Uvea: iris pearls in leprosy: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Uvea: iris pearls in leprosy

Sample item

A man with multibacillary leprosy and loss of the lateral eyebrows is found at the slit lamp to have tiny glistening yellow-white beads at the pupillary margin of the iris. What are these called?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Iris pearls

Iris pearls are discrete, shining, bead-like collections of lepra bacilli and inflammatory cells on the iris, characteristic of lepromatous disease. They are different from the granulomas of sarcoid and tuberculosis, and from the developmental spots of Down syndrome and neurofibromatosis.

Option by option

  • A. Lisch nodules

    Lisch nodules are pigmented iris hamartomas in neurofibromatosis type 1.

  • B. Koeppe nodules

    Koeppe nodules are inflammatory deposits at the pupillary margin in granulomatous uveitis such as sarcoidosis.

  • C. Brushfield spots

    Brushfield spots are white peripheral iris spots in Down syndrome.

  • D. Iris pearls (correct)

    Correct. Beads of bacilli on the iris in lepromatous leprosy are called iris pearls.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Iris pearls. Iris pearls are discrete, shining, bead-like collections of lepra bacilli and inflammatory cells on the iris, characteristic of lepromatous disease.

Why is "Lisch nodules" not the answer?

Lisch nodules are pigmented iris hamartomas in neurofibromatosis type 1.

Why is "Koeppe nodules" not the answer?

Koeppe nodules are inflammatory deposits at the pupillary margin in granulomatous uveitis such as sarcoidosis.

Why is "Brushfield spots" not the answer?

Brushfield spots are white peripheral iris spots in Down syndrome.

What concept does this question test?

It tests Uvea: iris pearls in leprosy in Ophthalmology. They are different from the granulomas of sarcoid and tuberculosis, and from the developmental spots of Down syndrome and neurofibromatosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Uvea: iris pearls in leprosy?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.