris is not the principal histological feature of a pterygium. - Pterygium involves **hyperplasia of conjunctival epithelium** and **subepithelial fibrovascular tissue growth**, not merely dead cell accumulation.

Q: NOT a feature of trachoma:

Chalazion. ***Chalazion*** - A **chalazion** is a **lipogranulomatous inflammation** of a **meibomian gland** and is not directly caused by *Chlamydia trachomatis* infection, though chronic inflammation could theoretically predispose to it. - While chronic inflammation of the eyelids in trachoma can cause various complications, a chalazion is a distinct condition related to meibomian gland dysfunction and is not a direct, defining feature of trachoma. *Entropion* - **Entropion**, the **inward turning of the eyelid margin**, is a severe late complication of trachoma caused by conjunctival scarring and contraction. - This inward turning leads to **trichiasis** (**misdirected eyelashes**), which abrades the cornea. *Corneal opacity* - **Corneal opacity** is a common and serious consequence of chronic trachoma, resulting from repeated **corneal abrasions** by misdirected eyelashes (trichiasis) and chronic inflammation. - This scarring can lead to **severe vision impairment** and **blindness**. *Herbert's pits* - **Herbert's pits** are characteristic depressions on the **limbus** (corneoscleral junction) formed after the resolution of **limbal follicles** in chronic trachoma. - They are a diagnostic sign of past or present trachomatous infection.

Q: What is the causative agent of angular conjunctivitis?

Moraxella lacunata. ***Moraxella Lacunata*** - **_Moraxella lacunata_** is well-known as the primary cause of **angular conjunctivitis**, characterized by inflammation and maceration of the skin at the outer canthus of the eye. - This bacterium produces **proteolytic enzymes** that contribute to the tissue damage seen in the corners of the eye. *Gonococcus* - **_Neisseria gonorrhoeae_** typically causes **hyperacute purulent conjunctivitis**, often with severe discharge and rapid onset. - It is not commonly associated with angular conjunctivitis. *Moraxella catarrhalis* - **_Moraxella catarrhalis_** is a common cause of **otitis media** and **bronchitis**, and sometimes conjunctivitis, but it does not specifically cause angular conjunctivitis. - While a Moraxella species, it lacks the specific enzymes that cause the characteristic angular lesion. *Meningococcus* - **_Neisseria meningitidis_** can cause **meningitis** and, less commonly, severe **conjunctivitis**, which is usually purulent and acute. - It is rarely implicated in cases of angular conjunctivitis.

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: Regarding Chlamydia infection of the eyes, true statements include the following except:

Penicillin is the treatment. ***Penicillin is the treatment*** - **Penicillin** is ineffective against *Chlamydia trachomatis* because *Chlamydia* lacks a **peptidoglycan cell wall**, which is the target of penicillin. - The standard treatment for chlamydial infections, including ocular infections, involves **azithromycin** or **doxycycline**. *Inclusion conjunctivitis is an acute ocular infection caused by sexually transmitted C. trachomatis strains (usually serovars D through K)* - **Inclusion conjunctivitis** is indeed caused by sexually transmitted serovars of *Chlamydia trachomatis* (typically **D through K**). - It usually occurs in sexually active adults and can affect neonates through maternal transmission. *Can be cultured* - *Chlamydia* are **obligate intracellular bacteria**, meaning they can only replicate inside host cells. - While they can be grown in cell cultures, this is a specialized technique and not a typical method for routine diagnosis due to its complexity and time-consuming nature. *Acute inclusion conjunctivitis typically presents with mucopurulent discharge* - **Acute inclusion conjunctivitis** is characterized by a **mucopurulent discharge**, along with **follicular conjunctivitis** and sometimes **preauricular lymphadenopathy**. - This discharge results from the inflammatory response to the chlamydial infection in the conjunctiva.

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.

Question 1

All of the following are causes of acute red eye EXCEPT:

Accepted Answer

Acute macular oedema

Answer

Conjunctivitis

Answer

Acute glaucoma

Answer

Keratitis

Question 2

Which of the following is true about pterygium?

Accepted Answer

Conjunctival invasion making a flap over cornea

Answer

Fatty deposition of sclera

Answer

Inflammation of cornea

Answer

Dead epithelial debris accumulation

Question 3

NOT a feature of trachoma:

Accepted Answer

Chalazion

Answer

Entropion

Answer

Corneal opacity

Answer

Herbert's pits

Question 4

What is the causative agent of angular conjunctivitis?

Accepted Answer

Moraxella lacunata

Answer

Gonococcus

Answer

Moraxella catarrhalis

Answer

Meningococcus

Question 5

Treatment of gonococcal ophthalmia neonatorum does not include:

Accepted Answer

IV bacitracin

Answer

Topical bacitracin

Answer

Ceftriaxone IM

Answer

Topical atropine

Question 6

Regarding Chlamydia infection of the eyes, true statements include the following except:

Accepted Answer

Penicillin is the treatment

Answer

Inclusion conjunctivitis is an acute ocular infection caused by sexually transmitted C. trachomatis strains (usually serovars D through K)

Answer

Can be cultured

Answer

Acute inclusion conjunctivitis typically presents with mucopurulent discharge

Question 7

Not a feature of ligneous conjunctivitis:

Accepted Answer

Bacterial origin

Answer

Wood-like membranes

Answer

Plasminogen deficiency

Answer

Recurrent nature

Question 8

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 9

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 10

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

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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