Glaucoma Practice Questions

Q: Most common cause of frequent changes in presbyopic glasses among the following is:

Senile Cataract. ***Senile Cataract*** - A common symptom of **senile cataracts** is a progressive change in the **refractive index of the lens**, which can lead to frequent changes in presbyopic glass prescriptions. - The developing cataract can cause a **myopic shift**, temporarily improving near vision (second sight) but requiring new glasses as it progresses. *Glaucoma* - **Glaucoma** primarily affects the optic nerve due to increased intraocular pressure and can lead to **peripheral vision loss**, but it generally does not cause frequent changes in refractive error or presbyopic glass prescriptions. - It does not directly affect the **focusing power of the lens** in a way that necessitates repeated adjustments to presbyopic correction. *Diabetic Retinopathy* - **Diabetic retinopathy** is a microvascular complication of diabetes affecting the retina, potentially causing **vision loss, floaters, or blurred vision**. - While uncontrolled blood sugar can cause temporary refractive shifts, it is not the most common cause of **frequent, progressive changes in presbyopic glasses** compared to the structural lens changes seen in cataracts. *Age-Related Macular Degeneration* - **Age-related macular degeneration (ARMD)** involves the deterioration of the macula, leading to **central vision loss** and distortion. - It does not significantly affect the **overall refractive power of the eye** or the need for frequent changes in presbyopic glasses.

Q: Normal intraocular pressure is typically in the range of:

10-21 mm Hg. ***10-21 mm Hg*** - This range is widely accepted as the **normal intraocular pressure (IOP)** in healthy individuals. - Maintaining IOP within this range is crucial for preventing damage to the **optic nerve** and conditions like **glaucoma**. *2.1-6 mm Hg* - This range is significantly **lower** than the normal physiological IOP. - Pressures in this range could indicate conditions like **hypotony**, which can lead to vision problems. *7-14 mm Hg* - While closer to the normal range, this range is still generally considered to be at the **lower end of normal** or slightly below. - Many individuals would fall within 10-21 mm Hg, making this a less accurate representation of the typical normal range. *16-32 mm Hg* - The upper part of this range (above 21 mm Hg) is considered **elevated IOP**, a significant risk factor for **glaucoma**. - Pressures above 21 mm Hg require closer monitoring and potentially treatment to prevent **optic nerve damage**.

Q: Vogt's triad is indicative of:

Past attack of acute angle-closure glaucoma. ***Past attack of acute-angle closure glaucoma*** - Vogt's triad refers to three specific signs observed in the eye after an episode of **acute angle-closure glaucoma**. - The triad includes **glaukomflecken** (anterior subcapsular lens opacities), **iris stromal atrophy**, and **pupil dilation or distortion**. *Vogt-Koyanagi-Harada syndrome* - This is a **multisystem inflammatory disease** primarily affecting pigmented structures, not characterized by Vogt's triad. - It involves **uveitis**, dermatological manifestations (e.g., poliosis, vitiligo), neurological symptoms (e.g., tinnitus, meningitis), and auditory symptoms. *Past attack of acute iridocyclitis* - While iridocyclitis involves **inflammation of the iris and ciliary body**, it does not typically lead to the specific triad of signs seen in Vogt's triad. - Complications of severe iridocyclitis might include synechiae or cataract, but not glaukomflecken or specific iris atrophy described by Vogt. *Past attack of herpes zoster ophthalmicus* - This condition is caused by the **reactivation of the varicella-zoster virus** in the ophthalmic division of the trigeminal nerve. - Ocular manifestations include keratitis, uveitis, and neurotrophic keratopathy, but not the specific changes of Vogt's triad.

Q: A patient with angle-closure glaucoma is posted for laser iridotomy. Which of the following lasers is used for iridotomy?

Nd:YAG laser. ***Nd:YAG laser*** - The **Nd:YAG laser** is a **photodisruptive** laser commonly used for **laser iridotomy** due to its ability to create a small opening in the iris with minimal thermal damage. - Its short pulse duration and high peak power allow for precise tissue disruption, making it effective for creating a patent **iridectomy** to relieve pupillary block in angle-closure glaucoma. *Argon laser* - The **argon laser** is a **photocoagulative** laser that works by selectively heating and destroying pigmented tissue, often used for **trabeculasty** or retinal procedures. - While it can be used for iridotomy, the Argon laser carries a higher risk of **thermal damage** and inflammation compared to the Nd:YAG laser, making Nd:YAG the preferred choice. *Helium-Neon laser* - The **Helium-Neon laser** emits red light and is primarily used for **aiming and illumination** in ophthalmic laser systems, not for therapeutic tissue destruction. - It does not possess the power or tissue interaction properties required to perform a surgical procedure like **iridotomy**. *Krypton laser* - The **Krypton laser** is a **photocoagulative** laser, primarily used for various **retinal treatments**, particularly in conditions involving subretinal neovascularization due to its deeper penetration and less scattering by hemoglobin. - It is not suitable for iridotomy as its wavelength and tissue interaction are not optimized for creating an opening in the **iris**.

Q: Which of the following is not a treatment option for glaucoma?

Vitrectomy. ***Vitrectomy*** - A **vitrectomy** is a surgical procedure to remove the **vitreous humor** from the eye, typically performed for conditions like **retinal detachment**, **diabetic retinopathy**, or **vitreous hemorrhage**, not glaucoma. - While glaucoma can sometimes coexist with these conditions, vitrectomy itself is not a direct treatment for addressing the **intraocular pressure** or **optic nerve damage** characteristic of glaucoma. *Trabeculectomy* - **Trabeculectomy** is a common surgical procedure for glaucoma that creates a new drainage pathway for **aqueous humor** to reduce **intraocular pressure**. - It involves removing a small piece of the **trabecular meshwork** and sclera to form a filtering bleb. *Trabeculotomy* - **Trabeculotomy** is a surgical procedure primarily used in **congenital glaucoma** or some forms of **open-angle glaucoma** to improve the outflow of aqueous humor. - It involves incising the **trabecular meshwork** to open up the natural drainage channels. *Viscoanulostomy* - **Viscocanalostomy** (not viscoanulostomy) is a non-penetrating glaucoma surgery that aims to reduce **intraocular pressure** by improving the outflow of **aqueous humor** through the **Schlemm's canal**. - It involves dissecting the outer wall of **Schlemm's canal** and injecting viscoelastic material to dilate the canal, without creating a full-thickness fistula.

Q: Secondary glaucoma following corneal perforation is due to:

Peripheral anterior synechiae. **Peripheral anterior synechiae** - **Peripheral anterior synechiae (PAS)** occur when the iris adheres to the trabecular meshwork after corneal perforation, blocking **aqueous outflow**. - This blockage leads to increased **intraocular pressure (IOP)**, resulting in secondary glaucoma. *Central anterior synechiae formation* - **Central anterior synechiae** involve adhesion between the iris and the central cornea, which typically causes **visual obstruction** rather than glaucoma. - While it can occur after perforation, it does not directly block the **trabecular meshwork**. *Intraocular haemorrhage* - **Intraocular haemorrhage** can cause secondary glaucoma, but it does so by physically obstructing the **trabecular meshwork** or causing inflammation, not by directly sealing off the angle. - While possible after trauma, it is not the primary mechanism of glaucoma directly attributable to perforation itself, particularly when compared to PAS. *Angle recession* - **Angle recession** is a widening of the **ciliary body band** and deepening of the anterior chamber angle due to trauma, which damages the **trabecular meshwork**. - This typically occurs with blunt trauma and can lead to glaucoma years later, but it is not the immediate cause of secondary glaucoma following a corneal perforation.

Q: Laser iridotomy is useful in

Angle closure glaucoma. ***Angle closure glaucoma*** - **Laser iridotomy** creates a small hole in the iris, allowing aqueous humor to flow directly from the posterior chamber to the anterior chamber, thus relieving **pupillary block** and re-opening the angle. - This procedure is a definitive treatment for **primary angle-closure glaucoma (PACG)** and is used prophylactically in eyes at risk of angle closure. *Neovascular glaucoma* - This type of glaucoma results from the formation of **new blood vessels** on the iris and trabecular meshwork, obstructing aqueous outflow. - While laser photocoagulation to the retina (panretinal photocoagulation) is the primary treatment, **iridotomy alone** is not effective as it does not address the underlying neovascularization. *Open angle glaucoma* - In **open-angle glaucoma**, the drainage angle is open, but there is still resistance to aqueous outflow, typically at the **trabecular meshwork**. - **Laser iridotomy** does not improve aqueous outflow through the trabecular meshwork and is therefore not indicated for this condition. *Secondary glaucoma* - **Secondary glaucoma** is a broad category where the cause of elevated intraocular pressure is known, such as inflammation, trauma, or certain medications. - While iridotomy might be rarely indicated for specific secondary angle-closure mechanisms (e.g., in uveitic glaucoma with pupillary block), it is not a general treatment for **all forms of secondary glaucoma**.

Q: Which of the following is the gold standard to measure the angles of the eye?

Gonioscopy. ***Gonioscopy*** - **Gonioscopy** is the gold standard for directly visualizing the **anterior chamber angle** structures, which include the iris, ciliary body, trabecular meshwork, and Schwalbe's line. - This technique uses a special **goniolens** in conjunction with a slit lamp to assess the patency and health of the drainage angle, crucial for diagnosing and managing **glaucoma**. *Perimetry* - **Perimetry**, also known as visual field testing, measures the **extent of a person's peripheral vision** and helps detect defects in the visual field. - It does not directly visualize or measure the anatomical angles within the eye's anterior chamber. *Van Herick's grading* - **Van Herick's grading** is a non-contact technique that estimates the **depth of the anterior chamber angle** by observing the peripheral anterior chamber depth with a slit lamp. - While useful for screening, it is an indirect assessment and does not provide the detailed, direct visualization offered by gonioscopy. *Cover-uncover test* - The **cover-uncover test** is used to detect and measure the presence of a **tropia** (a manifest ocular deviation) or **phoria** (a latent ocular deviation) by observing eye movements when one eye is covered and uncovered. - This test assesses eye alignment and muscle balance, not the internal angles of the anterior chamber.

Question 1

Most common cause of frequent changes in presbyopic glasses among the following is:

Accepted Answer

Senile Cataract

Answer

Glaucoma

Answer

Diabetic Retinopathy

Answer

Age-Related Macular Degeneration

Question 2

Normal intraocular pressure is typically in the range of:

Accepted Answer

10-21 mm Hg

Answer

2.1-6 mm Hg

Answer

7-14 mm Hg

Answer

16-32 mm Hg

Question 3

Vogt's triad is indicative of:

Accepted Answer

Past attack of acute angle-closure glaucoma

Answer

Past attack of acute iridocyclitis

Answer

Vogt-Koyanagi-Harada syndrome

Answer

Past attack of herpes zoster ophthalmicus

Question 4

A patient with angle-closure glaucoma is posted for laser iridotomy. Which of the following lasers is used for iridotomy?

Accepted Answer

Nd:YAG laser

Answer

Helium-Neon laser

Answer

Argon laser

Answer

Krypton laser

Question 5

Which of the following is not a treatment option for glaucoma?

Accepted Answer

Vitrectomy

Answer

Trabeculectomy

Answer

Trabeculotomy

Answer

Viscocanalostomy

Question 6

Secondary glaucoma following corneal perforation is due to:

Accepted Answer

Peripheral anterior synechiae

Answer

Central anterior synechiae

Answer

Intraocular haemorrhage

Answer

Angle recession

Question 7

Laser iridotomy is useful in

Accepted Answer

Angle closure glaucoma

Answer

Neovascular glaucoma

Answer

Open angle glaucoma

Answer

Secondary glaucoma

Question 8

Which of the following is the gold standard to measure the angles of the eye?

Accepted Answer

Gonioscopy

Answer

Perimetry

Answer

Van Herick's grading

Answer

Cover-uncover test

Glaucoma — MCQs

Glaucoma — MCQs

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