Traumatic Cataract — MCQs

10 questions

Following injury to the right temple region, a patient complains of pain in the right eye and loss of vision. On examination, the eye movements are normal, and the pupil normally reacts to light. The affected eye shows increased intraocular pressure of 32 mmHg (normal: 10-21 mmHg), mild corneal edema, and a small hyphema visible in the anterior chamber. The diagnosis is

Which type of cataract is associated with blunt trauma to the eye?

Which drug is generally contraindicated in the management of traumatic hyphema in a patient with sickle cell disease?

Following blunt trauma a young male presents with a D shaped pupil. What is the diagnosis?

Rosette cataract is seen after:

Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?

Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?

The presentation shown below is seen in:

All are manifestation of dengue virus infection in eye except?

Q10

Vision 2020 "The right to sight" includes all except-

Traumatic Cataract Indian Medical PG Practice Questions and MCQs

Question 1: Following injury to the right temple region, a patient complains of pain in the right eye and loss of vision. On examination, the eye movements are normal, and the pupil normally reacts to light. The affected eye shows increased intraocular pressure of 32 mmHg (normal: 10-21 mmHg), mild corneal edema, and a small hyphema visible in the anterior chamber. The diagnosis is

A. Traumatic glaucoma (Correct Answer)
B. Optic nerve atrophy
C. Sub-arachnoid haemorrhage
D. Functional loss of vision

Explanation: ***Traumatic glaucoma*** - Increased **intraocular pressure (32 mmHg)** after a **temple injury** with **corneal edema** and **hyphema** are classic signs of traumatic glaucoma. - The hyphema (blood in the anterior chamber) obstructs the **trabecular meshwork**, impeding aqueous humor outflow and leading to elevated IOP. *Optic nerve atrophy* - While optic nerve atrophy can cause **vision loss**, it is a chronic condition and typically not an acute presentation following trauma unless there is direct optic nerve damage. - It would not explain the acute findings of **hyphema**, **corneal edema**, or acutely elevated **intraocular pressure**. *Sub-arachnoid haemorrhage* - A **sub-arachnoid hemorrhage** might present with headache and loss of consciousness, or **papilledema** in severe cases, but typically would not cause such specific eye findings as **hyphema** or **corneal edema** from elevated IOP. - While a blow to the head could cause this, the direct eye findings point to a local ocular issue. *Functional loss of vision* - **Functional vision loss** (or psychogenic vision loss) is a diagnosis of exclusion where no organic cause can be found. - The presence of clear organic signs such as **hyphema**, **corneal edema**, and significantly elevated **intraocular pressure** rules out a functional cause.

Question 2: Which type of cataract is associated with blunt trauma to the eye?

A. Sunflower cataract
B. Lamellar cataract
C. Rosette cataract (Correct Answer)
D. Christmas tree cataract

Explanation: ***Rosette cataract*** - A **rosette cataract** is a classic sign of **blunt trauma** to the eye, characterized by a petal-like or stellate opacity in the lens. - The blunt force can cause a contusion injury to the lens, disrupting lens fibers and leading to this specific cataract morphology. *Sunflower cataract* - **Sunflower cataracts** are typically associated with **Wilson's disease**, a genetic disorder of copper metabolism. - They are characterized by a colorful, sunflower-like deposition of **copper** in the lens capsule and superficial cortex. *Lamellar cataract* - A **lamellar cataract**, also known as a zonular cataract, is typically a **congenital** or **developmental** cataract. - It affects specific layers or lamellae of the lens, often in a familial pattern, and is not usually linked to trauma. *Christmas tree cataract* - **Christmas tree cataracts** are characterized by highly refractile, polychromatic (multicolored) crystalline deposits within the lens. - They are commonly associated with **myotonic dystrophy** but can also be seen in aging, and are not typically due to trauma.

Question 3: Which drug is generally contraindicated in the management of traumatic hyphema in a patient with sickle cell disease?

A. Timolol
B. Steroids
C. Acetazolamide (Correct Answer)
D. Atropine

Explanation: ***Acetazolamide*** - **Acetazolamide** is a **carbonic anhydrase inhibitor** that is **generally contraindicated** in patients with **sickle cell disease or trait**. - It causes **systemic acidosis** by increasing renal bicarbonate excretion, which lowers blood pH. - **Acidosis promotes sickling** of red blood cells, which can lead to **vaso-occlusion**, increased blood viscosity, and potential complications including **anterior chamber obstruction** and **secondary glaucoma**. - Despite its usefulness in lowering intraocular pressure in other settings, this risk makes it contraindicated in sickle cell patients with hyphema. *Timolol* - **Timolol** is a **beta-blocker** that reduces aqueous humor production and is generally **safe and effective** for reducing **intraocular pressure** in traumatic hyphema. - It does not cause systemic acidosis or affect red blood cell sickling. - Commonly used in hyphema management regardless of sickle cell status. *Steroids* - **Topical or systemic steroids** are often used to reduce **inflammation** and anterior chamber reaction in traumatic hyphema. - They help prevent **secondary hemorrhage** and reduce complications. - They do not contribute to red blood cell sickling or systemic acidosis and are safe in sickle cell disease. *Atropine* - **Atropine** is a **cycloplegic agent** used to paralyze the ciliary body and dilate the pupil, which helps **relieve pain** and prevent **posterior synechiae** in hyphema. - It has no adverse effects related to **sickle cell disease** or red blood cell sickling. - Routinely used in hyphema management.

Question 4: Following blunt trauma a young male presents with a D shaped pupil. What is the diagnosis?

A. Iridodialysis (Correct Answer)
B. Orbital fracture
C. Traumatic hyphema
D. Iridoschisis

Explanation: ***Iridodialysis*** - A **D-shaped pupil** strongly suggests **iridodialysis**, which is a disinsertion of the iris root from the ciliary body. - This typically occurs after **blunt trauma** to the eye, allowing the pupil to be distorted towards the point of detachment. *Orbital fracture* - An orbital fracture often presents with **periorbital ecchymosis**, **diplopia**, **enophthalmos**, or **proptosis**, depending on the fracture location. - While it results from blunt trauma, it doesn't directly cause a D-shaped pupil but can lead to other ocular complications. *Traumatic hyphema* - Traumatic hyphema is characterized by **blood in the anterior chamber** of the eye, which can be visible as a red fluid level. - While caused by blunt trauma, it typically presents with blurred vision and pain, not a D-shaped pupil. *Iridoschisis* - Iridoschisis is a rare condition involving the **splitting of the iris stroma**, usually in the elderly, and is not typically associated with acute trauma or a D-shaped pupil. - It often leads to **fine, detached iris fibers** floating in the anterior chamber, rather than a gross deformation of the pupil.

Question 5: 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 6: Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?

A. Angle closure glaucoma
B. Traumatic iritis (Correct Answer)
C. Retinal detachment
D. Corneal ulcer

Explanation: ***Traumatic iritis*** - A **Vossius ring** is a circular pigment deposit on the anterior lens capsule, formed by the impact of the iris during **ocular trauma**. - Its presence is a clear indicator of **blunt globe trauma**, which often leads to traumatic iritis. *Angle closure glaucoma* - This condition involves an **acute increase in intraocular pressure** due to the iris blocking the drainage angle. - While it can cause severe pain and vision loss, it does not involve the formation of a **Vossius ring**. *Retinal detachment* - This condition involves the separation of the sensory retina from the underlying retinal pigment epithelium. - Symptoms include **flashing lights**, **floaters**, and a **"curtain" vision loss**, with no association with a Vossius ring. *Corneal ulcer* - A corneal ulcer is an **open sore on the cornea**, typically caused by infection or injury. - It presents with **pain**, **photophobia**, **redness**, and **discharge**, without the characteristic lens pigment deposit.

Question 7: Consider the following causes of visual loss : 1. Obstruction of the central retinal artery 2. Vitreous and retinal haemorrhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient?

A. 1, 3 and 4
B. 1, 2 and 3
C. 2, 3 and 4
D. 1, 2 and 4 (Correct Answer)

Explanation: ***1, 2 and 4*** - **Obstruction of the central retinal artery**, **vitreous and retinal haemorrhage**, and **retinal detachment** all present as sudden, acute vision loss. - **Central retinal artery occlusion** causes complete, sudden, painless monocular vision loss. **Vitreous hemorrhage** is acute, painless, and can present with floaters or red haze. **Retinal detachment** is acute, painless vision loss, often preceded by flashes and floaters, and can present as a "curtain" coming across the vision. *1, 3 and 4* - While **central retinal artery obstruction** and **retinal detachment** cause acute vision loss, **cataracts** typically cause gradual, progressive vision loss over months to years. - Cataracts primarily affect lens clarity, leading to blurry vision, glare, and dull colors rather than an abrupt onset of blindness. *1, 2 and 3* - **Central retinal artery obstruction** and **vitreous/retinal hemorrhage** lead to acute vision loss, but **cataracts** are a cause of *chronic* and *gradual* vision impairment. - The onset and progression of a **cataract** are distinctly different from the sudden nature of acute vision loss conditions. *2, 3 and 4* - **Vitreous and retinal haemorrhage** and **retinal detachment** are causes of acute vision loss, but a **cataract** is not. - The defining characteristic of acute vision loss is its rapid onset, which does not align with the slow development of a cataract.

Question 8: 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 9: All are manifestation of dengue virus infection in eye except?

A. Cataract (Correct Answer)
B. Vitreous hemorrhage
C. Maculopathy
D. Optic neuritis

Explanation: ***Cataract*** - **Cataracts** are primarily associated with aging, congenital factors, trauma, or long-term steroid use, not directly with acute dengue virus infection. - While dengue can cause various ocular manifestations, the formation of cataracts is a **chronic process** that does not fit the typical acute or subacute presentation of dengue-related eye complications. *Vitreous hemorrhage* - **Vitreous hemorrhage** can occur in dengue due to associated **thrombocytopenia** and coagulation abnormalities, leading to bleeding in the eye. - Severe dengue can induce systemic vasculopathy and bleeding tendencies, which may manifest as intraocular hemorrhage. *Maculopathy* - **Dengue maculopathy** is a recognized complication, often presenting as macular edema, hemorrhage, or foveolitis, leading to visual impairment. - This is thought to be due to direct viral effects, immune-mediated responses, or vasculitis affecting the retinal microvasculature. *Optic neuritis* - **Optic neuritis** following dengue infection has been reported, characterized by inflammation of the optic nerve, causing acute vision loss. - This is considered to be an **immune-mediated post-infectious complication** rather than a direct viral cytopathic effect on the nerve.

Question 10: Vision 2020 "The right to sight" includes all except-

A. Measles induced blindness (Correct Answer)
B. Onchocerciasis
C. Trachoma
D. Cataract

Explanation: ***Measles induced blindness*** - Vision 2020 primarily targets conditions that are either preventable or treatable with *cost-effective interventions* and contribute significantly to *avoidable blindness*. - While measles can cause blindness, the specific program focuses on a defined list of priority diseases for intervention, and measles-related blindness is generally addressed through broader public health initiatives (vaccination) rather than direct "right to sight" surgical or direct medical interventions for established blindness. *Onchocerciasis* - **Onchocerciasis** (river blindness) is a major focus of Vision 2020 due to its profound impact on sight, particularly in endemic areas. - It is a **preventable** and **treatable** cause of blindness through mass drug administration. *Trachoma* - **Trachoma** is recognized as one of the leading infectious causes of blindness globally and is explicitly targeted by Vision 2020 through the **SAFE strategy** (Surgery, Antibiotics, Facial cleanliness, Environmental improvement). - It is a highly **preventable** and **treatable** condition, fitting the program's objectives. *Cataract* - **Cataract** is the leading cause of blindness worldwide and is highly **treatable** through a relatively simple and cost-effective surgical procedure. - Providing cataract surgery is a cornerstone of the Vision 2020 initiative to restore sight.

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