Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva Indian Medical PG Practice Questions and MCQs

Question 301: Arlt's line is seen in?

A. Bacterial conjunctivitis
B. Trachoma (Correct Answer)
C. Vernal catarrh
D. Allergic conjunctivitis

Explanation: ***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.

Question 302: Pterygium is

A. A fibrovascular growth (Correct Answer)
B. A neoplastic condition
C. An infectious condition
D. A degenerative condition of the conjunctiva

Explanation: ***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.

Question 303: Phlyctenular conjunctivitis is primarily associated with which of the following underlying causes?

A. Hypersensitivity to specific allergens
B. Mycobacterium tuberculosis infection (Correct Answer)
C. Staphylococcus aureus infection
D. Post viral infection

Explanation: ***Mycobacterium tuberculosis infection*** - **Phlyctenular conjunctivitis** is a **delayed hypersensitivity reaction (Type IV)** to bacterial antigens, classically associated with **tuberculosis**. - The immune response to **tuberculoproteins** deposited in the conjunctiva or cornea leads to the formation of characteristic limbal nodules or **"phlyctenules"**. - In **TB-endemic regions** like India, tuberculosis remains a major underlying cause and should be investigated, especially in recurrent or bilateral cases. - This is particularly relevant for **NEET PG** and **Indian Medical PG** examinations given the epidemiological context. *Staphylococcus aureus infection* - *Staphylococcus aureus* is actually a **common cause** of phlyctenular conjunctivitis, particularly in developed countries and cases associated with chronic blepharitis. - The hypersensitivity reaction occurs to **staphylococcal antigens** from lid colonization. - However, in the **Indian context** and for competitive exam purposes, **tuberculosis** is emphasized as the primary association due to high TB prevalence and the need to rule out systemic TB. - While S. aureus is important clinically, TB is the classical teaching point and more relevant differential in endemic areas. *Hypersensitivity to specific allergens* - **Allergic conjunctivitis** presents with itching, redness, and chemosis, often with seasonal triggers or exposure to specific allergens. - It does **not** produce the characteristic **phlyctenules** (nodular lesions) seen in phlyctenular conjunctivitis. - The mechanism is **Type I hypersensitivity** (IgE-mediated), not the Type IV delayed hypersensitivity seen in phlyctenulosis. *Post viral infection* - **Viral conjunctivitis** (commonly adenoviral) presents with watery discharge, follicular reaction, and preauricular lymphadenopathy. - It does not cause the nodular **phlyctenules** characteristic of phlyctenular keratoconjunctivitis. - The mechanism is direct viral infection and inflammation, not bacterial antigen-mediated delayed hypersensitivity.

Question 304: 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?

A. Vernal conjunctivitis (Correct Answer)
B. Fungal keratoconjunctivitis
C. Viral conjunctivitis
D. Trachoma

Explanation: ***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.

Question 305: 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:

A. Vernal conjunctivitis (Correct Answer)
B. Viral conjunctivitis
C. Phlyctenular conjunctivitis
D. Trachoma

Explanation: ***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.

Question 306: Maxwell Lyon's sign is a feature of:

A. Allergic conjunctivitis (Correct Answer)
B. Acanthamoeba keratitis
C. Trachoma
D. Epidemic keratoconjunctivitis

Explanation: ***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.

Question 307: Which of the following is not true of acute conjunctivitis?

A. Vision is not affected
B. Topical antibiotics are the mainstay of treatment (Correct Answer)
C. Pupil remains unaffected
D. Corneal infiltration occurs

Explanation: ***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 308: Which of the following statements about membranous conjunctivitis is false?

A. Caused by corynebacterium
B. Easy to peel (Correct Answer)
C. May cause corneal ulceration
D. May lead to cicatrisation

Explanation: ***Easy to peel*** - This statement is **FALSE** because **membranous conjunctivitis** forms a **true membrane** that is **firmly adherent** to the conjunctiva and **bleeds upon removal**. - Its firm adherence is due to involvement of the **superficial layers of the substantia propria**, making it **difficult to peel** without causing tissue trauma and bleeding. - This distinguishes it from **pseudomembranous conjunctivitis**, where the membrane is loosely adherent and can be peeled easily without bleeding. *Caused by corynebacterium* - **Corynebacterium diphtheriae** is a classic cause of membranous conjunctivitis, producing a severe inflammatory response through exotoxin production. - Other causes include severe bacterial infections (β-hemolytic streptococci), ligneous conjunctivitis, and severe adenoviral infections. - This statement is TRUE. *May lead to cicatrisation* - The severe inflammatory process involving deeper conjunctival layers leads to **scarring (cicatrisation)** of the conjunctiva. - Complications include **symblepharon** (adhesions between bulbar and palpebral conjunctiva), **entropion**, **trichiasis**, and **fornix shortening**. - This statement is TRUE. *May cause corneal ulceration* - The intense inflammation and toxic products from causative organisms can extend to the cornea. - **Corneal complications** include ulceration, pannus formation, and potential perforation in severe cases. - Secondary bacterial infection can further compromise corneal integrity. - This statement is TRUE.

Question 309: What does the Phenol red thread test assess in relation to dry eye?

A. Colour change on contact with tears to assess the volume of tears (Correct Answer)
B. Uses a pH meter for measurement and interpretation
C. Measures ocular surface mucin deficiency if thread colour changes to blue
D. Requires instillation of topical anesthesia before the procedure

Explanation: ***Colour change on contact with tears to assess the volume of tears*** - The Phenol red thread test measures the **volume of aqueous tears** by observing how far a thread changes color when moistened by reflex tearing. - The thread is impregnated with a **pH-sensitive dye** that changes from yellow to red-orange in contact with the alkaline pH of tears. *Uses a pH meter for measurement and interpretation* - The Phenol red thread test relies on a **visual color change** of the thread itself, not a separate pH meter. - The color change directly indicates the extent of wetting by tears, not a precise pH value for interpretation. *Measures ocular surface mucin deficiency if thread colour changes to blue* - The Phenol red thread test primarily assesses **aqueous tear production**, not mucin deficiency. - The dye changes to shades of **red or orange** in the presence of tears, not blue. *Requires instillation of topical anesthesia before the procedure* - The Phenol red thread test is designed to be a **non-irritating** and **unstimulated** tear test. - Topical anesthesia **should not be used** as it can interfere with natural tear production and lead to inaccurate results.

Question 310: Patient developed acute redness of eye with mucopurulent discharge and halos. It did not stain with fluorescein. The halos subsided after washing with clean water and the patient responded to five day course of topical antibiotics. What should be your probable diagnosis?

A. Immature senile cataract
B. Uveitis
C. Angle closure glaucoma
D. Acute bacterial conjunctivitis (Correct Answer)

Explanation: ***Acute bacterial conjunctivitis*** - The presence of **mucopurulent discharge**, **acute redness**, and "halos" (which can be caused by corneal edema secondary to inflammation) that resolved after washing suggest an infection. - The rapid response to **topical antibiotics** further supports a bacterial etiology, and the lack of fluorescein staining rules out corneal abrasion or ulceration. *Angle closure glaucoma* - While it can cause **halos around lights** and acute redness, it is typically associated with **severe pain**, blurred vision, and a fixed, mid-dilated pupil. - It would not normally present with **mucopurulent discharge** and would not resolve with simple washing or topical antibiotics. *Uveitis* - Uveitis can cause **redness and pain**, but typically presents with **photophobia**, ciliary flush, and often no discharge or a watery discharge, not mucopurulent. - **Halos** are not a typical symptom, and it would not resolve with washing or a short course of topical antibiotics. *Immature senile cataract* - Cataracts cause **gradual, painless vision loss** and **halos around lights** due to light scatter through the cloudy lens. - They do not cause acute redness, mucopurulent discharge, or suddenly resolve with washing.

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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