An 8-year-old boy presents with photophobia, watering, and blurred vision. Slit-lamp examination shows diffuse stromal haze with deep stromal neovascularisation giving a salmon-coloured appearance, while the overlying epithelium remains intact and fluorescein negative. On general examination he has widely spaced, notched upper central incisors and a depressed nasal bridge. What is the most likely diagnosis?

• A Herpes simplex disciform keratitis
• B Congenital rubella keratitis
• C Cogan syndrome
• D Congenital syphilitic interstitial keratitis ✓

Explanation

Non-ulcerative interstitial keratitis with deep 'salmon-patch' vascularisation plus Hutchinson teeth, saddle nose, and other stigmata establishes late congenital syphilis. Rubella keratitis occurs in infancy and lacks dental stigmata, while Cogan syndrome presents in young adults with vestibuloauditory symptoms rather than Hutchinson teeth, which kills both tempting distractors.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.