Diseases of the Cornea Practice Questions

Q: A patient presents with guttate lesions in one eye and bullous keratopathy in the other eye. What is the most likely diagnosis?

Fuchs' endothelial dystrophy. ***Fuchs' endothelial dystrophy*** - This condition involves progressive loss of corneal endothelial cells and deposition of abnormal basement membrane material (**guttae**). The presence of **guttate lesions** represents early disease. - As the disease progresses and the remaining endothelial cells fail to pump fluid effectively, the cornea swells, leading to epithelial and stromal edema, clinically described as **bullous keratopathy**. *Interstitial keratitis* - This is non-ulcerative inflammation predominantly affecting the **corneal stroma**, often associated with systemic infections like **congenital syphilis** or Cogan's syndrome. - It typically causes stromal clouding and deep **neovascularization** (ghost vessels) but does not primarily involve guttate lesions or asymmetric endothelial failure. *Viral corneal ulcer* - Viral ulcers (like those caused by **HSV**) present acutely with epithelial defects, often in a dendritic or geographic pattern, and cause significant inflammation. - They are acute processes characterized by surface epithelial involvement, not characterized by the slowly progressive, **endothelial-based changes** (guttae and bullae) seen in Fuchs' dystrophy. *Keratoconjunctivitis* - This is a general term for inflammation affecting both the cornea and conjunctiva, commonly seen in **adenoviral infections** or severe dry eye (**KCS**). - The primary findings are typically conjunctival injection and punctate epithelial erosions, not the specific endothelial deposits (**guttae**) or resulting severe edema (**bullous keratopathy**) characteristic of Fuchs' dystrophy.

Q: What does the following image show?

Jersey finger. ***Jersey finger*** - The image depicts an **avulsion fracture** of the distal phalanx where the **flexor digitorum profundus (FDP) tendon** has pulled off a piece of bone from its insertion point. - This injury commonly occurs when a fully flexed finger (often the ring finger) is forcefully extended, such as snagging a finger on an opponent's jersey, preventing active flexion of the **distal interphalangeal (DIP) joint**. *Mallet finger* - This injury involves a rupture or avulsion of the **extensor tendon** at the **DIP joint**, leading to an inability to actively extend the distal phalanx. - The digit would appear in a characteristic **flexed position at the DIP joint**, which is not shown in the image. *Jammed finger* - A jammed finger is a general term for a sprain or contusion of the finger joints, usually caused by axial compression. - It does not typically involve a **tendon avulsion** or bone fracture as clearly depicted in the image. *Boxer knuckle* - This term usually refers to an injury of the **extensor digitorum communis (EDC) tendon** at the **metacarpophalangeal (MCP) joint**, often sustained during punching. - The injury shown is clearly at the **distal interphalangeal (DIP) joint** and involves the flexor tendon, not the MCP joint or extensor tendon.

Q: A child from slums presents with cheese like lesion on temporal side of Cornea. What is the diagnosis?

Keratomalacia. ***Keratomalacia*** - The appearance of **"cheese-like" lesions** on the cornea, especially on the **temporal side**, in a child from underprivileged settings suggests **corneal melting due to severe vitamin A deficiency**, characteristic of keratomalacia. - This condition is typically associated with **malnutrition** and can lead to irreversible blindness if not treated promptly with **vitamin A supplementation**. *Phlyctenular keratoconjunctivitis* - This condition is characterized by **nodular lesions (phlyctenules)** on the cornea or conjunctiva, often seen in children with a **hypersensitivity reaction** to microbial antigens like tuberculosis. - Phlyctenules typically appear as small, white, elevated lesions, but are not described as "cheese-like" and their typical location and appearance differ from the image shown. *Corneal ulcer* - A corneal ulcer is an **open sore** on the cornea that can be caused by infection (bacterial, viral, fungal, protozoal) or trauma. - While it can appear whitish due to corneal infiltration, a "cheese-like" appearance specifically on the temporal side in a malnourished child points more directly to keratomalacia. *Pterygium* - A pterygium is a **fleshy, triangular growth** of conjunctival tissue that extends onto the cornea, typically from the nasal side, and is associated with **UV light exposure**. - Its appearance is distinct from the diffuse, cheesy lesion seen in the image, and it is less common in young children.

Q: Which is correct about the image shown below?

Radial keratoneuritis. ***Radial keratoneuritis*** - The image exhibits **radial, spoke-like opacities** in the cornea, which are characteristic of radial keratoneuritis. - This condition is associated with viral infections, particularly **herpes simplex virus (HSV)** and **varicella-zoster virus (VZV)**, causing inflammation along corneal nerves. - The spoke-like pattern represents corneal nerve inflammation with surrounding stromal infiltrates. *Keratoplasty* - **Keratoplasty** (corneal transplant) involves surgically replacing damaged corneal tissue with donor tissue. - While post-operative cases may show suture marks or graft-related changes, the radial spoke-like pattern of corneal opacities is not typical of keratoplasty. *Iridocyclitis* - **Iridocyclitis** is inflammation of the iris and ciliary body (anterior uveitis). - Primary signs include **ciliary flush**, **aqueous flare**, **cells in anterior chamber**, and **keratic precipitates** on the corneal endothelium. - The radial corneal stromal opacities seen in this image are not characteristic of iridocyclitis. *Vertical fixed pupil* - A **vertical fixed pupil** refers to an abnormally shaped pupil that is vertically elongated and non-reactive to light. - The pupil in the image appears round and normal, without vertical elongation or fixation. - This finding is unrelated to the corneal pathology shown.

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.

Question 1

A patient presents with guttate lesions in one eye and bullous keratopathy in the other eye. What is the most likely diagnosis?

Accepted Answer

Fuchs' endothelial dystrophy

Answer

Keratoconjunctivitis

Answer

Interstitial keratitis

Answer

Viral corneal ulcer

Question 2

What does the following image show?

Accepted Answer

Jersey finger

Answer

Mallet finger

Answer

Jammed finger

Answer

Boxer knuckle

Question 3

A child from slums presents with cheese like lesion on temporal side of Cornea. What is the diagnosis?

Accepted Answer

Keratomalacia

Answer

Phlyctenular keratoconjunctivitis

Answer

Corneal ulcer

Answer

Pterygium

Question 4

Which is correct about the image shown below?

Accepted Answer

Radial keratoneuritis

Answer

Keratoplasty

Answer

Iridocyclitis

Answer

Vertical fixed pupil

Question 5

Which is correct about the image shown below?

Accepted Answer

Nebula

Answer

Mooren's ulcer

Answer

Dendritic ulcer

Answer

Acanthamoeba keratitis

Question 6

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 7

Which is correct about the image shown below?

Accepted Answer

HSV keratitis

Answer

Mooren's ulcer

Answer

Acanthamoeba keratitis

Answer

Pseudomonas corneal ulcer

Question 8

What type of corneal opacity is shown in the image?

Accepted Answer

Nebula

Answer

Mooren's ulcer

Answer

Dendritic ulcer

Answer

Acanthamoeba keratitis

Question 9

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 10

What is correct about the image shown below?

Accepted Answer

Dendritic ulcer

Answer

Nebula

Answer

Mooren's ulcer

Answer

Acanthamoeba keratitis

Diseases of the Cornea — MCQs

Diseases of the Cornea — MCQs

On this page

Practice by Chapter

Want unlimited practice?