Corneal Ulcer — Bacterial and Fungal MCQ — NEET PG Practice Question | NEETPGAI
Corneal Ulcer — Bacterial and Fungal
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eye Ophthalmology
A 38-year-old contact lens wearer from Delhi presents with acute corneal ulcer, severe pain, and profuse purulent discharge. Culture grows Pseudomonas aeruginosa. Regarding bacterial corneal ulcers and their management, all of the following are appropriate EXCEPT:
A. Fortified topical antibiotics (cefazolin + tobramycin) are indicated for severe bacterial keratitis
B. Gram-negative organisms are the most common bacterial cause of corneal ulcers in contact lens wearers
C. Topical fluoroquinolone monotherapy is adequate for Pseudomonas keratitis
D. Corneal scarring and neovascularization are common sequelae of severe bacterial keratitis
Pseudomonas aeruginosa keratitis is a sight-threatening emergency that requires aggressive, combination topical antibiotic therapy, not monotherapy. Fluoroquinolone monotherapy is inadequate and risks treatment failure and perforation.
Add systemic antibiotics (fluoroquinolone or cephalosporin)
Systemic coverage for anterior chamber seeding
High-YieldNEET PG
Pseudomonas is aggressive and mucoid; it produces proteases and biofilm, making it resistant to single-agent therapy. Fortified topical antibiotics are the standard of care.
Cocci (Staphylococcus, Streptococcus — less common in CL wearers)
Candida (fungal, rare in CL keratitis)
Clinical Pearl
Contact lens overwear, poor hygiene, and contaminated lens solutions are the major risk factors. Pseudomonas thrives in moist environments (lens cases, solution bottles).
Sequelae of Severe Bacterial Keratitis
Corneal scarring (opacity, reduced vision)
Neovascularization (pannus formation)
Corneal thinning / ectasia
Anterior synechiae (if iritis develops)
Perforation (if untreated)
Warning
Topical corticosteroids should be avoided in the acute phase of bacterial keratitis; they increase the risk of perforation and dissemination. They may be cautiously introduced only after 48–72 hours of antibiotic therapy and clinical improvement.
Why Option 0 Is Incorrect
Fluoroquinolone monotherapy is inadequate for Pseudomonas keratitis. Although fluoroquinolones have good corneal penetration, Pseudomonas is virulent and requires fortified topical combination therapy (cephalosporin + aminoglycoside) applied frequently (every 1–2 hours initially) to achieve therapeutic corneal concentrations and prevent perforation.
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