Diseases of the Conjunctiva Practice Questions

Q: Which of the following viruses does not cause conjunctivitis?

CMV. **Explanation:** The correct answer is **A. CMV (Cytomegalovirus)**. **1. Why CMV is the correct answer:** While CMV is a member of the Herpesviridae family, it is primarily a **retinotropic** virus. In immunocompromised individuals (especially those with HIV/AIDS and CD4 counts <50 cells/µl), it causes **CMV Retinitis**, characterized by the classic "pizza-pie" or "cheese and ketchup" fundus appearance. CMV does not typically involve the conjunctiva or cause conjunctivitis. **2. Analysis of Incorrect Options:** * **Adenovirus (Option B):** The most common cause of viral conjunctivitis. It causes **Pharyngoconjunctival Fever (PCF)** (Serotypes 3, 4, 7) and **Epidemic Keratoconjunctivitis (EKC)** (Serotypes 8, 19, 37). * **Herpes Simplex Virus (Option C):** HSV-1 can cause primary blepharoconjunctivitis, typically presenting with unilateral follicular conjunctivitis and characteristic vesicular lesions on the lids. * **Picornavirus (Option D):** Specifically, **Enterovirus 70** and **Coxsackievirus A24** are the causative agents of **Acute Hemorrhagic Conjunctivitis (AHC)**, characterized by rapid onset, subconjunctival hemorrhages, and lid edema. **High-Yield Clinical Pearls for NEET-PG:** * **Follicular response:** The hallmark of most viral conjunctivitis (except CMV). * **Preauricular lymphadenopathy:** A key clinical sign of viral conjunctivitis (especially Adenovirus). * **Hutchinson’s Sign:** Vesicles on the tip of the nose indicating Herpes Zoster Ophthalmicus (Nasociliary nerve involvement), which carries a high risk of ocular complications. * **MC cause of Ophthalmia Neonatorum:** *Chlamydia trachomatis* (overall), but *N. gonorrhoeae* is the most hyperacute/destructive.

Q: Horner Trantas nodules are seen in:

Vernal conjunctivitis. **Explanation:** **Vernal Keratoconjunctivitis (VKC)**, also known as "Spring Catarrh," is a bilateral, recurrent, external ocular inflammation primarily affecting young males in hot, dry climates. It is a Type I and Type IV hypersensitivity reaction. **Why the correct answer is right:** **Horner-Trantas Nodules** are a hallmark clinical feature of the **Limbal variant** of VKC. These are small, white, elevated gelatinous dots found at the limbus. Pathologically, they consist of collections of **eosinophils and epithelial debris**. Their presence indicates active disease. In the Palpebral variant, the characteristic finding is "cobblestone" or giant papillae on the superior tarsal conjunctiva. **Why the incorrect options are wrong:** * **Blepharoconjunctivitis:** This involves inflammation of the eyelid margins and conjunctiva, typically presenting with crusting, redness, and telangiectasia, but does not feature limbal eosinophilic nodules. * **Phlyctenular conjunctivitis:** This is a Type IV hypersensitivity to endogenous antigens (like *M. tuberculosis* or *Staphylococcus*). It presents with a **Phlycten**—a small, pinkish-white nodule near the limbus that ulcerates—but it is not composed of eosinophils. * **Herpetic keratitis:** Caused by HSV, this typically presents with dendritic ulcers (epithelial) or disciform edema (stromal) and decreased corneal sensations, rather than allergic nodules. **High-Yield Clinical Pearls for NEET-PG:** * **Maxwell-Lyons Sign:** A ropey, tenacious discharge characteristic of VKC. * **Shield Ulcer:** A sterile, transverse oval ulcer in the upper cornea seen in severe VKC. * **Treatment:** Topical mast cell stabilizers (Olopatadine) are the mainstay; topical steroids are used for acute exacerbations. * **Histology:** Look for increased eosinophils, mast cells, and plasma cells in the conjunctiva.

Q: Acute hemorrhagic conjunctivitis is seen with which of the following?

Adenovirus. **Explanation:** **Acute Hemorrhagic Conjunctivitis (AHC)** is a highly contagious, self-limiting viral infection characterized by sudden onset of ocular pain, lid edema, and prominent subconjunctival hemorrhages. 1. **Why Adenovirus is Correct:** Adenoviruses are the most common cause of viral conjunctivitis. Specifically, **Adenovirus Serotypes 7 and 11** are known to cause AHC. However, the most frequent global causes of AHC are **Enterovirus 70** and **Coxsackievirus A24**. In the context of the given options, Adenovirus is the only viral pathogen listed and is a well-documented cause of hemorrhagic ocular presentations (such as in Epidemic Keratoconjunctivitis). 2. **Why Other Options are Incorrect:** * **Staphylococcal (B):** Typically causes acute mucopurulent conjunctivitis. It is characterized by crusting of lids and yellow discharge rather than frank subconjunctival hemorrhage. * **Pneumococcus (C) & Hemophilus (D):** These are common causes of bacterial conjunctivitis in children. While they can occasionally cause petechial hemorrhages, they primarily present with purulent discharge and "pink eye" symptoms, not the explosive, widespread hemorrhagic clinical picture seen in AHC. **High-Yield Clinical Pearls for NEET-PG:** * **Epidemic Keratoconjunctivitis (EKC):** Caused by Adenovirus serotypes **8, 19, and 37**. It is characterized by "pseudomembranes" and subepithelial corneal infiltrates. * **Pharyngoconjunctival Fever (PCF):** Caused by Adenovirus serotypes **3, 4, and 7**. It presents with the triad of fever, pharyngitis, and follicular conjunctivitis. * **AHC Key Feature:** The incubation period is very short (12–48 hours), and it often occurs in large-scale epidemics.

Q: Herpes pits are diagnostic of which condition?

Chlamydial infection. **Explanation:** **Herbert’s pits** (often misspelled or misheard as "Herpes pits") are a pathognomonic clinical feature of **Trachoma**, which is caused by *Chlamydia trachomatis* (Serotypes A, B, Ba, and C). ### Why Chlamydial Infection is Correct: In the active stage of Trachoma, lymphoid follicles form at the upper limbus. As these follicles heal and regress, they leave behind characteristic shallow, circular, pigmented depressions in the limbal area. These cicatricial depressions are known as **Herbert’s pits**. Their presence is diagnostic of past or chronic chlamydial infection. ### Why Other Options are Incorrect: * **Buphthalmos:** This refers to an enlarged eyeball due to congenital glaucoma. It is characterized by Haab’s striae (breaks in Descemet’s membrane), not limbal pits. * **HSV Infection:** Herpes Simplex Virus typically causes dendritic or geographic ulcers on the cornea. While it can cause follicular conjunctivitis, it does not result in Herbert’s pits. * **Vernal Catarrh (VKC):** This allergic condition presents with "cobblestone" papillae on the palpebral conjunctiva and **Trantas dots** (white limbal spots consisting of eosinophils), but not permanent cicatricial pits. ### NEET-PG High-Yield Pearls for Trachoma: * **Arlt’s Line:** A horizontal scar on the upper palpebral conjunctiva (junction of anterior 1/3rd and posterior 2/3rd). * **WHO Classification (FISTO):** **F**ollicles, **I**ntense inflammation, **S**carring, **T**richiasis, **O**pacity. * **SAFE Strategy:** **S**urgery, **A**ntibiotics (Azithromycin is the drug of choice), **F**acial cleanliness, **E**nvironmental improvement. * **Vector:** The common housefly (*Musca sorbens*).

Q: Which of the following may present as a bluish red nodule resembling conjunctival hemorrhage?

Kaposi sarcoma. **Explanation:** **Kaposi Sarcoma (KS)** is a vascular neoplasm caused by Human Herpesvirus 8 (HHV-8), most commonly seen in patients with HIV/AIDS. In the eye, it typically involves the conjunctiva (usually the inferior fornix). It presents as a **bright red or bluish-red, highly vascularized subconjunctival mass**. Because of its intense vascularity and color, it is frequently mistaken for a chronic subconjunctival hemorrhage. However, unlike a hemorrhage, it does not resolve over time and may appear as a fleshy, elevated nodule. **Why the other options are incorrect:** * **Ciliary Staphyloma:** This is a thinning of the sclera with incarceration of uveal tissue. While it appears dark blue/black, it is located over the ciliary body (behind the limbus) and represents a structural defect of the globe rather than a vascular nodular mass. * **Lymphoma:** Conjunctival lymphoma typically presents as a smooth, painless, **"salmon-pink" or "flesh-colored"** subconjunctival patch or mass. It lacks the intense bluish-red vascular appearance of KS. * **Limbal Dermoid:** This is a congenital choristoma (normal tissue in an abnormal location). It appears as a **whitish-yellow, firm, solid mass** at the limbus, often containing hair follicles or sebaceous glands. **High-Yield Clinical Pearls for NEET-PG:** 1. **HIV Association:** Any patient presenting with a lesion suspicious for Kaposi Sarcoma should be screened for HIV/AIDS. 2. **Differential Diagnosis:** Always differentiate a non-resolving "hemorrhage" from KS or a malignant melanoma. 3. **Treatment:** Management includes Highly Active Antiretroviral Therapy (HAART), local excision, cryotherapy, or radiotherapy. 4. **Salmon-patch appearance:** This is the classic buzzword for Conjunctival Lymphoma.

Q: Which of the following is NOT a feature of conjunctivitis?

Impaired pupillary reactions. **Explanation:** In ophthalmology, distinguishing between **conjunctivitis** (a superficial inflammation) and **sight-threatening intraocular conditions** (like acute glaucoma or iridocyclitis) is a high-yield clinical skill. **Why "Impaired pupillary reactions" is the correct answer:** Conjunctivitis is an inflammation of the conjunctiva, which is an extraocular structure. It does not involve the internal structures of the eye such as the iris or the ciliary body. Therefore, the **pupillary size and reaction to light remain normal**. Impaired pupillary reactions are "red flags" indicating deeper involvement: * **Fixed, mid-dilated pupil:** Suggests Acute Congestive Glaucoma. * **Constricted/Miosis (sluggish reaction):** Suggests Acute Iridocyclitis (Uveitis). **Analysis of incorrect options:** * **Mucoid discharge (A):** This is a hallmark of conjunctivitis. Discharge can be watery (viral), purulent (bacterial), or mucoid/ropy (allergic). * **Chemosis (C):** This refers to edema of the conjunctiva. It is a common sign of acute inflammation, especially in allergic or severe bacterial conjunctivitis. * **Halos (D):** While classically associated with glaucoma (due to corneal edema), halos can occur in conjunctivitis when thick **mucopurulent discharge** lies over the cornea, acting as a prism. These "false halos" disappear after washing the eye or blinking. **NEET-PG High-Yield Pearls:** * **Vision:** Always remains **normal** in simple conjunctivitis; it is blurred/decreased in glaucoma and uveitis. * **Ciliary Congestion:** Absent in conjunctivitis (which shows superficial conjunctival congestion) but present in keratitis and iridocyclitis. * **Pain:** Conjunctivitis presents with "grittiness" or "foreign body sensation," not the deep, throbbing ache seen in intraocular inflammation.

Q: Type IV hypersensitivity to Mycobacterium tuberculosis antigen may manifest as?

Phlyctenular conjunctivitis. **Explanation:** **Phlyctenular conjunctivitis** is a localized **Type IV (delayed-type) hypersensitivity reaction** of the conjunctiva and cornea to endogenous microbial proteins. Historically and most commonly in developing countries, the inciting antigen is **Mycobacterium tuberculosis**. Other triggers include *Staphylococcus aureus* (common in the West), *Moraxella*, and certain fungi. The condition is characterized by the formation of a **phlycten**—a small, greyish-yellow nodule surrounded by a zone of hyperemia. Pathologically, this represents a lymphocytic infiltration in the subepithelial tissue. **Analysis of Incorrect Options:** * **A. Iridocyclitis:** While TB can cause granulomatous uveitis, it is typically due to direct infection or a different immunological mechanism, not specifically a Type IV reaction manifesting as a phlycten. * **B. Polyarteritis nodosa (PAN):** This is a systemic necrotizing vasculitis associated with **Type III hypersensitivity** (immune complex deposition), frequently linked to Hepatitis B, not TB antigens. * **C. Giant cell arteritis:** This is a large-vessel vasculitis of the elderly. While it involves granulomatous inflammation, it is not a recognized manifestation of hypersensitivity to TB antigens. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Symptoms:** Photophobia, lacrimation, and blepharospasm (more severe when the cornea is involved). * **Fascicular Ulcer:** A characteristic wandering corneal ulcer that carries a leash of blood vessels behind it. * **Treatment:** Topical steroids (to control the hypersensitivity) and investigation/treatment of the underlying cause (e.g., Chest X-ray/Mantoux test for TB).

Question 1

Which of the following viruses does not cause conjunctivitis?

Accepted Answer

CMV

Answer

Adenovirus

Answer

Herpes simplex virus

Answer

Picornavirus

Question 2

Horner Trantas nodules are seen in:

Accepted Answer

Vernal conjunctivitis

Answer

Blepharoconjunctivitis

Answer

Phlyctenular conjunctivitis

Answer

Herpetic keratitis

Question 3

Which of the following is true about pterygium?

Accepted Answer

It is common with exposure to UV rays

Answer

It is common on the nasal side

Answer

It is a neoplastic condition

Answer

All pterygia require surgical intervention

Question 4

Acute hemorrhagic conjunctivitis is seen with which of the following?

Accepted Answer

Adenovirus

Answer

Staphylococcal

Answer

Pneumococcus

Answer

Hemophilus

Question 5

What is the primary treatment for Phlyctenular conjunctivitis?

Accepted Answer

Topical steroids

Answer

Systemic steroids

Answer

Antibiotics

Answer

Miotics

Question 6

Herpes pits are diagnostic of which condition?

Accepted Answer

Chlamydial infection

Answer

Buphthalmos

Answer

HSV infection

Answer

Vernal catarrh

Question 7

Which of the following may present as a bluish red nodule resembling conjunctival hemorrhage?

Accepted Answer

Kaposi sarcoma

Answer

Ciliary staphyloma

Answer

Lymphoma

Answer

Limbal dermoid

Question 8

Which of the following is NOT a feature of conjunctivitis?

Accepted Answer

Impaired pupillary reactions

Answer

Mucoid discharge

Answer

Chemosis

Answer

Halos

Question 9

Type IV hypersensitivity to Mycobacterium tuberculosis antigen may manifest as?

Accepted Answer

Phlyctenular conjunctivitis

Answer

Iridocyclitis

Answer

Polyarteritis nodosa

Answer

Giant cell arteritis

Question 10

A 10-year-old boy presents with severe itching of the eye and a ropy discharge. His symptoms aggravate in the summer season. What is the most likely diagnosis?

Accepted Answer

Vernal keratoconjunctivitis

Answer

Blepharitis

Answer

Trachoma

Answer

Acute conjunctivitis

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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