1. Conditions that can give rise to the following appearance include:
 

a. superior limbic keratoconjunctivitis
b. Sjogren's syndrome
c. Bell's palsy
d. Thygeson's keratitis
e. adenoviral keratitis

Answer
a.F     b.T     c.T     d.F     e.F
The Rose Bengal stains the inferior cornea showing inferior superficial punctate keratitis. This is seen in dry eyes and exposure keratitis. 
Superior limbic keratoconjunctivitis typically shows staining in the superior cornea. Whereas Thygeson's and adenoviral keratitis tends to have stainings which involve the whole cornea and are less dense.

2. Conditions that may be associated with the following cornea appearance include:
 

a. Sjogren's syndrome
b. cerebrovascular accident
c. prolonged patching
d. iritis
e. herpes simplex keratitis

Answer
a.T    b.T    c.T     d.F    e.F
The picture shows filamentary keratitis.
It is seen in dry eyes, recurrent erosions, exopsure keratopathy, herpes zoster, essential blepharospasm and midbrain cerebrovascular accident.

3. With regard this physical sign:
 
 

a. the abnormality is seen in the stroma
b. the underlying condition is inherited in an autosomal dominant fashion
c. its absence makes the diagnosis of the underlying condition unlikely
d. it usually begins at the nasal limbus
e. a brain MRI scan may of this patient may show the picture below

Answer
a.F     b.F     c.F     d.F     e.T
The cornea shows Kayser-Fleishcher's ring and the underlying condition is Wilson's disease. The copper deposit is seen in the Descemet's membrane.
Wilson's disease is an autosomal recessive condition.
The ring tends to develop with age and its absence does not exclude the diagnosis of Wilson's disease.
The deposit usually begins in the superior and inferior limbus. Gonioscopy may be needed to see it in early cases.
The MRI scan shows bilateral hyperdensity of the basal ganglia due to copper deposition in these areas.

4. The following are true about this condition:
 

a. it is related to solar damage
b. it is seen in chronic corneal inflammation
c. the Bowman's membrane is replaced by scar tissue
d. histology shows amyloid deposits
e. penetrating keratoplasty is useful in patients with involvement of the 
    visual axis

Answer
a.F    b.T    c.T    d.F    e.F
The picture shows Salzmann's nodular degeneration.
This condition is usually seen in patients with a past history of chronic keratitis.
The surface is elevated with greyish-white opacities.
The Bowman's membrane in the involved area is replaced by scar tissue
The visual acuity usually remains normal but in cases where there is visual axis involvement, superficial keratectomy or lamellar keratoplasty is preferred.

5. This is the corneal appearance of a contact lens wearer. The picture on the right is the organism 
    responsible:
 

Figure 1

Figure 2

a. the organism originates in the tap water
b. a corneal biopsy may show the picture below (Figure 3)
c. the condition is responsive to gentamicin
d. ciprofloxacin can be used as monotherapy
e. the organism is difficult to eradicate

Figure 3

Answer
a.F     b.F    c.T    d.T    e.F
The corneal ulcer results from Pseudomonas aeruginosa.
Figure 2 shows Pseudomonas appearing as Gram -ve rods 
Pseudomonas is ubiquitous and is commonly found in contact lens cases.
Treatment is with ciprofloxacin or gentamicin.
Figure 3 shows Acanthoamoeba cyst in the corneal stroma.
Unlike Acanthamoeba, most Psuedomonas responds well to antibiotic.