Q-31. Which one of the following is not used in glaucoma?
a) Timolol
b) Physostigmine
c) Donepezil
d) Dipivefrin
Answer: Donepezil
Explanation:
Medications used in glaucoma
Beta-adrenergic blockers- Timolol maleate
Adrenergic agonists- Brimonidine
Less-selective sympathomimetics- Dipivefrin, Epinephrine
Carbonic anhydrase inhibitors- Acetazolamide, Dorzolamide
Prostaglandin analogs- Latanoprost, Bimatoprost
Miotic agents (para-sympathomimetics)- Pilocarpine
Q-32. A 35 year old insulin dependent diabetes mellitus (IDDM) patient on insulin for the past 10 years complains of gradually progressive painless loss of vision. Most likely he has:
a) Cataract
b) Vitreous hemorrhage
c) Total rhegmatogenous retinal detachment
d) Tractional retinal detachment not involving the macula
Answer: Cataract
Explanation:
Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years.
The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss.
Cataracts, refractive error, corneal blindness and early diabetic macular edema are generally reversible.
Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision.
Senile cataract occurs earlier and more frequently in diabetics.
Q-33. In human corneal transplantation, the donor tissue is
a) Synthetic polymer
b) Donated human cadaver eyes
c) Donated eyes from live human beings
d) Monkey eyes
Answer: Donated human cadaver eyes
Explanation:
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty).
The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the viability of the donated tissue or the health of the recipient.
The cornea should be removed from cadaveric donors within 6 hours after death, sometimes up-to 12 hours after death in cold climate countries.
Q-34. The most common retro-bulbar orbital mass in adults is-
a) Neurofibroma
b) Meningioma
c) Cavernous hemangioma
d) Schwannoma
Answer: Cavernous hemangioma
Explanation:
Cavernous hemangiomas are the most common intra-orbital tumors found in adults.
These benign, vascular lesions are slow growing and can manifest as a painless, progressively proptotic eye. Most of these tumefactions are exceedingly unilateral.
Q-35. A patient with clinically significant diabetic macular edema with non progressive diabetic retinopathy was treated with macular grid photocoagulation. The patient still has vitreo-macular-traction. What is the preferred treatment?
a) Intravitreal Bevacizumab
b) Pars plana vitrectomy
c) Repeat macular grid photocoagulation
d) Augmented macula photocoagulation
Answer: Pars plana vitrectomy
Explanation:
Vitrectomy is the treatment of choice for vitreo-macular-traction which if left would lead to retinal detachment.
It involves removing the cloudy vitreous and replacing it with silicon oil.
Important point:
Pars plana vitrectomy is a surgical procedure that involves removal of vitreous gel and the instruments are introduced through the pars plana.
Q-36. Baby born prematurely at 29 wks on examination at 42 wks with ROP both eyes shows stage 2, zone 1 ‘plus’ disease, how will you manage the patient?
a) Examine the patient after 1 week
b) Laser photocoagulation of both eyes
c) Laser photocoagulation of worse eye follow-up of other eye
d) Vitreo-retinal surgery
Answer: Laser photocoagulation of both eyes
Explanation:
Retinopathy of prematurity (Earlier known as retro-lental fibrosis):
It is bilateral proliferative retinopathy occurring in premature infants with low birth weight (Primary causative factors) who often have been exposed to high concentration of oxygen.
Retinopathy of prematurity is usually confined to those with a birth weight of less than 1.5 kg and/ or a gestational age of 32 weeks.
Stages of Retinopathy of prematurity:
Stage-I: Demarcation line
Stage-II: Demarcation ridge
Stage-III: Extra-retinal fibro-vascular proliferation
Stage-IV-a: Sub-total retinal detachment not involving macula
Stage-IV-b: Sub-total retinal detachment involving macula
Stage-V: Total retinal detachment (Funnel shaped detachment)
Zones of involving Retinopathy of prematurity:
Zones-I: Circle with optic disc as centre and twice the disc-macula distance as the radius
Zones-II: Circle with optic disc as centre and disc-nasal ora serrata as the radius excluding zone-I
Zones-III: Temporal arc of retina beyond Zone-II
Plus disease:
Presence of tortuous dilated vessels at posterior pole at any stage of retinopathy of prematurity
Important point:
Retinal examinations in preterm infants should be performed by an ophthalmologist who has sufficient knowledge and experience to identify accurately the location and sequential retinal changes of ROP.
Photocoagulation or Cryotherapy may check progression of the disease if applied in the early stage.
Q-37. In a case of anisocoria when 1% pilocarpine is instilled into the eye with abnormally dilated pupil, no response occurs. Cause of anisocoria may be
a) Adie’s pupil
b) Horner’s syndrome
c) Pharmacological blockage
d) Uncal herniation
Answer: Pharmacological blockage
Explanation:
Causes of anisocoria (Unequal pupil sizes):
Horner syndrome and physiologic anisocoria:
Produce normally reactive pupils with anisocoria greater in darkness
Oculomotor nerve palsy:
Poorly reactive and mydriatic compared with the contra-lateral pupil
Tonic pupils:
Respond poorly to light but briskly to a near target, and they maintain this near-induced miosis for a prolonged period (tonic). The classic tonic pupil is the Adie tonic pupil.
The pharmacologically dilated pupil:
Larger than in most other causes of anisocoria
The pupil fails to respond to light stimuli, near stimuli, or 1% pilocarpine solution.
Mechanical iris disruption can also account for such findings and can be distinguished with slit lamp examination.
Q-38. Drug used in LUMINATE programme for non infectious uveitis is
a) Voclosporin
b) Methotrexate
c) Infliximab
d) Cyclosporine
Answer: Voclosporin
Explanation:
Voclosporin is a next-generation calcineurin inhibitor. Calcineurin inhibitors are potent immuno-suppressants that reversibly inhibit T-cell proliferation and prevent release of pro-inflammatory cytokines by blocking the activity of the calcium-regulated serine-threonine phosphatase calcineurin, an enzyme found in cell cytoplasm.
A new agent for the treatment of noninfectious uveitis: LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to Treatment) trials of steroid-sparing voclosporin
If voclosporin proves to be an effective and safer treatment for noninfectious uveitis, inflammation will be controlled, visual acuity will be maintained, and the need to take corticosteroids will be reduced or eliminated.
If the LUMINATE program is successful, voclosporin will become the first steroid-sparing immunosuppressive drug approved by the FDA for the treatment of uveitis.
Q-39. Mizuo phenomenon is seen in
a) Fundus Albipunctatus
b) Oguchi’s disease
c) Fundus amaculateus
d) Choroidermia
Answer: Oguchi’s disease
Explanation:
Mizuo–Nakamura phenomenon is a phenomenon observed in Oguchi’s disease.
Oguchi’s disease is characterized by a golden-brown fundus with a yellow-gray ‘metallic’ sheen in the light-adapted state.
After complete dark adaptation, the fundus appears normal, and this disappearance of the shiny, yellow, fundus reflex is called the Mizuo–Nakamura phenomenon.
Q-40. Following a RTA on fourth day a person developed proptosis and pain over right eye. On examination there is bruise on the eye and forehead. What may be the diagnosis?
a) Fracture sphenoid
b) Cavernous sinus thrombosis
c) Internal carotid artery aneurysm
d) Carotid cavernous fistula
Answer: Carotid cavernous fistula
Explanation:
Carotid cavernous fistula:
Abnormal communication between the cavernous sinus or dural veins and the carotid arterial system
Presentation days or weeks after head injury:
Proptosis
Conjunctival chemosis
Whooshing noise in head
Ophthalmoplegia in 60-70 % due to ocular motor nerve damage
The 6th nerve damage is most frequently affected because of its free floating location within the cavernous sinus.
Investigation:
CT/ MRI Findings:
Prominence of superior ophthalmic vein and diffuse enlargement of extra-ocular muscles
Choice of investigation-> Selective arterio-graphy of both internal and external carotid arteries