Diseases of the Lens — MCQs

Diseases of the Lens Indian Medical PG Practice Questions and MCQs

Question 241: The presentation shown below is seen in:

A. Steroid induced cataract
B. Traumatic cataract
C. Dermatogenic cataract
D. Rose thorn injury to lens (Correct Answer)

Explanation: ***Rose thorn injury to lens*** - The image exhibits a **stellate or rosette-shaped opacity** in the lens, which is characteristic of traumatic cataracts, particularly those caused by a perforating injury. - A thorn injury is a common cause of such **perforating trauma** that can directly affect the lens and lead to a distinct cataract morphology. *Steroid induced cataract* - Steroid-induced cataracts typically manifest as **posterior subcapsular cataracts**, appearing as granular or vacuolated opacities. - They tend to affect the central visual axis more directly but do not typically present with the **stellate or rosette pattern** seen in the image. *Traumatic cataract* - While this is a form of traumatic cataract, the question specifies a **more precise cause** (rose thorn injury) that leads to this distinct morphology. - The general term "traumatic cataract" encompasses various causes and appearances, but the **stellate/rosette pattern points to a perforating injury**, which a rose thorn can cause. *Dermatogenic cataract* - Dermatogenic cataracts are associated with certain **skin conditions** (e.g., atopic dermatitis, eczema) and typically present as **anterior or posterior subcapsular plaques** or dense opacities. - This type of cataract does not typically produce the **sharp, stellate, or iridescent appearance** observed in the image, which is more indicative of mechanical trauma.

Question 242: A patient presents with pain, redness, and photophobia. The slit-lamp image is shown below. What is the diagnosis?

A. Anterior uveitis with posterior synechiae (Correct Answer)
B. Anterior uveitis with anterior synechiae
C. Posterior uveitis with posterior synechiae
D. Posterior uveitis with anterior synechiae

Explanation: ***Anterior uveitis with posterior synechiae*** - The image clearly shows a constricted and irregular pupil, indicative of adhesions between the **iris** and the **anterior lens capsule**. These adhesions are known as **posterior synechiae**. - Visible ciliary flush (redness around the cornea) and the presence of synechiae are classic signs of **anterior uveitis**, which involves inflammation of the iris and ciliary body. *Anterior uveitis with anterior synechiae* - While **anterior uveitis** is present, the adhesions seen are between the iris and the lens, not between the **iris** and the **cornea**. - **Anterior synechiae** involve adhesion of the iris to the cornea, which would typically present as iris tissue pulled towards the peripheral cornea or forming peripheral anterior synechiae that can lead to glaucoma. *Posterior uveitis with posterior synechiae* - **Posterior uveitis** primarily affects the **choroid** and **retina**, and its primary clinical signs are vitreous inflammation, retinal vasculitis, or choroiditis. - While posterior synechiae can sometimes occur in severe panuveitis (a complete inflammation of the uveal tract), they are not a primary feature of posterior uveitis itself, nor do they arise directly from posterior segment inflammation. *Posterior uveitis with anterior synechiae* - This option incorrectly combines **posterior uveitis** with **anterior synechiae**. - Adhesions between the iris and cornea (anterior synechiae) are associated with anterior segment pathology, and posterior uveitis does not typically cause either anterior or posterior synechiae as its primary feature.

Question 243: Which type of cataract is shown in the image?

A. Stellate cataract (Correct Answer)
B. Steroid induced cataract
C. Lamellar cataract
D. Posterior subcapsular cataract

Explanation: ***Stellate cataract*** - The image clearly displays a star-shaped opacity, which is characteristic of a **stellate cataract**, also known as a **floriform cataract**, often associated with congenital rubella. - This type of cataract gets its name from its distinctive stellar or flower-like appearance, which is evident in the lens. *Steroid induced cataract* - **Steroid-induced cataracts** typically manifest as a **posterior subcapsular cataract**, characterized by opacities located in the posterior cortex just beneath the lens capsule. - The pattern in the image does not show the granular, plaque-like appearance or iridescence associated with posterior subcapsular cataracts. *Lamellar cataract* - A **lamellar cataract** (or zonular cataract) presents as opacities in a specific layer (lamella) of the lens, often with clear lens matter surrounding the opacified layer, appearing as concentric rings or zones. - This type of cataract does not exhibit the star-shaped pattern shown in the image. *Posterior subcapsular cataract* - **Posterior subcapsular cataracts** are characterized by granular or plaque-like opacities located at the posterior pole of the lens, often causing significant glare and difficulty with reading. - The image clearly shows a star-shaped pattern rather than the typical appearance of a posterior subcapsular cataract.

Question 244: What does the following image show?

A. Aphakia
B. Pseudophakia
C. Soemmering ring (Correct Answer)
D. Lens subluxation

Explanation: ***Soemmering ring*** - The image exhibits a distinctive **ring-shaped opacity** within the lens, characteristic of a **Soemmering ring**. - This condition occurs due to the proliferation of residual lens epithelial cells and their migration post-capsulotomy, forming a ring of cortical material. *Aphakia* - **Aphakia** refers to the **absence of the crystalline lens** from the eye, which would appear as a black pupil without any lenticular structures. - The image clearly shows a complex structure behind the pupil, inconsistent with a missing lens. *Pseudophakia* - **Pseudophakia** indicates the presence of an **intraocular lens (IOL)** implanted after cataract surgery, which typically appears as a clear, artificial lens. - The observed ring-shaped opacity is not an IOL and differs significantly from the appearance of a pseudophakic eye. *Lens subluxation* - **Lens subluxation** involves the **partial displacement of the lens** from its normal position due to zonular weakness or trauma. - While it can manifest as a decentered pupil or visible zonules, the primary feature here is an organized ring of cortical material, not a dislocated lens.

Question 245: Which of the following is correct about the image shown below?

A. Chalcosis bulbi
B. Siderosis bulbi (Correct Answer)
C. Snowflake cataract
D. Christmas tree cataract

Explanation: ***Siderosis bulbi*** - The image exhibits signs of **iron deposition**, characterized by a **rusty discoloration** and **degenerative changes** in the lens. - This condition, usually resulting from a **retained iron-containing intraocular foreign body**, leads to widespread iron toxicity within the eye. *Chalcosis bulbi* - This condition involves **copper deposition** in the eye, typically caused by a **copper-containing foreign body**. - It would present with specific signs like a **Kayser-Fleischer ring** or a **"sunflower" cataract**, which are not seen here. *Snowflake cataract* - This type of cataract is typically associated with **poorly controlled diabetes mellitus** and is characterized by multiple tiny, **fluffy, white, subcapsular opacities**. - The appearance in the image does not match the typical description of a snowflake cataract. *Christmas tree cataract* - This is a rare form of cataract characterized by the presence of **multicolored, glittering opacities**, resembling tinsel on a Christmas tree. - The image does not show these iridescent, needle-like crystals that are diagnostic of a Christmas tree cataract.

Question 246: A 55-year-old banker presents with painless progressive loss of vision. He also complains of glare at night especially when driving back home. Recently his wife commented on the whiteness in his eye. What does the image show?

A. Immature cataract
B. Mature cataract (Correct Answer)
C. Hypermature cataract
D. Hypermature sclerotic cataract

Explanation: ***Mature cataract*** - The image clearly shows a **completely opacified lens**, appearing milky white, which is characteristic of a mature cataract. In a **mature cataract, all cortical material has become opaque**, leading to a significant loss of vision. - The history of **painless progressive vision loss**, **glare**, and a wife commenting on the **whiteness in his eye** collectively point towards a visually significant, advanced cataract. *Immature cataract* - An immature cataract would present with **partial lens opacification**, meaning some clear lens material would still be visible, allowing for some vision. - The image shows **complete opacification**, ruling out an immature stage. *Hypermature cataract* - A **hypermature cataract** typically exhibits further degenerative changes, such as **liquefaction of cortical material** (Morgagnian cataract) where the nucleus sinks inferiorly, or a shrunken, wrinkled capsule (sclerotic hypermature cataract). - The image does not show these features; the lens appears uniformly opaque without signs of shrinkage or nuclear displacement. *Hypermature sclerotic cataract* - A **hypermature sclerotic cataract** would involve significant **shrinking and wrinkling of the lens capsule** due to water loss, making the lens appear smaller and often causing the anterior chamber to deepen. - The lens in the image is full and well-maintained within the capsule, with no signs of shrinkage or obvious anterior chamber deepening.

Question 247: What does the following image show?

A. Anterior polar cataract
B. Posterior polar cataract
C. Blue dot cataract (Correct Answer)
D. Cuneiform cataract

Explanation: ***Blue dot cataract*** - The image shows numerous small, discrete, bluish-white opacities scattered throughout the **lens cortex**, which are characteristic of **blue dot cataract**, also known as punctate cerulean cataract. - This type of cataract is often congenital or developmental, typically **non-progressive**, and usually has little to no impact on visual acuity. *Anterior polar cataract* - An anterior polar cataract presents as a **well-demarcated, whitish opacity located at the center of the anterior lens capsule**. - It usually appears as a single, distinct spot, differing significantly from the widespread blue dots seen in the image. *Posterior polar cataract* - A posterior polar cataract is an opacity located at the **center of the posterior lens capsule**, often appearing as a disc-shaped lesion. - It is distinct from the numerous anterior cortical punctate opacities shown in the image and has a higher risk of posterior capsular rupture during surgery. *Cuneiform cataract* - Also known as cortical cataract, cuneiform cataracts present as **wedge-shaped or spoke-like opacities** that start in the periphery of the lens cortex and gradually extend towards the center. - The appearance in the image is of scattered dots, not the characteristic spokes of a cuneiform cataract.

Question 248: What does the following image show?

A. Anterior polar cataract
B. Cupuliform cataract (Correct Answer)
C. Blue dot cataract
D. Cuneiform cataract

Explanation: ***Cupuliform cataract*** - The image displays a **posterior subcapsular cataract** with a characteristic **cup-shaped opacity** located in the posterior cortex of the lens. - This type of cataract is often associated with conditions such as **diabetes**, chronic steroid use, and inflammatory eye diseases. *Anterior polar cataract* - This type of cataract would appear as a **small, well-defined, white opacity** on the anterior surface of the lens capsule, usually congenital, which is not what is shown. - It would be located at the **central anterior pole** of the lens, contrasting with the posterior location seen here. *Blue dot cataract* - This refers to **punctate blue opacities** scattered throughout the lens, a type of pulverulent cataract, typically congenital and often asymptomatic. - The diffuse, cup-shaped, and more significant opacity in the image does not fit the description of a blue dot cataract. *Cuneiform cataract* - Also known as **cortical cataracts**, these appear as **wedge-shaped opacities** starting at the periphery of the lens and extending towards the center like spokes of a wheel. - While there are some radial patterns, the predominant feature in the image is the dense, central posterior opacity, not peripheral wedges.

Question 249: A 30-year-old school teacher presents with complaints of red eye with photophobia. Ocular findings are shown below. All are true about the condition shown except: (Recent NEET Pattern 2016-17)

A. Mutton-fat keratic precipitates
B. Dalen-Fuchs nodules
C. Aqueous flare
D. Muddy iris (Correct Answer)

Explanation: ***Muddy iris*** - A "muddy iris" appearance refers to loss of the normal iris architecture and fine details due to **diffuse iris stromal edema** - This is a characteristic feature of **non-granulomatous (acute) anterior uveitis**, not granulomatous uveitis - The images show **granulomatous anterior uveitis** (evidenced by mutton-fat KPs), where muddy iris is typically **absent** or less prominent - **This is the correct answer** as it is NOT a typical feature of the condition shown *Mutton-fat keratic precipitates* - The left image shows large, greasy-looking deposits on the corneal endothelium - These are characteristic **mutton-fat keratic precipitates (KPs)** composed of macrophages and epithelioid cells - These are **pathognomonic for granulomatous uveitis** and are clearly visible in the condition shown *Dalen-Fuchs nodules* - These are yellowish-white collections of lymphocytes and epithelioid cells between **Bruch's membrane and the RPE** in the peripheral fundus - They are a feature of **granulomatous posterior uveitis**, particularly in **Vogt-Koyanagi-Harada (VKH) disease** and sympathetic ophthalmia - While not visible in these anterior segment images, they **can coexist** in patients with granulomatous panuveitis *Aqueous flare* - The right image (slit lamp beam) shows visible **aqueous flare** - cloudiness in the anterior chamber - This indicates **protein leakage** from breakdown of the blood-aqueous barrier - This is a **direct sign of active inflammation** and is commonly seen in both granulomatous and non-granulomatous uveitis

Question 250: Which of the following is responsible for abnormal shape of anterior chamber shown below?

A. Myopia
B. Hypermetropia
C. Iris bombe (Correct Answer)
D. Intumescent cataract

Explanation: ***Iris bombe*** - The image shows the anterior chamber is *flattened* centrally and *bowed forward* peripherally, creating a characteristic convex appearance of the iris. - This occurs due to **pupillary block**, where aqueous humor becomes trapped behind the iris causing it to bulge forward. *Myopia* - Myopia (nearsightedness) refers to a refractive error where light focuses *in front* of the retina, often due to an *elongated eyeball*. - It does not directly cause the *anatomical bowing* of the iris seen in the image. *Hypermetropia* - Hypermetropia (farsightedness) is a refractive error where light focuses *behind* the retina, often due to a *shortened eyeball*. - While hypermetropic eyes can be predisposed to angle closure glaucoma, they do not inherently show the specific *iris bombe configuration*. *Intumescent cataract* - An intumescent cataract is a *swollen cataract* that can push the iris forward by *increasing the lens thickness*. - While it can cause pupillary block and angle closure, the primary feature in the image is the *iris bowing from an obstruction at the pupil*, not necessarily lens swelling itself.

Practice by Chapter

Lens Anatomy and Physiology

Practice Questions

Age-Related Cataract

Practice Questions

Congenital and Developmental Cataracts

Practice Questions

Traumatic Cataract

Practice Questions

Metabolic Cataracts

Practice Questions

Drug-Induced Cataracts

Practice Questions

Cataract Surgery Techniques

Practice Questions

Intraocular Lens Implants

Practice Questions

Complications of Cataract Surgery

Practice Questions

Posterior Capsular Opacification

Practice Questions

Lens Subluxation and Dislocation

Practice Questions

Specialty IOLs

Practice Questions

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