Features
• Progressive corneal thinning and conical protrusion
• Irregular astigmatism → progressive visual distortion
• Often bilateral but asymmetric
• Onset typically in adolescence or young adulthood
Associations
• Atopy (eczema, asthma)
• Down syndrome
• Eye rubbing (e.g., in allergic conjunctivitis)
Signs
• Scissoring reflex on retinoscopy
• Fleischer ring (iron deposition)
• Vogt striae (stromal lines)
Management
• Rigid gas-permeable contact lenses
• Corneal cross-linking (halts progression)
• Keratoplasty (severe cases)
Causes
• Bacterial: most common; contact lens wearers (Pseudomonas)
• Viral: herpes simplex → dendritic ulcers (fluorescein staining)
• Fungal: trauma with vegetative matter; contact lens wear
Features
• Severe eye pain
• Redness, photophobia
• Corneal opacity or ulcer visible
• Purulent discharge
Management
• Urgent ophthalmology referral
• Intensive topical antibiotics (for bacterial)
• Antivirals for HSV keratitis (e.g., topical aciclovir)
Features
• Foreign body sensation
• Grittiness, burning, transient blurring
• Worse after prolonged visual tasks (e.g., screen use)
Causes
• Sjögren’s syndrome (primary or secondary)
• Age-related lacrimal hypofunction
• Medications: antihistamines, anticholinergics, antidepressants
• Environmental: air conditioning, prolonged screen time
Tests
• Schirmer’s test (tear production)
Management
• Artificial tears
• Treat underlying cause (e.g., systemic disease)
• Punctal plugs (severe cases)
Extra Revision Pearls
• Contact lens wearer + corneal ulcer clue → Pseudomonas risk
• Dendritic ulcer clue → HSV keratitis (avoid steroids!)
• Young person with progressive astigmatism clue → keratoconus
• Dry eye + systemic autoimmunity clue → Sjögren’s syndrome
• Iron ring clue (Fleischer) → keratoconus
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
