Board Certified Ophthalmologist FREE Cornea and External Disease Questions and Answers 2

Question 1

A 45-year-old contact lens wearer presents with a rapidly progressive corneal ulcer and satellite lesions. Culture on Sabouraud agar grows filamentous organisms. Which antifungal agent is the most appropriate first-line treatment?

Accepted Answer

Natamycin 5% ophthalmic suspension

Answer

Natamycin 5% is the preferred first-line topical antifungal for filamentous fungal keratitis such as Fusarium and Aspergillus species.

Question 2

Which layer of the cornea is most responsible for maintaining corneal deturgescence and transparency?

Accepted Answer

Corneal endothelium

Answer

The corneal endothelium actively pumps fluid out of the stroma via Na+/K+-ATPase, maintaining the relative dehydration essential for corneal transparency.

Question 3

A patient with rheumatoid arthritis develops progressive corneal thinning with an overlying epithelial defect in the peripheral cornea. What is the most likely diagnosis?

Accepted Answer

Peripheral ulcerative keratitis

Answer

Peripheral ulcerative keratitis (PUK) is strongly associated with systemic collagen vascular diseases, especially rheumatoid arthritis, and presents with peripheral stromal thinning and an overlying epithelial defect.

Question 4

A 30-year-old male presents with recurrent episodes of unilateral stromal keratitis with decreased corneal sensation. Examination reveals ghost vessels and stromal scarring. Which pathogen is most likely responsible?

Accepted Answer

Herpes simplex virus type 1

Answer

HSV-1 stromal keratitis classically presents with recurrent unilateral inflammation, corneal hypoesthesia, ghost vessels, and progressive stromal scarring.

Question 5

During penetrating keratoplasty, the surgeon notes a positive Seidel test at one of the suture sites on the first postoperative day. The anterior chamber is well-formed. What is the most appropriate initial management?

Accepted Answer

Application of a bandage contact lens

Answer

A small wound leak with a well-formed anterior chamber can be managed conservatively with a bandage contact lens, which tamponades the leak and promotes epithelial healing over the suture track.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist FREE Cornea and External Disease Questions and Answers 2