Diseases of the Retina — MCQs
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A young man presented with night blindness and tubular vision. On examination, the findings include an intraocular pressure of 18 mm, a normal anterior segment, and fundus examination reveals waxy pallor of the disc, attenuation of arterioles, and bony corpuscles resembling spicules of pigmentation in the midperipheral retina. Perimetry testing shows a ring scotoma with subnormal electroretinography. What is your most likely diagnosis?
A 25-year-old male presents with a history of sudden, painless loss of vision in one eye for the past two weeks, with no history of trauma. On examination, the anterior segment is normal, but there is no fundal glow. Which one of the following is the most likely cause?
Which of the following treatments is not suitable for advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment?
Which of the following is not a feature in diabetic retinopathy on fundus examination?
What type of laser is primarily used in confocal scanning laser ophthalmoscopy?
Endophthalmitis involves inflammation of all of the following, except:
All of the following are true about the incidence of retinoblastoma except:
Not a common cause of night blindness is:
Which of the following is true about pericentral retinitis pigmentosa?
What is the immediate management approach for severe vitreous hemorrhage in the eye?
Diseases of the Retina Indian Medical PG Practice Questions and MCQs
Question 591: A young man presented with night blindness and tubular vision. On examination, the findings include an intraocular pressure of 18 mm, a normal anterior segment, and fundus examination reveals waxy pallor of the disc, attenuation of arterioles, and bony corpuscles resembling spicules of pigmentation in the midperipheral retina. Perimetry testing shows a ring scotoma with subnormal electroretinography. What is your most likely diagnosis?
- A. Pigmented retinal dystrophy (Correct Answer)
- B. Primary angle-closure glaucoma
- C. Retinal lattice degeneration
- D. Retinal paving stone degeneration
Explanation: ***Pigmented retinal dystrophy*** - **Night blindness**, **tubular vision** (due to **ring scotoma**), **waxy pallor of the optic disc**, **arteriolar attenuation**, and **bony spicule** retinal pigmentation are classic signs of **retinitis pigmentosa**, a form of pigmented retinal dystrophy. - **Subnormal electroretinography (ERG)** confirms widespread retinal dysfunction, particularly in photoreceptors. *Primary angle-closure glaucoma* - Characterized by **elevated intraocular pressure** (IOP) and optic nerve damage, often presenting with acute pain, redness, and blurred vision. - The presented IOP of 18 mmHg is normal, and the fundus findings do not correspond to typical glaucomatous changes. *Retinal lattice degeneration* - Involves **thinning of the peripheral retina** with a characteristic lattice-like appearance, which predisposes to retinal tears and detachment. - It does not present with **night blindness**, **pigmentary changes**, or **tubular vision**. *Retinal paving stone degeneration* - Consists of small, round, **hyperpigmented or depigmented lesions** in the far peripheral retina, typically benign and asymptomatic. - It is not associated with **night blindness**, **visual field constriction**, or the severe fundus changes described.
Question 592: A 25-year-old male presents with a history of sudden, painless loss of vision in one eye for the past two weeks, with no history of trauma. On examination, the anterior segment is normal, but there is no fundal glow. Which one of the following is the most likely cause?
- A. Vitreous haemorrhage (Correct Answer)
- B. Optic atrophy
- C. Acute attack of angle closure glaucoma
- D. Developmental cataract
Explanation: ***Vitreous haemorrhage*** - Sudden, **painless loss of vision** and absence of **fundal glow** are classic signs of vitreous haemorrhage, as blood obscures the light path to the retina. - This condition can occur spontaneously due to vitreous detachment, proliferative diabetic retinopathy, or retinal tears, leading to **blood accumulation** in the **vitreous cavity**. *Optic atrophy* - **Optic atrophy** involves pallor of the optic disc due to nerve fiber loss, leading to gradual, often chronic, vision loss, which does **not typically present as sudden blindness**. - The fundal glow is usually preserved, though vision is impaired, unlike in vitreous haemorrhage where light is blocked. *Developmental cataract* - A **developmental cataract** would cause gradual blurring of vision or present as reduced acuity from birth or childhood, not sudden vision loss in an adult. - While it can obstruct the fundal glow in severe cases, the onset and presentation (sudden, painless) do not align with cataract. *Acute attack of angle closure glaucoma* - An **acute attack of angle-closure glaucoma** presents with sudden, severe eye pain, headache, fixed mid-dilated pupil, and often **halos around lights**, which are not reported here. - While vision loss is rapid, the overwhelming symptoms are pain and red eye, and the fundal glow is typically present, though the view may be hazy due to **corneal edema**.
Question 593: Which of the following treatments is not suitable for advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment?
- A. Removal of epiretinal membrane
- B. Photocoagulation (Correct Answer)
- C. Vitrectomy
- D. Reattachment of detached or torn retina
Explanation: ***Photocoagulation*** - The question asks for a treatment **not suitable** for **advanced proliferative diabetic retinopathy** with **extensive vitreoretinal fibrosis** and **tractional retinal detachment (TRD)**. - **Panretinal photocoagulation (PRP)** is a laser treatment used to ablate ischemic peripheral retina and prevent neovascularization in proliferative diabetic retinopathy. However, it is a **preventive measure** used in **earlier stages of PDR** before the development of extensive fibrosis and tractional detachment. - Once **tractional retinal detachment** has developed with **extensive vitreoretinal fibrosis**, photocoagulation alone **cannot relieve the mechanical traction** on the retina or **reattach the detached retina**. At this advanced stage, **surgical intervention is required**. - While endolaser photocoagulation can be performed **during vitrectomy** as an adjunctive measure, standalone photocoagulation is not suitable as a primary treatment for established TRD with extensive fibrosis. *Vitrectomy* - **Pars plana vitrectomy** is the **definitive surgical treatment** for advanced PDR with tractional retinal detachment and extensive vitreoretinal fibrosis. - The procedure involves removal of the vitreous gel, fibrovascular membranes, and blood, which relieves traction on the retina and allows for retinal reattachment. - This is the **gold standard treatment** for this condition. *Removal of epiretinal membrane* - **Membrane peeling** (removal of epiretinal and fibrovascular membranes) is an **essential component** of vitrectomy for tractional retinal detachment. - Removing these membranes relieves the mechanical traction causing the retinal detachment, making this a **suitable and necessary** treatment step. - This is performed as part of the comprehensive vitrectomy procedure. *Reattachment of detached or torn retina* - **Retinal reattachment** is the primary **therapeutic goal** for tractional retinal detachment in advanced PDR. - This is achieved through vitrectomy with membrane peeling, often combined with endolaser, fluid-gas exchange, or silicone oil tamponade. - This is clearly a **suitable treatment objective** for this condition.
Question 594: Which of the following is not a feature in diabetic retinopathy on fundus examination?
- A. Microaneurysms
- B. Retinal hemorrhages
- C. Arteriolar dilatation (Correct Answer)
- D. Neovascularisation
Explanation: ***Arteriolar dilatation*** - **Arteriolar dilatation** is NOT a feature of diabetic retinopathy; instead, **arteriolar narrowing** or normal caliber arterioles are typically observed. - The vascular changes in diabetic retinopathy predominantly affect the **venous system** (venular dilatation, venous beading, venous loops) and **capillaries** (microaneurysm formation). - Diabetic retinopathy is characterized by **microvascular damage, increased permeability, and ischemia**, not primary arteriolar dilatation. *Microaneurysms* - **Microaneurysms** are the **earliest clinically detectable sign** of diabetic retinopathy, appearing as small red dots on fundus examination. - They result from **pericyte loss** and weakening of capillary walls, leading to localized outpouchings that may leak fluid and lipid exudates. *Retinal hemorrhages* - **Retinal hemorrhages** are common in diabetic retinopathy, including **dot-and-blot hemorrhages** (deep retinal layers) and **flame-shaped hemorrhages** (superficial nerve fiber layer). - They occur due to **rupture of weakened microaneurysms** and breakdown of the blood-retinal barrier from chronic hyperglycemia-induced endothelial damage. *Neovascularisation* - **Neovascularization** is the hallmark of **proliferative diabetic retinopathy** (PDR), involving growth of abnormal new vessels on the retina (NVE) or optic disc (NVD). - These fragile vessels lack normal structural support and are prone to **vitreous hemorrhage** and **tractional retinal detachment**, the major vision-threatening complications of PDR.
Question 595: What type of laser is primarily used in confocal scanning laser ophthalmoscopy?
- A. Infrared laser (Correct Answer)
- B. Diode laser
- C. YAG laser
- D. Excimer laser
Explanation: ***Infrared laser*** - **Confocal scanning laser ophthalmoscopy (CSLO)** primarily uses **near-infrared diode lasers** with wavelengths typically between **670-830 nm**. - Infrared wavelengths provide **optimal tissue penetration** with minimal light scatter, allowing high-resolution, three-dimensional imaging of the retina and optic nerve head. - The **Heidelberg Retina Tomograph (HRT)**, a widely used CSLO device, operates at **670 nm** (near-infrared range), making infrared laser the standard for this imaging modality. - The infrared spectrum is particularly useful for imaging through **media opacities** and provides excellent **contrast** for structural analysis. *Diode laser* - While CSLO does use **diode laser technology**, the distinguishing characteristic is the **wavelength** (infrared spectrum), not just the laser type. - Diode lasers can emit light across various wavelengths; the specific use of **infrared wavelengths** is what makes them suitable for CSLO. - In ophthalmology literature, CSLO is characterized by its use of **infrared** light rather than just being described as "diode laser" imaging. *Excimer laser* - **Excimer lasers** emit ultraviolet (UV) light and are used in **refractive surgery** such as **LASIK** for precise corneal ablation. - The high-energy UV spectrum is **not suitable for diagnostic imaging** such as CSLO, as it would cause tissue damage rather than provide safe, non-invasive imaging. *YAG laser* - **Nd:YAG lasers** (neodymium-doped yttrium aluminum garnet) are used for **photodisruptive procedures** such as **posterior capsulotomy** and **peripheral iridotomy**. - They produce **high-energy, short-duration pulses** at 1064 nm to create tissue disruption, not the continuous low-power scanning required for CSLO imaging.
Question 596: Endophthalmitis involves inflammation of all of the following, except:
- A. Retina
- B. Vitreous
- C. Uvea
- D. Sclera (Correct Answer)
Explanation: ***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.
Question 597: All of the following are true about the incidence of retinoblastoma except:
- A. Is the most common intraocular tumour of childhood
- B. No sex predisposition
- C. More common in African children than Caucasian children (Correct Answer)
- D. Occurs in 1 in 14000-34000 live births
Explanation: ***More common in African children than Caucasian children*** - This statement is **false**, as retinoblastoma incidence shows **no significant racial predilection**. The reported incidence rates are globally consistent across different ethnic groups. - While healthcare access and outcomes may vary, the inherent genetic predisposition and occurrence rate are similar worldwide, independent of race. *Is the most common intraocular tumour of childhood* - This is a **true** statement; retinoblastoma is indeed the most frequently diagnosed primary **intraocular malignancy** in children. - It accounts for a significant proportion of childhood eye cancers, often presenting before the age of five. *No sex predisposition* - This is a **true** statement; studies consistently show that the incidence of retinoblastoma is **equal between male and female children**. - There is no statistically significant difference in the occurrence of this cancer based on sex. *Occurs in 1 in 14000-34000 live births* - This is a **true** statement; the worldwide incidence of retinoblastoma is estimated to be approximately **1 in 14,000 to 1 in 34,000 live births**. - This relatively low but consistent incidence makes it a rare but significant childhood cancer.
Question 598: Not a common cause of night blindness is:
- A. Oguchi disease
- B. Pathological myopia (Correct Answer)
- C. Cataract
- D. RP
Explanation: ***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.
Question 599: Which of the following is true about pericentral retinitis pigmentosa?
- A. Progressive Choroid degeneration
- B. Central vision loss occurs first (Correct Answer)
- C. Bony spicule in the peripheral retina
- D. Bony spicule in the fovea
Explanation: ***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.
Question 600: What is the immediate management approach for severe vitreous hemorrhage in the eye?
- A. Steroids
- B. Antibiotics
- C. Conservative management (observation) (Correct Answer)
- D. Vitrectomy
Explanation: ***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
Practice by Chapter
Retinal Anatomy and Physiology
Practice Questions
Age-Related Macular Degeneration
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Diabetic Retinopathy
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Retinal Vascular Diseases
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Retinal Detachment
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Hereditary Retinal Dystrophies
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Inflammatory Retinal Diseases
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Retinal Tumors
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Retinopathy of Prematurity
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Retinal Imaging Techniques
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Intravitreal Pharmacotherapy
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Vitreoretinal Surgery
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