Glaucoma: epithelial downgrowth: 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 · Glaucoma: epithelial downgrowth

Sample item

Three weeks after repair of a penetrating corneal wound that leaked, a man develops raised intraocular pressure and a thin translucent sheet with a sharp edge on the back of the cornea. Laser burns placed on the iris turn white where the sheet covers it. What is the diagnosis?

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

The answer and the reasoning

C. Epithelial downgrowth

Surface epithelium can enter the anterior chamber through a leaking wound, spread over the back of the cornea, angle and iris, and block outflow. Laser burns on the iris whiten where epithelium covers it, which maps the extent of the membrane. Control is difficult and the outlook for vision is poor.

Option by option

  • A. Detachment of Descemet membrane

    Detachment of Descemet membrane gives a localised corneal fold or oedema, and does not make iris burns turn white.

  • B. Bullous keratopathy from endothelial failure

    Bullous keratopathy produces epithelial bullae from endothelial failure, not a sheet with a sharp edge over the iris.

  • C. Epithelial downgrowth (correct)

    Correct. A sharply edged retrocorneal sheet after a leaking wound, with whitening of laser burns, identifies epithelial downgrowth.

  • D. Iridocorneal endothelial syndrome

    Iridocorneal endothelial syndrome occurs spontaneously in young women, not after a wound leak, and has no white-burn 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 C, Epithelial downgrowth. Surface epithelium can enter the anterior chamber through a leaking wound, spread over the back of the cornea, angle and iris, and block outflow.

Why is "Detachment of Descemet membrane" not the answer?

Detachment of Descemet membrane gives a localised corneal fold or oedema, and does not make iris burns turn white.

Why is "Bullous keratopathy from endothelial failure" not the answer?

Bullous keratopathy produces epithelial bullae from endothelial failure, not a sheet with a sharp edge over the iris.

Why is "Iridocorneal endothelial syndrome" not the answer?

Iridocorneal endothelial syndrome occurs spontaneously in young women, not after a wound leak, and has no white-burn response.

What concept does this question test?

It tests Glaucoma: epithelial downgrowth in Ophthalmology. Laser burns on the iris whiten where epithelium covers it, which maps the extent of the membrane. Control is difficult and the outlook for vision is poor.

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 Glaucoma: epithelial downgrowth?

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.