Glaucoma Practice Questions

Q: Which of the following predisposes to glaucoma, except?

Increased length of eyeball. **Explanation:** The question asks for the condition that does **not** predispose to glaucoma. To solve this, one must understand the anatomical risk factors for Angle-Closure Glaucoma (ACG). **1. Why "Increased length of eyeball" is the correct answer:** An increased axial length of the eyeball is the hallmark of **Myopia**. Myopic eyes are generally larger, with deeper anterior chambers and wider iridocorneal angles. Therefore, they are anatomically protected against angle-closure glaucoma. While myopes are at a higher risk for *Open-Angle Glaucoma*, the anatomical configuration of a long eye does not "predispose" to the mechanical obstruction of the angle. **2. Analysis of Incorrect Options:** * **Flat Cornea (Cornea Plana):** A flatter cornea is often associated with a shallower anterior chamber, which crowds the angle and increases the risk of Primary Angle-Closure Glaucoma (PACG). * **Angular Recession:** This refers to a tear between the longitudinal and circular muscles of the ciliary body, usually due to blunt trauma. It is a classic cause of **Secondary Open-Angle Glaucoma** because the scarring and damage to the trabecular meshwork reduce aqueous outflow. * **Large size of ciliary body:** A large or anteriorly positioned ciliary body can push the peripheral iris forward (Plateau Iris Syndrome), leading to mechanical closure of the angle. **Clinical Pearls for NEET-PG:** * **Hypermetropia (Short axial length):** This is a major risk factor for PACG due to a shallow anterior chamber and a relatively large lens. * **Lens changes:** An increase in lens thickness (intumescent cataract) or anterior displacement of the lens predisposes to pupillary block. * **Demographics:** PACG is more common in females (3:1 ratio), elderly patients, and individuals of South East Asian descent.

Q: Which of the following is a cause of secondary angle closure glaucoma?

Pseudophakia. **Explanation:** **Secondary Angle Closure Glaucoma (SACG)** occurs when the drainage angle is physically obstructed by the iris due to an underlying ocular or systemic condition. **Why Pseudophakia is correct:** In a pseudophakic eye (an eye with an artificial intraocular lens), secondary angle closure can occur via two primary mechanisms: 1. **Pupillary Block:** Adhesions (synechiae) form between the iris and the IOL or the posterior capsule, blocking aqueous flow and causing the iris to bulge forward (iris bombe). 2. **Non-pupillary Block:** Large or malpositioned IOLs can directly push the peripheral iris into the angle. **Analysis of Incorrect Options:** * **B. Corticosteroid-induced:** This is a form of **Secondary Open Angle Glaucoma**. Steroids cause increased resistance to aqueous outflow by inducing structural changes in the trabecular meshwork (increased deposition of glycosaminoglycans). * **C. Angle Recession Glaucoma:** This is a **Secondary Open Angle Glaucoma** caused by blunt trauma. The trauma tears the ciliary body muscles, leading to scarring of the trabecular meshwork over time. * **D. Congenital Glaucoma:** This is a developmental glaucoma caused by **trabeculodysgenesis** (malformation of the angle structures), not a secondary closure of a previously normal angle. **High-Yield Clinical Pearls for NEET-PG:** * **Topiramate** use is a classic "drug-induced" cause of secondary angle closure (due to ciliary body edema). * **Neovascular Glaucoma (NVG)** is a common SACG where a fibrovascular membrane pulls the angle shut (Synechial closure). * **Phacomorphic Glaucoma** is secondary angle closure caused by an intumescent (swollen) cataractous lens. * Distinguishing feature: In SACG, the mechanism is either "pushing" the iris from behind or "pulling" the iris into the angle.

Q: Chronic simple glaucoma is a type of_____ glaucoma?

Primary open angle. **Explanation:** **Chronic Simple Glaucoma** is the synonymous clinical term for **Primary Open Angle Glaucoma (POAG)**. It is a chronic, progressive optic neuropathy characterized by a triad of: 1. **Open anterior chamber angles** (on gonioscopy). 2. **Characteristic optic disc changes** (cupping). 3. **Corresponding visual field defects** (e.g., arcuate scotoma). The condition is "Primary" because it occurs without an identifiable systemic or ocular cause, and "Open Angle" because the trabecular meshwork is visible, though its microscopic resistance to aqueous outflow is increased, leading to elevated Intraocular Pressure (IOP). **Analysis of Incorrect Options:** * **Option A (Primary Closed Angle):** This involves physical apposition between the iris and the cornea, blocking the drainage angle. It is usually acute or subacute and presents with a shallow anterior chamber. * **Options C & D (Secondary Glaucomas):** These occur due to identifiable pre-existing ocular conditions (e.g., pseudoexfoliation, pigment dispersion, uveitis, or trauma). Chronic simple glaucoma, by definition, lacks these secondary triggers. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Age (>40 years), Family history, Myopia, Diabetes Mellitus, and African race. * **Early Sign:** The earliest visual field defect is often a **Paracentral scotoma** or **Siedel’s sign**. * **Treatment:** Prostaglandin analogues (e.g., Latanoprost) are the first-line medical management. * **Gold Standard Diagnosis:** Goldmann Applanation Tonometry (for IOP) and Humphrey Visual Field analysis.

Q: Trabecular (conventional) outflow of aqueous humor accounts for what percentage?

90 percent. **Explanation:** The drainage of aqueous humor from the anterior chamber occurs via two primary pathways. The **Trabecular (Conventional) pathway** is the predominant route, accounting for approximately **90%** of total aqueous outflow. In this pathway, fluid flows through the trabecular meshwork, into the Canal of Schlemm, and eventually enters the episcleral veins. This route is pressure-dependent, meaning the rate of drainage increases as intraocular pressure (IOP) rises. **Analysis of Options:** * **Option A (90%):** Correct. Standard physiological data indicates that the vast majority of aqueous exits via the trabecular route. * **Options B, C, and D:** These are incorrect because they underestimate the contribution of the conventional pathway. The remaining **10%** of aqueous drainage occurs via the **Uveoscleral (Unconventional) pathway**, where fluid passes through the ciliary muscle into the suprachoroidal space. **High-Yield Clinical Pearls for NEET-PG:** 1. **Uveoscleral Pathway:** While it only accounts for 10% of drainage, it is the primary target for **Prostaglandin analogues** (e.g., Latanoprost), which increase outflow through this route. 2. **Resistance Site:** The maximum resistance to aqueous outflow in a normal eye is located at the **juxtacanalicular trabecular meshwork** (the portion closest to the Canal of Schlemm). 3. **Steroid-Induced Glaucoma:** Corticosteroids reduce the permeability of the trabecular meshwork, leading to decreased conventional outflow and increased IOP. 4. **Blood in Schlemm’s Canal:** Can be seen during gonioscopy if episcleral venous pressure exceeds IOP (e.g., in Sturge-Weber Syndrome).

Q: Which of the following is NOT a cause of hypotony maculopathy?

Suprachoroidal hemorrhage. **Explanation:** **Hypotony maculopathy** occurs when intraocular pressure (IOP) drops significantly (usually <6 mmHg), leading to structural collapse of the globe. This results in chorioretinal folds, vascular engorgement, and edema in the macular region, which can cause permanent vision loss. **Why Suprachoroidal Hemorrhage is the Correct Answer:** Suprachoroidal hemorrhage (SCH) involves the accumulation of blood in the suprachoroidal space. This is a **space-occupying lesion** that causes a sudden **increase** in intraocular pressure (acute glaucoma) and a shallowing of the anterior chamber. Because it is associated with high IOP (hypertony) rather than low IOP, it cannot cause hypotony maculopathy. **Analysis of Incorrect Options:** * **Perforating corneal ulcer:** Any full-thickness breach in the globe (trauma or ulcer) leads to the leakage of aqueous humor, causing profound hypotony. * **Overfiltering bleb:** A common complication of trabeculectomy where excessive drainage of aqueous into the subconjunctival space lowers IOP below physiological limits. * **Cyclodialysis:** This involves the separation of the ciliary body from the scleral spur, creating an abnormal drainage pathway for aqueous into the suprachoroidal space, leading to chronic hypotony. **NEET-PG High-Yield Pearls:** * **Definition of Hypotony:** IOP < 6 mmHg. * **Classic Sign:** "Stellate" or radial chorioretinal folds centered at the fovea. * **Common Causes:** Post-surgical leak (most common), cyclodialysis cleft, ciliary body detachment, and pharmacological inhibition of aqueous (e.g., Cidofovir). * **Management:** The primary goal is to identify and fix the source of the leak or over-filtration to restore normal IOP.

Q: Secondary glaucoma in the early stage of herpes zoster ophthalmicus occurs due to:

Trabeculitis. **Explanation:** The correct answer is **A. Trabeculitis.** In the **early stage** of Herpes Zoster Ophthalmicus (HZO), secondary glaucoma is primarily caused by an inflammatory process involving the trabecular meshwork, known as **trabeculitis**. The Varicella-Zoster Virus (VZV) causes direct viral infiltration and inflammation of the trabecular cells, leading to edema and reduced outflow facility of the aqueous humor. This results in a sudden, often significant, rise in intraocular pressure (IOP). **Analysis of Options:** * **B. Iridocyclitis:** While HZO frequently causes iridocyclitis (uveitis), the glaucoma associated with it is specifically due to the inflammation of the drainage channels (trabeculitis) rather than the inflammation of the iris/ciliary body itself. In late stages, uveitis can cause glaucoma via synechiae, but trabeculitis is the hallmark of the early phase. * **C. Hemorrhagic hypopyon:** This is a rare finding and not a standard mechanism for glaucoma in HZO. * **D. Hypersecretion of aqueous humor:** Glaucoma is almost always a result of decreased outflow, not increased production (hypersecretion) of aqueous humor. **High-Yield Clinical Pearls for NEET-PG:** * **Hutchinson’s Sign:** Vesicles on the tip or side of the nose (involving the nasociliary nerve) indicate a high risk of ocular involvement in HZO. * **Sectoral Iris Atrophy:** A classic late-stage complication of HZO-related uveitis due to ischemic vasculitis. * **Treatment:** Management involves topical steroids to control inflammation and aqueous suppressants (like Beta-blockers or Carbonic anhydrase inhibitors) to lower IOP. **Prostaglandin analogues** are generally avoided in active viral uveitis as they may exacerbate inflammation.

Q: Very high intraocular pressure, vertically oval mid-dilated pupil, and shallow anterior chamber are seen in which condition?

Acute primary angle closure glaucoma. ### Explanation **Correct Answer: B. Acute primary angle closure glaucoma (APACG)** The clinical triad described—**very high intraocular pressure (IOP)**, a **vertically oval mid-dilated pupil**, and a **shallow anterior chamber**—is the classic presentation of an acute attack of angle-closure glaucoma. * **Pathophysiology:** A sudden total blockage of the drainage angle leads to a rapid rise in IOP (often 40–70 mmHg). This high pressure causes **ischemia of the iris sphincter muscle**, resulting in a pupil that is non-reactive and fixed in a mid-dilated, vertically oval position. The shallow anterior chamber is the predisposing anatomical factor. **Why other options are incorrect:** * **A. Primary Open Angle Glaucoma (POAG):** This is a "silent" chronic condition. The IOP rises gradually, the anterior chamber depth is normal, and the pupil remains normal. * **C. Malignant Glaucoma (Ciliary Block):** While it presents with a shallow chamber and high IOP, it typically occurs **post-operatively** (e.g., after glaucoma surgery). The hallmark is the flattening of both the central and peripheral anterior chamber. * **D. Pupillary Block Glaucoma:** This is the *mechanism* behind most cases of angle closure, but "Acute Primary Angle Closure Glaucoma" is the specific clinical diagnosis that encompasses the full constellation of symptoms (pain, vomiting, and pupillary changes). **High-Yield Clinical Pearls for NEET-PG:** * **Symptoms:** Sudden ocular pain, headache, nausea, vomiting, and seeing **colored halos** around lights (due to corneal edema). * **Cornea:** Appears "steamy" or "cloudy" (ground-glass appearance). * **Immediate Management:** IV Mannitol, Acetazolamide, and topical Beta-blockers to lower IOP. * **Definitive Treatment:** **Laser Peripheral Iridotomy (LPI)** is the treatment of choice for both the affected eye and the fellow (prophylactic) eye.

Q: Primary open-angle glaucoma is associated with all of the following EXCEPT?

Pars planitis. **Explanation:** Primary Open-Angle Glaucoma (POAG) is a chronic, progressive optic neuropathy characterized by an open anterior chamber angle and typical optic disc changes. The question asks for the condition **not** associated with POAG. **Why Pars Planitis is the correct answer:** Pars planitis is a form of intermediate uveitis. While it can lead to increased intraocular pressure, it causes **Secondary Glaucoma** (due to inflammatory debris or steroid use), not Primary Open-Angle Glaucoma. POAG, by definition, occurs in the absence of an underlying ocular or systemic disease that physically obstructs the trabecular meshwork. **Analysis of incorrect options (Risk factors for POAG):** * **Diabetes Mellitus:** There is a strong clinical association between DM and POAG. Proposed mechanisms include microangiopathy of the optic nerve head and metabolic dysfunction of the trabecular meshwork. * **Myopia:** High myopia is a well-established risk factor. Myopic eyes often have structural changes in the lamina cribrosa that make the optic nerve more susceptible to pressure-induced damage. * **Hyperthyroidism:** Thyroid eye disease (Graves' ophthalmopathy) is associated with increased episcleral venous pressure and orbital congestion, which correlates with a higher prevalence of open-angle glaucoma. **High-Yield Clinical Pearls for NEET-PG:** * **Major Risk Factors for POAG:** Age (>40 years), Family history (Heredity), Race (African-Americans), Raised IOP, and Cardiovascular disease (Hypertension). * **Steroid-Induced Glaucoma:** This is a type of secondary open-angle glaucoma that must be differentiated from POAG. * **Genetic Link:** Mutations in the **MYOC** (Myocilin) gene are most commonly associated with POAG. * **Diagnosis:** Requires the triad of raised IOP (usually), characteristic optic disc cupping, and specific visual field defects (e.g., Bjerrum’s scotoma).

Question 1

Which of the following predisposes to glaucoma, except?

Accepted Answer

Increased length of eyeball

Answer

Flat cornea

Answer

Angular recession

Answer

Large size of ciliary body

Question 2

Which of the following is a cause of secondary angle closure glaucoma?

Accepted Answer

Pseudophakia

Answer

Corticosteroid-induced

Answer

Angle recession glaucoma

Answer

Congenital glaucoma

Question 3

Chronic simple glaucoma is a type of_____ glaucoma?

Accepted Answer

Primary open angle

Answer

Primary closed angle

Answer

Secondary open angle

Answer

Secondary closed angle

Question 4

Which statement regarding glaucoma is true?

Accepted Answer

None of the above.

Answer

If recognized early, the optic neuropathy of glaucoma is reversible.

Answer

Topical B-adrenergic antagonists have few if any side effects due to their systemic absorption.

Answer

The initial symptom of optic neuropathy due to glaucoma is loss of central vision.

Question 5

Trabecular (conventional) outflow of aqueous humor accounts for what percentage?

Accepted Answer

90 percent

Answer

80 percent

Answer

70 percent

Answer

60 percent

Question 6

Which of the following is NOT a cause of hypotony maculopathy?

Accepted Answer

Suprachoroidal hemorrhage

Answer

Perforating corneal ulcer

Answer

Overfiltering bleb

Answer

Cyclodialysis

Question 7

Secondary glaucoma in the early stage of herpes zoster ophthalmicus occurs due to:

Accepted Answer

Trabeculitis

Answer

Iridocyclitis

Answer

Hemorrhagic hypopyon

Answer

Hypersecretion of aqueous humor

Question 8

Which tonometer is characterized by a variation in its application surface?

Accepted Answer

Maklakov tonometer

Answer

Mackey-Marg tonometer

Answer

Rebound tonometer

Answer

Dreger's tonometer

Question 9

Very high intraocular pressure, vertically oval mid-dilated pupil, and shallow anterior chamber are seen in which condition?

Accepted Answer

Acute primary angle closure glaucoma

Answer

Primary open angle glaucoma

Answer

Malignant glaucoma

Answer

Pupillary block glaucoma

Question 10

Primary open-angle glaucoma is associated with all of the following EXCEPT?

Accepted Answer

Pars planitis

Answer

Diabetes mellitus

Answer

Myopia

Answer

Hyperthyroidism

Glaucoma — MCQs

Glaucoma — MCQs

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