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Photos courtesy of: Michael Westafer, MS4, Hart Moss, M.D. and Kenneth Cohen, M.D.
Photos taken by: Debra Cantrell, COA.
Used with permission. Not to be reproduced.

An 18-year-old man presented with three days of painful eyes. He had been seen by his primary eye physician several months earlier for similar symptoms and diagnosed with overuse of soft contact lenses. He has no prior ocular history other than myopia. Today, his vision is 20/20 OD with contact lens and 20/70, pinhole to 20/30 uncorrected OS. There is no inflammation of the eyelids. There is minimal hyperemia of the bulbar conjunctiva but no follicles or papillae of the tarsal conjunctivae, OU. The preauricular nodes are not palpable. Biomicroscopy of the corneas reveals multiple localized gray punctate opacities. IOPs are normal and anterior chambers are deep and quiet. Figures 1 and 2 show the patient’s right and left corneas respectively, with arrows indicating corneal opacities. Figure 3 shows fluorescein staining of the left cornea.

1.	What corneal layer(s) are involved?
	a. epithelium b. subepithelial and Bowman’s layer c. anterior stroma d. (a) and (b) e. none of the above
2.	What is the most likely diagnosis?
	a. adenovirus keratitis b. staphylococcus hypersensitivity keratitis c. recurrent Herpes simplex keratitis d. chlamydial keratoconjunctivitis e. Thygeson’s superficial punctate keratitis (SPK) f. bacterial keratitis
3.	What is the most appropriate management for this patient?
	a. topical fluoroquinolone b. artificial tears c. strong topical corticosteroid d. weak topical corticosteroid e. topical antiviral
4.	What is the prognosis?
	a. wax and wane over years b. does not cause permanently decreased vision c. causes corneal scarring and decreased vision d. spontaneously improves e. (a), (b), and (d)

For answers to the above, click here on or after Octorber 4, 2011.