Diseases of the Conjunctiva Practice Questions

Q: A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Trachoma. ***Trachoma*** - The image shows **conjunctival follicles** and **gritty sensation** in a patient from a slum, which are classic signs of Trachoma caused by *Chlamydia trachomatis*. The everted eyelid typically reveals these characteristic follicles. - Trachoma is prevalent in areas with **poor sanitation** and **limited access to water**, consistent with a "slum" setting. *Vernal conjunctivitis* - Characterized by **giant papillae (cobblestone papillae)** on the upper tarsal conjunctiva, often associated with a history of allergies and intense itching. - While it can cause grittiness, the picture does not show the typical giant papillae, but rather smaller, more numerous follicles. *Eales disease* - This is an **idiopathic inflammatory vaso-occlusive disease** affecting the retinal vessels, primarily in young adult males. - It presents with **recurrent vitreous hemorrhages and retinal detachment**, not primarily with conjunctival findings or grittiness. *Phlyctenular keratoconjunctivitis* - Involves the formation of **phlyctenules** (small, nodular lesions) on the conjunctiva or cornea, often associated with delayed hypersensitivity to microbial antigens, such as *Staphylococcus* or *Mycobacterium tuberculosis*. - While it can cause grittiness and photophobia, the follicular pattern in the image is not typical of phlyctenules.

Q: A 5-year-old child presents with severe itching and ropy discharge. Image shows:

Vernal conjunctivitis. ***Vernal conjunctivitis*** - The image exhibits **giant papillae** on the upper tarsal conjunctiva, a hallmark feature of vernal conjunctivitis. - The history of **severe itching** and **ropy discharge** in a child are classic symptoms of this allergic condition. *Ligneous conjunctivitis* - Characterized by the formation of **wood-like, firm, white, or yellowish pseudomembranes** on the conjunctiva, which are not seen here. - This is a rare form of chronic conjunctivitis often associated with **plasminogen deficiency**. *Angular conjunctivitis* - Primarily caused by **_Moraxella lacunata_** and is characterized by chronic conjunctival inflammation predominantly affecting the **outer canthi** (angles of the eye). - It typically presents with localized redness, soreness, and maceration of the skin at the **lateral canthi**, and not the diffuse papillary hypertrophy seen in the image. *Parinaud's conjunctivitis* - A rare unilateral conjunctivitis associated with **lymphadenopathy** caused by various infections, most commonly **cat-scratch disease** (_Bartonella henselae_). - It presents with **granulomas** and **follicles** on the conjunctiva, along with a prominent preauricular or submandibular lymph node, features not consistent with the image or symptoms.

Q: The image shown below depicts:

Pterygium. ***Pterygium*** - The image shows a **triangular growth of conjunctival tissue** extending onto the cornea, which is characteristic of a pterygium. - This growth typically involves **vascularization** and can eventually affect vision by encroaching on the pupillary area. *Bitot's spots* - These are **foamy, white, or silvery patches** on the conjunctiva, often associated with **vitamin A deficiency**. - They are distinct from the fleshy, vascularized growth seen in the image. *Nodular scleritis* - Nodular scleritis presents as a **painful, localized nodule** on the sclera, often red or bluish, due to inflammation of the sclera. - The lesion in the image is a **conjunctival and corneal growth**, not an inflamed scleral nodule. *Pinguecula* - A pinguecula is a **yellowish, benign growth** on the conjunctiva, usually on the nasal side, but it **does not extend onto the cornea**. - The image clearly shows the growth extending past the limbus onto the cornea, differentiating it from a pinguecula.

Q: A five-year-old child presents with recurrent episodes of thick, woody pseudomembranous growths on the conjunctiva that have been difficult to remove. Which condition is shown in the image below?

Ligneous conjunctivitis. ***Ligneous conjunctivitis*** - The image shows a **thick, woody, and pseudomembranous growth** on the conjunctiva, which is characteristic of ligneous conjunctivitis. - This condition is a rare form of chronic pseudomembranous conjunctivitis linked to a deficiency in **plasminogen**, leading to impaired fibrinolysis. *Adenovirus pseudomembrane* - While adenoviral conjunctivitis can cause pseudomembranes, they are typically **thinner** and more easily peelable than the thick, fibrin-rich lesions seen in the image. - Adenoviral infections are usually acute and self-limiting, whereas ligneous conjunctivitis tends to be **chronic and recurrent**. *Vernal conjunctivitis* - Vernal conjunctivitis is an **allergic condition** characterized by **cobblestone papillae** on the upper tarsal conjunctiva and **Trantas dots** at the limbus, which are not depicted in the image. - It often presents with intense itching and a ropy mucous discharge, distinct from the solid mass shown. *Foreign body granuloma* - A foreign body granuloma typically presents as a **localized, firm nodule** and is usually a reaction to a retained foreign material. - The diffuse, extensive, and often bilateral involvement of the conjunctiva as seen here is inconsistent with a typical foreign body granuloma.

Q: A 25-year-old lady presents with itching and excoriation of the skin near inner canthus bilaterally. Sometimes a slight mucopurulent discharge is present in the morning. What is the best treatment for this patient? (Recent NEET Pattern 2016-17)

Oxytetracycline with zinc oxide. ***Oxytetracycline with zinc oxide*** - The patient's symptoms of itching, excoriation near the inner canthus bilaterally, and mucopurulent discharge suggest an **angular blepharoconjunctivitis**, often caused by *Staphylococcus* or *Moraxella*. - **Oxytetracycline is an effective broad-spectrum antibiotic** against these organisms, and **zinc oxide has astringent and mild antiseptic properties** that help in drying out the moist excoriated skin and soothing irritation, making this combination ideal. *Gentamicin with boric acid* - **Gentamicin is an aminoglycoside antibiotic** that can be effective against certain bacterial infections, but it's not the **first-line choice for angular blepharoconjunctivitis** and can have higher rates of allergic reactions. - **Boric acid has weak antiseptic properties** but is generally less effective for the significant excoriation and discharge seen in angular blepharitis compared to zinc oxide. *Gentamicin with zinc oxide* - While **zinc oxide** is beneficial for the skin irritation, **gentamicin** may not be the most appropriate primary antibiotic for the causative organisms of angular blepharitis. - The efficacy against common pathogens of this condition might be superior with alternative antibiotics like tetracyclines. *Oxytetracycline with boric acid* - **Oxytetracycline is a good antibiotic choice** for angular blepharoconjunctivitis. - However, **boric acid is typically less effective than zinc oxide** for the specific excoriation and skin healing required in this condition, as zinc oxide provides better astringent and protective properties for inflamed skin.

Q: A patient presents with red eye. What is correct about the image shown below?

$X=$ Conjunctival congestion, $Y=$ Ciliary congestion. ***Correct: X = Conjunctival congestion, Y = Ciliary congestion*** - Image X demonstrates **conjunctival congestion**, characterized by dilated superficial blood vessels that are more prominent away from the limbus and **reddening in the fornices**, indicating a superficial inflammation like conjunctivitis. - Image Y shows **ciliary congestion (perilimbal injection)**, where prominent deep vessels form a reddish-purple ring around the limbus, suggesting deeper inflammation such as **uveitis, keratitis, or acute angle-closure glaucoma**. *Incorrect: X = Ciliary congestion, Y = Conjunctival congestion* - This option reverses the patterns of vascular dilation shown in images X and Y. - Ciliary congestion (Y) is characterized by a **violaceous flush around the cornea (limbus)**, while conjunctival congestion (X) shows **more diffuse redness that is worse in the fornices**. *Incorrect: X = Phlyctenular keratoconjunctivitis, Y = Angular conjunctivitis* - This option incorrectly identifies specific inflammatory conditions rather than the types of congestion shown. - **Phlyctenular keratoconjunctivitis** involves nodular lesions (phlyctenules) near the limbus, which are not depicted in image X. - **Angular conjunctivitis** causes redness and excoriation primarily at the outer and inner canthi, not the perilimbal pattern seen in image Y. *Incorrect: X = Angular conjunctivitis, Y = Phlyctenular keratoconjunctivitis* - This option reverses the incorrect attributions from the previous option. - Angular conjunctivitis affects the **canthi** (not the diffuse pattern in X), and phlyctenular keratoconjunctivitis involves **nodules on the conjunctiva or cornea** (not the circumcorneal congestion in Y).

Q: All are correct about the lesion shown except:

More common on temporal side as compared to nasal side. ***More common on temporal side as compared to nasal side*** - The image shows a **pterygium**, which is a fleshy, triangular growth of conjunctival tissue on the cornea. Pterygia are **more common on the nasal side** of the eye, typically growing from the nasal conjunctiva towards the cornea. - The statement claims it's more common on the temporal side, which is incorrect and therefore the exception. *Exposure to UV light is a risk factor* - **Chronic exposure to ultraviolet (UV) light** from sunlight is a well-established and major risk factor for the development and progression of pterygium. - This is why pterygium is more prevalent in individuals living in equatorial regions or those with outdoor occupations. *Probe cannot be passed beneath the neck* - A characteristic feature of a pterygium, differentiating it from a pseudopterygium, is that a **probe cannot be passed beneath its neck** (the corneal portion). - This indicates that the pterygium is firmly adherent to the corneal surface, representing an invasive growth. *Conjunctival limbal autograft has the least recurrence rate* - Surgical excision of a pterygium combined with a **conjunctival limbal autograft** (CLAG) is considered one of the most effective techniques to prevent recurrence. - The autograft tissue, containing limbal stem cells, helps repopulate the limbus and discourage further fibrovascular invasion onto the cornea, leading to a significantly lower recurrence rate compared to simple excision.

Q: Spring catarrh is a type of conjunctivitis caused by

Exogenous allergen. ***Exogenous allergen*** - **Spring catarrh**, also known as **vernal keratoconjunctivitis (VKC)**, is exclusively a type of allergic conjunctivitis. - It is triggered by exposure to **environmental allergens**, commonly identified as dust, pollen, or other airborne irritants, especially during warmer seasons. *Virus infection* - Viral conjunctivitis, such as that caused by **adenovirus**, often presents with watery discharge, redness, and may be associated with an upper respiratory tract infection. - Unlike spring catarrh, it is highly **contagious** and does not typically recur seasonally due to allergen exposure. *Endogenous toxins* - Ocular conditions caused by endogenous toxins are rare and usually associated with systemic diseases or metabolic disorders affecting body system, not typically a primary cause of conjunctivitis. - This category does not align with the clear allergic and seasonal presentation characteristic of spring catarrh. *Bacterial infection* - Bacterial conjunctivitis is characterized by purulent (pus-like) discharge, severe redness, and often involves one eye initially (though can spread to both). - It is treated with antibiotics and does not typically exhibit the seasonal recurrence or papillary hypertrophy on the tarsal conjunctiva seen in spring catarrh.

Q: All are true about Vernal conjunctivitis EXCEPT:

Most signs are in lower lid. ***Most signs are in lower lid*** ✗ - This is **INCORRECT** and is the answer to this EXCEPT question. - **Vernal conjunctivitis (VKC)** primarily affects the **upper tarsal conjunctiva**, not the lower lid. - The characteristic **cobblestone papillae** develop on the **upper eyelid** due to friction from blinking, causing **papillary hypertrophy**. - While bulbar conjunctiva and limbus can be affected, the most severe signs are in the **upper lid**. *Type of allergic conjunctivitis* ✓ - **VKC** is correctly classified as a chronic, bilateral, severe form of **allergic conjunctivitis**. - It is typically a **Type I hypersensitivity reaction**, often associated with atopy. *Cobblestone appearance* ✓ - This refers to the characteristic **large, flattened giant papillae** that develop on the **upper tarsal conjunctiva** in VKC. - The appearance results from marked hypertrophy of these papillae, resembling cobblestones. *Itchy eyes with other allergic problems* ✓ - **Intense itching** is the cardinal symptom of VKC, often accompanied by **photophobia**, **tearing**, and stringy mucous discharge. - Patients frequently have a personal or family history of other **atopic conditions** like asthma, eczema, or allergic rhinitis.

Question 1

A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Trachoma

Answer

Vernal conjunctivitis

Answer

Eales disease

Answer

Phlyctenular keratoconjunctivitis

Question 2

A 5-year-old child presents with severe itching and ropy discharge. Image shows:

Accepted Answer

Vernal conjunctivitis

Answer

Ligneous conjunctivitis

Answer

Angular conjunctivitis

Answer

Parinaud's conjunctivitis

Question 3

The image shown below depicts:

Accepted Answer

Pterygium

Answer

Bitot's spots

Answer

Nodular scleritis

Answer

Pinguecula

Question 4

A five-year-old child presents with recurrent episodes of thick, woody pseudomembranous growths on the conjunctiva that have been difficult to remove. Which condition is shown in the image below?

Accepted Answer

Ligneous conjunctivitis

Answer

Adenovirus pseudomembrane

Answer

Vernal conjunctivitis

Answer

Foreign body granuloma

Question 5

A 25-year-old lady presents with itching and excoriation of the skin near inner canthus bilaterally. Sometimes a slight mucopurulent discharge is present in the morning. What is the best treatment for this patient? (Recent NEET Pattern 2016-17)

Accepted Answer

Oxytetracycline with zinc oxide

Answer

Gentamicin with boric acid

Answer

Gentamicin with zinc oxide

Answer

Oxytetracycline with boric acid

Question 6

A patient presents with red eye. What is correct about the image shown below?

Accepted Answer

$X=$ Conjunctival congestion, $Y=$ Ciliary congestion

Answer

$X=$ Ciliary congestion, $Y=$ Conjunctival congestion

Answer

$X=$ Phlyctenular keratoconjunctivitis, $Y=$ Angular conjunctivitis

Answer

$X=$ Angular conjunctivitis, $Y=$ Phlyctenular keratoconjunctivitis

Question 7

All are correct about the lesion shown except:

Accepted Answer

More common on temporal side as compared to nasal side

Answer

Exposure to UV light is a risk factor

Answer

Probe cannot be passed beneath the neck

Answer

Conjunctival limbal autograft has the least recurrence rate

Question 8

All are true about the image shown EXCEPT:

Accepted Answer

Plasma retinol level is the most accurate indicator of Vitamin A status

Answer

Corynebacterium xerosis in cheesy plaques

Answer

Squamous metaplasia

Answer

Punctuate keratitis

Question 9

Spring catarrh is a type of conjunctivitis caused by

Accepted Answer

Exogenous allergen

Answer

Virus infection

Answer

Endogenous toxins

Answer

Bacterial infection

Question 10

All are true about Vernal conjunctivitis EXCEPT:

Accepted Answer

Most signs are in lower lid

Answer

Type of allergic conjunctivitis

Answer

Cobblestone appearance

Answer

Itchy eyes with other allergic problems

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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