A 7-year-old girl from a dry village in Rajasthan with poor access to water has chronic red, gritty eyes. Eversion of the upper lids shows many follicles on the tarsal conjunctiva, and her siblings have similar findings. Under the WHO SAFE strategy, which drug is given for mass treatment of the community?

Single oral dose of azithromycin

Topical ciprofloxacin for two weeks

Topical chloramphenicol for a week

Oral doxycycline for three weeks

A 35-year-old auto-rickshaw driver had a red, watery eye and was given prednisolone drops by a chemist. A week later the eye is worse. Fluorescein shows a branching ulcer with knobbed ends, and corneal sensation is reduced in that eye. What is the most appropriate management?

Stop the steroid and start topical acyclovir

Stop the steroid and start natamycin

Continue the steroid and add moxifloxacin

Increase the steroid to hourly drops

A 68-year-old man in Lucknow has a painful vesicular rash over the right forehead and upper eyelid, not crossing the midline, for three days. Vesicles are also present on the tip and side of his nose. Why do the nasal vesicles make eye involvement likely?

The nasociliary nerve supplies both the nose tip and the eye

The facial nerve supplies both the nose tip and the lacrimal gland

The frontal nerve supplies both the nose tip and the cornea

The maxillary nerve supplies both the nose tip and the iris

Conjunctiva, cornea and uvea

24 NEET-PG practice questions on Conjunctiva, cornea and uvea, part of Ophthalmology. The first 24 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A 45-year-old paddy farmer was hit in the eye by a rice stalk ten days ago. He now has a dry-looking, greyish-white corneal ulcer with feathery margins, satellite lesions and a hypopyon. What is the first-line topical treatment?
1. AMoxifloxacin 0.5% eye drops
2. BNatamycin 5% eye drops
3. CPrednisolone 1% eye drops
4. DAcyclovir 3% eye ointment
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Answer: B · Natamycin 5% eye drops
Injury with vegetable matter followed by a dry ulcer with feathery margins, satellite lesions and an immobile hypopyon is typical of filamentous fungal keratitis, usually Fusarium or Aspergillus in India. Natamycin 5% is the first-line topical drug for filamentous fungi; voriconazole is an alternative or add-on. Diagnosis is confirmed by KOH mount and culture of corneal scrapings. Topical steroids are contraindicated because they worsen fungal growth.
- A: Moxifloxacin treats bacterial keratitis and has no antifungal action.
- C: Steroids enhance fungal growth and can cause perforation.
- D: Acyclovir treats herpes simplex keratitis, which gives a dendritic ulcer.
Question 2 · Medium
A 14-year-old boy with vernal keratoconjunctivitis has been buying dexamethasone eye drops from a chemist and using them for 8 months. He now has IOP 34 mmHg in both eyes with open angles and early cupping of the discs. The steroid is tapered and stopped. Which drug is best for long-term control of his allergic disease without this risk?
1. ATopical chloramphenicol
2. BTopical fluorometholone
3. COral prednisolone
4. DTopical cyclosporine
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Answer: D · Topical cyclosporine
Long-term topical steroids raise IOP in susceptible people (steroid responders) by reducing aqueous outflow through the trabecular meshwork, and also cause posterior subcapsular cataract. Children with vernal disease who self-medicate are at particular risk. Topical calcineurin inhibitors (cyclosporine or tacrolimus), together with mast cell stabilisers and antihistamines, control vernal disease without raising IOP. The raised IOP is treated with aqueous suppressants and monitored, and steroid prescriptions should be time-limited.
- A: Chloramphenicol is an antibiotic and does nothing for allergic inflammation.
- B: Fluorometholone is a weaker steroid but still raises IOP with long use.
- C: Systemic steroids also raise IOP and have far more adverse effects.
Question 3 · Easy
A 7-year-old girl from a dry village in Rajasthan with poor access to water has chronic red, gritty eyes. Eversion of the upper lids shows many follicles on the tarsal conjunctiva, and her siblings have similar findings. Under the WHO SAFE strategy, which drug is given for mass treatment of the community?
1. ATopical ciprofloxacin for two weeks
2. BSingle oral dose of azithromycin
3. CTopical chloramphenicol for a week
4. DOral doxycycline for three weeks
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Answer: B · Single oral dose of azithromycin
Follicles on the upper tarsal conjunctiva in children of a crowded, water-poor community suggest active trachoma, caused by Chlamydia trachomatis serotypes A to C. SAFE stands for Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. A single oral dose of azithromycin is used for mass drug administration because it clears ocular and extra-ocular reservoirs and is easy to supervise; topical tetracycline ointment is the alternative. Repeated infection leads to scarring (Arlt's line, Herbert's pits), trichiasis and corneal blindness.
- A: Topical ciprofloxacin is not part of the SAFE strategy.
- C: Chloramphenicol is not the trachoma drug and a short topical course does not clear the reservoir.
- D: Doxycycline is not used for community campaigns and is avoided in young children.
Question 4 · Medium
A 35-year-old auto-rickshaw driver had a red, watery eye and was given prednisolone drops by a chemist. A week later the eye is worse. Fluorescein shows a branching ulcer with knobbed ends, and corneal sensation is reduced in that eye. What is the most appropriate management?
1. AStop the steroid and start topical acyclovir
2. BStop the steroid and start natamycin
3. CContinue the steroid and add moxifloxacin
4. DIncrease the steroid to hourly drops
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Answer: A · Stop the steroid and start topical acyclovir
A dendritic ulcer with terminal bulbs and reduced corneal sensation is epithelial herpes simplex keratitis. Steroids promote viral replication and can turn a dendrite into a large geographic ulcer, so they must be stopped. Topical acyclovir 3% ointment (or ganciclovir gel) is the treatment, and gentle debridement of the infected epithelium helps. Steroids have a role only later, under antiviral cover, for stromal (immune) herpetic keratitis.
- B: Natamycin is antifungal and has no action on herpes simplex.
- C: Continuing the steroid worsens viral replication, and an antibiotic does not treat HSV.
- D: More steroid would enlarge the ulcer into a geographic ulcer.
Question 5 · Medium
A 68-year-old man in Lucknow has a painful vesicular rash over the right forehead and upper eyelid, not crossing the midline, for three days. Vesicles are also present on the tip and side of his nose. Why do the nasal vesicles make eye involvement likely?
1. AThe nasociliary nerve supplies both the nose tip and the eye
2. BThe facial nerve supplies both the nose tip and the lacrimal gland
3. CThe frontal nerve supplies both the nose tip and the cornea
4. DThe maxillary nerve supplies both the nose tip and the iris
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Answer: A · The nasociliary nerve supplies both the nose tip and the eye
This is herpes zoster ophthalmicus, reactivation of varicella-zoster virus in the ophthalmic division of the trigeminal nerve. Vesicles on the tip or side of the nose (Hutchinson sign) show that the nasociliary nerve is involved; its long ciliary branches supply the cornea, iris and ciliary body, so keratitis and uveitis are much more likely. Oral antivirals such as acyclovir or valacyclovir, started within 72 hours of the rash, reduce eye complications. Patients need slit-lamp review even if the eye looks quiet.
- B: The facial nerve is motor to the face and carries secretomotor fibres; it does not give the nose tip's sensation.
- C: The frontal nerve supplies the forehead and upper lid, not the nose tip or cornea.
- D: The maxillary nerve supplies the cheek and does not supply the iris.
Question 6 · Medium
A 48-year-old fisherman from Kollam has a fleshy, triangular growth of conjunctiva on the nasal side of his right eye. Its apex has crossed the limbus by 4 mm, it is advancing towards the pupil, and he has new astigmatism. What is the preferred surgery to limit recurrence?
1. AExcision with a bandage contact lens
2. BCauterisation of the head of the growth
3. CSimple excision with bare sclera
4. DExcision with conjunctival autograft
Answer and explanation in LearnFree account
Question 7 · Medium
A 9-year-old undernourished boy from a slum in Mumbai, whose father is on treatment for pulmonary tuberculosis, has photophobia and watering of the left eye. There is a small, raised, pinkish-grey nodule at the limbus with a leash of dilated vessels running to it. His Mantoux test is strongly positive. What is the mechanism of this lesion?
1. ADirect invasion by tubercle bacilli
2. BDelayed (type IV) hypersensitivity
3. CImmune complex (type III) deposition
4. DIgE-mediated (type I) hypersensitivity
Answer and explanation in LearnFree account
Question 8 · Hard
A 34-year-old woman from Pune has blurred vision in both eyes, fever and swelling in front of both ears for three weeks. Both eyes show mutton-fat keratic precipitates and Koeppe nodules. She has bilateral parotid enlargement and a left lower motor neuron facial palsy. Mantoux test is 0 mm. Which investigation is most useful next?
1. AToxoplasma IgG
2. BSerum ANA titre
3. CChest radiograph
4. DHLA-B27 typing
Answer and explanation in LearnFree account
Question 9 · Medium
A newborn delivered at home in a village in Bihar is brought on the third day of life with tense, swollen lids and copious, thick, yellow pus that wells out when the lids are parted. A Gram stain of the discharge shows Gram-negative intracellular diplococci. What is the most appropriate treatment?
1. ASystemic ceftriaxone with saline irrigation
2. BSilver nitrate drops and observation
3. COral erythromycin for two weeks
4. DTopical chloramphenicol drops only
Answer and explanation in LearnFree account
Question 10 · Hard
A 45-year-old man with recurrent granulomatous anterior uveitis has 360-degree posterior synechiae with iris bombe and IOP 38 mmHg in the right eye. The uveitis is being treated with topical steroid and atropine. While planning a laser iridotomy, which IOP-lowering drug should be avoided?
1. ABrimonidine
2. BAcetazolamide
3. CTimolol
4. DPilocarpine
Answer and explanation in LearnFree account
Question 11 · Medium
During the monsoon, 40 people attending one eye clinic in Pune develop red, watery eyes within two weeks; one eye usually starts and the other follows. A 30-year-old nurse has follicles in the lower fornix, a tender preauricular node and, two weeks later, small round subepithelial corneal opacities. Consider four statements about this outbreak: 1. Tender preauricular lymphadenopathy is common. 2. Subepithelial infiltrates may cause glare for months. 3. Routine topical antibiotics shorten the illness. 4. Spread is mainly through hands, towels and instruments. Which statements are correct?
1. A1, 2, 3 and 4
2. B2, 3 and 4 only
3. C1, 2 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 12 · Hard
A 26-year-old man from Delhi has had recurrent painful mouth ulcers several times a year and two episodes of scrotal ulcers. He now has blurred vision in the right eye. There is a layered hypopyon in a mildly congested eye, vitritis and sheathed retinal vessels with intraretinal haemorrhages. A sterile needle prick on his forearm produced a pustule after 48 hours. What is the most likely diagnosis?
1. AHLA-B27 anterior uveitis
2. BBehcet disease
3. CVogt-Koyanagi-Harada disease
4. DEndogenous endophthalmitis
Answer and explanation in LearnFree account
Question 13 · Easy
A 12-year-old boy from Nagpur is brought every April and May with intense itching of both eyes and a thick, ropy, white discharge. Eversion of the upper lids shows large, flat-topped papillae like cobblestones, and there are small white dots at the limbus. What is the most likely diagnosis?
1. AGiant papillary conjunctivitis
2. BPhlyctenular keratoconjunctivitis
3. CTrachoma in the active stage
4. DVernal keratoconjunctivitis
Answer and explanation in LearnFree account
Question 14 · Medium
A 27-year-old man from Hyderabad with low back pain and morning stiffness for two years presents with a painful red left eye, photophobia and blurred vision for two days. There is circumcorneal congestion, a small pupil, fine keratic precipitates and 3+ cells in the anterior chamber. IOP is 14 mmHg. What is the most appropriate initial treatment?
1. ATopical moxifloxacin every two hours
2. BOral acyclovir for ten days
3. CTopical pilocarpine with timolol
4. DTopical steroid with a cycloplegic
Answer and explanation in LearnFree account
Question 15 · Hard
A 27-year-old woman in Chennai who rinses her monthly contact lenses in tap water has had a painful right eye for six weeks. She was treated for herpes simplex keratitis with acyclovir without benefit. Her pain is severe, out of proportion to the signs, and there is a paracentral ring-shaped stromal infiltrate with radial perineural infiltrates. Calcofluor white staining of scrapings shows double-walled cysts. What is the most appropriate treatment?
1. ATopical moxifloxacin hourly
2. BTopical natamycin 5% hourly
3. CTopical polyhexamethylene biguanide (PHMB)
4. DTopical acyclovir with prednisolone
Answer and explanation in LearnFree account
Question 16 · Medium
A 23-year-old software engineer in Bengaluru who sleeps in her soft contact lenses presents with 36 hours of severe pain and a red eye. There is a dense central stromal infiltrate with a ring, thick mucopurulent discharge adherent to the ulcer, rapid melting of the stroma and a hypopyon. Which organism is most likely?
1. AHerpes simplex virus
2. BPseudomonas aeruginosa
3. CStaphylococcus epidermidis
4. DFusarium solani
Answer and explanation in LearnFree account
Question 17 · Medium
A 30-year-old woman in a district hospital has a red, painful right eye with photophobia. The doctor notes four findings: 1. Congestion most marked around the limbus. 2. A small pupil that reacts sluggishly. 3. Flare and cells in the aqueous on slit-lamp examination. 4. A fixed, mid-dilated pupil with IOP 56 mmHg. Which findings favour acute anterior uveitis?
1. A1, 2 and 3 only
2. B1, 2, 3 and 4
3. C1 and 3 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 18 · Hard
A 52-year-old farmer from Thanjavur with culture-proven Fusarium keratitis has used natamycin 5% hourly for three weeks, with topical voriconazole added a week ago. The ulcer has enlarged to 8 mm, approaches the limbus and now has a 3 mm perforation with iris plugging it and a flat anterior chamber. Seidel test is positive. What is the next best step?
1. ASwitch to fortified cefazolin and tobramycin
2. BTherapeutic penetrating keratoplasty
3. CAdd a topical steroid to limit melting
4. DBandage contact lens and review in a week
Answer and explanation in LearnFree account
Question 19 · Medium
A 40-year-old woman from a sugarcane-growing village near Kolhapur was scratched in the eye by a sugarcane leaf two weeks ago and has used antibiotic drops from a local chemist without relief. She has a greyish-white ulcer with a raised, dry surface and fluffy margins. Which bedside investigation of corneal scrapings gives the quickest support for the likely diagnosis?
1. A10% KOH wet mount
2. BAqueous tap for culture
3. CSchirmer test
4. DZiehl-Neelsen stain
Answer and explanation in LearnFree account
Question 20 · Medium
A 4-year-old girl with oligoarticular juvenile idiopathic arthritis affecting one knee is ANA-positive. Her eyes are white and she has no complaints. The paediatrician refers her for slit-lamp examination every three months. What is the main reason for this schedule?
1. AShe is at high risk of acute angle closure
2. BHer uveitis can be silent until damage is done
3. CMethotrexate causes early retinal toxicity
4. DHer arthritis predisposes to retinal detachment
Answer and explanation in LearnFree account
Question 21 · Easy
A 26-year-old welder comes to the eye casualty with pain, watering and photophobia after a metal particle was removed from his eye at a local clinic. The corneal surface looks almost clear in white light. Which dye, viewed under cobalt blue light, best shows the area of epithelial loss?
1. ALissamine green
2. BRose bengal
3. CTrypan blue
4. DFluorescein sodium
Answer and explanation in LearnFree account
Question 22 · Easy
Mutton-fat keratic precipitates on the corneal endothelium indicate:
1. ANon-granulomatous uveitis
2. BBacterial keratitis
3. CGranulomatous uveitis
4. DAcute angle-closure glaucoma
Answer and explanation in LearnFree account
Question 23 · Medium
A 24-year-old woman from Kolkata, who eats undercooked meat and keeps cats at home, has floaters and blurred vision in the left eye. Fundoscopy shows a fluffy, white focus of retinochoroiditis next to an old, pigmented chorioretinal scar, seen through a dense vitreous haze. Which organism is the most likely cause?
1. AToxoplasma gondii
2. BMycobacterium tuberculosis
3. CCytomegalovirus
4. DToxocara canis
Answer and explanation in LearnFree account
Question 24 · Medium
A 32-year-old construction worker in Surat had a penetrating injury involving the ciliary body of his right eye, repaired seven weeks ago. He now has pain, photophobia and blurred vision in both eyes. Both eyes show mutton-fat keratic precipitates, vitritis and small yellow-white spots in the peripheral fundus. What is the most likely diagnosis?
1. ABilateral bacterial endophthalmitis
2. BVogt-Koyanagi-Harada disease
3. CSympathetic ophthalmia
4. DPhacoanaphylactic uveitis
Answer and explanation in LearnFree account

Conjunctiva, cornea and uvea

A 45-year-old paddy farmer was hit in the eye by a rice stalk ten days ago. He now has a dry-looking, greyish-white corneal ulcer with feathery margins, satellite lesions and a hypopyon. What is the first-line topical treatment?

A 35-year-old auto-rickshaw driver had a red, watery eye and was given prednisolone drops by a chemist. A week later the eye is worse. Fluorescein shows a branching ulcer with knobbed ends, and corneal sensation is reduced in that eye. What is the most appropriate management?

A 68-year-old man in Lucknow has a painful vesicular rash over the right forehead and upper eyelid, not crossing the midline, for three days. Vesicles are also present on the tip and side of his nose. Why do the nasal vesicles make eye involvement likely?

A 48-year-old fisherman from Kollam has a fleshy, triangular growth of conjunctiva on the nasal side of his right eye. Its apex has crossed the limbus by 4 mm, it is advancing towards the pupil, and he has new astigmatism. What is the preferred surgery to limit recurrence?

A newborn delivered at home in a village in Bihar is brought on the third day of life with tense, swollen lids and copious, thick, yellow pus that wells out when the lids are parted. A Gram stain of the discharge shows Gram-negative intracellular diplococci. What is the most appropriate treatment?

A 45-year-old man with recurrent granulomatous anterior uveitis has 360-degree posterior synechiae with iris bombe and IOP 38 mmHg in the right eye. The uveitis is being treated with topical steroid and atropine. While planning a laser iridotomy, which IOP-lowering drug should be avoided?

A 12-year-old boy from Nagpur is brought every April and May with intense itching of both eyes and a thick, ropy, white discharge. Eversion of the upper lids shows large, flat-topped papillae like cobblestones, and there are small white dots at the limbus. What is the most likely diagnosis?

A 4-year-old girl with oligoarticular juvenile idiopathic arthritis affecting one knee is ANA-positive. Her eyes are white and she has no complaints. The paediatrician refers her for slit-lamp examination every three months. What is the main reason for this schedule?

A 26-year-old welder comes to the eye casualty with pain, watering and photophobia after a metal particle was removed from his eye at a local clinic. The corneal surface looks almost clear in white light. Which dye, viewed under cobalt blue light, best shows the area of epithelial loss?

Mutton-fat keratic precipitates on the corneal endothelium indicate: