Conjunctiva and cornea: peripheral ulcerative 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: peripheral ulcerative keratitis

Sample item

A woman with long-standing rheumatoid arthritis has a painful red eye with a crescentic peripheral corneal ulcer, stromal melt and an adjacent scleral inflammation. What is the key principle of treatment?

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

The answer and the reasoning

D. Systemic immunosuppression with corticosteroids

Peripheral ulcerative keratitis in rheumatoid arthritis reflects systemic vasculitis, and without systemic immunosuppression the cornea may perforate and the patient is at risk of life-threatening vasculitis. Topical therapy alone does not control it.

Option by option

  • A. Observation with lubricants

    Lubricants alone would allow the melt to progress to perforation.

  • B. Topical antibiotics alone

    Antibiotics alone do not treat a sterile immune melt.

  • C. Topical antifungal therapy

    No fungal infection is present in this setting.

  • D. Systemic immunosuppression with corticosteroids (correct)

    Correct. Systemic immunosuppression is needed for this immune-mediated melt.

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, Systemic immunosuppression with corticosteroids. Peripheral ulcerative keratitis in rheumatoid arthritis reflects systemic vasculitis, and without systemic immunosuppression the cornea may perforate and the patient is at risk of life-threatening vasculitis.

Why is "Observation with lubricants" not the answer?

Lubricants alone would allow the melt to progress to perforation.

Why is "Topical antibiotics alone" not the answer?

Antibiotics alone do not treat a sterile immune melt.

Why is "Topical antifungal therapy" not the answer?

No fungal infection is present in this setting.

What concept does this question test?

It tests Conjunctiva and cornea: peripheral ulcerative keratitis in Ophthalmology. Topical therapy alone does not control it.

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: peripheral ulcerative 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.