Conjunctiva and cornea: Thygeson superficial punctate keratitis: 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 · Conjunctiva and cornea: Thygeson superficial punctate keratitis

Sample item

A 28-year-old has had recurrent bilateral foreign body sensation and photophobia for years. Each episode shows clusters of coarse, slightly raised grey-white epithelial opacities that stain with fluorescein, in a white and quiet eye with no follicles and no subepithelial scarring. Symptoms settle with a short, weak topical steroid and then recur. What is the diagnosis?

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

The answer and the reasoning

A. Thygeson superficial punctate keratitis

Thygeson keratitis is a chronic, remitting, bilateral epithelial keratitis with minimal conjunctival injection that responds to low-potency topical steroid but tends to recur. Absence of follicles, nodes and subepithelial infiltrates separates it from adenoviral disease.

Option by option

  • A. Thygeson superficial punctate keratitis (correct)

    Correct. Chronic bilateral coarse epithelial lesions in a quiet eye that respond to weak steroid and recur are typical.

  • B. Adenoviral keratoconjunctivitis

    Adenoviral disease has follicular conjunctivitis, a preauricular node and later subepithelial infiltrates.

  • C. Herpes simplex dendritic keratitis

    Herpes simplex keratitis gives a branching dendrite with terminal bulbs, usually unilateral.

  • D. Meesmann epithelial dystrophy

    Meesmann dystrophy has tiny epithelial microcysts present from childhood and does not fluctuate with steroid response.

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 A, Thygeson superficial punctate keratitis. Thygeson keratitis is a chronic, remitting, bilateral epithelial keratitis with minimal conjunctival injection that responds to low-potency topical steroid but tends to recur.

Why is "Adenoviral keratoconjunctivitis" not the answer?

Adenoviral disease has follicular conjunctivitis, a preauricular node and later subepithelial infiltrates.

Why is "Herpes simplex dendritic keratitis" not the answer?

Herpes simplex keratitis gives a branching dendrite with terminal bulbs, usually unilateral.

Why is "Meesmann epithelial dystrophy" not the answer?

Meesmann dystrophy has tiny epithelial microcysts present from childhood and does not fluctuate with steroid response.

What concept does this question test?

It tests Conjunctiva and cornea: Thygeson superficial punctate keratitis in Ophthalmology. Absence of follicles, nodes and subepithelial infiltrates separates it from adenoviral disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Conjunctiva and cornea: Thygeson superficial punctate keratitis?

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.