Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva Indian Medical PG Practice Questions and MCQs

Question 291: Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

A. Staphylococcus (Correct Answer)
B. Chlamydia
C. Pneumococcus
D. Aspergillus

Explanation: ***Staphylococcus*** - **Phlyctenular conjunctivitis** is characterized by delayed (Type IV) hypersensitivity reactions to bacterial antigens, most commonly from **Staphylococcus aureus**. - This condition often presents with small, nodular lesions (phlyctenules) on the conjunctiva or cornea, which are essentially collections of inflammatory cells responding to bacterial proteins. - **Important note**: **Mycobacterium tuberculosis** is another well-documented cause of phlyctenular conjunctivitis, particularly in TB-endemic regions, and should be considered in the differential diagnosis. - Other triggers include protein antigens from organisms colonizing the ocular surface. *Chlamydia* - While **Chlamydia trachomatis** can cause chronic conjunctivitis (e.g., trachoma, adult inclusion conjunctivitis), it does not typically lead to the distinct nodular lesions seen in phlyctenular conjunctivitis. - Ocular chlamydial infections are primarily characterized by follicular conjunctivitis and pannus formation. *Pneumococcus* - **Streptococcus pneumoniae** (Pneumococcus) is a common cause of acute bacterial conjunctivitis, characterized by purulent discharge and redness. - However, it is not associated with the specific delayed hypersensitivity reaction that defines phlyctenular conjunctivitis. *Aspergillus* - **Aspergillus** species are fungi and are more commonly implicated in fungal keratitis or allergic bronchopulmonary aspergillosis, particularly in immunocompromised individuals. - Fungal infections of the conjunctiva are rare and do not typically manifest as phlyctenular conjunctivitis.

Question 292: All statements are true about trachoma except:

A. Strains mainly responsible are A, B, Ba and C
B. Trachoma is caused by bedsonian organism of psittacosis - lymphogranuloma - trachoma (PLT) group.
C. Marked papillary hyperplasia with limbal follicles are seen in stage III (Correct Answer)
D. Corneal ulceration is a complication

Explanation: ***Marked papillary hyperplasia with limbal follicles are seen in stage III*** - This statement is **INCORRECT** and is the exception being sought. - In trachoma staging (MacCallan classification), **Stage III** is characterized by **mature follicles and papillary hypertrophy**, but limbal follicles are not specifically a defining feature of Stage III. - **Limbal follicles** (Herbert's pits when they heal) can occur in trachoma but are not the hallmark of Stage III specifically. - The classic stages focus on conjunctival follicles and papillae, not specifically limbal follicles as a Stage III feature. *Trachoma is caused by bedsonian organism of psittacosis - lymphogranuloma - trachoma (PLT) group* - This statement is **TRUE**. Trachoma is caused by *Chlamydia trachomatis*, which historically was classified as a Bedsonian organism. - The PLT group (Psittacosis-Lymphogranuloma venereum-Trachoma) was an early classification for obligate intracellular bacteria including Chlamydia species. *Strains mainly responsible are A, B, Ba and C* - This statement is **TRUE**. Trachoma is caused by serovars A, B, Ba, and C of *Chlamydia trachomatis*. - These serovars are distinct from those causing other chlamydial infections (D-K for urogenital infections, L1-L3 for lymphogranuloma venereum). *Corneal ulceration is a complication* - This statement is **TRUE**. Corneal ulceration can occur as a complication of trachoma. - Chronic inflammation, scarring, entropion, and trichiasis lead to corneal abrasion and potential ulceration in severe cases.

Question 293: Cicatrising trachoma is associated with which stage of the disease?

A. Stage-1
B. Stage-2
C. Stage-3 (Correct Answer)
D. Stage-4

Explanation: ***Stage-3*** - **Cicatrising trachoma** corresponds to Stage 3 of the WHO classification for trachoma, characterized by scarring of the conjunctiva. - This stage is marked by the presence of **conjunctival scarring (TS)**, which can lead to further complications. *Stage-1* - Stage 1 is characterized by **trachomatous inflammation, follicular (TF)**, indicating active infection with follicles in the upper tarsal conjunctiva. - It represents the initial, active inflammatory phase and does not involve scarring. *Stage-2* - Stage 2 is characterized by **trachomatous inflammation, intense (TI)**, where there is pronounced inflammation that obscures blood vessels. - While intense inflammation is present, significant scarring has not yet developed at this stage, differentiating it from cicatrising trachoma. *Stage-4* - Stage 4 is characterized by **trachomatous trichiasis (TT)**, where the eyelashes turn inward and rub against the cornea. - This stage is a direct complication of the scarring from Stage 3, leading to corneal damage, rather than the cicatrising stage itself.

Question 294: Stocker's line is seen in?

A. Pterygium (Correct Answer)
B. Glaucoma
C. Posterior scleritis
D. Diabetic retinopathy

Explanation: **Pterygium** - **Stocker's line** is a **ferrous deposit** that appears as a brown or yellow line at the leading edge of a **pterygium**. - Its presence signifies the progressive nature of the pterygium, indicating ongoing iron deposition due to chronic epithelial degeneration and remodeling. *Glaucoma* - Glaucoma is characterized by **optic nerve damage** and **visual field loss**, usually associated with elevated intraocular pressure. - It does not involve the formation of Stocker's line, which is a corneal or conjunctival finding. *Posterior scleritis* - Posterior scleritis is an **inflammation of the sclera** behind the equator of the globe, often presenting with pain, vision loss, or choroidal folds. - It does not involve the characteristic Stocker's line, which is specific to pterygium. *Diabetic retinopathy* - Diabetic retinopathy involves **microvascular damage** to the retina, leading to vision loss, and is characterized by microaneurysms, hemorrhages, and neovascularization. - It is a retinal disease and does not present with Stocker's line.

Question 295: Which of the following is the most specific feature of vernal conjunctivitis?

A. Cobblestone appearance of conjunctiva
B. Horner-Tranta's spots (deposits at the limbus) (Correct Answer)
C. Shield ulcer (corneal ulcer due to keratoconjunctivitis)
D. Papillary hypertrophy (enlarged papillae on the conjunctiva)

Explanation: ***Horner-Tranta's spots (deposits on the cornea)*** - **Horner-Tranta's spots** are white, raised gelatinous or chalky white concretions composed of degenerated epithelial cells and eosinophils, found at the limbus. - While not exclusive, their presence is highly characteristic and considered the most **specific clinical sign** of vernal conjunctivitis. *Shield ulcer (corneal ulcer due to keratoconjunctivitis)* - A **shield ulcer** is a complication of vernal conjunctivitis, not a primary or most specific feature itself. It indicates more severe disease. - It results from chronic friction from giant papillae and allergic inflammation leading to epithelial defects, but its absence does not rule out VC. *Cobblestone appearance of conjunctiva* - The **cobblestone appearance** refers to the presence of large, flattened papillae on the upper tarsal conjunctiva. - While highly indicative of vernal conjunctivitis, it is a general sign of severe allergic conjunctivitis and not as specific as Horner-Tranta's spots, which are more pathognomonic. *Papillary hypertrophy (enlarged papillae on the conjunctiva)* - **Papillary hypertrophy** is a common finding in many forms of chronic conjunctivitis, including allergic conjunctivitis. - While prominent in vernal keratoconjunctivitis (VKC), it is a less specific feature compared to Horner-Tranta's spots, which are unique to VKC.

Question 296: What is the term for the fusion of the palpebral and bulbar conjunctiva?

A. Trichiasis (inward growth of eyelashes)
B. Ectropion (outward turning of eyelid)
C. Symblepharon (Correct Answer)
D. Tylosis (thickening of skin on palms and soles)

Explanation: ***Symblepharon*** - **Symblepharon** is the term for the adhesion between the **palpebral conjunctiva** (lining the eyelid) and the **bulbar conjunctiva** (covering the eyeball). - This condition can limit eye movement and cause chronic irritation, often resulting from severe conjunctival inflammation or injury. *Trichiasis (inward growth of eyelashes)* - **Trichiasis** refers to the misdirection of eyelashes such that they rub against the cornea or conjunctiva. - It causes irritation, foreign body sensation, and can lead to corneal abrasion, but it does not involve fusion of conjunctival layers. *Ectropion (outward turning of eyelid)* - **Ectropion** is a condition where the lower eyelid turns outward or sags away from the eyeball. - This exposes the conjunctiva, causing dryness, irritation, and epiphora (excessive tearing), but it is not a fusion of conjunctival tissues. *Tylosis (thickening of skin on palms and soles)* - **Tylosis** is a medical term referring to diffuse **hyperkeratosis** or thickening of the skin, typically observed on the palms and soles. - This condition is completely unrelated to the conjunctiva or eye structures.

Question 297: In which condition is a subconjunctival cyst most commonly observed?

A. Toxoplasmosis
B. Cysticercosis (Correct Answer)
C. Leishmaniasis
D. Chagas disease

Explanation: ***Cysticercosis*** - **Cysticercosis**, caused by the larval stage of *Taenia solium*, is a common cause of **subconjunctival cysts** globally, especially in endemic areas. - The larvae (cysticerci) can migrate and encyst in various tissues, including the subconjunctival space, presenting as mobile, yellowish cysts. *Toxoplasmosis* - **Toxoplasmosis** primarily affects the eye as **retinochoroiditis**, where inflammation and scarring occur in the retina and choroid. - It does not typically form characteristic subconjunctival cysts. *Leishmaniasis* - **Leishmaniasis** can manifest in several forms, including cutaneous, mucocutaneous, and visceral, with ocular involvement generally being secondary to skin lesions on the eyelids or adnexa. - It does not commonly result in the formation of **subconjunctival cysts**. *Chagas disease* - **Chagas disease**, caused by *Trypanosoma cruzi*, is associated with ocular manifestations such as **Romaña's sign** (unilateral periorbital edema and conjunctivitis) in the acute phase. - It does not typically present with subconjunctival cysts as a primary feature.

Question 298: Conjunctival mucosal overgrowth over the cornea is known as

A. Pterygium (Correct Answer)
B. Vernal keratoconjunctivitis
C. Pinguecula
D. Herbert's pits

Explanation: ***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.

Question 299: Which of the following indicates activity of anterior uveitis?

A. Cells in anterior chamber (Correct Answer)
B. Circumcorneal congestion
C. Keratic precipitate
D. Corneal edema

Explanation: ***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.

Question 300: Which of the following is a feature of vernal keratoconjunctivitis?

A. Follicular hypertrophy
B. Papillary hypertrophy (Correct Answer)
C. Pseudomembrane formation
D. Membrane formation

Explanation: ***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.

Practice by Chapter

Conjunctivitis: Bacterial

Practice Questions

Conjunctivitis: Viral

Practice Questions

Conjunctivitis: Allergic

Practice Questions

Conjunctivitis: Chronic

Practice Questions

Degenerations of Conjunctiva

Practice Questions

Benign Tumors of Conjunctiva

Practice Questions

Malignant Tumors of Conjunctiva

Practice Questions

Conjunctival Manifestations of Systemic Diseases

Practice Questions

Cicatricial Conjunctival Disorders

Practice Questions

Pterygium and Pinguecula

Practice Questions

Conjunctival Trauma

Practice Questions

Subconjunctival Hemorrhage

Practice Questions

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