CONJUNCTIVA

Mucopurulent

Bacterial
Purulent
Conjunctivitis

Membranous
Epidemic
Keratoconjunctivitis
Adenovirus
Pharyngoconjunctival
Picornavirus Fever
Viral
Microbial Conjuncitivitis
Herpes Simplex

Moluscum Contagiosum

Trachoma
Conjunctivitis

Chlamydial Adult Inclusion

Neonatal Inclusion

Acute Allergic

Seasonal

Allergic Vernal

Atopic

Non Microbial
Phlyctenular

Occular Cicatricial
Pemphigoid
Autoimmune
SJS
Papillae  Allergic, Bacterial
Follicular  Viral,Chlamydial
Organism Discharge

Bacterial(Staph, Strep, H influenza) + Chlamydial Mucopurulent

BACTERIAL

Neisseria gonorrhea Purulent

Corynebacterium diphtheria Serous

Viral Watery

Molluscum Contagiosum Mucoid

A.Viral Conjunctivitis
1. A 45-year-old male patient presented with burning and redness in both eyes for last three days. On examination, there is watery discharge, follicular conjunctival reaction and painful preauricular
lymphadenopathy.
a) What is the most likely diagnosis? (1)
b) How will you manage this case? (3)
c) What complication can occur? (1)
[Supple 2019 held in 2020]
Marginal Corneal Ulcer, Blepharitis, Superficial Keratitis, Dacrocystitis

2. A 19 years old female presented with severe irritation, redness, watering and photophobia in both eyes after upper respiratory tract infection. Her elder brother had similar episode 1 week earlier.
a) What is your diagnosis? (1)
b) Name other clinical signs to look for in this case. (2)
c) Name treatment options for this case. (2)
[Supple 2017 held in 2018]

3. A 20-year-old girl presents with acute onset of watering and redness in both eyes. On examination, her visual acuity is 6/6 in both eyes. There is mild chemosis, follicle formation in the inferior fornixes
and pre-auricular lymphadenopathy.
a) What is the most likely diagnosis?
b) What other complications can be seen in her?
c) What are the different types of presentation of this disease?
[Annual 2015]
4. A 20-year-old boy developed pain, redness, and watering in both eyes one after the other. His younger brother had same condition 3-4 days ago which he incurred at school.
a) What is your diagnosis?
b) What is the treatment of this condition?
c) How can you prevent this condition from spreading?

[Annual 2012 + Supple 2010]

B.Pharyngoconjunctival Fever
1. A 15-year-old boy presents with sudden onset of bilateral pink eye with fever and pharyngitis. On examination, his visual acuity is 6/6 and there are follicles present in the inferior fornix in association
with diffuse conjunctival congestion. Corneal examination shows punctate keratitis bilaterally.
a) What is most likely diagnosis?
b) What organism causes this disease?
Adenovirus serotype 3,4,7
c) Why should the child be advised to stay at home?
Contagious
d) What is the most appropriate treatment?
[Annual 2011]

C.Trachoma
1. A 30 years old man of low socio-economic group presents within turned lashes of upper lid. Lid eversion shows a significant white horizontal line involving the conjunctiva and tarsal plate.
a) What is the most probable diagnosis? (1)
Trachoma/ Egyptian Ophthalmia
b) Give the most recent staging of this disease. (2)
WHO has suggested the following classifications in 1987.
1. TF (Trachomatous inflammation—Follicular)
a. Atleast five or more follicles (each 0.5mm or more in diameter) should be present on the upper tarsal conjunctiva.
b. The deep tarsal vessels should be visible through the follicles.
2. TI (Trachomatous inflammation—Intense)
a. There is marked inflammatory thickening of the upper tarsal conjunctiva which appears red, rough, thickened with numerous follicles.
b. This obscures 50% or more of the deep tarsal vessels.
3. TS (Trachomatous scarring)
Presence of scarring is seen in the upper tarsal conjunctiva. Which is seen as white fibrous lines, bands or sheets.
4. TT (Trachomatous trichiasis)
a. Atleast one or more misdirected eyelashes rub against the eyeball.
b. Evidence of recent removal of inturned eyelashes should be regarded as trichiasis.
5. CO (Corneal opacity)
Easily visible corneal opacity over the pupil results in visual impairment
c) Enumerate the treatment strategies in this condition. (2)
[Annual 2017]

2. A 3 years old child is brought to you with mixed follicular/papillary conjunctivitis with mucopurulent discharge and superior pannus formation.
a) What is your diagnosis?
b) What are the sequelae of this disease?
c) How will you treat this patient?
[Annual 2016]
3.
a) Write down the WHO classification of Trachoma.
b) What is the treatment of trachoma?
[Supple 2014]
4.
a) Describe the clinical features of trachoma.
b) What are the complications and treatment of this disease?
[Supple 2009]
5.
a) Enumerate four complications of trachoma.

b) Name drugs used in the treatment of trachoma.

[Annual 2006]
D.Neonatal Conjunctivitis (Ophthalmia Neonatorum)
1. A 3 days old child is seen in the eye outpatient department. There is mucopurulent discharge with lid swelling. Pseudo-membrane is also seen.
a) What is the most probable diagnosis? (1)
b) Give two most important organisms responsible for this condition. (2)
Chlamydia, Neisseria
c) What medications will you use to treat this condition? (2)
[Annual 2019]
2. A 2-week-old baby girl has swelling and sticking of eye lids. On examination, there is mucopurulent discharge and conjunctival congestion most marked in the fornixes.
a) What is your diagnosis?
b) What organism is associated with this problem?
c) How would you treat her?
[Annual 2014]
3. A newborn child who is 48 hours old is brought to accident emergency with bilateral severe purulent discharge. On opening the eye with retractor, ulceration of cornea is
seen in the right eye.
a) What is most probable diagnosis?
b) Which organism is most likely the cause of this condition?
c) What investigation would you perform?
d) What is most appropriate treatment?
[Supple 2011]
E.Acute Allergic Conjunctivitis
1. A young man presents with itchy, swollen red eyes with clear watery discharge following exposure to dust.
a) What is the most likely diagnosis?
Acute Catarrhal Conjunctivitis
b) What drugs can be used to treat?
Treatment
1. Removal of the allergen is absolutely necessary. If this cannot be done, desensitization may be done by long course of injections.
2. Astringent lotions are applied frequently.
3. Vasoconstrictor, e.g. adrenaline solution (1 in 10000) reduces the congestion.
4. Antihistamine drugs (antistine privine1%) are effective in controlling allergic reaction.
5. Disodium cromoglycate 2% is a mast cell stabilizer, thus, preventing the release of histamine. It is safe and can be used for long period.
6. Corticosteroid drops are effective in the treatment of severe cases.
7. In atropine irritation, the drug should be withdrawn. Phenylephrine (10%) or mydricaine injection (subconjunctival) may be substituted.
c) What complications can develop in cornea?
d) What is the n natural course of disease if left untreated?
[Annual 2010]
i) Persists for years Seasonal Recurrences with exaceberations & Remissions (Common)
ii)Majority of time subsides around puberty

F.Vernal Keratoconjunctivitis (Spring Catarrh)

1. A 12 years old boy complains of severe irritation in his both eyes and stringy mucus
discharge from the last 4 years. He tells that these symptoms decrease in winter and
aggravate in summers.
a) What is your diagnosis?
b) Enumerate classification.
c) Write down its treatment.
[Supple 2016 held in 2017]
2. A 15 years old boy presents in OPD with complains of mucoid discharge from both eyes. Examination revealed hyperemia, chemosis, and giant papillae on the palpebral conjunctiva on both sides.
a) What is your diagnosis for this case?
b) Enumerate four causative factors.
i) Endogenous Bacterial proteins( S aureus)
ii) Exogenous Pollens, Dust
iii) Chemicals like Atropine
iv) Contact Lens
v) Old Scar or Loose Stitch
c) How will you manage this case?
[Supple 2014]
3. A 15 years old girl comes to eye OPD complaining of intense itching and mild photophobia in both eyes. History reveals it is to be seasonal. On examination, her visual acuity in both eyes is 6/6 + N5. Eyes
show mild redness and cobble stone appearance on eversion of upper eyelids.
a) What is your diagnosis? Palpebral Form of Vernal Cattarh
b) What are the different types of this conditions?
c) What is the treatment?
[Annual 2014]
4. During month of summer, principal of school reported that half of his secondary class has red, painful and watery eyes associated with the itching. He wants to have
your expert opinion about.
a) What is diagnosis?
b) What clinical findings will help you in reaching at the diagnosis?
c) How will you manage this situation?
d) How can you prevent this situation?
[Annual 2013]
Prophylaxis
1. Beta-radiation is given in proliferative cases at monthly intervals during the months of February, March and April to prevent the onset of symptoms. This does not cure the disease.
2. Disodium cromoglycate 2% eyedrops are applied 3-4 times before the onset of the disease.
3. Desensitization has also been tried without much rewarding results.
5. A 15-year-old male presents with severe itching and burning of both eyes. The condition gets aggravated in summer. His eyes show conjunctival redness, a gelatinous mass all around the cornea and flat-
topped nodules on the upper tarsal conjunctiva. Visual acuity is 6/6 of both eyes.
a) What is the most likely diagnosis?
b) What are the likely complications?
Complications
Complications are mainly due to corneal involvement. Serious complications are never seen and the ultimate prognosis is good.
Keratopathy
Buckley has classified the corneal involvement into 5 clinical stages:
i. Superficial punctate keratitis—These are tiny microerosions in upper cornea.
ii. Epithelial macroerosion and ulceration occurs due to epithelial loss.
iii. Plaque—There is bare area caused by macroerosion of epithelium which becomes coated
with mucus.
iv. Ring scar is formed as a result of subepithelial corneal scarring.
v. Pseudogeron toxon—It resembles arcus senilis with appearance of ‘cupid’s bow’
c) What is the treatment?
[Supple 2013]
6. A 9-year-old boy presents with burning, itching and thick ropy discharge. The symptoms get aggravated in summer season and respond well to topical medications.
a) What is most probable diagnosis?
b) What is the etiology of the disease?
c) What are treatment options?
[Annual 2009]
7. A young boy of 13 years was noted for excessive rubbing of both eyes associated with redness and thick discharge collected at the inner corners of eye. He started these symptoms some years ago which
were more marked during summer season. Diagnosed as a case of atopy and vernal catarrh or seasonal allergy, he was managed accordingly.
a) What type of hypersensitivity reaction is involved in this type?
I and IV
b) What would happen if the patient is moved to a cooler environment?
Regress/ Subsides
c) How an attack of allergic conjunctivitis is treated?
[Annual 2008]
8. A ten-year-old presents with red itchy eyes at the beginning of spring.
a) What is the diagnosis?
b) Name two drugs used in its treatment.
c) What are the complications of severe disease?
[Annual 2007]
9. A 10-year-old boy presents with red itchy eyes at the beginning of spring.
a) What is the diagnosis?
b) Name two drugs used in its treatment.
c) What are complications of severe disease?
[Annual 2006]
10. Describe the symptoms, signs and management of spring catarrh. [Annual 2005]

G.Ocular Cicatricial Pemphigoid

1. A 65 years old lady has low grade itching in the eyes and whole body for last three years. She is a known case of ocular cicatricial pemphigoid.
a) Write four clinical signs of the disease. (2)
i) Entropion
ii) Trichiasis
iii)Pannus
iv) Corneal Opacification
b) What are ocular complications of this disease? (2)
c) What is the ocular treatment of the disease? (1)
[Supple 2018 held in 2019]
H.Pterygium
1. A 60 years old farmer came to eye OPD with triangular growth on the medial side of both eyes in the inter-palpebral area. The growth was encroaching the cornea and reaching the pupillary area. The
eye was otherwise normal.
a) What is the most probable diagnosis? (2)
b) What are the indications for treating this condition and how will you treat it? (3)
[Annual 2018]
I.Vitamin A deficiency
1. List ocular manifestations of Vitamin A deficiency. [Annual 2008]