Diseases of the Cornea Practice Questions

Q: Which is correct about the image shown below?

Nebula. ***Nebula*** - The image shows a **subtle, hazy corneal opacity** without significant ulceration or stromal thinning, consistent with a nebula. - A nebula is a **faint, superficial corneal scar** that typically develops after mild inflammation or injury and causes minimal visual impairment. *Mooren's ulcer* - This is a **severe, progressive chronic peripheral ulcerative keratitis** that would show significant corneal thinning, guttering, and often an overhanging edge, which is not depicted. - Mooren's ulcer is characterized by an **idiopathic, painful, and destructive ulceration** of the peripheral cornea. *Dendritic ulcer* - A dendritic ulcer is a classic manifestation of **Herpes Simplex Keratitis**, characterized by a **branching, tree-like lesion** on the corneal surface, typically staining with fluorescein. - The image does not show the characteristic linear branching pattern attributable to dendritic ulcers. *Acanthamoeba keratitis* - This infection often presents with a **ring infiltrate** or a **pseudodendrite-like pattern**, and severe pain disproportionate to clinical findings. - There is no visible ring infiltrate or other characteristic features of *Acanthamoeba* infection in the provided image.

Q: The corneal image shown below demonstrates a ring infiltrate. What is the most likely diagnosis?

Acanthamoeba keratitis. ***Acanthamoeba keratitis*** - The image shows a **ring infiltrate** in the cornea, which is a classic and highly suggestive sign of *Acanthamoeba keratitis*. - This condition is often associated with contact lens wear and can cause severe pain and vision loss due to inflammation and ulceration of the cornea. *Mooren's ulcer* - Mooren's ulcer is a rare, severe, and progressive chronic peripheral corneal ulceration that is typically **idiopathic** and often **painful**. - It usually presents as a **creeping, circumferential ulcer** that undermines the peripheral cornea, but does not involve a distinct ring infiltrate like the one shown. *Dendritic ulcer* - A dendritic ulcer is a characteristic lesion of **herpes simplex keratitis**, appearing as a **branching, tree-like epithelial defect** when stained with fluorescein. - The image does not show this specific branching pattern; instead, it exhibits a ring-shaped infiltrate within the corneal stroma. *Interstitial keratitis* - Interstitial keratitis involves inflammation of the **corneal stroma without primary involvement of the epithelium or endothelium**. - It often results in **corneal clouding and vascularization** (ghost vessels) but does not typically present with the distinct ring infiltrate seen in the image.

Q: Which is correct about the image shown below?

HSV keratitis. ***HSV keratitis*** - HSV keratitis is characterized by **dendritic ulcers with terminal bulbs**, which are pathognomonic for HSV epithelial keratitis and clearly visible in this image. - The **branching pattern** with club-shaped terminal enlargements is virtually diagnostic of **herpes simplex viral infection** of the cornea. - **HSV-1** accounts for the vast majority of herpetic eye infections. *Mooren's ulcer* - Mooren's ulcer is a rare, chronic, and painful **peripheral corneal ulceration** that typically starts near the limbus with an **overhanging edge**. - It presents as a **sterile, progressive ulceration** without the characteristic dendritic branching pattern seen in this image. *Acanthamoeba keratitis* - *Acanthamoeba* keratitis is commonly associated with **contact lens use** and typically causes severe pain disproportionate to clinical findings initially. - It often presents with a **radial perineuritis** or characteristic **ring infiltrate** in later stages, neither of which match the dendritic pattern shown. *Pseudomonas corneal ulcer* - While Pseudomonas causes severe **suppurative keratitis** with dense infiltrates and **hypopyon**, it does not produce the characteristic dendritic pattern with terminal bulbs seen in this image. - Pseudomonas ulcers typically present with **feathery margins** and rapid progression but lack the pathognomonic branching morphology of HSV.

Q: What type of corneal opacity is shown in the image?

Nebula. ***Nebula*** - The image depicts a **faint, grayish corneal opacity** that is barely perceptible to the naked eye. This characteristic appearance is consistent with a nebula, which is the **mildest form of corneal opacification** in the classification: nebula < macula < leukoma. - A nebula typically results from **superficial corneal scarring** and may not significantly impair vision, though it can cause some **haze or glare**, particularly affecting night vision or driving. - The **iris details remain visible** through a nebula, unlike denser opacities. *Mooren's ulcer* - This is a **rare, chronic, painful, and progressive peripheral corneal ulcer** that is typically idiopathic and not depicted in this image. - It usually presents as a **marginal corneal guttering** or thinning with an overhanging edge, which is distinct from the diffuse, faint opacity shown. - Associated with significant pain and inflammation. *Dendritic ulcer* - A dendritic ulcer is a characteristic lesion of **herpes simplex keratitis**, appearing as a **branching, tree-like epithelial defect** with terminal bulbs, which is not seen here. - It stains positively with **fluorescein** and is typically associated with significant pain, photophobia, and decreased corneal sensation. *Acanthamoeba keratitis* - This severe corneal infection typically presents with a **ring infiltrate** or **radial keratoneuritis**, often associated with contact lens use and disproportionate pain. - The image does not show the typical features of inflammation, stromal infiltrate, or necrosis associated with this serious infection.

Q: The clinical image shows a corneal pathology. What is the most likely diagnosis?

Mooren's ulcer. ***Mooren's ulcer*** - The image exhibits a **peripheral corneal ulceration** with an **undermined edge**, and significant **vascularization** and inflammation of the adjacent conjunctiva, which are classic features of **Mooren's ulcer**. - **Mooren's ulcer** is a rare, severe, chronic, and progressive **idiopathic peripheral ulcerative keratitis (PUK)** that often affects older individuals and can lead to severe vision loss. *Mycotic corneal ulcer* - Mycotic corneal ulcers typically present with a **feathery border**, **satellite lesions**, and a **dry, gray appearance**, which are not seen in this image. - They often occur after **trauma with vegetable matter** or in immunocompromised individuals. *Dendritic ulcer* - A dendritic ulcer is characteristic of **herpes simplex keratitis** and appears as a **branching, tree-like lesion** stained with fluorescein, which is distinct from the peripheral ulceration shown. - It involves the epithelial layer and typically has **terminal bulbs** at the branches. *Acanthamoeba keratitis* - Acanthamoeba keratitis often presents with severe pain disproportionate to findings, a **ring infiltrate**, and epithelial or stromal pseudodentrites. - This condition is frequently associated with **contact lens wear** and exposure to contaminated water, and its appearance differs significantly from the imaged ulcer.

Q: What is correct about the image shown below?

Dendritic ulcer. ***Dendritic ulcer*** - The image shows a **corneal ulcer** with a characteristic **branching or dendritic pattern**, typical of **herpes simplex keratitis**. - These ulcers are identified by staining with **fluorescein**, revealing the epithelial defect with **terminal bulbs**. - This is the classic appearance of **HSV keratitis**, one of the most common causes of infectious corneal ulceration. *Nebula* - A nebula refers to a **faint, cloud-like opacity** in the cornea, which is not depicted in the image. - This term describes a **superficial corneal scar** that is barely visible without magnification. *Mooren's ulcer* - Mooren's ulcer is a **chronic, painful, progressive ulceration** of the corneal periphery without an apparent cause. - It typically shows an **undermined edge**, starts at the limbus, and progresses circumferentially and centrally. - This is distinct from the central branching pattern shown in the image. *Acanthamoeba keratitis* - Acanthamoeba keratitis presents with **severe pain disproportionate to clinical findings** and a **ring infiltrate** or **radial keratoneuritis**. - Most commonly seen in **contact lens wearers** with poor hygiene or exposure to contaminated water. - The image does not display the characteristic ring-shaped or perineural infiltrates associated with this infection.

Q: In a child with juvenile idiopathic arthritis, the eye examination shows presence of:

Band keratopathy. ***Band keratopathy*** - **Band keratopathy** is a common ocular manifestation in children with chronic uveitis secondary to **juvenile idiopathic arthritis (JIA)**, characterized by a horizontal band-like deposition of calcium salts in the superficial cornea. - The image depicts a whitish or grayish band across the cornea, consistent with **calcium deposition**, which is a hallmark of band keratopathy. *Vortex keratopathy* - **Vortex keratopathy** (or **cornea verticillata**) is a swirling, whorl-like pattern of corneal deposits, typically caused by drug toxicity (e.g., amiodarone, chloroquine) or metabolic disorders (e.g., Fabry disease). - It does not present as a horizontal band or diffuse opacification like that seen in the image, and is unrelated to JIA. *Fuchs' endothelial dystrophy* - **Fuchs' endothelial dystrophy** is a unilateral or bilateral progressive condition primarily affecting the corneal endothelium, leading to stromal edema and **guttae** (small excrescences on Descemet's membrane). - It typically affects older adults and is not primarily linked to JIA or the appearance in the provided image. *Bitot's spots* - **Bitot's spots** are foamy, triangular patches of keratinized conjunctival epithelium, usually located on the temporal bulbar conjunctiva, and are pathognomonic for **vitamin A deficiency**. - They are a conjunctival finding, not a corneal one, and are not associated with JIA.

Q: Dendrites on the cornea as shown below may be seen with:

HSV keratitis. ***HSV keratitis*** - The image shows classic **dendritic corneal ulcers**, which are pathognomonic for **herpes simplex virus (HSV) keratitis**. - These linear, branching lesions with terminal bulbs represent active viral replication in the corneal epithelium. *Staphylococcal keratitis* - This typically presents as a **bacterial keratitis** with a focal, dense, white or yellow infiltrate, often associated with an overlying epithelial defect. - It does not produce the characteristic dendritic pattern seen in the image. *Pseudomonas keratitis* - This is a severe form of bacterial keratitis, often caused by contact lens use, characterized by a rapidly progressing, **dense, greenish-yellow infiltrate**, often with stromal melting and hypopyon. - It does not manifest as dendritic lesions. *Acanthamoeba keratitis* - This parasitic infection of the cornea typically presents with severe pain disproportionate to clinical signs, and characteristic **radial perineuritis** or **ring-shaped infiltrates** in later stages. - It does not cause dendrites.

Q: A 30-year-old lady presents with blepharospasm, lid edema and red eye. Based on the clinical photograph shown, what is the diagnosis?

Herpes simplex keratitis. ***Herpes simplex keratitis*** - The image shows a classic **dendritic ulcer**, which is pathognomonic for **herpes simplex keratitis**, often accompanied by conjunctival redness, blepharospasm, and lid edema. - Presence of **epithelial defects** with characteristic branching patterns and the associated symptoms strongly indicate HSV infection. *Fungal ulcer* - Fungal ulcers typically present with a **feathery border**, **satellite lesions**, and often a history of **trauma with vegetative matter**, which are not seen or mentioned here. - These are usually **grayish-white**, elevated lesions that can be quite difficult to treat. *Bacterial ulcer* - Bacterial ulcers usually appear as a **dense, white-yellow stromal infiltrate** with ragged edges, often associated with diffuse stromal edema and hypopyon. - The characteristic dendritic pattern seen in the image would be absent in a bacterial ulcer. *Ulcus serpens* - **Ulcus serpens** is a rapidly spreading, severe form of bacterial corneal ulcer typically caused by *Streptococcus pneumoniae*. - It presents with a **serpiginous leading edge** of necrosis, often with an associated hypopyon, which differs from the dendritic pattern shown.

Q: A 30-year-old lady presents with blepharospasm, lid edema and red eye. Examination findings are shown in the image. What is the diagnosis?

Herpes simplex keratitis. ***Herpes simplex keratitis*** - The image likely depicts a **dendritic ulcer**, a hallmark feature of herpes simplex keratitis, which is further supported by symptoms like blepharospasm, lid edema, and red eye. - Herpes simplex keratitis often causes **recurrent episodes** and can lead to significant corneal scarring if not treated appropriately. *Fungal ulcer* - Fungal ulcers typically present with **feathery borders**, satellite lesions, and often a history of trauma involving vegetable matter or contact lens use. These features are not explicitly described or obvious in the provided image. - They tend to progress more slowly than bacterial ulcers but more aggressively than viral ulcers. *Bacterial ulcer* - Bacterial ulcers usually present as a **well-demarcated, dense, white or yellowish stromal infiltrate** with significant inflammation, often associated with rapid progression and severe pain. - The image does not clearly show the characteristic appearance of a typical bacterial corneal ulcer. *Ulcus serpens* - "Ulcus serpens" is an older term for a severe form of **bacterial corneal ulcer**, specifically a **hypopyon ulcer** caused by virulent bacteria, leading to a spreading serpiginous edge. - While it involves severe inflammation and often a hypopyon, the primary lesion in the image appears more consistent with a viral dendritic pattern rather than a rapidly spreading bacterial infiltrate.

Question 1

Which is correct about the image shown below?

Accepted Answer

Nebula

Answer

Mooren's ulcer

Answer

Dendritic ulcer

Answer

Acanthamoeba keratitis

Question 2

The corneal image shown below demonstrates a ring infiltrate. What is the most likely diagnosis?

Accepted Answer

Acanthamoeba keratitis

Answer

Mooren's ulcer

Answer

Dendritic ulcer

Answer

Interstitial keratitis

Question 3

Which is correct about the image shown below?

Accepted Answer

HSV keratitis

Answer

Mooren's ulcer

Answer

Acanthamoeba keratitis

Answer

Pseudomonas corneal ulcer

Question 4

What type of corneal opacity is shown in the image?

Accepted Answer

Nebula

Answer

Mooren's ulcer

Answer

Dendritic ulcer

Answer

Acanthamoeba keratitis

Question 5

The clinical image shows a corneal pathology. What is the most likely diagnosis?

Accepted Answer

Mooren's ulcer

Answer

Mycotic corneal ulcer

Answer

Dendritic ulcer

Answer

Acanthamoeba keratitis

Question 6

What is correct about the image shown below?

Accepted Answer

Dendritic ulcer

Answer

Nebula

Answer

Mooren's ulcer

Answer

Acanthamoeba keratitis

Question 7

In a child with juvenile idiopathic arthritis, the eye examination shows presence of:

Accepted Answer

Band keratopathy

Answer

Vortex keratopathy

Answer

Fuchs' endothelial dystrophy

Answer

Bitot's spots

Question 8

Dendrites on the cornea as shown below may be seen with:

Accepted Answer

HSV keratitis

Answer

Staphylococcal keratitis

Answer

Pseudomonas keratitis

Answer

Acanthamoeba keratitis

Question 9

A 30-year-old lady presents with blepharospasm, lid edema and red eye. Based on the clinical photograph shown, what is the diagnosis?

Accepted Answer

Herpes simplex keratitis

Answer

Fungal ulcer

Answer

Bacterial ulcer

Answer

Ulcus serpens

Question 10

A 30-year-old lady presents with blepharospasm, lid edema and red eye. Examination findings are shown in the image. What is the diagnosis?

Accepted Answer

Herpes simplex keratitis

Answer

Fungal ulcer

Answer

Bacterial ulcer

Answer

Ulcus serpens

Diseases of the Cornea — MCQs

Diseases of the Cornea — MCQs

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