Diseases of the Retina Practice Questions

Q: Endophthalmitis involves inflammation of all of the following, except:

Sclera. ***Sclera*** - **Endophthalmitis** is an inflammation of the internal structures of the eye, specifically the **vitreous cavity**, **anterior chamber**, and sometimes the retina and uvea. - The **sclera** is the outer protective white layer of the eye and is typically not directly involved in endophthalmitis, although inflammation of surrounding structures could secondarily affect it. *Uvea* - The **uveal tract** (iris, ciliary body, and choroid) is frequently involved in endophthalmitis, as it is a highly vascularized layer within the eye. - Inflammation can spread to or originate from the uvea due to its proximity to the vitreous and its rich blood supply. *Retina* - The **retina**, particularly the inner retinal layers, can be significantly affected in endophthalmitis, especially if the infection or inflammation is severe. - **Retinal vasculitis** and **necrosis** are possible complications, leading to severe vision loss. *Vitreous* - The **vitreous cavity** is the primary site of inflammation in endophthalmitis, often filled with inflammatory cells and debris. - The presence of pus or inflammatory exudates in the vitreous is a hallmark of endophthalmitis.

Q: Which of the following is true about pericentral retinitis pigmentosa?

Central vision loss occurs first. ***Central vision loss occurs first*** - In **pericentral retinitis pigmentosa** (also called **central RP** or **inverse RP**), the primary pathology affects the **central retina and macula** first, unlike classical RP. - This leads to **early impairment of central vision**, including **loss of visual acuity** and **difficulty with reading and color vision**, before peripheral vision is significantly affected. - The **fovea and perifoveal regions** show early **photoreceptor degeneration** and **pigmentary changes**. *Bony spicule in the peripheral retina* - **Bony spicules** (pigment deposits) in the **peripheral retina** are characteristic features of **classical retinitis pigmentosa**, which typically causes **peripheral vision loss** first with **night blindness** as an early symptom. - Pericentral retinitis pigmentosa primarily affects the macula and central retina, and peripheral pigmentary changes occur later in the disease course, not initially. *Bony spicule in the fovea* - While **pigmentary changes** can occur in the **macular region** in pericentral RP, **bony spicules specifically in the fovea** are not a typical early feature. - **Foveal involvement** in pericentral RP is characterized by early **macular atrophy**, **pigment mottling**, and **photoreceptor degeneration**, rather than prominent spicule formation seen in peripheral classical RP. *Progressive choroid degeneration* - **Choroidal atrophy** can occur in advanced stages of various retinal dystrophies, but it is not the primary or initial defining characteristic of **pericentral retinitis pigmentosa**. - The initial pathology in pericentral RP is the degeneration of **photoreceptors and retinal pigment epithelium in the central retina**, not the choroid.

Q: Not a common cause of night blindness is:

Pathological myopia. ***Pathological myopia*** - While high myopia can cause various visual disturbances, it is **not typically a common primary cause of night blindness**. - Significant **refractive error** itself does not directly impair rod function required for night vision to the extent of other conditions. *Cataract* - A **cataract** is a clouding of the eye's natural lens, which can scatter light and reduce the amount of light reaching the retina. - This reduction in light can make it difficult to see in dim conditions, thus causing **night blindness**. *RP* - **Retinitis pigmentosa (RP)** is a group of genetic disorders that result in progressive degeneration of the photoreceptors, particularly the **rod cells**, which are responsible for vision in low light. - The progressive loss of rod function directly leads to significant and often initial symptoms of **night blindness**. *Oguchi disease* - **Oguchi disease** is a rare form of **congenital stationary night blindness** characterized by a dark-adapted retina that appears golden-yellow or grayish upon fundus examination, known as Mizuo-Nakamura phenomenon. - Patients experience severe night blindness from birth due to a dysfunction of the phototransduction cascade in the rod photoreceptors.

Q: What is the immediate management approach for severe vitreous hemorrhage in the eye?

Conservative management (observation). ***Correct: Conservative management (observation)*** - **Conservative management with observation** is the immediate approach for severe vitreous hemorrhage, as most cases resolve spontaneously over 2-3 months - Initial management includes **bed rest with head elevation** to allow blood to settle inferiorly and **bilateral eye patching** to reduce eye movement - This approach allows time for **spontaneous resorption** of blood while monitoring for complications like retinal detachment - **Vitrectomy is reserved for later** if there's no improvement after 2-3 months, or if there are urgent indications like retinal detachment *Incorrect: Vitrectomy* - While vitrectomy is definitive treatment, it is **not immediate management** for uncomplicated vitreous hemorrhage - **Indications for vitrectomy** include: failure to clear after 2-3 months of observation, bilateral hemorrhage in diabetics, suspected retinal detachment, or ghost cell glaucoma - Immediate vitrectomy would expose patients to **unnecessary surgical risks** when most cases resolve spontaneously *Incorrect: Steroids* - **Steroids** reduce inflammation but do not address the blood in the vitreous cavity - They have **no role** in managing vitreous hemorrhage itself, though they may be used for associated inflammatory conditions *Incorrect: Antibiotics* - **Antibiotics** treat bacterial infections and have **no role** in vitreous hemorrhage management, which is a bleeding issue, not an infection - Inappropriate antibiotic use contributes to resistance without providing benefit for this condition

Q: A 3-year-old child presented with leukocoria in the right eye since 2 months. On examination, a total retinal detachment was present in the same eye. Ultrasound B-scan revealed a heterogeneous subretinal mass with calcification associated with retinal detachment. What is the most likely clinical diagnosis?

Retinoblastoma. ***Retinoblastoma*** - The presence of **leukocoria**, a **heterogeneous subretinal mass with calcification**, and **total retinal detachment** in a 3-year-old child is highly characteristic of retinoblastoma. - **Calcification** within an intraocular mass in a child is almost pathognomonic for retinoblastoma. *Coats disease* - Characterized by **retinal telangiectasias** and massive subretinal exudation, leading to retinal detachment, but typically **no intraocular mass or calcification** is seen. - While it can cause leukocoria and retinal detachment, the absence of a distinct mass with calcification makes it less likely than retinoblastoma. *Toxocariasis (can cause mass-like lesions)* - Can cause **granulomatous inflammation** and sometimes a retinal mass (e.g., peripheral granuloma), but **calcification is rare**, and the mass is typically inflammatory. - Often associated with a history of **exposure to dogs or soil**, and presents with signs of inflammation like vitritis or uveitis. *Retinal tuberculoma (inflammatory lesion)* - A rare manifestation of tuberculosis, presenting as a **granulomatous mass**; however, it is typically an **inflammatory lesion without calcification**. - Less common in young children as a primary cause of leukocoria and usually associated with systemic tuberculosis.

Q: In diabetic retinopathy, which layer of the retina is primarily affected?

Inner nuclear layer. ***Inner nuclear layer*** - The inner nuclear layer contains the **retinal capillary network**, which is the primary site of pathology in diabetic retinopathy. - **Microangiopathy** (pericyte loss, basement membrane thickening, endothelial cell damage) occurs in the capillaries located within this layer. - **Microaneurysms**, the earliest ophthalmoscopic sign of diabetic retinopathy, form from damaged capillaries in the inner nuclear layer. - **Diabetic macular edema (DME)** involves fluid accumulation that begins at the level of the capillaries in the inner nuclear and inner plexiform layers, then extends to the outer plexiform layer. *Outer plexiform layer* - This layer is **secondarily affected** by leakage from damaged capillaries in deeper retinal layers (inner nuclear and inner plexiform layers). - **Hard exudates** (lipid and protein deposits) accumulate in the outer plexiform layer as a consequence of capillary leakage, but this is not the primary site of vascular pathology. - The outer plexiform layer itself has minimal vasculature and is not where the initial microvascular changes occur. *Layer of rods and cones* - Photoreceptors are affected only in advanced stages of diabetic retinopathy due to chronic ischemia and secondary damage. - The primary pathology is vascular and occurs in the inner retinal layers where capillaries are located, not in the avascular photoreceptor layer. *Retinal pigment epithelium* - The RPE is not directly affected by the microvascular changes that characterize diabetic retinopathy. - RPE dysfunction is more characteristic of **age-related macular degeneration (AMD)** and other degenerative conditions. - In diabetic retinopathy, the RPE may be affected indirectly in very advanced cases but is not a primary site of pathology.

Q: Pupil in an acute attack of anterior uveitis is

Constricted & sluggish reacting. ***Constricted & sluggish reacting*** - In **acute anterior uveitis**, the pupil is characteristically **constricted (miotic)** due to **ciliary muscle spasm** and **iris sphincter irritation**. - The key feature in the acute phase is that the pupil is **sluggish or poorly reactive to light** due to inflammatory involvement of the iris. - This combination of **miosis + sluggish reaction** is the hallmark of acute anterior uveitis. *Irregular & constricted* - While this describes a constricted pupil, **irregularity** develops **later** in the course of uveitis when **posterior synechiae** form (iris adhesions to the anterior lens capsule). - In the **acute phase**, the pupil is typically **regular** in shape, though constricted and sluggish. - This represents a complication rather than the initial acute presentation. *Large and fixed* - A **large (dilated) and fixed pupil** is the classic finding in **acute angle-closure glaucoma**, where high intraocular pressure causes **mid-dilated fixed pupil** due to iris sphincter ischemia. - This is the **opposite** of the miosis seen in acute anterior uveitis. *Semidilated* - A **semidilated pupil** may be seen in conditions like **Adie's tonic pupil**, **oculomotor nerve palsy**, or **pharmacological mydriasis**. - This is **not** characteristic of acute anterior uveitis, where pupillary constriction predominates.

Q: Which of the following statements about sympathetic ophthalmitis is false?

Pathological features are of non-granulomatous panuveitis. ***Pathological features are of non-granulomatous panuveitis*** - Sympathetic ophthalmia is characterized by a **granulomatous inflammation** of the uveal tract, making a non-granulomatous panuveitis feature incorrect. - The hallmark histological finding is a **diffuse granulomatous infiltrate** with epithelioid cells, lymphocytes, and sometimes multinucleated giant cells within the uvea, specifically sparing the choriocapillaris. *Clinically manifests as granulomatous iridocyclitis* - Sympathetic ophthalmia typically presents as a **granulomatous panuveitis**, affecting the iris, ciliary body, and choroid. - The clinical presentation varies but commonly includes signs of inflammation in both the anterior and posterior segments of the eye, often with **mutton-fat keratic precipitates** and granulomas. *The non-injured eye developing uveitis is called the sympathizing eye.* - In sympathetic ophthalmia, the term "**sympathizing eye**" refers to the uninjured eye which develops inflammation following trauma or surgery to the fellow "exciting" eye. - This condition is thought to be an **autoimmune reaction** triggered by exposure of uveal antigens to the immune system in the injured eye, leading to a delayed hypersensitivity response in both eyes. *It is a bilateral disease* - Sympathetic ophthalmia is inherently a **bilateral condition**, affecting both the eye that suffered the initial trauma or surgery (exciting eye) and the fellow, previously healthy eye (sympathizing eye). - While the inflammation might start in one eye, it eventually involves the other eye because it is an **immune-mediated systemic response** to uveal antigens.

Q: Exudative retinal detachment is seen in which of the following conditions?

Preeclampsia. ***Preeclampsia*** - **Exudative retinal detachment** in preeclampsia occurs due to **choroidal ischemia and infarction**, leading to accumulation of subretinal fluid. - This condition is caused by **vasospasm and endothelial dysfunction**, characteristic of severe preeclampsia, affecting the choroidal vasculature. *Severe myopia* - Severe myopia is a significant risk factor for **rhegmatogenous retinal detachment**, which involves a tear in the retina. - It does not primarily cause exudative detachment, which is characterized by fluid accumulation without a retinal tear. *Retinal degeneration* - Retinal degeneration, such as that seen in **retinitis pigmentosa**, can lead to progressive vision loss and may increase the risk of rhegmatogenous retinal detachment. - However, it is not a direct cause of exudative retinal detachment. *Penetrating injuries to the eye* - Penetrating eye injuries typically lead to **traumatic retinal detachment**, which can be rhegmatogenous or tractional, or a combination. - While inflammation and fluid can be present, the primary mechanism of detachment is not exudative due to systemic vascular dysfunction.

Question 1

Endophthalmitis involves inflammation of all of the following, except:

Accepted Answer

Sclera

Answer

Retina

Answer

Vitreous

Answer

Uvea

Question 2

Which of the following is true about pericentral retinitis pigmentosa?

Accepted Answer

Central vision loss occurs first

Answer

Progressive Choroid degeneration

Answer

Bony spicule in the peripheral retina

Answer

Bony spicule in the fovea

Question 3

Not a common cause of night blindness is:

Accepted Answer

Pathological myopia

Answer

Oguchi disease

Answer

Cataract

Answer

RP

Question 4

What is the immediate management approach for severe vitreous hemorrhage in the eye?

Accepted Answer

Conservative management (observation)

Answer

Steroids

Answer

Antibiotics

Answer

Vitrectomy

Question 5

A 3-year-old child presented with leukocoria in the right eye since 2 months. On examination, a total retinal detachment was present in the same eye. Ultrasound B-scan revealed a heterogeneous subretinal mass with calcification associated with retinal detachment. What is the most likely clinical diagnosis?

Accepted Answer

Retinoblastoma

Answer

Coats disease

Answer

Toxocariasis

Answer

Retinal tuberculoma

Question 6

In diabetic retinopathy, which layer of the retina is primarily affected?

Accepted Answer

Inner nuclear layer

Answer

Layer of rods and cones

Answer

Retinal pigment epithelium

Answer

Outer plexiform layer

Question 7

Pupil in an acute attack of anterior uveitis is

Accepted Answer

Constricted & sluggish reacting

Answer

Irregular & constricted

Answer

Large and fixed

Answer

Semidilated

Question 8

Which of the following statements about sympathetic ophthalmitis is false?

Accepted Answer

Pathological features are of non-granulomatous panuveitis

Answer

Clinically manifests as granulomatous iridocyclitis

Answer

It is a bilateral disease

Answer

The non-injured eye developing uveitis is called the sympathizing eye

Question 9

Exudative retinal detachment is seen in which of the following conditions?

Accepted Answer

Preeclampsia

Answer

Penetrating injuries to the eye

Answer

Severe myopia

Answer

Retinal degeneration

Question 10

What is a reverse hypopyon?

Accepted Answer

Collection of emulsified silicone oil in the anterior chamber

Answer

Collection of pus in the vitreous

Answer

Abscess in the orbit

Answer

Seen in corneal ulcer close to being ruptured

Diseases of the Retina — MCQs

Diseases of the Retina — MCQs

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