Glaucoma Practice Questions

Q: Identify the instrument shown below:

Flushing curette. ***Flushing curette*** - This instrument is characterized by its **long shaft** and **fenestrated, looped tip**, often used for flushing and gentle tissue removal from the uterus. - The design allows for both **scraping** and **irrigating or aspirating** simultaneously, making it suitable for removing retained products of conception or uterine polyps while minimizing trauma. *Uterine curette* - A standard uterine curette typically has a **solid spoon-shaped or loop-shaped tip** that is sharp or blunt, designed solely for scraping the uterine lining. - It lacks the **perforations or channels** for fluid flushing or aspiration seen in the flushing curette. *Ovum forceps* - Ovum forceps are grasping instruments with **fenestrated jaws**, designed to remove **retained products of conception** or gestational tissue from the uterus. - They are used for **grasping and extracting** tissue, not for scraping or flushing. *Uterine tenaculum* - A uterine tenaculum has **sharp, pointed hooks** at its tip, designed to grasp and stabilize the cervix during gynecological procedures. - Its primary function is to **immobilize the cervix**, not to scrape, flush, or remove uterine contents.

Q: Identify the instrument used: (AIIMS Nov 2017)

Episiotomy scissors. ***Episiotomy scissors*** - These scissors are characterized by their **blunt, angled tip** on one blade, which is designed to protect the fetal head during an episiotomy. - The image clearly shows this specific design, making them ideal for cutting soft tissues in a controlled manner without puncturing underlying structures. *Dissection scissors* - Dissection scissors typically have **sharp tips**, either straight or curved, and are used for cutting and separating tissues with precision. - They lack the blunt, angled tip characteristic of episiotomy scissors. *Mayo scissors* - **Mayo scissors** are heavy-duty scissors, typically used for cutting **fascia, sutures, and dense tissues**. - They often have straight or slightly curved blades without the protective blunt tip seen in episiotomy scissors. *Metzenbaum scissors* - **Metzenbaum scissors** are known for their **long handles and relatively short, delicate blades**, designed for cutting and dissecting fine, delicate tissues. - Their blades are typically slender and do not feature the angled, blunt tip of episiotomy scissors.

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: Argon laser trabeculoplasty is done in:

Open angle glaucoma. ***Open angle glaucoma*** - **Argon laser trabeculoplasty (ALT)** is primarily used in **open-angle glaucoma** to improve aqueous humor outflow through the **trabecular meshwork**. - It creates **small burns** in the trabecular meshwork, increasing permeability and lowering **intraocular pressure (IOP)**. *Secondary glaucoma* - This is a broad category of glaucoma caused by other eye conditions or systemic diseases, and the specific treatment depends on the underlying etiology. - While ALT might be considered in some types of **secondary open-angle glaucoma**, it is not a primary or universal treatment for all secondary glaucomas. *Angle recession glaucoma* - This type of glaucoma occurs after blunt trauma to the eye, causing a tear in the **ciliary body** and widening of the **ciliary body band**. - ALT is generally **ineffective** in angle recession glaucoma because the damage to the trabecular meshwork is structural and not amenable to laser modification. *Angle closure glaucoma* - In **angle-closure glaucoma**, the iris blocks the drainage angle, preventing aqueous outflow. - Treatment typically involves **laser peripheral iridotomy** to create a hole in the iris, or surgical procedures, to open the angle, rather than laser trabeculoplasty.

Question 1

Identify the instrument shown below:

Accepted Answer

Flushing curette

Answer

Uterine curette

Answer

Ovum forceps

Answer

Uterine tenaculum

Question 2

Identify the instrument used: (AIIMS Nov 2017)

Accepted Answer

Episiotomy scissors

Answer

Dissection scissors

Answer

Mayo scissors

Answer

Metzenbaum scissors

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

Argon laser trabeculoplasty is done in:

Accepted Answer

Open angle glaucoma

Answer

Secondary glaucoma

Answer

Angle recession glaucoma

Answer

Angle closure glaucoma

Glaucoma — MCQs

Glaucoma — MCQs

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