External Disease and Cornea

A 72-year-old woman reports experiencing a foreign-body sensation in her eyes. The referring ophthalmologist thought she had dry eyes, yet her symptoms have not been relieved by artificial tear supplementation throughout the day or use of topical cyclosporine. Which clinical sign would suggest another etiology for her underlying problem?

Schirmer test result <5.5 mm after 5 minutes without anesthetic

Tear meniscus height of 0.5mm

Tear breakup time of 4 seconds

Redundancy of the inferior bulbar conjunctiva overhanging the lower eyelid margin

Which of the following laboratory test results would be consistent with dry eye?

Tear hyperosmolarity

Decreased level of matrix metalloproteinase-9

Increased level of tear lactoferrin

Increased level of tear lysozyme

Which of the following treatments is a good therapeutic option for initial treatment of a neurotrophic corneal ulcer?

Gundersen flap placement

Boston keratoprosthesis

Tarsorrhaphy

Bandage contact lenses

What is the most appropriate initial treatment of unilateral stem cell deficiency with irregularity extending into the visual axis that is secondary to contact lens use?

Boston type I keratoprosthesis

Corneal debridement

Discontinuation of contact lens use

Limbal stem cell allograft transplantation

Unlike the human immunodeficiency viruses, viruses of the family Adenoviridae have a differential ability to survive for weeks on inanimate surfaces. This ability is best explained by which anatomical feature of the Adenoviridae?

Their double-stranded DNA genetic makeup

Their absence of a surface lipid bilayer envelope

The integrin-binding site on their surface

The existence of numerous serotypes

A healthy 65-year-old man presents with a 2-day history of a painful rash on the left side of this forehead extending down to his eyelids. A vesicular skin lesion is also present at the tip of his nose. Which of the following treatment options would most likely reduce his risk of postherpetic neuralgia?

Administration of systemic corticosteroids within the first 72 hours

Use of oral famciclovir 500mg TID for 7-10 days after 1 week of symptoms

Prior varicella-zoster vaccination

Use of oral valacyclovir 500mg TID, beginning at the time of presentation

A 30-year-old immunocompetent patient presents with a 1-day history of vesicular lesions on his upper lip and the third recurrence within the past year of a dendritic epithelial lesion of his right cornea. Which of the following options would be the most appropriate treatment at this time?

Topical ophthalmic ganciclovir ointment 0.15% 5 times a day for 1 week

Topical trifluridine eyedrops 1% 9 times a day for 3 weeks

Systemic famciclovir 500mg TID for 10 days

Systemic valacyclovir 500mg TID for 10 days followed by maintenance dosing

A corneal transplant patient on long-term topical corticosteroid and topical antibaterial treatment presents with an indolent midperipheral keratitis. Smear testing shows yeast and pseudohyphae. Which of the following protocols is the most appropriate initial treatment?

Topical natamycin 5% every hour

Intrastromal corneal injection of natamycin

Topical amphotericin B 0.15% every hour

Topical moxifloxacin 0.5% every hour

A 27-year-old woman who underwent uncomplicated laser in situ keratomileusis 6 weeks ago presents for routine follow-up examination and is noted to have a new infiltrate in the interface. There is no improvement after 3 days of hourly administration of fluoroquinolone eyedrops. Which of the following actions is the most appropriate next step in management?

Change topical antibiotic to fortified vancomycin

Lift flap and irrigate with vancomycin

Lift flap; obtain cultures on blood, chocolate agar, and Sabouraud's agar; change antibiotic to fortified vancomycin and gentamicin

Add topical corticosteroids

An 80-year-old nursing home resident presents with a 2-day history of a 6-mm central corneal infiltrate after accidentally striking the left eye with a bottle of timolol. What is the best choice for initial management?

Empiric, topic, fourth-generation fluoroquinolone every hour

Corneal scraping for culture and sensitivity testing, followed by topical fourth-generation fluoroquinolone every hour

Empiric fortified vancomycin and gentamicin every hour

Corneal scraping for culture and sensitivity testing, followed by fortified topical vancomycin and gentamicin

Which condition is typically associated with keratinized epithelial cells?

Mucous membrane pemphigoid-associated conjunctivitis

Herpes keratoconjunctivitis

Vernal keratoconjunctivitis

Chlamydial (inclusion) conjunctivitis

How do corneal angiogenesis and lymphangiogenesis affect outcomes after corneal transplantation?

Vascularization of the cornea increases the risk of immune rejection after corneal transplantation, leading to a frequency of graft rejection >90%. This may occur even when a strict regimen of topical and systemic immunosuppressive agents is used.

Lymphatic neovessels may grow in parallel with the blood vessels but do not affect the risk of immune rejection.

Blockade of angiogenesis or lymphangiogenesis decreases the risk of graft failure in animal models.

VEGF inhibitors, including pegaptanib, ranibizumab, and bevacizumab, have been used for the treatment of corneal neovascularization after corneal transplantation to improve graft survival in humans.

Which of the following treatments is MOST recommended in the vision rehabilitation of patients with severe ocular surface disease associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis?

Osteo-odonto-keratoprosthesis

Penetrating keratoplasty

Keratomileusis

Autologous stem cell transplantation

Which statement is more characteristic of atopic keratoconjunctivitis than of vernal keratoconjunctivitis

Patients with atopic keratoconjunctivitis are younger

The papillae occur in the lower palpebral conjunctiva only

Eosinophils in conjunctival cytology specimens are less numerous and are more often degranulated

Extensive corneal vascularization and opacification rarely occur secondary to chronic epithelial disease (likely as the result of limbal stem cell dysfunction)

Which of the following neoplastic lesions of the conjunctiva is most likely to be associated with a systemic neoplastic disease?

Ocular surface squamous neoplasia

Conjucntival papilloma

Conjunctival lymphoma

Conjunctival myxoma

Which of the following is a risk factor for tumor recurrence after the successful treatment of ocular surface squamous neoplasia?

Presence of leukoplakia

Coexistence of ocular surface squamous neoplasia and pterygium

Tarsal involvement

Male sex

Which of the following statements characterizes Peters anomaly?

A central opacity of the cornea weith underlying endothelial defect and iris adhesions

A central opacity of the cornea that is always bilateral

A central opacity of the cornea that is never adherent to the lens

A central opacity that is always associated with systemic anomalies

Which statement best characterizes the corneal injury caused by birth trauma?

A corneal abrasion that heals, leaving no permanent injury

A stretching of the corneal stroma leading to a keratoconus-like protrusion

A stretching of Descemet membrane that leads to endothelial dysfunction and corneal edema

A vertical break in the corneal endothelium, leaving vertical ruptures in Descemet membrane that lead to corneal edema; the edema often clears and may produce high astigmatism

Which of the following corneal dystrophies is autosomal recessive?

Macular dystrophy

Lattice dystrophy type I

Granular dystrophy

Fuchs endothelial corneal dystrophy

Which of the following metabolic disorders that affect the cornea is X-linjked recessive?

Hunter syndrome

Hurler syndrome

Maroteaux-Lamy syndrome

Scheie syndrome

Which of the following features is characteristic of Marfan syndrome?

Autosomal recessive inheritance

Spherophakia

Corneal flattening

Defect in the elastin gene

Which of the following is the most significant risk factor for pterygium development?

Peripheral ulcerative keratitis

Connective tissue disease

UV light exposure

Dry eye

Terrien marginal degeneration is characterized by which of the following?

A primarily inflammatory condition

Corneal thinning that usually begins superiorly

Male predilection

Spontaneous corneal perforation

Which of the following statements characterizes calcific band keratopathy?

The condition begins with fine, dustlike, basophilic deposits in Descemet membrane

The changes are usually first noted peripherally in the 6- and 12-o'clock positions

A lucid interval is present between the limbus and the peripheral edge of the keratopathy

The condition is a dystrophy of the superficial cornea

Traumatic hyphema should typically be treated with which medicines?

Aminocaproic acid to slow clot dissolution and prevent rebleeding

Topical corticosteroids and cycloplegic agents

Tissue plasminogen activator to hasten dissolution of the clot

Intravenous corticosteroids to reduce the inflammation

What is the best management of a suspected corneal laceration?

Prescribe topical and oral antibiotics and have the patient return for follow-up in 48 hours

To improve exposure, apply 4 rectus sutures in the operating room, usually with general anesthesia

Perform a thorough, gentle exploration and repair int he operating room, usually under general anesthesia

Irrigate the fornices to enusre that no particles are left behind

Which clinical finding best supports a diagnosis of limbal stem cell failure?

Corneal thinning and melting

Corneal edema

Absence of limbal palisades of Vogt with superficial corneal neovascularization

Corneal opacities with deep corneal neovascularization

Which of the following statements is best in relation to corneal surface healing?

Central corneal epithelium is maintained bu continued centripetal movement of central corneal epithelium toward the periphery

The corneal epithelium is entirely regenerated about every 21 days, with the stem cells serving as the source of this renewal

When there is concurrent damage to the limbal stem cells, the conjunctival cells do not become involved in repopulating the corneal surface

The limbal basal layer contains the stem cells of the corneal epithelium that normally repopulate the corneal surface

Eight weeks after undergoing corneal transplantation, a 75-year-old patient presents with a clear graft and no vascularization to the wound. There are 8 interrupted and 1 complete continuous sutures. The visual acuity is 20/100 uncorrected and 20/40 best corrected. The corneal topography is 48.40 x 90/42.60 x 180 with clear mires. The refraction is -2.00+5.00x90. What is the best next step at this point?

Remove the continuous suture

Remove an interrupted suture at 180

Perform a relaxing incision at 90

Remove an interrupted suture at 90

A 55-year-old patient with Fuchs endothelial corneal dystrophy presents with visual acuity of 20/200l Slit-lamp examination reveals significant stromal and epithelial edema but no significant corneal scarring. Which one of the following procedures would be the most appropriate treatment for this patient's cornea?

Penetrating keratoplasty

Endothelial keratoplasty (using DSEK or DMEK)

Keratomileusis

Deep anterior lamellar keratoplasty

A patient presents 3 weeks after corneal transplantation surgery with a persistent epithelial defect that has not responded to patching and lubrication. What is the most appropriate next step in this patient's management?

A second corneal transplantation

Administration of oral acyclovir 400mg 4 times daily

Conjunctival flap procedure

Increased frequency of topical corticosteroids

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