Glaucoma Practice Questions

Q: Which of the following is incorrect about a 2-yearold child presenting with watering from both eyes?

Nasolacrimal duct malformation. ***Nasolacrimal duct malformation*** - **Nasolacrimal duct malformation is NOT a feature of congenital glaucoma**, making this the incorrect statement. - While **nasolacrimal duct obstruction (NLDO)** can cause watering (epiphora) in infants, it is a separate entity from congenital glaucoma and presents differently. - In NLDO, there is watering **without photophobia, without corneal clouding, and without globe enlargement**. - The watering in **congenital glaucoma** is due to **corneal irritation and photophobia** from elevated intraocular pressure, not from nasolacrimal pathology. - There is no primary association between congenital glaucoma and nasolacrimal duct malformation. *Corneal clouding* - **Corneal clouding** is a classic sign of congenital glaucoma, caused by **corneal edema** secondary to elevated intraocular pressure. - The cloudy appearance results from breaks in **Descemet's membrane** (Haab's striae) and stromal edema. - This is a **correct statement** about congenital glaucoma. *Corneal edema* - **Corneal edema** is a direct consequence of sustained elevated intraocular pressure in congenital glaucoma. - The elevated IOP causes fluid accumulation within the corneal layers, leading to a hazy appearance. - This contributes to the photophobia and tearing seen in these patients. - This is a **correct statement** about congenital glaucoma. *Deep anterior chamber* - A **deep anterior chamber** is a hallmark feature of congenital glaucoma, NOT an incorrect finding. - In infants, elevated IOP causes the pliable eye to stretch, resulting in **buphthalmos** (enlarged globe). - As the cornea bows forward and enlarges (diameter >12mm), the **anterior chamber deepens significantly**. - This is a **correct statement** about congenital glaucoma and would be seen in this 2-year-old child.

Q: Which of the following methods of visual field testing is shown below?

Humphrey analyzer. ***Correct: Humphrey analyzer*** - The image distinctly shows a patient positioned with their head on a **chin rest** and forehead strap, looking into a large, automated machine with a **bowl-shaped perimeter** and an external monitor displaying test results, which is characteristic of a Humphrey Field Analyzer. - This **automated perimetry** device is widely used for quantitative assessment of the visual field, especially for detecting and monitoring **glaucoma** and neurologic conditions. *Incorrect: Bjerrum screen* - The Bjerrum screen is a **manual perimetry** method using a tangent screen, typically made of black felt, where targets are moved manually by the examiner. - This method is older and simpler, primarily used for detecting **central and paracentral scotomas** and would not involve a complex electronic device as pictured. *Incorrect: Goldmann perimeter* - The Goldmann perimeter is a **manual kinetic perimetry** device, characterized by a large white bowl where a light spot is moved by the examiner to map visual field boundaries. - While it uses a bowl, it is operated manually and does not feature the electronic screen and automated components seen in the image. *Incorrect: Lister's perimeter* - The term "Lister's perimeter" is not a standard or commonly recognized method of visual field testing in modern ophthalmology. - There is no widely accepted or used device by this name for perimetry.

Q: Which method of visual field testing is shown below?

Goldmann perimeter. ***Goldmann perimeter*** - The image displays a **radial grid pattern** commonly used in **Goldmann perimetry**, a manual kinetic perimetry technique. - This method involves moving a target of a specific size and intensity from a non-seeing area to a seeing area to map out the **isopters** (lines of equal visual sensitivity). - The **bowl-shaped design with concentric circles** is the hallmark of Goldmann perimeter charts. *Bjerrum screen* - The Bjerrum screen typically uses a **flat, tangential screen** for charting the **central 30 degrees** of the visual field. - While it also identifies scotomas, its representation is a flat map, not the curved, radial grid of bowl perimeters. *Humphrey analyzer* - The Humphrey Field Analyzer is an **automated static perimeter** that presents targets of various intensities at fixed locations. - The output is usually a **grayscale or numeric printout** showing statistical analyses like total deviation and pattern deviation, rather than a direct radial grid. *Ferster perimeter* - The Ferster perimeter is another type of **manual arc perimeter** used for peripheral visual field testing. - While similar in concept to Goldmann, the **characteristic radial and concentric grid pattern** depicted is most specific to Goldmann perimetry charts.

Q: Which field defect is shown in the image below?

Roenne's nasal step. ***Roenne's nasal step*** - The image depicts a visual field defect characterized by a **step-like loss of vision along the horizontal meridian** on the nasal side. This pattern is characteristic of a Roenne's nasal step. - This defect occurs due to **glaucomatous damage to retinal nerve fibers**, specifically those running from the temporal retina that cross the midline to the nasal side, leading to an abrupt change in visual sensitivity. *Bjerrum scotoma* - A Bjerrum scotoma (also known as an arcuate scotoma) is an **arc-shaped blind spot** that typically arises from the blind spot and arcs above or below the macula before ending abruptly at the horizontal midline. - It is a common finding in glaucoma but has a distinct arcuate shape, unlike the step-like defect shown. *Seidel scotoma* - A Seidel scotoma is an **early, localized enlargement of the blind spot**, often taking on a comma or sickle shape. - While it is an early glaucomatous field defect, it does not typically present as a distinct step along the horizontal meridian as shown in the image. *Superior paracentral scotoma* - A paracentral scotoma is a **small, isolated blind spot** located close to the central vision (but not involving it). - A superior paracentral scotoma would be located in the **upper visual field**, but the image shows a defect that extends to the periphery along the nasal meridian with a distinct step, which is not characteristic of an isolated paracentral scotoma.

Q: Which of the given field defects is shown in the image given below?

Bjerrum scotoma. ***Bjerrum scotoma*** - The image shows an **arcuate scotoma** that extends from the blind spot, arching above or below the macula, and typically does not cross the horizontal meridian. This is characteristic of a Bjerrum scotoma. - This type of visual field defect is a classic sign of **early to moderate glaucoma**, resulting from damage to the retinal nerve fiber layer. *Roenne's nasal step* - Roenne's nasal step is a **depression of the nasal visual field** that respects the horizontal meridian, appearing as a sharp step in the visual field plot. - While also associated with glaucoma, it primarily involves the nasal visual field and looks distinctly different from the arcuate defect shown. *Seidel scotoma* - A Seidel scotoma is a **sickle-shaped extension of the blind spot** superiorly or inferiorly. - It is an **early indicator of glaucoma** but is typically smaller and less extensive than a full Bjerrum scotoma. *Superior paracentral scotoma* - A superior paracentral scotoma is a localized area of visual field loss **close to the central fixation point** and in the superior visual field. - While it can be an early sign of glaucoma, the image depicts an **arcuate shape extending from the blind spot**, rather than a small, isolated paracentral defect.

Q: What is the test being performed in the image shown below?

Perkins applanation tonometry. ***Perkins applanation tonometry*** - The image shows a **handheld device** being used by an examiner to measure intraocular pressure (IOP) in a patient who is seated or reclined. - This portable nature and direct application to the cornea with a visible prism are characteristic features of the **Perkins applanation tonometer**, often used for patients who cannot be positioned at a slit lamp. *Goldmann's applanation tonometry* - This method requires the patient to be seated at a **slit lamp microscope**, and the tonometer head is attached to the slit lamp. - The image clearly shows a handheld device, **not integrated with a slit lamp**, making Goldmann's tonometry an incorrect option. *Schiotz tonometry* - Schiotz tonometry is an **indentation tonometer** that rests on the central cornea while the patient is in a supine position. - The device in the image is an applanation tonometer, which determines IOP by **flattening a small area of the cornea**, not indenting it. *Noncontact tonometry* - Noncontact tonometry, also known as the **"air puff" test**, measures IOP without direct contact with the eye. - The image clearly depicts a device with direct contact with the patient's eye, specifically the cornea, making noncontact tonometry an incorrect option.

Q: A 25 -year-old lady with past history of seeing colored haloes was watching a movie in a theater when she started having right eye pain. She started feeling nauseous and had to leave the movie midway due to vomiting. On examination she is found to have ciliary and conjunctival congestion and the pupil is vertically oval. The picture of the eye is given below. All are true about the condition shown except:

Present PL. ***Present PL (Perception of Light)*** - In **acute angle-closure glaucoma (AACG)**, visual acuity is typically severely reduced due to corneal edema and elevated intraocular pressure, but **perception of light (PL) is usually preserved** in acute presentations. - While vision may be reduced to counting fingers or hand movements, **complete loss of light perception is uncommon** unless there is severe, prolonged attack with irreversible optic nerve damage. - All other features listed (loss of iris pattern, steamy cornea, absent pupillary reactions) are **consistently present** in AACG, whereas PL can be variable but is typically **present initially**. - This makes "Present PL" the **correct answer** as it is the statement that is **NOT always/universally true** - though PL is often present, the question implies it as a definitive feature when it's actually variable. *Loss of iris pattern* - This is a **consistent finding** in AACG during an acute attack. - The iris becomes **edematous** due to elevated intraocular pressure (often >40 mmHg), which obscures the normal radial folds and crypts. - The iris appears dull, muddy, and featureless - a key diagnostic sign. *Steamy insensitive cornea* - The markedly elevated intraocular pressure causes **corneal epithelial and stromal edema**. - This produces a **hazy or "steamy" appearance** that interferes with visualization of anterior chamber structures. - Corneal sensation may be reduced due to epithelial edema and ischemia. *Absent reaction to light and accommodation* - The pupil in AACG is characteristically **fixed and mid-dilated (4-6 mm)**, often vertically oval as described. - **Complete absence of pupillary light reflex** (both direct and consensual) occurs due to iris sphincter ischemia. - **No accommodation response** due to the fixed, dilated pupil and compromised iris function.

Q: Name the test being performed in the image shown below:

Schiotz tonometry. ***Schiotz tonometry*** - The image shows a **Schiotz tonometer** being held vertically on the supine patient's eye, which is characteristic of this indentation tonometry method. - This method measures intraocular pressure (IOP) by determining the **depth of corneal indentation** caused by a known weight. *Goldmann's applanation tonometry* - This method uses a **slit lamp** and a prism to flatten a small area of the cornea. - It is considered the **gold standard** for IOP measurement but requires a specialized setup not seen here. *Perkins applanation tonometry* - This is a **portable applanation tonometer** that can be used on supine or sitting patients. - While portable, its mechanism involves flattening the cornea rather than indentation, and it looks different from the instrument in the image. *Noncontact tonometry* - This method uses a **puff of air** to flatten the cornea and does not directly touch the eye. - It is commonly used for screening but is not represented by the hand-held device seen in the image.

Q: Which of the following is responsible for abnormal shape of anterior chamber shown below?

Iris bombe. ***Iris bombe*** - The image shows the anterior chamber is *flattened* centrally and *bowed forward* peripherally, creating a characteristic convex appearance of the iris. - This occurs due to **pupillary block**, where aqueous humor becomes trapped behind the iris causing it to bulge forward. *Myopia* - Myopia (nearsightedness) refers to a refractive error where light focuses *in front* of the retina, often due to an *elongated eyeball*. - It does not directly cause the *anatomical bowing* of the iris seen in the image. *Hypermetropia* - Hypermetropia (farsightedness) is a refractive error where light focuses *behind* the retina, often due to a *shortened eyeball*. - While hypermetropic eyes can be predisposed to angle closure glaucoma, they do not inherently show the specific *iris bombe configuration*. *Intumescent cataract* - An intumescent cataract is a *swollen cataract* that can push the iris forward by *increasing the lens thickness*. - While it can cause pupillary block and angle closure, the primary feature in the image is the *iris bowing from an obstruction at the pupil*, not necessarily lens swelling itself.

Q: These vertical striations in the cornea shown below are seen in: (Recent NEET Pattern 2016-17)

Congenital glaucoma. ***Congenital glaucoma*** - The image exhibits **vertical striations in the cornea**, which are known as **Haab's striae**. These are ruptures in Descemet's membrane due to increased intraocular pressure. - **Haab's striae** are pathognomonic of **congenital glaucoma** and are typically oriented vertically or arcuately. *Keratoconus* - **Keratoconus** is characterized by progressive thinning and steepening of the cornea, leading to a cone-like protrusion. - While it can cause some corneal irregularities, it typically presents with **Vogt's striae** (fine, vertical lines in the deep stroma due to corneal stress), different from the broader Haab's striae of congenital glaucoma. *Aphakia* - **Aphakia** refers to the absence of the crystalline lens in the eye, usually due to surgical removal or trauma. - This condition does not cause vertical striations in the cornea; its primary visual effect is severe hyperopia. *Subluxated lens* - A **subluxated lens** (partially dislocated lens) means the lens is displaced but remains within the pupil. - It can cause visual disturbances like monocular diplopia or astigmatism but does not directly lead to the characteristic vertical corneal striations seen in the image.

Question 1

Which of the following is incorrect about a 2-yearold child presenting with watering from both eyes?

Accepted Answer

Nasolacrimal duct malformation

Answer

Corneal clouding

Answer

Corneal edema

Answer

Deep anterior chamber

Question 2

Which of the following methods of visual field testing is shown below?

Accepted Answer

Humphrey analyzer

Answer

Bjerrum screen

Answer

Goldmann perimeter

Answer

Lister's perimeter

Question 3

Which method of visual field testing is shown below?

Accepted Answer

Goldmann perimeter

Answer

Bjerrum screen

Answer

Humphrey analyzer

Answer

Ferster perimeter

Question 4

Which field defect is shown in the image below?

Accepted Answer

Roenne's nasal step

Answer

Bjerrum scotoma

Answer

Seidel scotoma

Answer

Superior paracentral scotoma

Question 5

Which of the given field defects is shown in the image given below?

Accepted Answer

Bjerrum scotoma

Answer

Roenne's nasal step

Answer

Seidel scotoma

Answer

Superior paracentral scotoma

Question 6

What is the test being performed in the image shown below?

Accepted Answer

Perkins applanation tonometry

Answer

Goldmann's applanation tonometry

Answer

Schiotz tonometry

Answer

Noncontact tonometry

Question 7

A 25 -year-old lady with past history of seeing colored haloes was watching a movie in a theater when she started having right eye pain. She started feeling nauseous and had to leave the movie midway due to vomiting. On examination she is found to have ciliary and conjunctival congestion and the pupil is vertically oval. The picture of the eye is given below. All are true about the condition shown except:

Accepted Answer

Present PL

Answer

Loss of iris pattern

Answer

Steamy insensitive cornea

Answer

Absent reaction to light and accommodation

Question 8

Name the test being performed in the image shown below:

Accepted Answer

Schiotz tonometry

Answer

Goldmann's applanation tonometry

Answer

Perkins applanation tonometry

Answer

Noncontact tonometry

Question 9

Which of the following is responsible for abnormal shape of anterior chamber shown below?

Accepted Answer

Iris bombe

Answer

Myopia

Answer

Hypermetropia

Answer

Intumescent cataract

Question 10

These vertical striations in the cornea shown below are seen in: (Recent NEET Pattern 2016-17)

Accepted Answer

Congenital glaucoma

Answer

Keratoconus

Answer

Aphakia

Answer

Subluxated lens

Glaucoma — MCQs

Glaucoma — MCQs

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