Diseases of the Conjunctiva Practice Questions

Q: Viral Conjunctivitis is most commonly caused by which virus?

Adenovirus. **Explanation:** **Adenovirus** is the most common cause of viral conjunctivitis worldwide, accounting for up to 65–90% of all cases. It typically presents as a highly contagious follicular conjunctivitis. Two specific clinical syndromes are high-yield for exams: 1. **Pharyngoconjunctival Fever (PCF):** Caused by serotypes 3, 4, and 7; characterized by fever, pharyngitis, and follicular conjunctivitis. 2. **Epidemic Keratoconjunctivitis (EKC):** Caused by serotypes 8, 19, and 37; more severe, often involving the cornea with pathognomonic **subepithelial infiltrates**. **Analysis of Incorrect Options:** * **Herpes Simplex Virus (HSV):** While a common cause of viral keratitis (dendritic ulcers), it is a less frequent cause of isolated conjunctivitis. It is typically unilateral and associated with vesicular skin lesions. * **Enterovirus & Coxsackie A Virus:** These are the primary causative agents of **Acute Hemorrhagic Conjunctivitis (AHC)** (specifically Enterovirus 70 and Coxsackie A24). While they cause dramatic subconjunctival hemorrhages and have a rapid onset, they occur in explosive epidemics and are less common than Adenoviral infections. **Clinical Pearls for NEET-PG:** * **Preauricular Lymphadenopathy:** A hallmark sign of viral conjunctivitis (especially Adenoviral). * **Transmission:** Highly contagious via respiratory droplets or contaminated fingers/ophthalmic instruments (Tonometers). * **Management:** Primarily supportive (cold compresses, artificial tears). Steroids are contraindicated in the acute phase unless membranes/pseudomembranes are present.

Q: Trantas spots are seen in which of the following conditions?

Vernal conjunctivitis. **Explanation:** **Trantas spots** (also known as Horner-Trantas spots) are a pathognomonic clinical feature of **Vernal Keratoconjunctivitis (VKC)**, a bilateral, recurrent, seasonal allergic inflammation of the conjunctiva typically affecting young males. 1. **Why Vernal Conjunctivitis is correct:** Trantas spots are small, white, chalky elevations found at the **limbus**. They are composed of collections of **eosinophils and degenerated epithelial cells**. They are most commonly seen in the limbal or mixed variety of VKC. Their presence indicates active disease. 2. **Why other options are incorrect:** * **Eczematous conjunctivitis:** Also known as Phlyctenular keratoconjunctivitis, it is characterized by "phlyctens" (small greyish-yellow nodules) which are a type IV hypersensitivity reaction to endogenous bacterial proteins (most commonly Tubercular protein), not eosinophilic aggregates. * **Ophthalmia nodosa:** This is a granulomatous inflammation caused by the penetration of caterpillar hairs into the ocular tissues. It presents with nodules but lacks the allergic eosinophilic pathology of Trantas spots. * **Tularemia:** This causes Parinaud’s Oculoglandular Syndrome, characterized by granulomatous conjunctivitis with regional lymphadenopathy, usually following contact with infected animals (rabbits). **High-Yield Clinical Pearls for NEET-PG:** * **VKC Hallmarks:** Cobblestone/Giant papillae (Palpebral form), Shield ulcers (due to macro-papillae rubbing the cornea), and Maxwell-Lyons sign (stringy discharge). * **Pathology:** Type 1 and Type 4 hypersensitivity reactions. * **Treatment:** Mast cell stabilizers (Olopatadine) are the mainstay; topical steroids are used for acute exacerbations.

Q: Which of the following are features of vernal keratoconjunctivitis?

Tantra's Spots. **Explanation:** **Vernal Keratoconjunctivitis (VKC)**, also known as "Spring Catarrh," is a bilateral, recurrent, external ocular inflammation primarily affecting young boys in hot, dry climates. It is a Type I and Type IV hypersensitivity reaction. **Why Option D is Correct:** **Trantas’ Spots** (also known as Horner-Trantas spots) are a hallmark clinical feature of the limbal or mixed form of VKC. They are small, white, elevated dots found at the limbus, consisting of **eosinophils and degenerated epithelial cells**. Their presence is highly diagnostic for active VKC. **Analysis of Incorrect Options:** * **A. Papillary hypertrophy:** While VKC is characterized by papillae (specifically large, "cobblestone" or "pavement stone" papillae on the superior tarsal conjunctiva), the question asks for a specific feature. In many exams, Trantas' spots are considered the more pathognomonic sign compared to generalized papillary hypertrophy, which can occur in other forms of conjunctivitis. * **B. Follicular hypertrophy:** This is characteristic of **Viral** or **Chlamydial** conjunctivitis. VKC is a papillary disease, not a follicular one. * **C. Herbert's pits:** These are scarred, depressed remnants of limbal follicles and are pathognomonic for **Trachoma** (Stage IV), not VKC. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in males aged 5–15 years. * **Symptoms:** Intense itching (hallmark), ropy discharge, and photophobia. * **Corneal Involvement:** Look for **Shield Ulcers** (sterile, indolent) and **Maxwell-Lyons sign** (ropy discharge). * **Treatment:** Mast cell stabilizers (Prophylaxis), Topical Steroids (Acute phase), and Cyclosporine/Tacrolimus for steroid-sparing effects.

Q: What is the dosage of retinol palmitate for early stages of xerophthalmia?

110 mg orally on two successive days. ### Explanation **1. Understanding the Correct Answer (Option C)** The treatment protocol for clinical xerophthalmia (Bitot’s spots, corneal xerosis, keratomalacia) involves the immediate administration of high-dose Vitamin A. The standard therapeutic dose for adults and children over one year of age is **200,000 International Units (IU)**. In pharmacological terms, **1 IU of Vitamin A is equivalent to 0.55 mcg of Retinol Palmitate**. Therefore: * 200,000 IU × 0.55 mcg = 110,000 mcg * 110,000 mcg = **110 mg** The WHO treatment schedule requires this dose to be given on **Day 1, Day 2, and Day 14** (or at follow-up 2–4 weeks later). The question specifically highlights the initial intensive phase (two successive days). **2. Why Other Options are Incorrect** * **Options A, B, and D:** These values (90 mg, 100 mg, 120 mg) do not mathematically correspond to the standardized 200,000 IU dose of retinol palmitate. 100 mg is a common distractor because it is a "round number," but it falls short of the required 200,000 IU potency. **3. High-Yield Clinical Pearls for NEET-PG** * **Prophylaxis vs. Treatment:** Do not confuse treatment doses (200,000 IU) with the Vitamin A Prophylaxis Program doses (100,000 IU for 6–11 months; 200,000 IU for 1–5 years every 6 months). * **Age-Specific Dosing (Treatment):** * ** 1 year:** 200,000 IU (110 mg) * **Xerophthalmia Classification:** Remember the WHO "X" classification (X1A: Conjunctival xerosis; X1B: Bitot’s spots; X3A/B: Corneal ulceration/Keratomalacia). * **Night Blindness (XN):** The earliest clinical sign; Bitot’s spots are the most common objective sign.

Q: Identify the ocular condition shown in the image.

Herbert's pits. ***Herbert's pits*** - The image displays shallow, scalloped depressions at the superior corneoscleral junction (limbus), which are characteristic of **Herbert's pits**. - These pits are pathognomonic for **trachoma**, representing the cicatricial remains of resolved limbal follicles. *Horner-Trantas spots* - These are distinct gelatinous nodules or dots at the limbus composed of degenerated epithelial cells and **eosinophils**. - They are a hallmark sign of **vernal keratoconjunctivitis (VKC)**, an allergic eye disease, and do not appear as pitted scars. *Pannus* - Pannus is the ingrowth of fibrovascular tissue and **neovascularization** onto the cornea, typically from the superior limbus. - While pannus is also a sign of **trachoma**, the image specifically highlights the pitted scarring of Herbert's pits, not a sheet of blood vessels. *Arlt's line* - This refers to a line of scarring on the **tarsal conjunctiva**, which is the inner surface of the eyelid. - It is a sign of cicatricial **trachoma** but would only be visible upon eversion of the eyelid, not on the globe itself as shown in the image.

Q: The finding seen in the image is:

Herbert's pits. ***Herbert's pits*** - These are pathognomonic signs of **cicatricial trachoma**, representing shallow, depressed scars located at the superior corneoscleral junction (limbus). - They are formed by the resolution and scarring of **limbal follicles**, which are characteristic of the active inflammatory stage of trachoma. *Horner-Trantas spots* - These are small, white, gelatinous nodules seen at the limbus, composed of degenerated eosinophils and epithelial cells. - They are a characteristic finding in **vernal keratoconjunctivitis (VKC)**, an allergic eye condition, and are not seen in trachoma. *Pannus* - Pannus refers to the growth of fibrovascular tissue from the limbus onto the peripheral cornea. - While a **superior pannus** is a common finding in trachoma, the specific depressions shown in the image are Herbert's pits, not the pannus itself. *Arlt's line* - This is a horizontal line of scar tissue found on the **tarsal conjunctiva** of the upper eyelid. - It is another sign of cicatricial trachoma but is located on the inner surface of the eyelid, not at the limbus as seen in the image.

Q: What is the diagnosis shown in the image?

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image shows a **thick, ropy white discharge** (mucus plaque) on the lower conjunctiva, which is a classic sign of **vernal keratoconjunctivitis (VKC)**. - VKC is a chronic, bilateral allergic inflammatory disease, more common in young males, presenting with severe itching, photophobia, and the characteristic discharge as seen here, often associated with a **cobblestone appearance** of the upper tarsal conjunctiva. *Trachoma* - Trachoma is characterized by conjunctival inflammation, leading to **follicle formation** on the upper tarsal conjunctiva and later scarring (Arlt's line) and inversion of the eyelids (**trichiasis**). - The discharge in trachoma is typically mucopurulent, but not the thick, ropy white plaque seen in the image. *Atopic keratoconjunctivitis* - Atopic keratoconjunctivitis (AKC) is a chronic allergic inflammation that typically affects **older patients with a history of atopic dermatitis**. - While AKC can present with mucoid discharge and papillary changes, it is more commonly associated with **lower tarsal involvement**, lid margin inflammation, and occurs in an older age group compared to VKC. *Phlyctenular keratoconjunctivitis* - Phlyctenular keratoconjunctivitis is characterized by the appearance of small, localized, **nodular lesions (phlyctenules)** on the conjunctiva or cornea, often associated with delayed-type hypersensitivity reactions to bacterial antigens (e.g., Mycobacterium tuberculosis, Staphylococcus aureus). - While it involves conjunctival inflammation, it typically does not present with the thick, ropy mucus plaques characteristic of VKC.

Q: A patient presents with chronic redness and discharge from the eye. The image shows the conjunctival findings. What is the most likely diagnosis?

Trachoma. ***Trachoma*** - The image shows **conjunctival injection**, **mucopurulent discharge**, and **follicular conjunctivitis** which are characteristic signs of active trachoma. - This chronic follicular conjunctivitis caused by **Chlamydia trachomatis** serotypes A, B, Ba, and C often leads to scarring and visual impairment. - **WHO classification:** Active trachoma shows follicles on upper tarsal conjunctiva. *Vernal conjunctivitis* - Typically presents with severe **itching**, **cobblestone papillae** on the upper tarsal conjunctiva, and sometimes **Horner-Trantas dots** at the limbus. - The discharge is usually **ropy and mucoid**, not mucopurulent as seen in the image. - Seasonal pattern and bilateral involvement are common. *Bacterial conjunctivitis* - While bacterial conjunctivitis also presents with **mucopurulent discharge** and conjunctival injection, it lacks the characteristic **follicular pattern** seen in trachoma. - Bacterial conjunctivitis is typically **acute and self-limiting**, whereas trachoma is chronic and progressive. - Common organisms include *Staphylococcus aureus*, *Streptococcus pneumoniae*, and *Haemophilus influenzae*. *Phlyctenular keratoconjunctivitis* - Characterized by the formation of **small, localized nodules (phlyctenules)** on the cornea or conjunctiva, often associated with delayed hypersensitivity to microbial antigens like *Mycobacterium tuberculosis*. - While it causes **redness and irritation**, the distinct follicular pattern and diffuse mucopurulent discharge presented in the image are not typical features.

Q: A 22-year-old Air-force test pilot presents after flying a sortie. Eye examination shows:

Subconjunctival hemorrhage. ***Subconjunctival hemorrhage*** - The image clearly shows a localized collection of **blood under the conjunctiva**, appearing as a bright red patch on the white of the eye. - This can be caused by sudden increases in **venous pressure**, such as during straining, coughing, or, in the case of a pilot, due to G-forces experienced during a sortie. *Arcus senilis* - This condition presents as a **grayish-white arc** or ring around the limbus (the edge of the cornea), caused by lipid deposits. - It is typically seen in older individuals but can occur in younger individuals with **hyperlipidemia**. The image does not show such a ring. *Phlyctenular keratoconjunctivitis* - This involves the formation of small, **nodular lesions (phlyctenules)** on the cornea or conjunctiva, often associated with hypersensitivity reactions to bacterial antigens (e.g., tuberculosis). - The image does not display distinct nodules or inflammatory lesions characteristic of this condition. *Hypopyon* - This refers to the accumulation of **pus or inflammatory cells in the anterior chamber** of the eye, appearing as a whitish-yellow fluid level, typically in the lower part of the iris. - The image shows blood on the surface of the sclera, not within the anterior chamber of the eye.

Q: What is correct about the image shown below?

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image exhibits **cobblestone papillae** on the upper tarsal conjunctiva, which are characteristic of vernal keratoconjunctivitis (VKC). - The small white dots on top of the papillae are often **Trantas dots**, another hallmark of active VKC, consisting of degenerated eosinophils and epithelial cells. *Trachoma* - Trachoma is characterized initially by **follicular conjunctivitis** and later by scarring, which can lead to **entropion** and trichiasis, not the large papillae seen here. - While it can cause superior tarsal scarring (Arlt's line) and Herbert’s pits, these features are distinct from the hypertrophied papillae in the image. *Eales disease* - Eales disease is primarily a **retinal vasculitis** affecting the peripheral retina, leading to recurrent vitreous hemorrhage and retinal detachment. - It does not present with conjunctival findings like those shown in the image. *Phlyctenular keratoconjunctivitis* - This condition involves the formation of **phlyctenules** (small, nodular lesions) on the cornea or conjunctiva, often associated with hypersensitivity reactions to bacterial antigens. - It does not present with diffuse cobblestone papillae on the tarsal conjunctiva.

Question 1

Viral Conjunctivitis is most commonly caused by which virus?

Accepted Answer

Adenovirus

Answer

Herpes simplex virus

Answer

Enterovirus

Answer

Coxsackie A virus

Question 2

Trantas spots are seen in which of the following conditions?

Accepted Answer

Vernal conjunctivitis

Answer

Eczematous conjunctivitis

Answer

Ophthalmia nodosa

Answer

Tularemia

Question 3

Which of the following are features of vernal keratoconjunctivitis?

Accepted Answer

Tantra's Spots

Answer

Papillary hypertrophy

Answer

Follicular hypertrophy

Answer

Herbert's pits

Question 4

What is the dosage of retinol palmitate for early stages of xerophthalmia?

Accepted Answer

110 mg orally on two successive days

Answer

90 mg orally on two successive days

Answer

100 mg orally on two successive days

Answer

120 mg orally on two successive days

Question 5

Identify the ocular condition shown in the image.

Accepted Answer

Herbert's pits

Answer

Arlt's line

Answer

Pannus

Answer

Horner-Trantas spots

Question 6

The finding seen in the image is:

Accepted Answer

Herbert's pits

Answer

Arlt's line

Answer

Pannus

Answer

Horner-Trantas spots

Question 7

What is the diagnosis shown in the image?

Accepted Answer

Vernal conjunctivitis

Answer

Trachoma

Answer

Phlyctenular keratoconjunctivitis

Answer

Atopic keratoconjunctivitis

Question 8

A patient presents with chronic redness and discharge from the eye. The image shows the conjunctival findings. What is the most likely diagnosis?

Accepted Answer

Trachoma

Answer

Vernal conjunctivitis

Answer

Bacterial conjunctivitis

Answer

Phlyctenular keratoconjunctivitis

Question 9

A 22-year-old Air-force test pilot presents after flying a sortie. Eye examination shows:

Accepted Answer

Subconjunctival hemorrhage

Answer

Arcus senilis

Answer

Phlyctenular keratoconjunctivitis

Answer

Hypopyon

Question 10

What is correct about the image shown below?

Accepted Answer

Vernal conjunctivitis

Answer

Trachoma

Answer

Eales disease

Answer

Phlyctenular keratoconjunctivitis

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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