A 22-year-old presents with recurrent seasonal bilateral red eye with intense itching, photophobia, and large cobblestone papillae on the upper tarsal conjunctiva. Corneal examination shows a Tranta's dot at the limbus and a shield ulcer at the superior cornea. This is vernal keratoconjunctivitis (VKC). The MOST appropriate management for the corneal shield ulcer is:

• A Topical fluoroquinolone antibiotic alone
• B Bandage contact lens alone for corneal protection
• C Surgical debridement of the ulcer base combined with intensified topical corticosteroids ✓
• D Topical cyclosporine 0.05% alone

Explanation

Shield ulcers in VKC are sterile plaques caused by eosinophilic toxic products deposited on the cornea, not by infection. Management requires debridement of the necrotic base (removing the impermeable plaque) to promote re-epithelialization, combined with intensified topical corticosteroids (dexamethasone or prednisolone) to control the underlying allergic inflammation and facilitate healing. Bandage contact lenses are used as adjuncts after debridement. Topical antibiotics prevent secondary infection but do not treat the plaque. Cyclosporine is a steroid-sparing agent for chronic VKC but is insufficient alone for acute shield ulcer management.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.