Diseases of the Lens — MCQs
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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?
Identify the instrument shown.
Rosette cataract is seen after:
Constantly changing refractive error is seen in:
Which laser is used in the management of posterior capsule opacification (PCO)?
Which of the following is not true about the difference between congenital cataract surgery and senile cataract surgery?
All are true except:
All of the following are causes of congenital blindness Except:
Which ocular condition is associated with "snowflake" cataracts?
A 50-year-old male presents with decreased vision and frequent changes in his glasses prescription. Examination reveals a clear cornea and increasing myopia. What is the most likely cause?
Diseases of the Lens Indian Medical PG Practice Questions and MCQs
Question 251: 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?
- A. Irvine-Gass syndrome
- B. After cataract (Correct Answer)
- C. UGH syndrome
- D. Endophthalmitis
Explanation: ***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 252: Identify the instrument shown.
- A. Episiotomy scissors
- B. Metzenbaum scissors (Correct Answer)
- C. Mayo scissors
- D. Bandage scissors
Explanation: ***Metzenbaum scissors*** - **Metzenbaum scissors** are characterized by their **long shanks** and **short, delicate blades**, which are either curved or straight. - They are primarily used for **dissecting and cutting delicate tissues** during surgical procedures. *Episiotomy scissors* - **Episiotomy scissors** have a distinct **angled or curved tip** on one blade, designed to protect the baby's head during an episiotomy. - Their blades are typically **blunt on one side** and sharp on the other to precisely cut the perineum. *Mayo scissors* - **Mayo scissors** have **heavy, strong blades**, usually straight or slightly curved, and a relatively **short shank-to-blade ratio**. - They are designed for **cutting tough tissues**, fascia, and sutures, unlike the more delicate instrument shown. *Bandage scissors* - **Bandage scissors** (Lister scissors) have a unique design with an **angled lower blade** and a **blunt tip** to safely slide under bandages without harming the patient's skin. - The blunt tip distinguishes them from the instrument in the image, which has two sharp tips.
Question 253: 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 254: Constantly changing refractive error is seen in:
- A. Morgagnian cataract
- B. Intumescent cataract
- C. Traumatic cataract
- D. Diabetic cataract (Correct Answer)
Explanation: ***Diabetic cataract*** - Fluctuating blood glucose levels in diabetes can cause changes in the **osmolarity of the aqueous humor**, which in turn affects the hydration of the lens and its refractive power. - This leads to a **constantly changing refractive error**, where a person's prescription might change rapidly over short periods of time. *Morgagnian cataract* - This is a type of **hypermature cataract** where the cortex has liquefied, allowing the nucleus to sink within the capsular bag. - While vision is severely impaired, it doesn't typically present with a constantly changing refractive error, but rather a stable, significant vision loss. *Intumescent cataract* - An **intumescent cataract** is a mature or hypermature cataract where the lens has become significantly swollen due to water absorption. - This swelling causes the anterior capsule to stretch, but it results in a fixed and profound vision loss, not a fluctuating refractive error. *Traumatic cataract* - A **traumatic cataract** develops as a result of blunt or penetrating ocular injury, causing damage to the lens fibers. - While the specific type of refractive error can vary depending on the trauma, it typically presents as a stable visual impairment rather than a constantly changing refractive error.
Question 255: Which laser is used in the management of posterior capsule opacification (PCO)?
- A. Krypton
- B. Argon
- C. Excimer
- D. Nd:YAG (Correct Answer)
Explanation: ***Nd:YAG*** - The **Nd:YAG laser** is the standard treatment for posterior capsule opacification (PCO) due to its ability to create a small opening in the **opacified posterior capsule** without damaging adjacent structures. - This laser works by **photodisruption**, using short pulses of high-energy light to create plasma and mechanically break apart the capsular tissue. *Krypton* - **Krypton lasers** are primarily used in ophthalmology for **retinal photocoagulation**, particularly for conditions like diabetic retinopathy and macular edema. - They are not used for treating PCO as their mechanism is based on thermal coagulation, which would be inappropriate for the delicate posterior capsule. *Argon* - **Argon lasers** are also used for **retinal photocoagulation** and for treating conditions like **glaucoma** (e.g., argon laser trabeculoplasty). - Similar to krypton lasers, their thermal effects are not suitable for the precise, non-thermal disruption required for PCO treatment. *Excimer* - The **excimer laser** is best known for its use in **refractive surgery** like LASIK and PRK to reshape the cornea. - Its mechanism involves **photoablation**, precisely removing tissue, but it is not used for creating an opening in the posterior capsule.
Question 256: Which of the following is not true about the difference between congenital cataract surgery and senile cataract surgery?
- A. Incidence of glaucoma is higher.
- B. The energy used in phacoemulsification is higher. (Correct Answer)
- C. Incidence of posterior capsular opacification is higher.
- D. The chances of refractive surprise are higher.
Explanation: ***The energy used in phacoemulsification is higher.*** - In congenital cataract surgery, the lens is typically **much softer and less dense** than in senile cataracts, requiring **less phacoemulsification energy**. - Senile cataracts are often **harder and denser**, necessitating **more phacoemulsification energy** to break them up. *Incidence of glaucoma is higher.* - **Secondary glaucoma** is a significantly **higher risk** after congenital cataract surgery due to factors like chronic inflammation, pupillary block, and angle dysgenesis. - While glaucoma can occur after senile cataract surgery, its incidence is **much lower** compared to the congenital form. *The chances of refractive surprise is higher.* - Predicting the **long-term refractive outcome** in children is challenging due to ongoing **eye growth and development**, leading to a higher chance of refractive surprise. - In adults with senile cataracts, eye growth has ceased, and biometry measurements are **more stable and predictable**, resulting in a lower chance of refractive surprise. *Incidence of posterior capsular opacification is higher.* - The **capsule-epithelial cells** in children are **more proliferative** and prone to migration, making posterior capsular opacification (PCO) a **very common complication** after congenital cataract surgery. - While PCO can occur after senile cataract surgery, the incidence is **lower** and generally more manageable with Nd:YAG capsulotomy.
Question 257: All are true except:
- A. The embryonic nucleus is situated between the two Y sutures
- B. Congenital blue dot cataracts are associated with development of senile cataract at an early stage
- C. The infantile nucleus is completely formed by one year of age (Correct Answer)
- D. Zonular cataracts typically affect the outer part of the fetal or the inner part of the adult nucleus
Explanation: ***The infantile nucleus is completely formed by one year of age*** - The **infantile nucleus** is NOT completely formed by one year of age; it continues to develop from birth until approximately **3 years of age**, not just one year. - Lens growth is a continuous process throughout life, with new fibers being laid down, leading to the formation of different nuclear layers over time. *The embryonic nucleus is situated between the two Y sutures* - The **embryonic nucleus** is indeed located between the **anterior and posterior Y sutures**, which mark the boundaries of the primary lens fibers. - These sutures are formed during the early stages of lens development. - This statement is **TRUE**. *Congenital blue dot cataracts are associated with development of senile cataract at an early stage* - **Blue dot cataracts (cerulean cataracts)** are typically stationary, benign, and **do not predispose** to the development of senile cataracts at an earlier stage. - They are usually congenital and do not significantly impair vision. - This statement is **TRUE** (they do NOT cause early senile cataracts, but the statement itself describes the condition accurately as a recognized entity). *Zonular cataracts typically affect the outer part of the fetal or the inner part of the adult nucleus* - **Zonular (lamellar) cataracts** are characterized by opacities that form concentric layers (zones) within the lens, typically affecting the **fetal nucleus** or the inner part of the **adult nucleus**. - They develop around the time of birth or in early childhood, often due to metabolic disturbances. - This statement is **TRUE**.
Question 258: All of the following are causes of congenital blindness Except:
- A. Toxoplasmosis
- B. Cataract
- C. Congenital rubella
- D. Vitamin A deficiency (Correct Answer)
Explanation: ***Vitamin A deficiency*** - While **Vitamin A deficiency** can lead to **xerophthalmia** and, if severe and prolonged, eventual **blindness** in children, it is typically an acquired condition, not a congenital cause of blindness present at birth. - It usually manifests postnatally due to inadequate dietary intake rather than being a developmental abnormality or intrauterine infection. *Toxoplasmosis* - **Congenital toxoplasmosis** can cause severe ocular damage, including **chorioretinitis**, which often leads to **visual impairment or blindness** from birth or early childhood. - It results from transplacental transmission of the pathogen, causing developmental anomalies in the eyes and brain. *Cataract* - **Congenital cataracts** are a significant and direct cause of **blindness** or severe visual impairment in infants. - They are opacities of the lens present at birth, interfering with light transmission to the retina. *Congenital rubella* - The **congenital rubella syndrome** is a well-known cause of **congenital blindness**, typically due to **cataracts**, **glaucoma**, or **chorioretinitis**. - It occurs when the mother contracts rubella during pregnancy, leading to various birth defects.
Question 259: Which ocular condition is associated with "snowflake" cataracts?
- A. Diabetes mellitus (Correct Answer)
- B. Glaucoma
- C. Hypertension
- D. Sickle cell disease
Explanation: ***Diabetes mellitus*** - **Snowflake cataracts** are a rare but characteristic presentation of rapidly progressing cataracts in patients with **poorly controlled diabetes mellitus**. - They are characterized by numerous small, grayish-white subcapsular opacities, sometimes with iridescent rainbow-like reflections, resembling snowflakes. - This is a pathognomonic finding in diabetic patients, particularly in young patients with type 1 diabetes or severe uncontrolled hyperglycemia. *Glaucoma* - Glaucoma is characterized by **optic nerve damage** and visual field loss, typically due to elevated intraocular pressure, not cataract formation. - While glaucoma and cataracts can coexist, glaucoma itself does not cause the specific "snowflake" morphology of cataracts. *Hypertension* - Hypertension is associated with various ocular changes such as **hypertensive retinopathy**, retinal vessel changes, and choroidopathy. - However, it is not directly associated with any specific type of cataract morphology like "snowflake" cataracts. *Sickle cell disease* - Sickle cell disease can cause various ocular complications, including **sickle cell retinopathy**, characterized by retinal vascular occlusions, neovascularization, and vitreous hemorrhage. - It does not typically cause "snowflake" cataracts; the cataracts associated with sickle cell disease are usually less specific and may be due to systemic effects or iron deposition.
Question 260: A 50-year-old male presents with decreased vision and frequent changes in his glasses prescription. Examination reveals a clear cornea and increasing myopia. What is the most likely cause?
- A. Nuclear sclerotic cataract (Correct Answer)
- B. Keratoconus
- C. Primary open-angle glaucoma
- D. Diabetic retinopathy
Explanation: ***Nuclear sclerotic cataract*** - **Nuclear sclerotic cataracts** are characterized by hardening and yellowing of the lens nucleus, causing a **myopic shift** (lenticular myopia) due to increased refractive index of the lens. - This **progressive myopia** necessitates **frequent changes in glasses prescription**, which is the hallmark presentation. - Patients may experience temporary improvement in near vision (**second sight of the elderly**) before significant **decreased vision** develops. - The **clear cornea** on examination is consistent with a lenticular (lens) problem rather than a corneal pathology. *Keratoconus* - **Keratoconus** involves progressive thinning and bulging of the cornea, causing irregular astigmatism and vision distortion. - The examination finding of a **clear cornea** does not rule out early keratoconus, but keratoconus typically presents with **corneal findings** (Fleischer ring, Vogt's striae, corneal protrusion on topography). - The key distinguishing feature here is the **progressive myopia without irregular astigmatism**, which is more consistent with nuclear sclerotic cataract. *Primary open-angle glaucoma* - **Primary open-angle glaucoma (POAG)** causes progressive optic nerve damage due to elevated intraocular pressure, leading to **peripheral visual field loss**. - POAG does **not cause increasing myopia** or frequent refractive changes; it's often asymptomatic in early stages. - Vision loss in POAG is due to nerve damage, not refractive changes. *Diabetic retinopathy* - **Diabetic retinopathy** affects retinal microvasculature, causing hemorrhages, exudates, and neovascularization. - While **fluctuating blood glucose** can cause temporary refractive changes due to lens hydration alterations, this causes **variable refraction** (not progressive myopia). - Diabetic retinopathy itself does not cause the **consistent myopic shift** seen with nuclear sclerotic cataract.
Practice by Chapter
Lens Anatomy and Physiology
Practice Questions
Age-Related Cataract
Practice Questions
Congenital and Developmental Cataracts
Practice Questions
Traumatic Cataract
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Metabolic Cataracts
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Drug-Induced Cataracts
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Cataract Surgery Techniques
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Intraocular Lens Implants
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Complications of Cataract Surgery
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Posterior Capsular Opacification
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Lens Subluxation and Dislocation
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Specialty IOLs
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