100+ Free CMSA Diploma in Ophthalmology Dip Ophth(SA) Practice Questions

Explanation: Topical fluoroquinolone monotherapy (e.g., ciprofloxacin 0.3% or moxifloxacin 0.5% drops hourly) is the standard empirical initial treatment for bacterial corneal ulcers, particularly in contact lens wearers where Pseudomonas aeruginosa is a primary pathogen. Urgent corneal scraping for Gram stain and culture should precede or accompany treatment, but intensive broad-spectrum topical bactericidal drops must not be delayed. Topical steroids and pressure patching are strictly contraindicated in active infectious keratitis.

Explanation: Fusarium or Aspergillus species are the classic fungal pathogens causing keratomycosis following vegetative ocular trauma in agricultural or outdoor workers. The clinical features of feathery stromal margins, satellite lesions, and elevated endothelial plaques are characteristic of filamentous fungal keratitis. Initial treatment requires topical natamycin 5% or amphotericin B drops.

Explanation: Topical acyclovir 3% eye ointment applied 5 times daily (or ganciclovir 0.15% gel) is the standard evidence-based treatment for HSV dendritic epithelial keratitis. Dendritic ulcers with terminal bulbs and decreased corneal hypoesthesia are hallmark diagnostic features of herpes simplex virus keratitis. Topical corticosteroids must be avoided in epithelial viral keratitis because they cause rapid geographic ulceration.

Explanation: Surgical excision with conjunctival autografting is the gold-standard surgical treatment for primary and recurrent pterygium extending onto the cornea, associated with the lowest recurrence rate (<5-10%). Simple excision with bare sclera leaves high recurrence rates of up to 40-70%. Topical steroids provide temporary symptomatic relief but do not eliminate the growth.

Explanation: Preservative-free artificial lubricant eye drops combined with warm eyelid compresses (for accompanying meibomian gland dysfunction) represent step 1 first-line therapy for evaporative and aqueous-deficient dry eye disease. Schirmer test <10 mm and TBTT <10 seconds confirm dry eye disease. Invasive procedures like punctal plugs are reserved for refractory moderate-to-severe cases after conservative therapy.

Explanation: Vernal keratoconjunctivitis (VKC) is a severe, recurrent allergic eye disease predominantly affecting young males in warm climates. Hallmark physical findings include giant 'cobblestone' papillae on the upper tarsal conjunctiva, Horner-Trantas dots (limbal eosinophil clumps), and shield ulcers. First-line maintenance includes dual-action topical mast cell stabilizers/antihistamines (e.g., olopatadine).

Explanation: A simple corneal abrasion is managed with prophylactic topical broad-spectrum antibiotic ointment/drops (e.g., chloramphenicol or ciprofloxacin) to prevent secondary bacterial infection, along with short-acting cycloplegics (e.g., cyclopentolate 1%) for ciliary spasm pain relief. Corneal epithelial defects heal rapidly (24-48 hours) without suturing.

Explanation: Anterior scleritis presents with severe, deep, boring ocular pain radiating to the forehead or trigeminal distribution, characteristically awakening the patient at night. Scleral deep vessel engorgement does NOT blanch following instillation of topical phenylephrine 2.5% (unlike episcleritis). Up to 50% of cases are associated with systemic autoimmune conditions like rheumatoid arthritis or GPA.

Explanation: Hutchinson sign refers to herpes zoster vesicles on the side or tip of the nose, indicating involvement of the external nasal branch of the nasociliary nerve (V1 branch). Because the nasociliary nerve also innervates the cornea and globe, Hutchinson sign strongly predicts ocular involvement (anterior uveitis, epithelial/stromal keratitis). Management requires oral aciclovir or valaciclovir.

Explanation: Adenovirus is the most common cause of acute viral epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever. Key features include watery discharge, marked palpebral conjunctival follicles, subepithelial corneal infiltrates, and palpable, tender preauricular lymph nodes. Treatment is supportive with lubricants and cold compresses.