Drug-Induced Cataracts — MCQs
A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?
All of the following drugs cause amorphous whorl like corneal deposits except:
Which of the following is NOT a known cause of posterior subcapsular cataract?
SAFE strategy is recommended for-
A 76-year-old female presents with difficulty reading. Bilateral white opacifications consistent with cataract formation are observed. In which structure are these opacifications located?
A patient complains of an inability to read a newspaper, particularly in bright sunlight. What is the most likely diagnosis?
Rosette cataract is seen after:
Which of the following is NOT a cause of posterior subcapsular cataract?
Hypovitaminosis D causes which of the following types of cataract?
What is the most common type of cataract observed in a newborn?
Drug-Induced Cataracts Indian Medical PG Practice Questions and MCQs
Question 1: A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?
- A. Methotrexate
- B. Hydroxychloroquine (Correct Answer)
- C. Sulfasalazine
- D. Leflunomide
Explanation: ***Hydroxychloroquine*** - **Hydroxychloroquine** [1] is known to cause **retinal toxicity** (maculopathy) as a dose-dependent, long-term side effect, leading to **blurring of vision** and other visual disturbances. - Patients on long-term hydroxychloroquine therapy require regular **ophthalmological screening** to detect and prevent irreversible vision loss. *Methotrexate* - **Methotrexate** is a common DMARD used in RA [1], but its ocular side effects are typically rare and less severe, usually involving **conjunctivitis** or **periorbital edema**. - It does not commonly cause **maculopathy** or sudden profound blurring of vision. *Sulfasalazine* - **Sulfasalazine** [1] can cause a range of side effects, including gastrointestinal issues and various hypersensitivity reactions. - Ocular side effects are infrequent and generally mild, such as **conjunctivitis** or **periorbital edema**, and not severe blurring of vision due to retinal damage. *Leflunomide* - **Leflunomide** is an immunosuppressive DMARD [1] whose common adverse effects include hepatotoxicity, gastrointestinal upset, and hypertension. - Significant **ocular toxicity** leading to blurring of vision, particularly retinal damage, is not a characteristic side effect of **leflunomide**.
Question 2: All of the following drugs cause amorphous whorl like corneal deposits except:
- A. Chlorpromazine
- B. Amiodarone
- C. Chloroquine
- D. Indomethacin (Correct Answer)
Explanation: ***Indomethacin*** - While indomethacin can cause various ocular side effects, **corneal deposits** are not typically described as the **amorphous whorl-like type** seen with the other listed drugs. - Ocular side effects of indomethacin more commonly include **corneal opacities** and **retinal changes** but not the specific **"cornea verticillata"** pattern. *Chlorpromazine* - **Chlorpromazine** can cause **corneal and lenticular deposits**, but these are typically described as **fine granular or stellate deposits** rather than the classic whorl pattern. - While these deposits can accumulate in the corneal epithelium, they do not characteristically present with the **"cornea verticillata"** (whorl keratopathy) pattern seen with amiodarone and chloroquine. - The deposits are generally benign but can lead to visual disturbances. *Amiodarone* - **Amiodarone** is a classic cause of **cornea verticillata**, or **whorl keratopathy**, with amorphous, whorl-like deposits in the corneal epithelium. - These deposits occur in **>90% of patients** on long-term therapy and are typically benign and rarely affect vision. - The whorl pattern is highly characteristic and reversible upon drug discontinuation. *Chloroquine* - **Chloroquine** (and hydroxychloroquine) commonly causes **corneal deposits** known as **cornea verticillata**, which appear as gray-brown, whorl-like opacities in the corneal epithelium. - While these deposits are usually asymptomatic, high doses or prolonged use can lead to visual blurring or halos. - The whorl pattern is a characteristic finding with this class of drugs.
Question 3: Which of the following is NOT a known cause of posterior subcapsular cataract?
- A. Diabetes mellitus
- B. Wilson's Disease (Correct Answer)
- C. Myotonic dystrophy
- D. Ionizing radiation
Explanation: ***Wilson's Disease*** - This is the **CORRECT ANSWER** because Wilson's disease does **NOT** cause posterior subcapsular cataract. - **Wilson's disease** is characterized by a **Kayser-Fleischer ring** (copper deposition in Descemet's membrane of the cornea) and less commonly by a **sunflower cataract** (copper deposition in the **anterior lens capsule**, not posterior). - The sunflower cataract has a characteristic appearance with petal-like opacities radiating from the center, but it affects the anterior capsule, not the posterior subcapsular region. *Myotonic dystrophy* - **Myotonic dystrophy** is a well-known cause of specific cataracts, including a distinctive **"Christmas tree" cataract**, which often begins as a **posterior subcapsular cataract**. - This condition is a systemic autosomal dominant disorder affecting multiple systems, including skeletal muscle, cardiac muscle, and the eyes. *Ionizing radiation* - Exposure to **ionizing radiation**, such as X-rays or radiation therapy, is a classic and recognized risk factor for developing **posterior subcapsular cataracts**. - The lens epithelial cells at the posterior pole are highly susceptible to damage from radiation, leading to migration and abnormal differentiation causing opacification. *Diabetes mellitus* - **Diabetes mellitus** is a significant risk factor for various types of cataracts, including both **snowflake cataracts** (in acute uncontrolled diabetes) and more commonly, **posterior subcapsular cataracts** in chronic diabetes. - High blood glucose levels lead to osmotic changes (sorbitol accumulation via the polyol pathway) and oxidative stress within the lens, contributing to cataract formation.
Question 4: SAFE strategy is recommended for-
- A. Diabetic retinopathy
- B. Trachoma (Correct Answer)
- C. Glaucoma
- D. Cataract
Explanation: ***Trachoma*** * The **SAFE strategy (Surgery, Antibiotics, Facial Cleanliness, Environmental improvement)** is the WHO-recommended public health approach for the elimination of **trachoma**, a chronic eye infection caused by *Chlamydia trachomatis*. * This comprehensive strategy addresses both active infection and its blinding sequelae, specifically **trichiasis** (in-turned eyelashes) through surgery. *Diabetic retinopathy* * Management of diabetic retinopathy primarily involves **blood sugar control, regular ophthalmologic exams, laser photocoagulation, and anti-VEGF injections**, not the SAFE strategy. * The focus is on preventing and treating retinal damage caused by **diabetes**, which is distinct from infectious causes. *Glaucoma* * Glaucoma is characterized by **optic nerve damage** and visual field loss, usually due to elevated intraocular pressure, and is managed with **medication, laser therapy, or surgery (e.g., trabeculectomy)**. * It is a **neurodegenerative condition**, not an infectious disease, so the SAFE strategy is not applicable. *Cataract* * Cataracts involve the **clouding of the natural lens** of the eye, leading to blurred vision, and are primarily treated through **surgical removal of the cloudy lens** and implantation of an artificial intraocular lens. * This condition is age-related or can be caused by trauma or disease, but it is **not an infection** for which the SAFE strategy would be relevant.
Question 5: A 76-year-old female presents with difficulty reading. Bilateral white opacifications consistent with cataract formation are observed. In which structure are these opacifications located?
- A. Aqueous humor
- B. Cornea
- C. Lens (Correct Answer)
- D. Optic nerve
Explanation: ***Lens*** - **Cataracts** are defined by the **clouding of the natural lens** of the eye, which causes blurred vision and difficulty with activities like reading. - The condition is very common, especially among older adults, and affects the **bilateral vision** as described in the case. *Aqueous humor* - The **aqueous humor** is a clear fluid that fills the space between the cornea and the lens; it is not the structure that becomes opaque in cataracts. - Problems with aqueous humor are typically associated with glaucoma (due to increased intraocular pressure) rather than cataract formation. *Cornea* - The **cornea** is the transparent outer layer of the eye that helps focus light, but it does not develop cataracts. - Opacities in the cornea (e.g., from injuries or infections) would be described differently and produce different visual symptoms. *Optic nerve* - The **optic nerve** transmits visual information from the retina to the brain; it is a nerve, not a structure where light focuses or where cataracts develop. - Damage to the optic nerve typically leads to vision loss or blind spots, not blurred vision from opacification.
Question 6: A patient complains of an inability to read a newspaper, particularly in bright sunlight. What is the most likely diagnosis?
- A. Nuclear cataract
- B. Cortical cataract
- C. Posterior subcapsular cataract (Correct Answer)
- D. Congenital cataract
Explanation: ***Posterior subcapsular cataract*** - This type of cataract causes significant **glare** and **photophobia**, making it difficult to read in bright light due to opacities located at the **posterior lens capsule**. - The patient experiences worsening vision in **bright light** conditions because the constricted pupil directs more light through the **central posterior opacity**, which lies directly in the visual axis. *Nuclear cataract* - Patients with **nuclear cataracts** typically experience **myopic shift** and improved near vision (second sight) due to increased refractive power of the lens. - Vision is usually worse in **dim light** conditions because of pupillary dilation, which allows more light to pass through the central opacity. *Cortical cataract* - Characterized by **spoke-like opacities** that start in the periphery and extend inward. - While it can cause glare, vision often remains good until the opacities encroach upon the **visual axis**, and it doesn't specifically cause worsening vision in bright light to the same degree as PSC. *Congenital cataract* - Present at birth or shortly after, and symptoms depend on the density and location of the opacity. - While it affects vision, the specific complaint of difficulty reading in bright sunlight is not a typical distinguishing feature of **congenital cataracts**.
Question 7: Rosette cataract is seen after:
- A. Infection
- B. Penetrating injury to eye
- C. Copper foreign body in eye
- D. Blunt trauma to eye (Correct Answer)
Explanation: ***Blunt trauma to eye*** - **Rosette cataract** is a classic finding following **blunt ocular trauma**, often due to the concussive force on the lens. - The characteristic **flower-petal or star-shaped opacity** forms in the anterior and/or posterior subcapsular regions of the lens. *Infection* - Ocular infections can lead to various complications like **uveitis** or **endophthalmitis**, but **rosette cataract** is not a typical direct sequela. - While inflammation can cause cataracts, they usually present as **inflammatory cataracts** rather than the specific rosette pattern. *Penetrating injury to eye* - **Penetrating injuries** to the eye often lead to **traumatic cataracts** due to direct lens capsule rupture. - These cataracts are typically focal and can progress rapidly, but the morphology is not usually described as a **rosette pattern** unless secondary to significant blunt force component. *Copper foreign body in eye* - A **copper foreign body** in the eye can cause **chalcosis oculi**, leading to a characteristic greenish-brown discoloration and a **sunflower cataract**. - This type of cataract has a distinct appearance from a **rosette cataract**, with a diffuse radial pattern rather than a focal star shape.
Question 8: Which of the following is NOT a cause of posterior subcapsular cataract?
- A. Ionizing radiation
- B. Wilson's Disease
- C. Myotonic dystrophy
- D. Congenital cataract (Correct Answer)
Explanation: ***Congenital cataract*** - **Congenital cataract** is the correct answer because it is **not an etiological cause** but rather a **temporal classification** describing cataracts present at birth or within the first year of life. - The question asks for **causes** (risk factors or etiological agents) of posterior subcapsular cataracts, whereas "congenital cataract" describes **when** the cataract occurs, not **what causes** it. - While congenital cataracts can have various morphologies (including posterior polar types), they arise from developmental abnormalities, genetic factors, or intrauterine infections—not from acquired causes like the other options listed. *Myotonic dystrophy* - **Myotonic dystrophy** is a well-established systemic disorder associated with **posterior subcapsular cataracts**, often with a characteristic **"Christmas tree" or polychromatic appearance**. - This is an **acquired cause** due to the genetic defect (CTG repeat expansion) affecting lens metabolism and protein structure. *Wilson's Disease* - **Wilson's disease**, a disorder of copper metabolism, causes the characteristic **"sunflower cataract"**, which is a type of **posterior subcapsular cataract** with a polychromatic, petal-like appearance. - Copper deposition in the lens capsule and epithelium is the underlying **etiological mechanism**. *Ionizing radiation* - Exposure to **ionizing radiation** (radiotherapy, occupational exposure) is a well-known **acquired cause** of **posterior subcapsular cataracts**. - Radiation damages lens epithelial cells, particularly in the posterior region, leading to migration and opacification in the posterior subcapsular zone.
Question 9: Hypovitaminosis D causes which of the following types of cataract?
- A. Zonular cataract (Correct Answer)
- B. Blue-dot cataract
- C. Rosette cataract
- D. Cupuliform cataract
Explanation: **Explanation:** **Zonular (Lamellar) cataract** is the most common type of developmental cataract. It occurs due to a transient metabolic disturbance affecting the fibers being formed at a specific period. **Hypovitaminosis D** and the resulting **hypocalcemia** are the classic systemic triggers. When serum calcium levels drop, it disrupts the development of the lens fibers, leading to an area of opacification (a "zone") surrounded by clear lens matter. Characteristically, these cataracts show "riders"—linear opacities extending from the equator of the zone. **Analysis of Incorrect Options:** * **Blue-dot cataract (Punctate cataract):** These are the most common congenital cataracts, appearing as small, bluish, opaque dots. They are usually stationary, asymptomatic, and not specifically linked to Vitamin D deficiency. * **Rosette cataract:** This is a classic sign of **mechanical ocular trauma** (concussive injury). The opacification follows the suture lines of the lens, resembling a flower or star. * **Cupuliform cataract:** Also known as **Posterior Subcapsular Cataract (PSC)**, this is typically associated with aging, prolonged systemic or topical steroid use, or ionizing radiation. **High-Yield Pearls for NEET-PG:** * **Zonular Cataract:** Always look for a history of maternal malnutrition or infantile tetany/hypocalcemia. It is usually bilateral and affects the vision significantly. * **Galactosemia:** Causes "Oil droplet" cataract. * **Diabetes Mellitus:** Causes "Snowflake" cataract. * **Myotonic Dystrophy:** Causes "Christmas tree" cataract. * **Wilson’s Disease:** Causes "Sunflower" cataract (found in the anterior capsule).
Question 10: What is the most common type of cataract observed in a newborn?
- A. Zonular cataract (Correct Answer)
- B. Morgagnian cataract
- C. Anterior polar cataract
- D. Posterior polar cataract
Explanation: **Explanation:** **Zonular (Lamellar) cataract** is the most common type of congenital cataract, accounting for approximately 50% of cases. It is characterized by opacification of a specific layer (lamella) of the lens fibers, usually surrounding a clear embryonic nucleus. This occurs due to a transient interference with lens development during fetal life. Clinically, it presents with "riders" (linear opacities extending from the equator of the cataract), which is a high-yield diagnostic feature. **Analysis of Incorrect Options:** * **Morgagnian cataract:** This is a stage of hypermature senile cataract where the cortex liquefies and the nucleus sinks to the bottom. It is an acquired condition of the elderly, not newborns. * **Anterior polar cataract:** These are small, central opacities on the anterior lens capsule. While common, they are typically stationary, often unilateral, and less frequent than the zonular type. * **Posterior polar cataract:** These occur at the posterior pole and are often associated with remnants of the hyaloid artery (Mittendorf dot). They are clinically significant due to the risk of posterior capsular rupture during surgery but are not the most common type. **NEET-PG High-Yield Pearls:** * **Most common cause of congenital cataract:** Idiopathic (followed by genetic/hereditary factors). * **Most common infection causing congenital cataract:** Rubella (presents as "pearly white" opacity). * **Galactosemia:** Associated with "Oil droplet" cataracts. * **Diabetes Mellitus:** Associated with "Snowflake" cataracts. * **Wilson’s Disease:** Associated with "Sunflower" cataracts.
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