Glaucoma — MCQs

Glaucoma Indian Medical PG Practice Questions and MCQs

Question 381: Van Herick angle grade '3' of anterior chamber denotes

A. Wide open angle
B. Closed angle
C. Narrow angle
D. Moderately open angle (Correct Answer)

Explanation: ***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"**).

Question 382: What are the characteristic features of Posner-Schlossman syndrome?

A. Ipsilateral optic atrophy with contralateral papilloedema
B. Unilateral glaucomatous changes with mild anterior uveitis (Correct Answer)
C. Granulomatous uveitis with iris heterochromia
D. None of the options

Explanation: ***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 383: What is the primary mechanism of pathogenesis in acute angle closure glaucoma?

A. Increased secretion of aqueous humor
B. Outflow obstruction due to anatomical factors (Correct Answer)
C. Increased absorption of aqueous humor
D. Decreased ciliary body function

Explanation: ***Outflow obstruction due to anatomical factors*** - **Acute angle-closure glaucoma (AACG)** occurs due to a sudden blockage of the **trabecular meshwork**, which is the primary drainage pathway for aqueous humor. - This blockage is caused by anatomical predispositions, such as a **narrow anterior chamber angle**, relatively large lens, and **pupillary block** leading to iris bombé with peripheral iris bowing forward. - The iridocorneal angle closure prevents aqueous humor drainage, causing **rapid IOP elevation**. *Increased secretion of aqueous humor* - While increased aqueous humor production can contribute to elevated intraocular pressure, it is **not the primary mechanism** in acute angle-closure glaucoma. - This mechanism is more relevant in **open-angle glaucoma** or conditions with ciliary body overactivity. - AACG's hallmark is **outflow obstruction**, not increased production. *Decreased ciliary body function* - Decreased ciliary body function would **reduce aqueous humor production**, leading to **hypotony** (low IOP), not elevated pressure. - This is the opposite of what occurs in AACG, where IOP rises dramatically due to impaired drainage. - Ciliary body dysfunction is seen in conditions like **uveitis** or post-surgical complications. *Increased absorption of aqueous humor* - **Increased absorption** of aqueous humor would **reduce intraocular pressure**, which is the opposite of what occurs in acute angle-closure glaucoma. - The disease is characterized by a **rapid and severe rise in intraocular pressure** due to impaired outflow, not enhanced absorption. - Normal aqueous absorption occurs via trabecular and uveoscleral pathways, both of which are blocked in AACG.

Question 384: Laser iridotomy is done in?

A. Pigmentary glaucoma
B. None of the options
C. Angle closure glaucoma (Correct Answer)
D. Open angle glaucoma

Explanation: ***Angle closure glaucoma*** - **Laser iridotomy** creates a small hole in the iris, allowing aqueous humor to flow directly from the posterior to the anterior chamber, thus relieving pupillary block and opening the angle. - This procedure is the definitive treatment to prevent further **angle closure attacks** and is also used prophylactically in eyes at risk. *Open angle glaucoma* - This condition involves an **open angle** but impaired outflow of aqueous humor through the **trabecular meshwork**. - Laser iridotomy is not indicated as it does not address the primary outflow obstruction in the trabecular meshwork. *Pigmentary glaucoma* - This is a type of **open-angle glaucoma** caused by pigment dispersion that clogs the trabecular meshwork, leading to increased intraocular pressure. - While pigment can be released from the iris, the primary issue is the **trabecular meshwork obstruction**, which is not directly resolved by iridotomy. *None of the options* - This option is incorrect because **angle closure glaucoma** is a clear indication for laser iridotomy.

Question 385: Which of the following conditions is least likely to be associated with neovascular glaucoma?

A. Diabetes
B. Open angle glaucoma (Correct Answer)
C. CRVO
D. Eale's disease

Explanation: ***Open angle glaucoma*** ✓ - **Open-angle glaucoma** is a primary **neurodegenerative disease** of the optic nerve, characterized by progressive loss of **retinal ganglion cells** and their axons, leading to characteristic **optic neuropathy** and visual field defects. - It does **NOT** directly cause **neovascularization** or increased VEGF production, which are the underlying mechanisms for **neovascular glaucoma**. - This is the **least likely** association among the given options. *Diabetes* - **Diabetic retinopathy** is a **major cause** of **neovascularization** due to retinal ischemia and increased production of **vascular endothelial growth factor (VEGF)**, which can lead to **neovascular glaucoma**. - **Neovascularization** on the iris (rubeosis iridis) and angle can block aqueous outflow, causing a severe, rapidly progressing form of secondary glaucoma. *CRVO (Central Retinal Vein Occlusion)* - **CRVO** leads to significant retinal ischemia and subsequent release of **VEGF**, which prompts the growth of new, fragile blood vessels. - These new vessels (neovascularization) can grow in the iris and angle, obstructing aqueous humor outflow and causing **neovascular glaucoma**. - **Ischemic CRVO** is one of the **most common causes** of neovascular glaucoma. *Eale's disease* - **Eale's disease** is an **idiopathic occlusive vasculitis** primarily affecting the **peripheral retinal veins**, leading to **retinal ischemia**. - This ischemia stimulates **neovascularization** and the production of **VEGF**, increasing the risk of **neovascular glaucoma** due to the formation of new blood vessels in the anterior chamber.

Question 386: Which of the following is not a risk factor for angle closure glaucoma?

A. Small eye
B. Small cornea
C. Small lens (Correct Answer)
D. Hypermetropia

Explanation: ***Correct Answer: Small lens*** - A smaller lens would lead to a **deeper anterior chamber**, reducing the likelihood of iridotrabecular contact and angle closure. - In contrast, a **large or thick lens** is a well-established risk factor for angle closure glaucoma as it pushes the iris forward, causing pupillary block. - Small lens size is **NOT a risk factor** for angle closure glaucoma. *Incorrect: Small eye* - A small eye (e.g., in **nanophthalmos**) is associated with a relatively large lens in proportion to the eye size, which can push the iris forward and narrow the angle. - This anatomical configuration makes individuals more prone to **pupillary block** and angle closure. *Incorrect: Hypermetropia* - **Hyperopic eyes** tend to be shorter with reduced axial length, which often results in a shallower anterior chamber and a relatively crowded anterior segment. - This shallow anterior chamber increases the risk of the iris occluding the **trabecular meshwork**, predisposing to angle closure. *Incorrect: Small cornea* - A small corneal diameter can be indicative of a generally smaller anterior segment, often correlating with a **shallow anterior chamber**. - A smaller cornea contributes to a more crowded anterior segment, predisposing to **angle closure glaucoma**.

Question 387: Broadest neuroretinal rim is seen in -

A. Nasal pole
B. Superior pole
C. Temporal pole
D. Inferior pole (Correct Answer)

Explanation: ***Inferior pole*** - The **inferior pole** of the optic disc typically has the broadest neuroretinal rim in healthy eyes. - This observation is often remembered by the "ISNT rule," where **I > S > N > T** (Inferior > Superior > Nasal > Temporal) describes the typical thickness of the neuroretinal rim. *Superior pole* - While the superior pole has a relatively thick neuroretinal rim, it is generally **thinner than the inferior rim**. - The superior rim is the second thickest based on the **ISNT rule**. *Nasal pole* - The nasal pole's neuroretinal rim is typically **thinner than both the inferior and superior poles**. - It ranks third in thickness according to the **ISNT rule**. *Temporal pole* - The temporal pole typically has the **thinnest neuroretinal rim**, making it the narrowest part of the disc. - This is due to the larger excavation of the optic cup temporally, accommodating the macular fibers.

Question 388: Which of the following statements is false about phacolytic glaucoma?

A. Open angle glaucoma
B. Lens induced glaucoma
C. Primarily caused by iris-lens contact (Correct Answer)
D. Seen in hypermature stage of cataract

Explanation: ***Primarily caused by iris-lens contact*** - This statement is **FALSE** because **phacolytic glaucoma** is caused by the leakage of **lens proteins** from a **hypermature cataract** into the **anterior chamber**, not by iris-lens contact. - **Iris-lens contact** is the mechanism in **pupillary block glaucoma** and **acute angle-closure glaucoma**, not in phacolytic glaucoma. - The pathophysiology involves **macrophages** engulfing leaked lens proteins and obstructing the **trabecular meshwork**. *Open angle glaucoma* - This statement is true because **phacolytic glaucoma** is definitively an **open-angle glaucoma**. - It involves obstruction of the **trabecular meshwork** by **macrophages** laden with **lens proteins**, which is an open-angle mechanism. - The angle remains anatomically open but functionally blocked. *Seen in hypermature stage of cataract* - This statement is true because **phacolytic glaucoma** develops when the **lens capsule** of a **hypermature (Morgagnian) cataract** becomes permeable. - This permeability allows **high-molecular-weight lens proteins** to leak into the **aqueous humor**. *Lens induced glaucoma* - This statement is true as **phacolytic glaucoma** is a specific type of **lens-induced glaucoma**, arising from the toxic effects of **leaked lens material**. - Other forms of **lens-induced glaucoma** include **phacomorphic glaucoma**, **lens-particle glaucoma**, and **phacoanaphylactic glaucoma**.

Question 389: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

A. Posner-Schlossman syndrome (Correct Answer)
B. Foster-Kennedy syndrome
C. Vogt-Koyanagi-Harada syndrome
D. Fuchs heterochromic iridocyclitis

Explanation: ***Posner-Schlossman syndrome*** - Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**. - The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma. - Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg). *Foster-Kennedy syndrome* - This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor. - It does not involve anterior uveitis or primary elevated intraocular tension. - This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition. *Vogt-Koyanagi-Harada syndrome* - An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms. - While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis. - IOP may be elevated but not the defining feature with dramatic episodic rises. *Fuchs heterochromic iridocyclitis* - A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia. - May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes. - Inflammation is typically **quiet and chronic** rather than acute and recurrent.

Question 390: In primary open-angle glaucoma (POAG), which of the following findings is NOT typically seen?

A. Bayoneting sign (arteriovenous crossing changes)
B. Peripapillary atrophy
C. Horizontal cupping of the optic disc
D. Macular edema (Correct Answer)

Explanation: ***Macular edema*** - **Macular edema** is characterized by fluid accumulation in the fovea or retina, causing blurry vision and metamorphopsia. - While it can occur in conditions like **diabetic retinopathy** or **uveitis**, it is **not a typical finding in POAG**, which primarily affects the optic nerve. *Horizontal cupping of the optic disc* - **Horizontal cupping** (or vertical elongation of the optic cup) is a common sign of **glaucomatous damage**, reflecting the loss of retinal ganglion cells. - This morphological change suggests the progression of optic nerve atrophy. *Bayoneting sign (arteriovenous crossing changes)* - The **bayoneting sign**, where blood vessels appear to dip below the optic disc margin and then sharply bend, is a feature of **advanced glaucomatous cupping**. - It indicates significant loss of optic nerve tissue and is often associated with deeply excavated optic discs. *Peripapillary atrophy* - **Peripapillary atrophy** (PPA) refers to areas of RPE and choroidal atrophy surrounding the optic disc, commonly seen in glaucoma. - While its presence and extent may correlate with **glaucoma severity**, it is a recognized clinical feature of the disease.

Practice by Chapter

Aqueous Humor Dynamics

Practice Questions

Primary Open-Angle Glaucoma

Practice Questions

Primary Angle-Closure Glaucoma

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Secondary Open-Angle Glaucomas

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Secondary Angle-Closure Glaucomas

Practice Questions

Developmental and Congenital Glaucomas

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Medical Management of Glaucoma

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Laser Therapy in Glaucoma

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Glaucoma Filtration Surgery

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Glaucoma Drainage Devices

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Angle Assessment Techniques

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Visual Field Testing in Glaucoma

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Glaucoma — MCQs

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