Diseases of the Lens Practice Questions

Q: The presentation shown below is seen in:

Traumatic cataract. ***Traumatic cataract*** - The **stellate or rosette-shaped opacity** pattern shown is the classic morphological hallmark of **blunt/concussive traumatic cataract**. - This distinctive **radial spoke-like pattern** occurs due to mechanical disruption of lens fibers following **blunt ocular trauma**. *Steroid induced cataract* - Steroid-induced cataracts typically present as **posterior subcapsular cataracts** with a granular or vacuolated appearance. - They do not produce the characteristic **stellate/rosette pattern** seen in this presentation, which is specific to mechanical trauma. *Dermatogenic cataract* - Associated with **atopic dermatitis** and other skin conditions, presenting as **anterior or posterior subcapsular plaques**. - Does not exhibit the **radial spoke-like morphology** characteristic of traumatic injury shown in the image. *Rose thorn injury to lens* - Rose thorn injury is a **penetrating trauma** that creates a **localized track-pattern opacity** at the site of penetration. - Unlike the **diffuse stellate pattern** shown, penetrating injuries cause **focal lens damage** along the injury tract, not the generalized rosette appearance.

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

Anterior uveitis with posterior synechiae. ***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.

Q: Which type of cataract is shown in the image?

Stellate cataract. ***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.

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

Siderosis bulbi. ***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.

Q: 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?

Mature cataract. ***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.

Q: What does the following image show?

Blue dot cataract. ***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.

Q: What does the following image show?

Cupuliform cataract. ***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.

Q: 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)

Muddy iris. ***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

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

Iris bombe. ***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.

Q: A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

After cataract. ***After cataract*** - The image depicts a **thickening and opacification of the posterior capsule** behind an intraocular lens, which is characteristic of after cataract (also known as **posterior capsular opacification** or PCO). - PCO is a common complication following cataract surgery, leading to **diminished vision** months to years after the initial procedure, consistent with the patient's presentation. *Irvine-Gass syndrome* - Irvine-Gass syndrome refers to **pseudophakic cystoid macular edema**, which causes diminished vision after cataract surgery due to fluid accumulation in the macula. - While it can cause vision loss post-cataract surgery, it is a retinal condition and does not present with the **posterior capsule opacification** seen in the image. *UGH syndrome* - UGH (Uveitis-Glaucoma-Hyphema) syndrome is a complication typically associated with poorly designed or positioned **intraocular lenses (IOLs)** that rub against uveal tissue. - It presents with **intraocular inflammation, elevated intraocular pressure, and recurrent hyphema**, none of which are directly suggested by the provided image or clinical details. *Endophthalmitis* - Endophthalmitis is a severe **intraocular infection** that typically occurs days to weeks after cataract surgery, presenting acutely with significant **pain, redness, and severe vision loss**. - The patient's presentation of diminished vision one year after surgery and the image showing a **fibrotic posterior capsule** are not consistent with the acute, infectious nature of endophthalmitis.

Question 1

The presentation shown below is seen in:

Accepted Answer

Traumatic cataract

Answer

Steroid induced cataract

Answer

Dermatogenic cataract

Answer

Rose thorn injury to lens

Question 2

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

Accepted Answer

Anterior uveitis with posterior synechiae

Answer

Anterior uveitis with anterior synechiae

Answer

Posterior uveitis with posterior synechiae

Answer

Posterior uveitis with anterior synechiae

Question 3

Which type of cataract is shown in the image?

Accepted Answer

Stellate cataract

Answer

Steroid induced cataract

Answer

Lamellar cataract

Answer

Posterior subcapsular cataract

Question 4

Which of the following is correct about the image shown below?

Accepted Answer

Siderosis bulbi

Answer

Chalcosis bulbi

Answer

Snowflake cataract

Answer

Christmas tree cataract

Question 5

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?

Accepted Answer

Mature cataract

Answer

Immature cataract

Answer

Hypermature cataract

Answer

Hypermature sclerotic cataract

Question 6

What does the following image show?

Accepted Answer

Blue dot cataract

Answer

Anterior polar cataract

Answer

Posterior polar cataract

Answer

Cuneiform cataract

Question 7

What does the following image show?

Accepted Answer

Cupuliform cataract

Answer

Anterior polar cataract

Answer

Blue dot cataract

Answer

Cuneiform cataract

Question 8

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)

Accepted Answer

Muddy iris

Answer

Mutton-fat keratic precipitates

Answer

Dalen-Fuchs nodules

Answer

Aqueous flare

Question 9

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

Accepted Answer

Iris bombe

Answer

Myopia

Answer

Hypermetropia

Answer

Intumescent cataract

Question 10

A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

Accepted Answer

After cataract

Answer

Irvine-Gass syndrome

Answer

UGH syndrome

Answer

Endophthalmitis

Diseases of the Lens — MCQs

Diseases of the Lens — MCQs

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