Scleritis: Anterior — MCQs
Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?
In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
Postoperative complications of cataract surgery are all except?
A 35 year old lady complains dysphagia, Raynaud's phenomenon, sclerodactyly. Investigations show antinuclear antibody. The likely diagnosis is ?
A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?
Most common type of scleritis is
A patient presents with a nodular swelling near the limbus, which does not blanch with topical vasoconstrictors and recurs after treatment. Based on the image and clinical presentation, what is the most probable diagnosis?
Ciliary staphyloma occurs due to all of the following except:
Massaging of nasolacrimal duct is done in ?
Which of the following conditions is associated with posterior staphyloma?
Scleritis: Anterior Indian Medical PG Practice Questions and MCQs
Question 1: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?
- A. Posner-Schlossman syndrome (Correct Answer)
- B. Foster-Kennedy syndrome
- C. Vogt-Koyanagi-Harada syndrome
- D. Fuchs heterochromic iridocyclitis
Explanation: ***Posner-Schlossman syndrome*** - Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**. - The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma. - Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg). *Foster-Kennedy syndrome* - This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor. - It does not involve anterior uveitis or primary elevated intraocular tension. - This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition. *Vogt-Koyanagi-Harada syndrome* - An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms. - While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis. - IOP may be elevated but not the defining feature with dramatic episodic rises. *Fuchs heterochromic iridocyclitis* - A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia. - May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes. - Inflammation is typically **quiet and chronic** rather than acute and recurrent.
Question 2: In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
- A. Topical steroids (Correct Answer)
- B. Topical beta-blockers
- C. Cycloplegics
- D. Miotics
Explanation: ***Topical steroids*** - **Topical corticosteroids** are the primary treatment for **anterior uveitis** to reduce inflammation, which is the underlying cause of both the uveitis and often the raised IOP. - While IOP is elevated, managing the inflammation with steroids is crucial, as the inflammation itself can lead to secondary **IOP elevation** due to trabecular meshwork dysfunction or synechiae formation. *Topical beta-blockers* - **Topical beta-blockers** are used to lower intraocular pressure, but they do not address the underlying **inflammation** in acute anterior uveitis. - Using them alone without treating the inflammation can lead to progression of the uveitis and further ocular damage. *Cycloplegics* - **Cycloplegics** (e.g., atropine, cyclopentolate) are important adjuncts in acute anterior uveitis to relieve pain from ciliary spasm and prevent posterior synechiae formation by dilating the pupil. - They do not, however, treat the **inflammation** directly or primarily address the elevated intraocular pressure. *Miotics* - **Miotics** (e.g., pilocarpine) **constrict the pupil**, which can worsen symptoms in acute anterior uveitis by increasing ciliary body spasm and potentially increasing the risk of posterior synechiae formation. - They are contraindicated in acute anterior uveitis as they exacerbate pain and inflammation, and do not treat the underlying cause.
Question 3: Postoperative complications of cataract surgery are all except?
- A. Endophthalmitis
- B. Glaucoma
- C. Scleritis (Correct Answer)
- D. After cataract
Explanation: ***Scleritis*** - **Scleritis** is an inflammatory condition of the sclera, which is the white outer layer of the eye, and is generally not a direct postoperative complication of cataract surgery. - While it can occur in patients with systemic inflammatory diseases, it is not causally linked to cataract surgery itself. *Endophthalmitis* - **Endophthalmitis** is a severe infection of the intraocular fluids (vitreous and aqueous humor) and tissues, representing a rare but devastating complication of cataract surgery. - It typically presents with rapidly progressive vision loss, pain, and hypopyon (pus in the anterior chamber) within days to weeks post-surgery. *Glaucoma* - **Glaucoma** can develop or worsen after cataract surgery due to various mechanisms, such as inflammation leading to trabecular meshwork dysfunction, pupillary block, or retained lens material. - Postoperative intraocular pressure (IOP) elevation can result in optic nerve damage if not promptly managed. *After cataract* - **After cataract**, also known as **posterior capsule opacification (PCO)**, is the most common long-term complication of cataract surgery. - It occurs when residual lens epithelial cells proliferate and migrate onto the posterior lens capsule, causing blurring of vision months to years after surgery, and is typically treated with Nd:YAG laser capsulotomy.
Question 4: A 35 year old lady complains dysphagia, Raynaud's phenomenon, sclerodactyly. Investigations show antinuclear antibody. The likely diagnosis is ?
- A. Rheumatoid arthritis
- B. Systemic lupus erythematosus
- C. Systemic sclerosis (Correct Answer)
- D. Mixed connective tissue disorder
Explanation: ***Systemic sclerosis*** - The classic triad of **Raynaud's phenomenon**, **sclerodactyly**, and **維持dysphagia** (due to esophageal dysmotility) is highly characteristic of systemic sclerosis [1]. - The presence of **antinuclear antibodies (ANA)** further supports this diagnosis, as ANA is positive in the majority of systemic sclerosis patients. *Rheumatoid arthritis* - Characterized by **symmetric polyarthritis**, often affecting small joints of the hands and feet, which is not described here. - While ANA can be positive, **rheumatoid factor** and **anti-CCP antibodies** are more specific markers, and the clinical features presented are not typical for RA. *Systemic lupus erythematosus* - This condition presents with a wide range of symptoms, including **arthritis**, malar rash, serositis, and renal involvement, which are not mentioned [2]. - While ANA is a hallmark, the specific combination of **sclerodactyly** and **significant dysphagia due to esophageal dysmotility** is less characteristic of SLE compared to systemic sclerosis [2]. *Mixed connective tissue disorder* - This syndrome features a combination of features from **SLE**, **systemic sclerosis**, and **polymyositis**, with high titers of **anti-U1-RNP antibodies** [1]. - While it can include Raynaud's phenomenon and sclerodactyly, the strong emphasis on prominent dysphagia along with isolated sclerodactyly points more specifically towards systemic sclerosis.
Question 5: A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?
- A. Interstitial lung disease (Correct Answer)
- B. Cardiomyopathy
- C. Renal failure
- D. Peripheral neuropathy
Explanation: ***Interstitial lung disease*** - **Scleritis** in a patient with **rheumatoid arthritis** often indicates a more severe, systemic form of the disease. - **Interstitial lung disease (ILD)** is a common and serious **extra-articular manifestation** of rheumatoid arthritis, associated with higher disease activity and worse prognosis. *Cardiomyopathy* - While cardiac involvement can occur in RA (e.g., pericarditis, myocarditis), **cardiomyopathy** is less directly correlated with scleritis as a linked severe systemic complication. - **Rheumatoid arthritis** can increase the risk of cardiovascular disease due to accelerated atherosclerosis and systemic inflammation, but cardiomyopathy itself is not typically the direct systemic complication associated with scleritis. *Renal failure* - **Renal involvement** in rheumatoid arthritis is uncommon, usually related to complications from treatment (e.g., NSAID-induced nephropathy) or secondary amyloidosis, not directly with scleritis. - Scleritis itself does not directly predispose to **renal failure** as a primary systemic complication of RA. *Peripheral neuropathy* - **Peripheral neuropathy** can be a complication of rheumatoid arthritis, particularly in severe cases or vasculitis. - However, it is not as strongly or directly linked to the presence of **scleritis** as **interstitial lung disease** is, in terms of signifying systemic disease severity.
Question 6: Most common type of scleritis is
- A. Diffuse anterior
- B. Nodular anterior
- C. Anterior (Correct Answer)
- D. Posterior
Explanation: ***Anterior*** - **Anterior scleritis** accounts for approximately **98%** of all scleritis cases, making it the most common type. - It involves inflammation of the sclera anterior to the **equator of the globe**, visible on external examination. - Anterior scleritis is further subdivided into **diffuse, nodular,** and **necrotizing** forms based on clinical presentation and severity. *Diffuse anterior* - **Diffuse anterior scleritis** is the most common subtype of anterior scleritis, characterized by widespread inflammation. - While common among anterior types, it represents a subset rather than the overall most common anatomical category. *Nodular anterior* - **Nodular anterior scleritis** presents with discrete nodules of inflamed scleral tissue. - It is less common than diffuse anterior scleritis but more common than necrotizing forms. *Posterior* - **Posterior scleritis** is rare, accounting for only about **2%** of all scleritis cases. - It involves inflammation posterior to the **equator of the globe** and can be difficult to diagnose due to its hidden location, often presenting with pain, proptosis, and vision loss.
Question 7: A patient presents with a nodular swelling near the limbus, which does not blanch with topical vasoconstrictors and recurs after treatment. Based on the image and clinical presentation, what is the most probable diagnosis?
- A. Scleritis with rheumatoid arthritis (Correct Answer)
- B. Episcleritis with rheumatoid arthritis
- C. Pinguecula
- D. Dry eye
Explanation: ***Scleritis with rheumatoid arthritis*** - The image shows **deep, violaceous conjunctival injection** with surrounding edema and a nodular appearance near the limbus, consistent with **nodular scleritis**. Scleritis is inflammation of the sclera, often characterized by severe pain and association with systemic autoimmune diseases like **rheumatoid arthritis**, which can cause destructive lesions and recurrence. - The characteristic **deep vessel engorgement that does not blanch with phenylephrine** and the history of recurrence further support scleritis. *Episcleritis with rheumatoid arthritis* - Episcleritis presents with a **more superficial, bright red injection** involving the episclera, which generally **blanches with topical phenylephrine** and is less painful than scleritis. - While episcleritis can be associated with rheumatoid arthritis, the clinical features described (nodular swelling, deep injection) are more typical of scleritis. *Pinguecula* - A pinguecula is a **yellowish patch or bump** on the conjunctiva, typically on the nasal side of the eye, that is **not inflamed** unless irritated. - It consists of **degenerated collagen fibers** and elastic tissue, and does not present with the diffuse, deep vascular injection seen in the image. *Dry eye* - Dry eye is characterized by **ocular dryness, irritation, and sometimes a foreign body sensation**, but it typically causes **diffuse conjunctival hyperemia** rather than a localized, nodular, deep inflammation with surrounding edema as shown. - While dry eye can be associated with autoimmune diseases, its appearance is not consistent with the depicted nodular lesion.
Question 8: Ciliary staphyloma occurs due to all of the following except:
- A. Scleritis
- B. Absolute glaucoma
- C. Episcleritis (Correct Answer)
- D. Perforating injury
Explanation: ***Episcleritis*** - **Episcleritis** is a benign, self-limiting inflammation of the episclera, which is a superficial layer of connective tissue, and does not lead to **scleral thinning** or ectasia. - Therefore, it does not cause **ciliary staphyloma**, which is a bulging of the sclera in the ciliary body region. *Scleritis* - **Scleritis** is a severe, chronic inflammatory disease affecting the sclera, often leading to **scleral thinning** and weakening. - This thinning can predispose to the formation of a **ciliary staphyloma**, especially if the inflammation is localized in the ciliary region. *Absolute glaucoma* - **Absolute glaucoma** is a severe form of glaucoma characterized by persistently high **intraocular pressure (IOP)**, leading to total vision loss and often significant **scleral thinning** due to chronic pressure. - The elevated IOP can cause stretching and thinning of the sclera, particularly in weakened areas like the **ciliary body**, resulting in a **ciliary staphyloma**. *Perforating injury* - A **perforating injury** to the globe can directly weaken the **scleral wall**, especially if it occurs near the **ciliary body**. - Subsequent healing with scar tissue, often under intraocular pressure, can lead to ectasia and the formation of a **ciliary staphyloma**.
Question 9: Massaging of nasolacrimal duct is done in ?
- A. Acute dacryocystitis
- B. Congenital dacryocystitis (Correct Answer)
- C. Conjunctivitis
- D. None of the options
Explanation: ***Congenital dacryocystitis*** - **Massaging the nasolacrimal duct** (Crigler massage) is a primary treatment for congenital dacryocystitis to promote the opening of the **valve of Hasner**. - This condition is due to incomplete canalization of the nasolacrimal duct, leading to tearing and discharge in infants. *Acute dacryocystitis* - This is an **acute infection of the lacrimal sac**, and massaging can worsen the condition by spreading the infection. - Treatment typically involves **antibiotics** and, if necessary, incision and drainage of any abscess. *Conjunctivitis* - **Conjunctivitis** is inflammation of the conjunctiva and is not related to obstruction of the nasolacrimal duct. - Massaging the nasolacrimal duct has no therapeutic role in treating conjunctivitis. *None of the options* - This option is incorrect because **congenital dacryocystitis** is a condition where nasolacrimal duct massage is a standard and effective treatment.
Question 10: Which of the following conditions is associated with posterior staphyloma?
- A. Pathological myopia (Correct Answer)
- B. Uveoscleritis
- C. Pseudocornea
- D. Angle closure glaucoma
Explanation: **Explanation:** **Posterior staphyloma** is a localized bulging of the weak, thinned sclera lined by uveal tissue, occurring posterior to the equator of the eye. 1. **Why Pathological Myopia is correct:** Pathological (high) myopia is the most common cause of posterior staphyloma. Progressive elongation of the anteroposterior axis of the eyeball leads to excessive stretching and thinning of the posterior pole. This results in an ectasia (bulging) of the sclera, typically at the macula or around the optic nerve head. It is a hallmark feature used to differentiate pathological myopia from simple myopia. 2. **Why the other options are incorrect:** * **Uveoscleritis:** While inflammation can weaken the sclera, it more commonly leads to **ciliary or anterior staphyloma** due to the weakening of the sclera in the limbal or ciliary body region. * **Pseudocornea:** This is a clinical feature of a **total corneal staphyloma**, where a perforated cornea is replaced by organized iris tissue and fibrous tissue, not a posterior scleral bulge. * **Angle closure glaucoma:** Chronic or absolute glaucoma is associated with **equatorial staphyloma** (where the sclera is perforated by vortex veins) or ciliary staphyloma, but not typically posterior staphyloma. **High-Yield Pearls for NEET-PG:** * **Types of Staphyloma:** * **Anterior (Corneal):** Due to corneal perforation/sloughing. * **Ciliary:** Occurs in the ciliary zone (2–3 mm behind limbus). Common in absolute glaucoma. * **Equatorial:** Occurs at the equator where vortex veins exit. * **Posterior:** Occurs at the posterior pole. * **Diagnosis:** Posterior staphyloma is best visualized using **B-scan ultrasonography** or optical coherence tomography (OCT). * **Complication:** It is a major risk factor for myopic macular degeneration and retinal detachment.
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