Glaucoma Drainage Devices Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Glaucoma Drainage Devices. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Glaucoma Drainage Devices Indian Medical PG Question 1: Which of the following is NOT an approach followed in revised NPCB cataract surgeries?
- A. Mobile surgical camps
- B. Consistent follow-up care
- C. Fixed-site surgical treatment alone (excluding camps) (Correct Answer)
- D. Standardized distribution of resources
Glaucoma Drainage Devices Explanation: ***Fixed-site surgical treatment alone (excluding camps)***
- The revised **National Programme for Control of Blindness and Visual Impairment (NPCBVI)** adopts a **multi-pronged integrated approach** combining both fixed-site facilities and mobile outreach camps.
- Relying **exclusively on fixed-site treatment** without mobile camps is **not the strategy** of the revised program, as this would limit access for rural and underserved populations.
- The program emphasizes **both institutional capacity** (fixed sites at district hospitals and eye hospitals) **and community outreach** (mobile surgical camps) working together.
*Mobile surgical camps*
- **Mobile camps** are a crucial strategy in the revised NPCB to reach underserved populations in rural and remote areas.
- They enhance **accessibility to care** and increase surgical coverage, particularly in areas without nearby fixed facilities.
- Camps are conducted with **quality standards** and linked to fixed sites for follow-up care.
*Consistent follow-up care*
- **Comprehensive follow-up** is a cornerstone of the revised NPCB to ensure positive outcomes and address complications.
- This includes **post-operative care protocols** at both camp and fixed-site surgeries to reduce morbidity.
- Follow-up mechanisms help achieve the program's goal of **quality cataract surgery outcomes**.
*Standardized distribution of resources*
- The revised NPCB promotes **equitable and efficient allocation** of resources to ensure quality cataract services across regions.
- This includes distribution of **equipment, consumables, trained personnel, and funding** based on need and surgical load.
- Resource standardization helps maintain **quality benchmarks** across different service delivery models.
Glaucoma Drainage Devices Indian Medical PG Question 2: Commonest complication of topical corticosteroids is -
- A. Ptosis
- B. Proptosis
- C. Glaucoma (Correct Answer)
- D. Cataract
Glaucoma Drainage Devices Explanation: ***Glaucoma***
- **Topical corticosteroids** are well-known to increase **intraocular pressure** by reducing the outflow of aqueous humor, leading to **steroid-induced glaucoma**.
- This complication can result in irreversible **optic nerve damage** and vision loss if not managed properly.
*Ptosis*
- **Ptosis** is a drooping of the upper eyelid and is not a common complication directly associated with topical corticosteroid use.
- It is more often linked to issues like **muscle weakness**, nerve damage, or age-related changes.
*Proptosis*
- **Proptosis** refers to the bulging of the eye and is typically associated with conditions like **Graves' ophthalmopathy** or orbital tumors.
- It is not a common or direct side effect of topical corticosteroid application.
*Cataract*
- While **steroid-induced cataracts** (specifically **posterior subcapsular cataracts**) are a known complication of chronic systemic corticosteroid use, they are less common with topical corticosteroids and usually require prolonged, high-dose therapy.
- In contrast, a rise in intraocular pressure (leading to glaucoma) can occur more acutely and with lower doses of topical corticosteroids.
Glaucoma Drainage Devices Indian Medical PG Question 3: Which of the following is NOT a feature of Primary Infantile (Congenital) glaucoma?
- A. Aniridia may be associated (Correct Answer)
- B. Treatment includes trabeculotomy
- C. Buphthalmos can occur
- D. Cornea is typically enlarged and cloudy.
Glaucoma Drainage Devices Explanation: ***Aniridia may be associated***
- **Aniridia** is a congenital absence of the iris that causes **secondary glaucoma**, not primary infantile glaucoma.
- Aniridia-associated glaucoma is a distinct entity from primary congenital glaucoma (PCG), which occurs due to isolated developmental abnormalities of the anterior chamber angle.
- This is **NOT a feature** of primary infantile glaucoma, making it the correct answer to this negation question.
*Treatment includes trabeculotomy*
- **Trabeculotomy** or **goniotomy** are the primary surgical treatments for primary infantile glaucoma.
- These procedures aim to improve aqueous outflow by incising or opening the trabecular meshwork.
- This is a **true feature** of the management of primary infantile glaucoma.
*Buphthalmos can occur*
- **Buphthalmos** (\"ox eye\") refers to the enlargement of the globe due to elevated intraocular pressure in infants when the sclera is still distensible.
- It is a **classic clinical sign** of primary infantile glaucoma, typically occurring before age 3 years.
- This is a **characteristic feature** of the condition.
*Cornea is typically enlarged and cloudy*
- The **cornea becomes enlarged** (increased horizontal corneal diameter >12 mm in newborns) due to stretching from elevated IOP.
- **Corneal cloudiness** results from corneal edema and Haab's striae (breaks in Descemet's membrane).
- These are **pathognomonic findings** in primary infantile glaucoma.
Glaucoma Drainage Devices Indian Medical PG Question 4: Placing cast under tap water is to be avoided as
- A. H2O Inhibits polymerization of dental resin
- B. H2O interferes with hygroscopic expansion
- C. H2O interferes with crystallization of dihydrate
- D. Gypsum is slightly soluble in water and the surface of the cast will be eroded (Correct Answer)
Glaucoma Drainage Devices Explanation: ***Gypsum is slightly soluble in water and the surface of the cast will be eroded***
- **Gypsum (calcium sulfate dihydrate)** is sparingly soluble in water, meaning prolonged exposure can lead to the **dissolution** of its surface material.
- This dissolution causes **surface erosion** and loss of fine detail in the cast, compromising its accuracy for dental procedures.
*H2O Inhibits polymerization of dental resin*
- While water can affect some dental materials, it does not directly inhibit the **polymerization of dental resin** when the cast itself is placed under tap water.
- Dental resins are typically applied to dry casts or models, and their polymerization is more sensitive to **impurities** or **inhibitors** mixed with the resin itself, rather than water on the cast surface.
*H2O interferes with hygroscopic expansion*
- **Hygroscopic expansion** is a property primarily associated with investments used for casting, where water is intentionally added to control expansion.
- Placing a set gypsum cast under tap water does not interfere with **hygroscopic expansion**; rather, it primarily affects the surface integrity due to solubility.
*H2O interferes with crystallization of dihydrate*
- **Crystallization of dihydrate** occurs during the setting process of gypsum, where calcium sulfate hemihydrate reacts with water to form a solid mass of dihydrate crystals.
- Once the cast is set and hardened, placing it under tap water does not interfere with its initial crystallization; instead, it slowly dissolves the already formed **dihydrate crystals**.
Glaucoma Drainage Devices Indian Medical PG Question 5: What is the most likely complication of the condition shown in the image below?
- A. Exposure Keratitis (Correct Answer)
- B. Difficulty in eye movement
- C. Cataract
- D. Glaucoma
Glaucoma Drainage Devices Explanation: ***Exposure Keratitis***
- The image shows **proptosis** (exophthalmos) of the right eye, where the eyeball protrudes forward. This condition often leads to incomplete eyelid closure (lagophthalmos).
- **Exposure keratitis** occurs when the cornea is inadequately covered by the eyelids, leading to drying and damage due to constant exposure to air and environmental factors.
*Difficulty in eye movement*
- While **proptosis** can sometimes be associated with restricted eye movements (e.g., in severe Graves' ophthalmopathy due to muscle swelling), it is not the **most likely direct complication** of the exposure itself.
- The image primarily depicts the physical displacement of the globe, which predisposes to corneal issues, not necessarily oculomotor dysfunction as the primary complication.
*Cataract*
- **Cataracts** are opacities of the lens and are typically associated with aging, trauma, or certain systemic conditions (e.g., diabetes, steroid use).
- They are not a direct or common complication of **proptosis** or the resulting **exposure of the ocular surface**.
*Glaucoma*
- **Glaucoma** is a group of conditions characterized by damage to the optic nerve, often due to elevated intraocular pressure.
- While severe **proptosis** leading to orbital congestion can theoretically increase intraocular pressure, it is not the most direct or prevalent complication compared to **exposure keratitis**, which is a direct consequence of inadequate globe protection.
Glaucoma Drainage Devices Indian Medical PG Question 6: Gold standard procedure to reduce recurrence of pterygium after surgical excision is
- A. Thiotepa
- B. Amniotic membrane grafting
- C. Conjunctival autograft (Correct Answer)
- D. Beta-radiation
Glaucoma Drainage Devices Explanation: ***Conjunctival autograft***
- **Conjunctival autografting** involves transplanting a piece of healthy conjunctiva from the superior bulbar conjunctiva to the bare scleral bed after pterygium excision, acting as a barrier to fibrovascular proliferation.
- This technique has consistently shown the **lowest recurrence rates** in comparative studies, making it the **gold standard** for preventing pterygium recurrence due to its high success rate and safety profile.
*Thiotepa*
- **Thiotepa** is an **antimetabolite** that inhibits DNA synthesis and cell proliferation, used topically post-excision to reduce recurrence by suppressing fibroblast activity.
- While it can lower recurrence rates compared to simple excision, its efficacy is generally **less than conjunctival autografting**, and it carries risks of corneal toxicity and limbal stem cell deficiency.
*Amniotic membrane grafting*
- **Amniotic membrane grafting** involves placing processed amniotic membrane over the scleral bed, which has anti-inflammatory, anti-scarring, and pro-epithelialization properties.
- It is an effective option, especially for **large pterygia** or for patients at high risk of recurrence, but its recurrence rates are generally **not as low as those achieved with conjunctival autografting**, and the graft can sometimes detach.
*B- radiation*
- **Beta-radiation** (strontium-90) is a form of adjuvant therapy applied to the scleral bed immediately after pterygium excision to inhibit fibroblast proliferation and reduce recurrence.
- It is effective but associated with potential complications such as **scleral melt**, corneal scarring, and cataract formation, making it a less preferred option than conjunctival autografting, especially in primary cases.
Glaucoma Drainage Devices Indian Medical PG Question 7: In case of blunt injury which one does not cause glaucoma :
- A. Optic neuropathy (Correct Answer)
- B. Hyphema
- C. Uveitis
- D. Angle recession
Glaucoma Drainage Devices Explanation: ***Optic neuropathy***
- While blunt injury can cause **optic neuropathy**, this condition directly affects the **optic nerve** and does not lead to glaucoma, which involves elevated intraocular pressure.
- **Glaucoma** is characterized by damage to the optic nerve secondary to increased intraocular pressure, whereas direct traumatic optic neuropathy is a primary nerve injury.
*Hyphema*
- **Hyphema**, or blood in the anterior chamber, can directly block the **trabecular meshwork**, leading to impaired aqueous outflow and secondary glaucoma.
- The breakdown products of red blood cells can also **clog** the drainage system, further increasing intraocular pressure.
*Uveitis*
- Traumatic **uveitis** can cause inflammation and swelling of the **trabecular meshwork**, impeding aqueous humor outflow and leading to secondary glaucoma.
- Inflammatory cells and protein exudates can also **obstruct** the outflow pathways, increasing intraocular pressure.
*Angle recession*
- **Angle recession** occurs when a blunt injury tears the **ciliary body** from its attachment to the scleral spur, causing damage to the trabecular meshwork.
- This damage to the outflow pathway can lead to a long-term increase in **intraocular pressure** and **secondary glaucoma**.
Glaucoma Drainage Devices Indian Medical PG Question 8: A patient with cataract presents with pain and redness of eye. On examination he had deep anterior chamber. What is the diagnosis?
- A. Acute phacolytic glaucoma (Correct Answer)
- B. Acute angle closure glaucoma
- C. Acute neovascular glaucoma
- D. Acute phacomorphic glaucoma
Glaucoma Drainage Devices Explanation: ***Acute phacolytic glaucoma***
- This condition occurs when **lens proteins leak** from a mature or hypermature cataract into the aqueous humor, causing an inflammatory reaction and **trabecular meshwork obstruction**, leading to elevated intraocular pressure.
- The presence of a **deep anterior chamber** distinguishes it from phacomorphic glaucoma, which is characterized by a shallow anterior chamber due to lens intumescence.
*Acute angle closure glaucoma*
- This typically presents with a **shallow anterior chamber** as the iris bows forward, blocking the trabecular meshwork.
- While it causes pain and redness, the deep anterior chamber described in the patient makes this diagnosis unlikely.
*Acute neovascular glaucoma*
- This type of glaucoma results from the formation of **new blood vessels** on the iris and in the angle of the anterior chamber, often due to conditions like **diabetic retinopathy** or **retinal vein occlusion**.
- There is no mention of such predisposing factors or visible neovascularization in the patient's presentation.
*Acute phacomorphic glaucoma*
- This condition is caused by the **intumescence (swelling) of a cataractous lens**, which pushes the iris forward, leading to a **shallow anterior chamber** and angle closure.
- The patient's presentation of a **deep anterior chamber** rules out phacomorphic glaucoma.
Glaucoma Drainage Devices Indian Medical PG Question 9: What does the following image show?
- A. Anterior uveitis
- B. Membranous conjunctivitis
- C. Pannus (Correct Answer)
- D. Pseudomembranous conjunctivitis
Glaucoma Drainage Devices Explanation: ***Pannus***
- The image distinctly shows **new blood vessels growing into the cornea** from the limbus, which is characteristic of pannus formation. This vascularization often accompanies chronic inflammation or hypoxia.
- This condition is a hallmark of certain ophthalmic diseases, such as **trachoma** or chronic irritation from prolonged **contact lens wear**.
*Anterior uveitis*
- Anterior uveitis presents with inflammation of the iris and ciliary body, typically causing **ciliary flush**, **miosis**, and cells/flare in the anterior chamber, which are not the primary features shown.
- While uveitis can sometimes lead to corneal changes, the prominent **vascularization extending onto the cornea** is not its defining visual characteristic.
*Membranous conjunctivitis*
- Membranous conjunctivitis is characterized by the formation of a **true membrane on the conjunctiva** that binds tightly to the underlying epithelium, often caused by severe bacterial infections like *Corynebacterium diphtheriae*.
- The image does not show a membrane on the conjunctival surface; instead, it highlights **corneal vascularization**.
*Pseudomembranous conjunctivitis*
- Pseudomembranous conjunctivitis involves a **fibrinous exudate loosely adherent** to the conjunctiva, which can be peeled off without significant bleeding, as seen in adenoviral conjunctivitis.
- The findings in the image, specifically **vascular ingrowth into the cornea**, are not consistent with the appearance of a pseudomembrane on the conjunctiva.
Glaucoma Drainage Devices Indian Medical PG Question 10: A 75-year-old patient presents with deterioration of vision. On examination, the pupillary reflex is observed to be sluggish, and the intraocular pressure is normal. Optic disc evaluation shows a large and deep cup and paracentral scotomas. What is the most likely diagnosis?
- A. Primary Narrow angle glaucoma
- B. Normal Tension Glaucoma (Correct Answer)
- C. Neovascular Glaucoma
- D. Absolute Glaucoma
Glaucoma Drainage Devices Explanation: **Explanation:**
The diagnosis is **Normal Tension Glaucoma (NTG)**, a variant of Primary Open-Angle Glaucoma (POAG). The key to this question lies in the triad of **normal intraocular pressure (IOP)**, characteristic **glaucomatous optic disc changes** (large, deep cup), and corresponding **visual field defects** (paracentral scotomas).
**Why Option B is Correct:**
In NTG, glaucomatous damage occurs despite IOP remaining consistently within the statistically normal range (≤21 mmHg). It is often associated with vascular dysregulation or systemic hypotension. The presence of a **sluggish pupillary reflex** indicates an Afferent Pupillary Defect (APD) due to advanced optic nerve damage. **Paracentral scotomas** are classically deeper and closer to the fixation point in NTG compared to high-tension POAG.
**Why Other Options are Incorrect:**
* **A. Primary Narrow Angle Glaucoma:** Typically presents with episodes of high IOP, ocular pain, and a shallow anterior chamber.
* **C. Neovascular Glaucoma:** A secondary glaucoma characterized by very high IOP and rubeosis iridis (new vessels on the iris), usually following retinal ischemia.
* **D. Absolute Glaucoma:** The final stage of any uncontrolled glaucoma where the eye is blind (No PL), the pupil is fixed/dilated, and IOP is usually very high.
**NEET-PG High-Yield Pearls:**
* **Drance Hemorrhage:** Flame-shaped disc margin hemorrhages are more common in NTG than in POAG.
* **Risk Factors:** NTG is frequently associated with Raynaud’s phenomenon, migraines, and nocturnal systemic hypotension.
* **Differential:** Always rule out "burnt-out" glaucoma or neurological compression of the optic nerve before diagnosing NTG.
* **Treatment Goal:** Even though IOP is "normal," the mainstay of treatment is still lowering the IOP by 30% from the baseline.
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