UPSC-CMS 2017 — Ophthalmology

Q: While working in a primary health centre, an elderly patient presents with a history of sudden loss of vision and curtain falling sensation in one eye. This symptom is highly suggestive that the patient has the following condition:

Retinal detachment. ***Retinal detachment*** - The classic description of **sudden loss of vision** accompanied by a **"curtain falling" sensation** is highly characteristic of **rhegmatogenous retinal detachment**. - This occurs when the **neurosensory retina** separates from the **retinal pigment epithelium**, often leading to a **progressive visual field defect** as the detachment spreads. - This is an **ophthalmic emergency** requiring urgent referral for surgical intervention. *Vitreous haemorrhage* - A **vitreous haemorrhage** typically causes sudden, painless decrease in vision, often described as **floaters**, cobwebs, or a diffuse haze. - While it can impair vision significantly, it does not usually present with the specific "curtain falling" sensation that indicates a progressive visual field loss from the periphery. *Acute onset ptosis* - **Ptosis** refers to the drooping of the upper eyelid and directly affects the field of vision by physically obstructing the eye. - While it causes a reduction in the visual field, it is a physical obstruction and not typically described as a "curtain falling" sensation within the eye itself. *Intracranial haemorrhage* - An **intracranial haemorrhage** can cause various neurological deficits, including visual disturbances like **hemianopia** or **homonymous defects**, depending on the location of the bleed. - However, sudden unilateral vision loss with a "curtain falling" sensation localized to one eye is not a typical direct initial presentation, which would suggest an ocular rather than a neurological cause. [Practice more Ophthalmology PYQs on OnCourse]

Q: What is the most common malignant tumour of eyelid?

Basal cell cancer. ***Basal cell cancer*** - **Basal cell carcinoma (BCC)** is by far the most common malignant tumor of the eyelid, accounting for approximately **90% of all eyelid malignancies**. - It typically appears as a **slow-growing nodule** with rolled borders, central ulceration, and telangiectasias, most commonly affecting the **lower eyelid and medial canthus**. - BCC is strongly associated with **chronic UV radiation exposure** and rarely metastasizes, but can cause significant local tissue destruction if untreated. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** (also known as meibomian gland carcinoma) is a rare but aggressive malignant tumor arising from the sebaceous glands of the eyelid. - It accounts for approximately **1-5% of eyelid malignancies** and has a higher risk of metastasis compared to BCC. - More common in **Asian populations** and often masquerades as chronic blepharoconjunctivitis, leading to delayed diagnosis. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the **second most common** malignant eyelid tumor, accounting for approximately **5-10% of cases**. - It presents as a firm, erythematous nodule or plaque and has a higher metastatic potential than BCC. - Associated with **UV exposure, HPV infection**, and immunosuppression. *Melanoma* - **Melanoma** is a rare malignant tumor of the eyelid, accounting for less than **1% of eyelid malignancies**. - It arises from melanocytes and carries a significant risk of metastasis and mortality. - Presents as a pigmented lesion with irregular borders, but amelanotic variants can also occur. [Practice more Ophthalmology PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

All Subjects Anatomy (4)Anesthesiology (1)Biochemistry (1)Community Medicine (36)Dermatology (2)Internal Medicine (8)Microbiology (2)Obstetrics and Gynecology (26)Ophthalmology (2)Pathology (4)Pediatrics (1)Pharmacology (3)Physiology (2)Surgery (23)

While working in a primary health centre, an elderly patient presents with a history of sudden loss of vision and curtain falling sensation in one eye. This symptom is highly suggestive that the patient has the following condition:

What is the most common malignant tumour of eyelid?

UPSC-CMS 2017 - Ophthalmology UPSC-CMS Practice Questions and MCQs

Question 1: While working in a primary health centre, an elderly patient presents with a history of sudden loss of vision and curtain falling sensation in one eye. This symptom is highly suggestive that the patient has the following condition:

A. Retinal detachment (Correct Answer)
B. Vitreous haemorrhage
C. Acute onset ptosis
D. Intracranial haemorrhage

Explanation: ***Retinal detachment*** - The classic description of **sudden loss of vision** accompanied by a **"curtain falling" sensation** is highly characteristic of **rhegmatogenous retinal detachment**. - This occurs when the **neurosensory retina** separates from the **retinal pigment epithelium**, often leading to a **progressive visual field defect** as the detachment spreads. - This is an **ophthalmic emergency** requiring urgent referral for surgical intervention. *Vitreous haemorrhage* - A **vitreous haemorrhage** typically causes sudden, painless decrease in vision, often described as **floaters**, cobwebs, or a diffuse haze. - While it can impair vision significantly, it does not usually present with the specific "curtain falling" sensation that indicates a progressive visual field loss from the periphery. *Acute onset ptosis* - **Ptosis** refers to the drooping of the upper eyelid and directly affects the field of vision by physically obstructing the eye. - While it causes a reduction in the visual field, it is a physical obstruction and not typically described as a "curtain falling" sensation within the eye itself. *Intracranial haemorrhage* - An **intracranial haemorrhage** can cause various neurological deficits, including visual disturbances like **hemianopia** or **homonymous defects**, depending on the location of the bleed. - However, sudden unilateral vision loss with a "curtain falling" sensation localized to one eye is not a typical direct initial presentation, which would suggest an ocular rather than a neurological cause.

Question 2: What is the most common malignant tumour of eyelid?

A. Sebaceous gland carcinoma
B. Squamous cell carcinoma
C. Melanoma
D. Basal cell cancer (Correct Answer)

Explanation: ***Basal cell cancer*** - **Basal cell carcinoma (BCC)** is by far the most common malignant tumor of the eyelid, accounting for approximately **90% of all eyelid malignancies**. - It typically appears as a **slow-growing nodule** with rolled borders, central ulceration, and telangiectasias, most commonly affecting the **lower eyelid and medial canthus**. - BCC is strongly associated with **chronic UV radiation exposure** and rarely metastasizes, but can cause significant local tissue destruction if untreated. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** (also known as meibomian gland carcinoma) is a rare but aggressive malignant tumor arising from the sebaceous glands of the eyelid. - It accounts for approximately **1-5% of eyelid malignancies** and has a higher risk of metastasis compared to BCC. - More common in **Asian populations** and often masquerades as chronic blepharoconjunctivitis, leading to delayed diagnosis. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the **second most common** malignant eyelid tumor, accounting for approximately **5-10% of cases**. - It presents as a firm, erythematous nodule or plaque and has a higher metastatic potential than BCC. - Associated with **UV exposure, HPV infection**, and immunosuppression. *Melanoma* - **Melanoma** is a rare malignant tumor of the eyelid, accounting for less than **1% of eyelid malignancies**. - It arises from melanocytes and carries a significant risk of metastasis and mortality. - Presents as a pigmented lesion with irregular borders, but amelanotic variants can also occur.