Glaucoma Practice Questions

Q: Descemet membrane breach is seen in ?

Congenital glaucoma (Buphthalmos). ***Congenital glaucoma (Buphthalmos)*** - In **congenital glaucoma**, increased intraocular pressure (IOP) in infancy stretches the developing eye, leading to enlargement (buphthalmos) and **Descemet membrane breaches** or ruptures. - These ruptures appear as fine, parallel, or branching lines on the posterior corneal surface, known as **Haab's striae**, which are characteristic signs of this condition. *Angle closure glaucoma* - This condition involves a sudden rise in IOP due to physical obstruction of the **aqueous humor outflow** and does not typically cause Descemet membrane breaks. - Clinical signs include **corneal edema** due to endothelial dysfunction, but not membrane breaches. *Acute Iridocyclitis* - **Acute iridocyclitis** is an inflammatory condition of the iris and ciliary body, primarily causing cells and flare in the anterior chamber. - It does not directly lead to **Descemet membrane breaches** or structural damage like stretching of the cornea. *Subconjunctival hemorrhage* - This condition is characterized by **bleeding under the conjunctiva** and is typically due to ruptured conjunctival blood vessels. - It is a superficial condition that does not involve the cornea or the Descemet membrane.

Q: Which of the following statements about congenital glaucoma is incorrect?

Anterior chamber is shallow. ***Anterior chamber is shallow*** - In congenital glaucoma, the **anterior chamber depth is typically normal or deep**, not shallow. - A shallow anterior chamber is more characteristic of **angle-closure glaucoma**, which is mechanistically different. - This makes the statement incorrect, as congenital glaucoma is associated with a **deep anterior chamber** due to globe enlargement. *Photophobia is most common symptom* - **Photophobia** (sensitivity to light) is indeed one of the classic presenting symptoms in congenital glaucoma. - It forms part of the classic triad: **photophobia, epiphora (tearing), and blepharospasm**. - This occurs due to **increased intraocular pressure** causing corneal edema and irritation. *Thin and blue sclera seen* - The **sclera** can appear thin and blue due to **buphthalmos** (enlargement of the eye) and stretching of the globe. - The stretching allows the underlying **uveal tissue** to show through, giving the characteristic blue appearance. - This is a direct consequence of elevated intraocular pressure in a developing eye. *Haab's Striae may be seen* - **Haab's striae** are **Descemet's membrane tears** that are pathognomonic of congenital glaucoma. - These horizontal or curvilinear breaks occur due to stretching of the cornea from **elevated intraocular pressure**. - They appear as visible linear opacities on corneal examination.

Q: What condition are miotics the treatment of choice for?

Open-angle glaucoma. ***Open-angle glaucoma*** - Miotics, such as **pilocarpine**, are a classical treatment option for **primary open-angle glaucoma (POAG)**. - They work by **contracting the ciliary muscle**, which opens up the **trabecular meshwork** and increases aqueous humor outflow. - This results in **reduction of intraocular pressure (IOP)**, the primary goal in glaucoma management. - Though less commonly used today due to side effects (brow ache, miosis affecting vision), they remain effective and are particularly useful in patients who cannot tolerate other medications. *Angle closure glaucoma* - Miotics are **contraindicated in acute angle-closure glaucoma** as they can worsen pupillary block during the acute attack. - The initial treatment involves **IOP-lowering agents, systemic medications, and laser iridotomy**, not miotics. - Miotics may have a limited role in chronic angle closure after definitive treatment, but they are NOT the treatment of choice. *Buphthalmos* - This refers to **enlargement of the eyeball** in infants due to congenital glaucoma. - Management primarily involves **surgical intervention** (goniotomy, trabeculotomy) to address the developmental anomalies of the drainage angle. - Medical management alone, including miotics, is insufficient. *Sympathetic ophthalmia* - A rare **bilateral granulomatous panuveitis** following penetrating trauma or surgery to one eye. - Treated with **corticosteroids and immunosuppressive agents**. - Miotics have no role in managing this inflammatory condition.

Q: Drug of choice for open angle glaucoma:

Latanoprost. ***Latanoprost*** - **Prostaglandin F2α analogs** like latanoprost are generally considered **first-line therapy** for open-angle glaucoma due to their efficacy and once-daily dosing. - They work by **increasing uveoscleral outflow** of aqueous humor, thereby lowering intraocular pressure (IOP). *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** that reduces aqueous humor production. - It is typically used for **acute angle-closure glaucoma** or when initial treatments fail, often due to systemic side effects with long-term use. *Timolol* - **Timolol** is a **non-selective beta-blocker** that reduces aqueous humor production. - While effective, it is often a second-line agent or used in combination due to potential systemic side effects like **bronchospasm** and **bradycardia**. *Brimonidine* - **Brimonidine** is an **alpha-2 adrenergic agonist** that reduces aqueous humor production and increases uveoscleral outflow. - It is typically used as a second-line agent or in combination therapy due to potential side effects like **ocular pruritus** and **allergic conjunctivitis**.

Q: What is the most common symptom associated with congenital glaucoma?

Excessive tearing. ***Excessive tearing*** - **Epiphora**, or excessive tearing, is one of the most common early symptoms of **congenital glaucoma** in infants. - This symptom occurs due to **corneal irritation** and **damage** resulting from elevated intraocular pressure. *Eye pain* - While glaucoma can cause eye pain, it is less commonly reported as the *initial* and *most frequent* symptom in **congenital glaucoma** in infants who cannot verbalize their discomfort. - **Irritability** or excessive crying might be indirect signs of pain, but tearing is a more direct and observable sign. *Sensitivity to light* - **Photophobia**, or sensitivity to light, is another common symptom of congenital glaucoma. - However, **excessive tearing** often precedes or co-occurs with photophobia as an initial presenting symptom in infants. *Itching of the eyes* - **Ocular itching** is typically associated with **allergic conjunctivitis** or other inflammatory conditions, not directly with congenital glaucoma. - Itching is not a primary or common symptom of elevated intraocular pressure in infants.

Q: What is the first-line treatment for acute angle closure glaucoma?

Acetazolamide. **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.

Q: Van Herick angle grade '3' of anterior chamber denotes

Moderately open angle. ***Moderately open angle*** - A **Von Herick angle grade 3** indicates that the width of the peripheral anterior chamber is approximately **one-quarter to one-half** the thickness of the peripheral cornea. - This assessment suggests a **moderately open anterior chamber angle**, indicating that while there is some risk of angle closure, it is not immediately narrow. *Wide open angle* - A **wide open angle** is typically represented by a **Von Herick grade 4**, where the anterior chamber angle is as wide or wider than the corneal thickness. - This grade signifies a **low risk of angle closure** and good aqueous outflow. *Narrow angle* - A **narrow angle** is generally associated with **Von Herick grades 1 or 2**, where the anterior chamber is significantly shallower. - Grade 1 indicates an angle width of **less than one-quarter** of peripheral corneal thickness, posing a higher risk of angle closure. *Closed angle* - A **closed angle** represents an extreme case where the **iris is in contact with the trabecular meshwork**, blocking aqueous outflow. - This condition is not typically graded in the Von Herick system as an existent angle, but rather as an absence of a visible angle (grade 0 or **"slit"**).

Q: Type of laser used for iridotomy?

Nd:YAG laser. ***Nd:YAG laser*** - The **Nd:YAG laser** is the most commonly used laser for performing a laser peripheral iridotomy due to its ability to create a small perforation in the iris. - Its **photodisruptive** mechanism allows for precise tissue disruption with minimal thermal damage to surrounding structures. *Excimer laser* - **Excimer lasers** operate in the **ultraviolet (UV) spectrum** and are primarily used in refractive surgery (e.g., LASIK) for corneal reshaping. - They are not suitable for iridotomy due to their limited penetrating ability and potential for corneal damage. *Krypton laser* - **Krypton lasers** produce red and yellow light, and were historically used for **photocoagulation** in retinal diseases. - They are not typically used for iridotomy as their primary mechanism is thermal coagulation rather than tissue disruption. *Diode laser* - **Diode lasers** are used in ophthalmology for various applications, including **photocoagulation** in the retina and transscleral cyclophotocoagulation for glaucoma. - While they can deliver energy to tissues, they are generally less effective and precise for creating a peripheral iridotomy compared to the Nd:YAG laser.

Q: Which Goldmann type is considered the standard in perimetry?

Goldmann type III (commonly used stimulus size). ***Goldmann type III (commonly used stimulus size)*** - This stimulus size is the **international standard** for kinetic perimetry and ensures comparability of visual field charts worldwide. - It provides a balance between **sensitivity** and minimizing the effects of **pupil size** and other ocular factors. *Goldmann type I (small stimulus size)* - While very small, this stimulus type is **not the standard** for general perimetry. - It is sometimes used for detecting **subtle defects** or for patients with very good visual acuity, but its small size can make it harder to detect. *Goldmann type II (medium-small stimulus size)* - This stimulus size is **smaller than the standard** and is not universally adopted for perimetry. - It offers slightly more sensitivity than the standard but can be more affected by **refractive errors** or media opacities. *Goldmann type IV (large stimulus size)* - This stimulus is **much larger than the standard** and is typically used for detecting **gross defects** or in patients with severely impaired vision. - Its large size makes it **less sensitive** to smaller visual field abnormalities.

Q: What are the characteristic features of Posner-Schlossman syndrome?

Unilateral glaucomatous changes with mild anterior uveitis. ***Unilateral glaucomatous changes with mild anterior uveitis*** - Posner-Schlossman syndrome, also known as **glaucomatocyclitic crisis**, is characterized by recurrent, acute attacks of **unilateral elevated intraocular pressure** (glaucomatous changes). - These attacks are accompanied by **mild anterior uveitis**, which typically presents with few or no precipitates and minimal redness. *Ipsilateral optic atrophy with contralateral papilloedema* - This constellation of symptoms, known as **Foster Kennedy syndrome**, is associated with intracranial masses, not Posner-Schlossman syndrome. - It involves **optic atrophy** in one eye due to direct pressure on the optic nerve and **papilledema** in the other eye due to increased intracranial pressure. *Granulomatous uveitis with iris heterochromia* - **Granulomatous uveitis** is characterized by large mutton-fat keratic precipitates and often seen in diseases like sarcoidosis or tuberculosis, which is not typical for Posner-Schlossman. - **Iris heterochromia** (different colored irises) is a characteristic feature of **Fuchs' heterochromic cyclitis**, another form of chronic anterior uveitis, but not Posner-Schlossman syndrome. *None of the options* - This option is incorrect as one of the provided choices accurately describes the characteristic features of Posner-Schlossman syndrome. - The other options describe different ophthalmological conditions.

Question 1

Descemet membrane breach is seen in ?

Accepted Answer

Congenital glaucoma (Buphthalmos)

Answer

Angle closure glaucoma

Answer

Acute Iridocyclitis

Answer

Subconjunctival hemorrhage

Question 2

Which of the following statements about congenital glaucoma is incorrect?

Accepted Answer

Anterior chamber is shallow

Answer

Thin and blue sclera seen

Answer

Photophobia is most common symptom

Answer

Haab's Striae may be seen

Question 3

What condition are miotics the treatment of choice for?

Accepted Answer

Open-angle glaucoma

Answer

Angle closure glaucoma

Answer

Buphthalmos

Answer

Sympathetic ophthalmia

Question 4

Drug of choice for open angle glaucoma:

Accepted Answer

Latanoprost

Answer

Acetazolamide

Answer

Brimonidine

Answer

Timolol

Question 5

What is the most common symptom associated with congenital glaucoma?

Accepted Answer

Excessive tearing

Answer

Eye pain

Answer

Sensitivity to light

Answer

Itching of the eyes

Question 6

What is the first-line treatment for acute angle closure glaucoma?

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 7

Van Herick angle grade '3' of anterior chamber denotes

Accepted Answer

Moderately open angle

Answer

Wide open angle

Answer

Closed angle

Answer

Narrow angle

Question 8

Type of laser used for iridotomy?

Accepted Answer

Nd:YAG laser

Answer

Excimer laser

Answer

Krypton laser

Answer

Diode laser

Question 9

Which Goldmann type is considered the standard in perimetry?

Accepted Answer

Goldmann type III (commonly used stimulus size)

Answer

Goldmann type I (small stimulus size)

Answer

Goldmann type II (medium-small stimulus size)

Answer

Goldmann type IV (large stimulus size)

Question 10

What are the characteristic features of Posner-Schlossman syndrome?

Accepted Answer

Unilateral glaucomatous changes with mild anterior uveitis

Answer

Ipsilateral optic atrophy with contralateral papilloedema

Answer

Granulomatous uveitis with iris heterochromia

Answer

None of the options

Glaucoma — MCQs

Glaucoma — MCQs

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