This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Ophthalmology
Steroid is contraindicated in ? 
Select and explain. 
A. Herpetic keratitis, B. Atopic dermatitis, C. Fungal corneal ulcer, D. Exposure keratitis
C: Fungal corneal ulcer
Answer: C: Fungal corneal ulcer 
Explanation: Ans. is 'c' i.e., Fungal corneal ulcer Topical coicosteroids enhance fungal replication and corneal invasion and therefore, contraindicated in a fungal corneal ulcer. Now, option 'a' requires specific mention here :- Topical coicosteroids are contraindicated in herpetic keratitis. But not in all forms of herpetic keratitis :- Epithelial herpetic keratitis (Dendritic ulcer, geographic ulcer) Topicla coicosteroids are contraindicated. Stromal keratitis (Disciform & Diffuse necrotic) Topical coicosteroids along with topical antiviral drugs are used as the first line of treatment. So, my opinion for this type of question is that :- If herpetic keratitis has given as the option, then look at other options. If any of the other options is a clear cut contraindication for coicosteroid (e.g. fungal corneal ulcer in this question), consider that option as your answer. If no ther option is a contraindication for topical coicosteroid, considere herpetic keratitis as the answer. If examiner has specifically mentioned dendritic ulcer as an option, consider it as the answer.