Glaucoma Practice Questions

Q: Identify the instrument shown:

A = Lister perimeter, B = Goldmann perimeter. ***A = Lister perimeter, B = Goldmann perimeter*** - Image A depicts a **Lister perimeter**, a type of **manual kinetic perimeter** used for visual field testing, characterized by its curved arm and a system for target presentation. - Image B shows a **Goldmann perimeter**, which is also a **manual kinetic perimeter** but features a large, bowl-shaped screen for testing, allowing for a broader and more controlled visual field assessment. *A = Goldmann perimeter, B = Lister perimeter* - This option incorrectly identifies image A as a **Goldmann perimeter** and image B as a **Lister perimeter**. - The distinct physical characteristics of each instrument, such as the curved arm of the Lister perimeter versus the bowl of the Goldmann perimeter, differentiate them. *A = Lister perimeter, B = Bjerrum's screen* - While image A is correctly identified as a **Lister perimeter**, image B is incorrectly identified as a **Bjerrum's screen**. - A **Bjerrum's screen** is a simpler, flat tangent screen used for central visual field testing, not the bowl-shaped instrument shown in image B. *A = Goldmann perimeter, B = Bjerrum screen* - This option incorrectly identifies image A as a **Goldmann perimeter** and image B as a **Bjerrum screen**. - The appearances of both the **Goldmann perimeter** and the **Bjerrum screen** do not match the instruments in images A and B, respectively.

Q: A 2-year-old child is brought with complaints of watering of eyes, photophobia and intermittently keeping eyes closed while watching TV. What may be the diagnosis? (AIIMS Nov 2018)

Congenital Glaucoma. ***Congenital Glaucoma*** - The triad of **watering of eyes (epiphora)**, **photophobia**, and **blepharospasm** (keeping eyes closed) is highly characteristic of **congenital glaucoma** in infants and young children. - The image also shows significantly enlarged and hazy corneas (buphthalmos), which are classic signs of increased intraocular pressure and corneal edema in congenital glaucoma. *Retinoblastoma* - While retinoblastoma affects children, its primary presentation is typically **leukocoria** (a white pupillary reflex) or strabismus. - It does not commonly present with watering of eyes, photophobia, or blepharospasm as prominent symptoms. *Congenital endothelial dystrophy* - Congenital endothelial dystrophy primarily causes **corneal edema** and haziness due to abnormal corneal endothelium. - While it can cause some photophobia and tearing, it generally does not present with the severe blepharospasm seen in glaucoma, and the corneal enlargement (buphthalmos) is not a feature. *Megalocornea* - Megalocornea is a condition characterized by an **enlarged cornea** but with normal intraocular pressure and clear corneas. - It is usually asymptomatic or associated with mild ametropia, and does not cause watering of eyes, photophobia, or corneal haziness.

Q: Select the FALSE statement pertaining to the disease depicted in this picture. (AP PG 2016)

Commonly detected because of visual field defects. The image displays an enlarged eye with a hazy cornea, notably seen in an infant, which is indicative of **congenital glaucoma** (also known as buphthalmos). ***Commonly detected because of visual field defects*** - **Visual field defects** are difficult to detect in children and infants due to their inability to cooperate with visual field testing. - Congenital glaucoma typically presents with symptoms like **epiphora**, **photophobia**, and **blepharospasm**, which are more prominent and observable. *Commonly causes haziness of cornea (Haab striae)* - **Corneal edema** is a hallmark sign of congenital glaucoma due to elevated intraocular pressure, leading to the characteristic corneal haziness. - **Haab striae**, or tears in Descemet's membrane, are also commonly seen in congenital glaucoma due to stretching and enlargement of the globe. *Commonly causes photophobia* - **Photophobia**, an abnormal sensitivity to light, is a very frequent and important symptom in children with congenital glaucoma. - Parents often notice the child squinting or trying to avoid light. *Often due to congenital glaucoma* - The image shows a significantly enlarged globe (buphthalmos) and corneal haziness in an infant, which are classic signs of **congenital glaucoma**. - This condition results from developmental abnormalities in the **aqueous humor outflow system** that lead to elevated intraocular pressure.

Q: The normal range of intraocular pressure (in mmHg) is

10-20. ***10-20*** - The **normal range for intraocular pressure (IOP)** is generally accepted to be between **10 and 20 mmHg**. - Maintaining IOP within this range is crucial for optimal eye health, as deviations can indicate conditions like **glaucoma** or **ocular hypotony**. *15-25* - While 15 mmHg falls within the normal range, **25 mmHg is considered elevated** and potentially indicative of **ocular hypertension** or **glaucoma**. - Sustained pressures above 20-21 mmHg raise concern for **optic nerve damage**. *20-30* - Both 20 mmHg and 30 mmHg are generally considered to be at the **upper end or above the normal range** of IOP. - Pressures in this range significantly increase the **risk of developing glaucoma** and require further evaluation. *5-15* - While 5 mmHg is generally considered low, **15 mmHg is within the normal range**. - An IOP of 5 mmHg or lower for an extended period could indicate **ocular hypotony**, which can lead to various visual problems.

Q: A patient presents with eye ache and difficulty in vision after watching a movie. What will be the first line of management?

Mannitol with Pilocarpine. ***Mannitol with Pilocarpine*** - This combination is appropriate for **acute angle-closure glaucoma (AACG)**, which can be triggered by pupillary dilation (e.g., in a dark movie theater). **Mannitol** is an osmotic diuretic that rapidly reduces intraocular pressure. - **Pilocarpine** is a miotic agent that constricts the pupil, pulling the iris away from the trabecular meshwork and opening the drainage angle to facilitate aqueous humor outflow. *Mannitol with Moxifloxacin* - While mannitol helps with intraocular pressure, **Moxifloxacin is an antibiotic** used to treat bacterial infections. - There is no indication of an ocular infection in this scenario, so an antibiotic would not be the first-line treatment for sudden eye pain and vision difficulty after watching a movie. *Mannitol with Atropine* - Adding **Atropine, a cycloplegic agent**, would cause further pupillary dilation, which would worsen acute angle-closure glaucoma and increase intraocular pressure. - Atropine is contraindicated in AACG and would exacerbate the patient's condition. *Mannitol with lubricating eye drops* - While mannitol helps with intraocular pressure, **lubricating eye drops** are used for dry eyes or surface irritation, not for acute angle-closure glaucoma. - Lubricating drops do not address the underlying pathology of increased intraocular pressure due to angle closure.

Q: A one-month-old baby presents with excessive tearing (watering) and an increased corneal size. What is the most likely diagnosis?

Buphthalmos. ***Buphthalmos*** - **Buphthalmos** refers to the enlargement of the eye in infants, typically caused by **congenital glaucoma**, which results in increased intraocular pressure. - The combination of **excessive tearing (epiphora)** and an **increased corneal size** (seen in the image as unusually large corneas for a one-month-old) are classic signs of buphthalmos due to elevated intraocular pressure stretching the infant's pliable sclera and cornea. *Galactosemia* - **Galactosemia** is a metabolic disorder that can cause cataracts and, in severe cases, liver damage and intellectual disability, but it does **not typically cause buphthalmos or enlarged corneas**. - While cataracts can lead to poor vision, they don't explain the excessive tearing or corneal enlargement. *Cataract* - A **cataract** is an opacity in the lens of the eye, which can cause blurry vision and a white pupil reflex (leukocoria), but **does not cause increased corneal size or excessive tearing** as primary symptoms. - While cataracts can occur in infants, they do not present with the specific combination of signs described. *Hurler syndrome* - **Hurler syndrome** is a lysosomal storage disorder (mucopolysaccharidosis type I) that can cause various ocular abnormalities, including **corneal clouding**, but typically **not corneal enlargement or buphthalmos**. - Other features include coarse facial features, skeletal abnormalities, and developmental delay, which are not mentioned in the presentation criteria.

Q: Which triad is seen after an acute attack of angle-closure glaucoma?

Vogt's triad. ***Vogt's triad*** - **Vogt's triad** refers to the classical findings seen after an acute attack of **angle-closure glaucoma**. - The triad consists of: **glaukomflecken** (anterior subcapsular lens opacities from ischemic necrosis of lens epithelium), **iris stromal atrophy** (sectoral iris atrophy in the area of ischemia), and **fixed mid-dilated pupil** (due to iris sphincter damage). - These signs indicate **ischemic damage** to the anterior segment following the acute episode of elevated intraocular pressure. *Gaucher triad* - **Gaucher triad** refers to the characteristic systemic symptoms of **Gaucher disease**, an inherited lipid storage disorder. - It involves **hepatosplenomegaly**, **bone pain**, and **thrombocytopenia**, which are unrelated to glaucoma. *Virchow triad* - The **Virchow triad** describes the three main factors contributing to **thrombus formation**: **stasis** of blood flow, **endothelial injury**, and **hypercoagulability**. - This triad is relevant to cardiovascular pathology, not the effects of angle-closure glaucoma. *Hutchinson's triad* - **Hutchinson's triad** is a set of symptoms associated with **congenital syphilis**. - It includes **interstitial keratitis**, **Hutchinson's teeth**, and **eighth nerve deafness**, which are entirely distinct from ocular hypertension.

Q: What is the earliest change in glaucoma on perimetry?

Isopter contraction + baring of blind spot. ***Isopter contraction + baring of blind spot*** - Early glaucomatous damage often manifests as an **isopter contraction**, meaning the **visual field narrows** for a given stimulus intensity. - **Baring of the blind spot** occurs when the isopter for a small target contracts inwards, leaving the physiological blind spot exposed to targets that would normally be seen. *Complete field loss* - This is indicative of **very advanced glaucoma**, representing extensive damage to the optic nerve. - It would be preceded by numerous earlier, more subtle visual field defects. *Tunnel vision defect* - **Tunnel vision** is a severe form of visual field constriction, characteristic of **advanced glaucoma** where only the central field of vision remains. - It is not the earliest change as it implies significant peripheral field loss has already occurred. *Complete vision loss* - **Complete vision loss** in an eye signifies end-stage disease, far beyond the earliest changes seen in glaucoma. - It means there is no light perception, indicating total destruction of the optic nerve fibers.

Q: Which of the following lens is used in direct gonioscopy?

Koeppe. ***Koeppe*** - The **Koeppe lens** is designed for direct gonioscopy, providing a wide-angle view of the **anterior chamber angle**. - It is typically used with the patient in a **supine position** and requires a coupling solution to be placed directly on the cornea. *Goldmann* - The **Goldmann lens** (3-mirror lens) is used for **indirect gonioscopy** and is characterized by mirrors that reflect the image of the angle. - It is used at a **slit lamp** and provides a magnified view as the light is reflected through the mirrors. *Richardson* - The **Richardson-Shaffer lens** is another direct gonioscopy lens, similar to the Koeppe lens. - However, the question asks for "**the**" lens used in direct gonioscopy, and **Koeppe** is the most commonly recognized and frequently used direct gonioscopy lens. - Richardson-Shaffer is less commonly used in modern practice compared to Koeppe. *Zeiss* - The **Zeiss lens** (4-mirror lens) is used for **indirect gonioscopy** and allows a rapid 360-degree view of the angle. - It is commonly used with a **slit lamp** and requires minimal or no coupling fluid due to its small contact surface.

Q: A 30-year-old female presents with redness and pain in the eye. Examination revealed 38 mm of Hg on IOP, aqueous flare, and corneal precipitates. Which of the following drugs must be avoided for her?

Prostaglandin analogs. ***Prostaglandin analogs*** - **Prostaglandin analogs** are **contraindicated in anterior uveitis** because they can significantly worsen inflammation. - They increase the risk of **cystoid macular edema (CME)** in patients with intraocular inflammation. - Can exacerbate existing **uveitis** and compromise treatment outcomes. - While they effectively lower IOP in non-inflammatory conditions, their pro-inflammatory effects make them unsuitable when aqueous flare and KPs are present. *Carbonic anhydrase inhibitors* - These drugs work by decreasing **aqueous humor production** and are safe and effective for reducing **IOP** in **uveitis**. - They do not exacerbate inflammation and are commonly used in the management of **uveitic glaucoma**. - Available in topical (dorzolamide, brinzolamide) and systemic (acetazolamide) formulations. *Mannitol* - **Mannitol** is an osmotic diuretic used for acute, severe elevations in **IOP**. - It rapidly reduces **IOP** by drawing fluid out of the vitreous and is safe to use in uveitis with elevated pressure. - Its use is typically for short-term, urgent IOP control. *Beta-blockers* - **Beta-blockers** (timolol, betaxolol) reduce **IOP** by decreasing **aqueous humor production**. - They are safe and commonly used to manage **elevated IOP** in uveitic patients. - They do not exacerbate inflammation and are first-line agents for IOP control.

Question 1

Identify the instrument shown:

Accepted Answer

A = Lister perimeter, B = Goldmann perimeter

Answer

A = Goldmann perimeter, B = Lister perimeter

Answer

A = Lister perimeter, B = Bjerrum's screen

Answer

A = Goldmann perimeter, B = Bjerrum screen

Question 2

A 2-year-old child is brought with complaints of watering of eyes, photophobia and intermittently keeping eyes closed while watching TV. What may be the diagnosis? (AIIMS Nov 2018)

Accepted Answer

Congenital Glaucoma

Answer

Retinoblastoma

Answer

Congenital endothelial dystrophy

Answer

Megalocornea

Question 3

Select the FALSE statement pertaining to the disease depicted in this picture. (AP PG 2016)

Accepted Answer

Commonly detected because of visual field defects

Answer

Commonly causes haziness of cornea (Haab striae)

Answer

Commonly causes photophobia

Answer

Often due to congenital glaucoma

Question 4

The normal range of intraocular pressure (in mmHg) is

Accepted Answer

10-20

Answer

15-25

Answer

20-30

Answer

5-15

Question 5

A patient presents with eye ache and difficulty in vision after watching a movie. What will be the first line of management?

Accepted Answer

Mannitol with Pilocarpine

Answer

Mannitol with Moxifloxacin

Answer

Mannitol with Atropine

Answer

Mannitol with lubricating eye drops

Question 6

A one-month-old baby presents with excessive tearing (watering) and an increased corneal size. What is the most likely diagnosis?

Accepted Answer

Buphthalmos

Answer

Galactosemia

Answer

Cataract

Answer

Hurler syndrome

Question 7

Which triad is seen after an acute attack of angle-closure glaucoma?

Accepted Answer

Vogt's triad

Answer

Gaucher triad

Answer

Virchow triad

Answer

Hutchinson's triad

Question 8

What is the earliest change in glaucoma on perimetry?

Accepted Answer

Isopter contraction + baring of blind spot

Answer

Complete field loss

Answer

Tunnel vision defect

Answer

Complete vision loss

Question 9

Which of the following lens is used in direct gonioscopy?

Accepted Answer

Koeppe

Answer

Goldmann

Answer

Richardson

Answer

Zeiss

Question 10

A 30-year-old female presents with redness and pain in the eye. Examination revealed 38 mm of Hg on IOP, aqueous flare, and corneal precipitates. Which of the following drugs must be avoided for her?

Accepted Answer

Prostaglandin analogs

Answer

Carbonic anhydrase inhibitors

Answer

Mannitol

Answer

Beta-blockers

Glaucoma — MCQs

Glaucoma — MCQs

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