Glaucoma — MCQs
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Most common cause of frequent changes in presbyopic glasses among the following is:
Normal intraocular pressure is typically in the range of:
Vogt's triad is indicative of:
A patient with angle-closure glaucoma is posted for laser iridotomy. Which of the following lasers is used for iridotomy?
Which of the following is not a treatment option for glaucoma?
Secondary glaucoma following corneal perforation is due to:
Laser iridotomy is useful in
Which of the following is the gold standard to measure the angles of the eye?
Glaucoma Indian Medical PG Practice Questions and MCQs
Question 401: Most common cause of frequent changes in presbyopic glasses among the following is:
- A. Glaucoma
- B. Senile Cataract (Correct Answer)
- C. Diabetic Retinopathy
- D. Age-Related Macular Degeneration
Explanation: ***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.
Question 402: Normal intraocular pressure is typically in the range of:
- A. 2.1-6 mm Hg
- B. 7-14 mm Hg
- C. 10-21 mm Hg (Correct Answer)
- D. 16-32 mm Hg
Explanation: ***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**.
Question 403: Vogt's triad is indicative of:
- A. Past attack of acute iridocyclitis
- B. Vogt-Koyanagi-Harada syndrome
- C. Past attack of acute angle-closure glaucoma (Correct Answer)
- D. Past attack of herpes zoster ophthalmicus
Explanation: ***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.
Question 404: A patient with angle-closure glaucoma is posted for laser iridotomy. Which of the following lasers is used for iridotomy?
- A. Nd:YAG laser (Correct Answer)
- B. Helium-Neon laser
- C. Argon laser
- D. Krypton laser
Explanation: ***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**.
Question 405: Which of the following is not a treatment option for glaucoma?
- A. Trabeculectomy
- B. Trabeculotomy
- C. Vitrectomy (Correct Answer)
- D. Viscocanalostomy
Explanation: ***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.
Question 406: Secondary glaucoma following corneal perforation is due to:
- A. Peripheral anterior synechiae (Correct Answer)
- B. Central anterior synechiae
- C. Intraocular haemorrhage
- D. Angle recession
Explanation: **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.
Question 407: Laser iridotomy is useful in
- A. Angle closure glaucoma (Correct Answer)
- B. Neovascular glaucoma
- C. Open angle glaucoma
- D. Secondary glaucoma
Explanation: ***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**.
Question 408: Which of the following is the gold standard to measure the angles of the eye?
- A. Perimetry
- B. Van Herick's grading
- C. Cover-uncover test
- D. Gonioscopy (Correct Answer)
Explanation: ***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.
Practice by Chapter
Aqueous Humor Dynamics
Practice Questions
Primary Open-Angle Glaucoma
Practice Questions
Primary Angle-Closure Glaucoma
Practice Questions
Secondary Open-Angle Glaucomas
Practice Questions
Secondary Angle-Closure Glaucomas
Practice Questions
Developmental and Congenital Glaucomas
Practice Questions
Medical Management of Glaucoma
Practice Questions
Laser Therapy in Glaucoma
Practice Questions
Glaucoma Filtration Surgery
Practice Questions
Glaucoma Drainage Devices
Practice Questions
Angle Assessment Techniques
Practice Questions
Visual Field Testing in Glaucoma
Practice Questions
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