Diseases of the Conjunctiva — MCQs
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Features of vernal conjunctivitis are:
Which of the following is NOT a characteristic feature of Trachoma?
A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?
Inclusion conjunctivitis is caused by:
Which of the following is not a treatment option for vernal keratoconjunctivitis?
Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?
Which of the following is a characteristic feature of trachoma?
Diseases of the Conjunctiva Indian Medical PG Practice Questions and MCQs
Question 311: Features of vernal conjunctivitis are:
- A. Papillary hypertrophy
- B. Horner-Trantas spots
- C. Shield ulcer
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Vernal conjunctivitis (VKC)** is a severe form of allergic conjunctivitis characterized by chronic inflammation of the conjunctiva, impacting the cornea in advanced stages. - **Shield ulcers**, **Horner-Trantas dots**, and **papillary hypertrophy** are all classic clinical features observed in VKC. *Shield ulcer* - This is a **corneal complication** of severe vernal conjunctivitis, characterized by epithelial defects that can lead to significant pain and vision impairment. - It develops due to corneal abrasion from the giant papillae on the upper tarsal conjunctiva and direct corneal toxicity from inflammatory mediators. *Horner-Trantas spots* - These are **gelatinous aggregations** of epithelial cells and eosinophils that appear as white dots at the limbus, particularly evident at the superior limbus. - They are one of the **pathognomonic signs** of vernal conjunctivitis, indicating significant allergic inflammation. *Papillary hypertrophy* - Characterized by the development of **large, flattened papillae** (often described as "cobblestone" papillae) on the upper tarsal conjunctiva. - This hypertrophy is a result of chronic inflammation and proliferation of mast cells, eosinophils, and lymphocytes in the conjunctival stroma.
Question 312: Which of the following is NOT a characteristic feature of Trachoma?
- A. Follicular conjunctivitis
- B. Corneal pannus
- C. Ectropion of upper eyelids (Correct Answer)
- D. Conjunctival scarring
Explanation: ***Ectropion of upper eyelids*** - **Ectropion** is the outward turning of the eyelid, which is not a characteristic feature of trachoma; instead, **entropion** (inward turning) is common due to scarring. - This condition specifically affects the **lower eyelids** more often when it occurs due to aging, not the upper eyelids as a primary feature of trachoma. *Conjunctival scarring* - **Conjunctival scarring** is a hallmark of chronic trachoma, often leading to severe complications like entropion and trichiasis. - The repeated inflammation caused by *Chlamydia trachomatis* infection damages the conjunctival tissue, resulting in fibrotic changes. *Follicular conjunctivitis* - **Follicular conjunctivitis** is an early and characteristic sign of active trachoma, particularly in its inflammatory stages. - The formation of lymphoid follicles on the tarsal conjunctiva is a direct immune response to the *Chlamydia trachomatis* infection. *Corneal pannus* - **Corneal pannus**, characterized by superficial vascularization and connective tissue growth over the cornea, is a common feature of advanced trachoma. - This chronic inflammatory process often leads to **corneal opacification** and can result in significant vision impairment or blindness.
Question 313: A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?
- A. Phlyctenular conjunctivitis (Correct Answer)
- B. Foreign body granuloma
- C. Vernal keratoconjunctivitis
- D. Episcleritis
Explanation: ***Phlyctenular conjunctivitis*** - This condition is an immune-mediated hypersensitivity reaction to a foreign antigen, often associated with systemic diseases like **tuberculosis** or **Staphylococcus aureus** infection, commonly seen in malnourished children from poor socioeconomic backgrounds. - The characteristic lesion is a **nodule (phlyctenule)** near the **limbus** with surrounding conjunctival hyperemia, which aligns with the child's presentation. *Foreign body granuloma* - A **foreign body granuloma** is a reaction to a foreign material embedded in the conjunctiva or sclera, typically caused by trauma or an identifiable foreign object. - It does not explain the concurrent **axillary and cervical lymphadenopathy** or the association with malnutrition and poor hygiene. *Vernal keratoconjunctivitis* - **Vernal keratoconjunctivitis** is a chronic, bilateral allergic disorder, primarily affecting children and young adults, often seasonal and related to atopy. - It is characterized by **giant papillae on the tarsal conjunctiva** and often forms a **Trantas dot** on the limbus, which are different from a single limbal nodule and not typically associated with lymphadenopathy or socioeconomic factors in this way. *Episcleritis* - **Episcleritis** is an acute, self-limiting inflammation of the episcleral tissue, presenting as **sectoral or diffuse redness** and mild discomfort. - It does not involve a distinct nodule around the limbus or systemic symptoms like **lymphadenopathy**, nor is it directly linked to malnutrition or poor hygiene.
Question 314: Inclusion conjunctivitis is caused by:
- A. Klebsiella species
- B. Chlamydia trachomatis (Correct Answer)
- C. Mycobacterium Leprae
- D. Adenovirus
Explanation: ***Chlamydia trachomatis*** - **Inclusion conjunctivitis** is primarily caused by **Chlamydia trachomatis serovars D-K**. - This form of conjunctivitis is characterized by follicular response and cytoplasmic inclusions seen in epithelial cells. *Klebsiella species* - **Klebsiella** are common bacteria that can cause a variety of infections, including pneumonia and urinary tract infections. - While they can cause conjunctivitis, it is typically a bacterial conjunctivitis and not specifically referred to as inclusion conjunctivitis. *Adenovirus* - **Adenoviruses** are a common cause of **viral conjunctivitis**, which often presents with watery discharge and pharyngitis. - Unlike *Chlamydia*, adenovirus infections do not form characteristic cytoplasmic inclusions in conjunctival cells. *Mycobacterium Leprae* - **Mycobacterium leprae** is the causative agent of **Leprosy**, a chronic infectious disease primarily affecting the skin, nerves, and upper respiratory tract. - It does not directly cause conjunctivitis as its primary manifestation, although ocular complications can occur in advanced leprosy.
Question 315: Which of the following is not a treatment option for vernal keratoconjunctivitis?
- A. Steroids
- B. Chromaglycate
- C. Olopatadine
- D. Antibiotics (Correct Answer)
Explanation: ***Antibiotics*** - **Vernal keratoconjunctivitis (VKC)** is a non-infectious, **allergic inflammatory condition** of the conjunctiva. - Antibiotics are primarily used to treat bacterial infections and have **no direct role** in the management of VKC. *Steroids* - **Topical corticosteroids** (e.g., prednisolone, loteprednol, fluorometholone) are a mainstay of VKC treatment, especially for severe cases and acute exacerbations. - They significantly reduce inflammation and associated symptoms by **suppressing the immune response**. *Chromaglycate* - **Sodium cromoglycate** is a **mast cell stabilizer** commonly used in the treatment of VKC. - It works by preventing the degranulation of mast cells, thereby **inhibiting the release of inflammatory mediators** like histamine. *Olopatadine* - **Olopatadine** is a dual-acting medication that functions as both an **antihistamine** and a **mast cell stabilizer**. - It provides rapid relief from itching and other allergic symptoms by blocking histamine receptors and stabilizing mast cells.
Question 316: Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?
- A. Allergic conjunctivitis
- B. Chlamydial conjunctivitis
- C. Giant papillary conjunctivitis
- D. Vernal keratoconjunctivitis (Correct Answer)
Explanation: ***Vernal keratoconjunctivitis*** - This condition is characterized by **large, flattened papillae** on the upper tarsal conjunctiva, which give it a classic **cobblestone appearance**. - It is a severe, chronic form of **allergic conjunctivitis**, often seen in children and young adults, associated with severe itching and seasonal recurrence. *Allergic conjunctivitis* - While it involves allergic reactions and sometimes papillae, the term **"cobblestone appearance"** specifically refers to the **large, flat papillae seen in Vernal Keratoconjunctivitis**, not general allergic conjunctivitis. - General allergic conjunctivitis often presents with **diffuse papillary hypertrophy** but not typically the characteristic cobblestoning unless it progresses to the chronic, severe form. *Chlamydial conjunctivitis* - This is primarily associated with **follicles** on the conjunctiva, particularly in the lower fornix, rather than a cobblestone appearance. - It is an **infectious condition**, often linked to sexually transmitted infections, and its conjunctival findings are distinct from allergic forms. *Giant papillary conjunctivitis* - While it features **giant papillae** (similar to those causing the cobblestone appearance), it is typically caused by mechanical irritation from **contact lenses** or ocular prostheses, not a primary allergic etiology like VKC. - It often affects the **upper tarsal conjunctiva** but is usually unilateral or asymmetrical and directly related to a foreign body.
Question 317: Which of the following is a characteristic feature of trachoma?
- A. Epithelial keratitis
- B. Corneal neovascularization (pannus)
- C. Herbert's pits in the limbus (Correct Answer)
- D. Follicle formation in the conjunctiva
Explanation: ***Herbert's pits in the limbus*** - **Herbert's pits** are **pathognomonic** (uniquely characteristic) depressions formed at the limbus due to the healing of active limbal follicles in **trachoma**. - Their presence indicates past or chronic **Chlamydia trachomatis** infection and distinguishes trachoma from other causes of follicular conjunctivitis. - This is the **most specific** diagnostic feature of trachoma. *Corneal neovascularization (pannus)* - While **superior corneal pannus** (neovascularization extending into the cornea from above) can occur in chronic trachoma, it is **not specific** to trachoma. - Pannus is also seen in **vernal keratoconjunctivitis**, **contact lens overwear**, and other chronic inflammations. - It represents chronic inflammation but is not unique to trachoma as a primary diagnostic feature. *Epithelial keratitis* - **Epithelial keratitis** involves inflammation of the corneal epithelium and is a **non-specific finding** in many eye conditions, including viral infections, bacterial keratitis, and dry eyes. - Although it can occur in trachoma, it is not a characteristic or specific feature for diagnosis. *Follicle formation in the conjunctiva* - **Follicle formation** in the upper tarsal conjunctiva is seen in active trachoma (**trachomatous inflammation—follicular, TF**) in the early stages. - However, follicular conjunctivitis is **not specific** to trachoma—it also occurs in **viral conjunctivitis** (adenovirus), **inclusion conjunctivitis** (Chlamydia in neonates/adults), **molluscum contagiosum**, and drug reactions. - While important for staging active disease, follicles alone cannot differentiate trachoma from other causes, making **Herbert's pits** the more characteristic diagnostic feature.
Practice by Chapter
Conjunctivitis: Bacterial
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Conjunctivitis: Viral
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Conjunctivitis: Allergic
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Conjunctivitis: Chronic
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Degenerations of Conjunctiva
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Benign Tumors of Conjunctiva
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Malignant Tumors of Conjunctiva
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Conjunctival Manifestations of Systemic Diseases
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Cicatricial Conjunctival Disorders
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Pterygium and Pinguecula
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Conjunctival Trauma
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Subconjunctival Hemorrhage
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