Diseases of the Retina Practice Questions

Q: What is the typical appearance of a subhyaloid hemorrhage in the eye?

Boat shaped. ***Boat shaped*** - A subhyaloid hemorrhage is located beneath the **hyaloid membrane** (the posterior vitreous cortex), which is attached to the retina. - The collected blood often assumes a **dependent, gravity-influenced shape**, appearing flat on top and curved underneath, resembling a boat. *Crescent shaped* - This shape is not characteristic of a typical subhyaloid hemorrhage; it might be seen in other types of hemorrhages or detachment patterns. - **Crescentic shapes** are more commonly associated with certain types of **retinal detachments** or tears where fluid accumulation takes on a curved boundary. *Round* - While hemorrhages can be round, a subhyaloid hemorrhage typically spreads out due to gravity within the confined space, resulting in a more distinct shape. - A **perfectly round hemorrhage** is less common in the subhyaloid space as blood tends to layer out rather than remain as a sphere. *Flame shaped* - **Flame-shaped hemorrhages** are typically found in the **nerve fiber layer** due to the orientation of nerve fibers. - These hemorrhages are shallower and follow the linear arrangement of nerve fibers, unlike the larger, more globular subhyaloid bleeds.

Q: What is the primary predisposing factor for retinopathy of prematurity?

Low gestational age. ***Low gestational age*** - **Prematurity** is the most significant risk factor, as the **retinal vasculature** is still immature and susceptible to abnormal development. - The earlier the gestational age, the **higher the risk** of ROP developing and progressing to severe stages. *Low birth weight* - While strongly correlated with ROP, **low birth weight** is often a consequence of prematurity rather than the primary predisposing factor itself. - Many term infants can have low birth weight due to **intrauterine growth restriction** but do not typically develop ROP. *Oxygen toxicity* - **Supplemental oxygen** can exacerbate ROP by causing initial **vasoconstriction** and subsequent abnormal vessel proliferation. - However, it acts as a secondary trigger in an already vulnerable, premature retina, not the primary predisposing factor. *Carbohydrate excess* - **Carbohydrate excess** is not a recognized predisposing factor for retinopathy of prematurity. - This condition is primarily related to the **vascular development of the retina** in premature infants.

Q: A 44-year-old woman presents with sudden painless loss of vision with a history of previous similar episodes. Fundoscopy shows no glow. What could be the possible diagnosis?

Vitreous Hemorrhage. ***Vitreous Hemorrhage*** - **Painless vision loss** is a hallmark symptom, and **previous similar episodes** suggest a recurrent condition, characteristic of vitreous hemorrhage from fragile vessels. - The **"no glow"** on fundoscopy indicates that light from the ophthalmoscope is unable to reflect off the retina due to something obstructing the clear media, such as blood in the vitreous cavity. *Rhegmatogenous Retinal Detachment* - While it causes **painless vision loss**, patients often report **floaters** or **flashes of light** preceding the detachment, which are not mentioned here. - Fundoscopy in rhegmatogenous retinal detachment would typically show a **grayish, elevated retina**, often with folds, not a complete loss of red reflex or ''no glow.'' *Acute Angle-Closure Glaucoma* - Characterized by **sudden, severe eye pain**, blurred vision, and often a **red eye** with a fixed, mid-dilated pupil. - Fundoscopy would typically reveal a **cupped optic disc** in advanced stages, but the primary finding is elevated intraocular pressure, with a clear vitreous, thus allowing an initial glow. *Fungal Keratitis* - This is an **infection of the cornea** that typically presents with pain, redness, photophobia, and a visible corneal ulcer or infiltrate. - Vision loss is gradual, and fundoscopy would still show a **normal red reflex** unless the corneal opacity is extremely dense, which is not implied by "no glow."

Q: What is the cause of glaucoma in retinoblastoma?

Neovascularisation. ***Neovascularisation*** - Retinoblastoma leads to **neovascularization of the iris (NVI)** and **angle structures** due to tumor necrosis, ischemia, and release of **angiogenic factors (VEGF)**. - The **neovascular membrane** grows over and obstructs the **trabecular meshwork** and anterior chamber angle, causing **secondary neovascular glaucoma**. - This is the **most characteristic and common mechanism** of glaucoma in advanced retinoblastoma. - Neovascular glaucoma in retinoblastoma is typically **refractory to medical treatment** and indicates poor prognosis. *Blockage of trabecular network* - While tumor cells can directly seed into the anterior chamber and block the trabecular meshwork, this mechanism is **less common** than neovascularization. - This option is also **less specific** as it doesn't identify the underlying pathophysiological process (neovascularization) that is characteristic of retinoblastoma-associated glaucoma. - Direct trabecular blockage by tumor cells typically occurs in advanced disease and often coexists with neovascularization. *Mass effect of the tumour* - The tumor mass itself rarely causes glaucoma through direct mechanical compression of outflow pathways. - Retinoblastoma causes glaucoma primarily through **secondary mechanisms** such as inflammation, neovascularization, or cellular seeding, not simple bulk effect. - Massive tumors may cause angle closure, but this is uncommon compared to neovascular mechanisms. *Lysis of the lens* - **Phacolytic glaucoma** from lens protein leakage is rare in retinoblastoma. - While lens damage can occur with advanced tumors, it is **not a typical or characteristic cause** of glaucoma in retinoblastoma. - The primary mechanisms involve the **tumor-angle-trabecular meshwork axis**, not lens pathology.

Q: Purtscher's retinopathy is associated with -

Head trauma. ***Head trauma*** - **Purtscher's retinopathy** is a rare occlusive microvasculopathy characterized by sudden vision loss and specific retinal findings, classically associated with **head or chest trauma**. - The condition occurs due to **fat embolization** and **leukoembolization** with complement activation, leading to occlusion of retinal precapillary arterioles. - Classic findings include **cotton wool spots**, intraretinal hemorrhages, and **Purtscher flecken** (polygonal areas of retinal whitening between the optic disc and macula). - The term "Purtscher's retinopathy" specifically refers to trauma-induced cases, while "Purtscher-like retinopathy" describes similar findings from non-traumatic causes (acute pancreatitis, fat embolism syndrome, amniotic fluid embolism). *Diabetes Mellitus* - **Diabetic retinopathy** is associated with chronic hyperglycemia causing microvascular damage, characterized by microaneurysms, dot-blot hemorrhages, hard exudates, and venous beading. - It involves gradual progressive changes over years, not acute embolic occlusion from trauma. - Advanced stages include **proliferative diabetic retinopathy** with neovascularization and diabetic macular edema. *Wilson's disease* - **Wilson's disease** is an autosomal recessive disorder of copper metabolism affecting the liver, brain, and eyes. - Ocular manifestations include **Kayser-Fleischer rings** (copper deposition in Descemet's membrane) and sunflower cataracts. - It does not cause acute retinal vascular occlusion or the specific findings of Purtscher's retinopathy. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting joints. - Ocular manifestations include **keratoconjunctivitis sicca** (dry eyes), **episcleritis**, **scleritis**, and peripheral ulcerative keratitis. - It is not associated with Purtscher's retinopathy, which is specifically linked to traumatic or embolic events.

Q: Most common age related change in vitreous?

Posterior vitreous detachment (PVD). ***Posterior vitreous detachment (PVD)*** - As we age, the **vitreous body** undergoes liquefaction and shrinkage, leading to its separation from the **retina**, most commonly posteriorly. - This is a very common and usually benign age-related phenomenon, often presenting with **floaters** and **flashes of light**. *Anterior vitreous detachment* - **Anterior vitreous detachment** is much less common than PVD and not typically considered the most frequent age-related change. - It often occurs secondary to **trauma** or specific surgical procedures rather than spontaneous aging alone. *Vitreous hemorrhage* - **Vitreous hemorrhage** is a pathological condition involving bleeding into the vitreous humor, often due to **diabetic retinopathy**, retinal tears, or trauma. - It is not a normal age-related change but a complication of underlying disease. *Vitritis* - **Vitritis** refers to inflammation of the vitreous humor, commonly associated with **uveitis** or infections. - It is an inflammatory disease process, not a physiological age-related degeneration of the vitreous.

Q: All of the following are true for sympathetic ophthalmitis except which of the following?

Affects the injured eye. ***Affects the injured eye*** - Sympathetic ophthalmia is a **bilateral, granulomatous panuveitis** that characteristically affects the **fellow, uninjured eye** (sympathizing eye) following trauma or surgery to the other eye (exciting eye). - The disease involves an immune response directed against ocular antigens, typically from the uveal tissue, in the uninjured eye. *Mostly results from a penetrating wound* - This statement is true; **penetrating ocular trauma** (e.g., from surgery or injury) is the most common trigger for sympathetic ophthalmia. - The exposure of uveal antigens from the injured eye initiates an autoimmune response. *Autoimmune etiology* - This statement is true; sympathetic ophthalmia is an **autoimmune disease** mediated by T-lymphocytes against uveal antigens. - The condition is characterized by a delayed hypersensitivity reaction against exposed uveal proteins. *Dalen Fuch's nodules may be seen* - This statement is true; **Dalen-Fuchs nodules** are characteristic histopathological findings in sympathetic ophthalmia. - These are accumulations of epithelioid cells and lymphocytes located between the retinal pigment epithelium and Bruch's membrane.

Q: Which of the following statements is false regarding Eale's disease?

Optic neuritis. ***Correct Answer: Optic neuritis*** - This statement is **false** because **Eale's disease** is a **peripheral retinal vasculitis** (periphlebitis) that primarily affects the **peripheral retinal veins**. - The condition does **NOT involve the optic nerve**, and **optic neuritis is NOT a recognized feature or complication** of Eale's disease. - The disease process is confined to the retinal vasculature and does not extend anteriorly to involve the optic disc or nerve in typical cases. *AKT is given* - While the exact etiology of Eale's disease remains uncertain, there is a **historical and clinical association with tuberculosis**, particularly in TB-endemic regions like India. - In clinical practice, **anti-tubercular therapy (ATT/AKT) is often empirically administered** when TB cannot be ruled out or when there is suspicion of systemic TB. - Some studies suggest ATT may help reduce inflammation and prevent recurrence in selected cases. *Vitreous Hemorrhage* - This is a **hallmark complication** of Eale's disease, particularly in stage 3 (proliferative stage). - **Recurrent vitreous hemorrhage** occurs due to rupture of fragile neovascular vessels that form in response to retinal ischemia. - It is one of the most common presentations requiring intervention. *Retinal detachment may occur* - **Tractional retinal detachment** is a recognized complication resulting from contraction of **fibrovascular proliferative membranes**. - **Rhegmatogenous retinal detachment** can also occur if vitreoretinal traction causes retinal breaks. - Both types may require surgical intervention (vitrectomy).

Q: Sudden loss of vision without pain - Which of the following is NOT a cause?

Acute congestive glaucoma. ***Acute congestive glaucoma*** - This condition is characterized by **sudden, severe eye pain** along with blurred vision, redness, and a fixed, mid-dilated pupil. - The pain arises from abrupt elevation of **intraocular pressure**, which differentiates it from painless vision loss. *CRAO* - **Central Retinal Artery Occlusion** (CRAO) typically presents as **sudden, profound, painless monocular vision loss**. - Funduscopic examination often reveals a **cherry-red spot** in the fovea with generalized retinal whitening. *CSR* - **Central Serous Retinopathy** (CSR) causes **sudden, painless blurred vision** or a scotoma, often described as a "watery" or "shimmering" effect. - It involves leakage of fluid under the retina, typically in the macula. *Vitreous Hemorrhage* - Presents as **sudden, painless loss of vision** or a shower of floaters, often described as cobwebs or clouds. - It results from bleeding into the **vitreous cavity**, which can obscure the retina.

Q: All of the following are true for retinopathy of prematurity except which of the following?

End result is bilateral blindness. ***End result is bilateral blindness*** - While retinopathy of prematurity (ROP) can lead to severe vision loss or blindness, it is not always a bilateral end result, especially with early diagnosis and treatment. The severity can vary between eyes, and some cases resolve spontaneously. - Modern screening and intervention strategies, such as laser photocoagulation or anti-VEGF injections, are often successful in preventing complete blindness in one or both eyes. *Due to hypoxia there occurs neovascularization followed by fibroproliferation* - This statement accurately describes the pathogenesis of ROP. The initial phase involves delayed normal retinal vascularization, followed by a proliferative phase characterized by **neovascularization** in response to hypoxia in the avascular retina. - These new, abnormal vessels are fragile and prone to bleeding, and their associated **fibrovascular proliferation** can lead to retinal detachment. *Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation* - This is a true statement. **Early diagnosis** through ophthalmologic screening of premature infants is crucial, and treatments like **laser photocoagulation** or **cryotherapy** are effective in ablating the avascular peripheral retina to halt the progression of abnormal vessel growth. - These interventions reduce the hypoxic drive that fuels neovascularization, thereby preventing severe retinal detachment and subsequent blindness. *Occurs in premature infants due to abnormal retinal blood vessel development.* - This statement is correct. ROP is a disease primarily affecting **premature infants** because their retinal blood vessels have not completed development by the time of birth. - Postnatal factors, including oxygen fluctuations and low birth weight, further disrupt this critical development, leading to **abnormal vascularization**.

Question 1

What is the typical appearance of a subhyaloid hemorrhage in the eye?

Accepted Answer

Boat shaped

Answer

Crescent shaped

Answer

Round

Answer

Flame shaped

Question 2

What is the primary predisposing factor for retinopathy of prematurity?

Accepted Answer

Low gestational age

Answer

Oxygen toxicity

Answer

Carbohydrate excess

Answer

Low birth weight

Question 3

A 44-year-old woman presents with sudden painless loss of vision with a history of previous similar episodes. Fundoscopy shows no glow. What could be the possible diagnosis?

Accepted Answer

Vitreous Hemorrhage

Answer

Rhegmatogenous Retinal Detachment

Answer

Acute Angle-Closure Glaucoma

Answer

Fungal Keratitis

Question 4

What is the cause of glaucoma in retinoblastoma?

Accepted Answer

Neovascularisation

Answer

Mass effect of the tumour

Answer

Blockage of trabecular network

Answer

Lysis of the lens

Question 5

Purtscher's retinopathy is associated with -

Accepted Answer

Head trauma

Answer

Diabetes Mellitus

Answer

Wilson's disease

Answer

Rheumatoid arthritis

Question 6

Most common age related change in vitreous?

Accepted Answer

Posterior vitreous detachment (PVD)

Answer

Anterior vitreous detachment

Answer

Vitreous hemorrhage

Answer

Vitritis

Question 7

All of the following are true for sympathetic ophthalmitis except which of the following?

Accepted Answer

Affects the injured eye

Answer

Mostly results from a penetrating wound

Answer

Autoimmune etiology

Answer

Dalen-Fuchs nodules may be seen

Question 8

Which of the following statements is false regarding Eale's disease?

Accepted Answer

Optic neuritis

Answer

AKT is given

Answer

Vitreous Hemorrhage

Answer

Retinal detachment may occur

Question 9

Sudden loss of vision without pain - Which of the following is NOT a cause?

Accepted Answer

Acute congestive glaucoma

Answer

CRAO

Answer

CSR

Answer

Vitreous Hemorrhage

Question 10

All of the following are true for retinopathy of prematurity except which of the following?

Accepted Answer

End result is bilateral blindness

Answer

Due to hypoxia there occurs neovascularization followed by fibroproliferation

Answer

Occurs in premature infants due to abnormal retinal blood vessel development.

Answer

Blindness can be prevented by early diagnosis and ablation of avascular peripheral retina with cryotherapy or photocoagulation

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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