Ocular Manifestations of Systemic Disorders — MCQs

Ocular Manifestations of Systemic Disorders Indian Medical PG Practice Questions and MCQs

Question 421: Which of the following can be associated with sarcoidosis?

A. Band keratopathy
B. Diabetic retinopathy
C. Angioid streaks
D. Granulomatous anterior uveitis (Correct Answer)

Explanation: ***Granulomatous anterior uveitis*** - **Granulomatous anterior uveitis** is the **most common and characteristic** ocular manifestation of **sarcoidosis**, characterized by inflammatory cells clumping together in the anterior chamber. - Classic findings include **mutton-fat keratic precipitates**, iris nodules (Koeppe and Busacca nodules), and posterior synechiae. - It can lead to complications such as glaucoma, cataracts, and posterior segment involvement. *Band keratopathy* - **Band keratopathy** is a corneal degeneration characterized by calcium deposits in the superficial cornea, typically seen in chronic ocular inflammation, hypercalcemia, or certain systemic disorders. - While sarcoidosis can cause **hypercalcemia** (in 10-20% of cases) which may lead to band keratopathy, this is an **indirect and uncommon** association. - **Granulomatous anterior uveitis** is the **direct, hallmark** ocular manifestation of sarcoidosis, making it the better answer. *Angioid streaks* - **Angioid streaks** are breaks in Bruch's membrane, associated with systemic conditions such as **pseudoxanthoma elasticum**, Ehlers-Danlos syndrome, Paget's disease, and sickle cell disease, but **not sarcoidosis**. - They can lead to choroidal neovascularization and vision loss. *Diabetic retinopathy* - **Diabetic retinopathy** is a microvascular complication of **diabetes mellitus**, characterized by damage to the retinal blood vessels. - It is **completely unrelated to sarcoidosis**.

Question 422: What visual field defect is commonly associated with pituitary gland enlargement?

A. Bitemporal hemianopia (Correct Answer)
B. Binasal hemianopia
C. Homonymous hemianopia
D. None of the options

Explanation: ***Bitemporal hemianopia*** - Pituitary gland enlargement often compresses the **optic chiasm**, where fibers from the nasal retina (responsible for temporal visual fields) decussate. - This compression leads to a loss of vision in the **outer half of both visual fields**. *Binasal hemianopia* - This defect involves loss of the nasal visual fields and is typically caused by lesions lateral to the optic chiasm, affecting the **uncrossed temporal fibers**. - It is much less common and not typically associated with a centrally growing pituitary mass. *Homonymous hemianopia* - Involves the loss of the same half of the visual field in both eyes (e.g., right homonymous hemianopia means loss of vision in the right half of both eyes). - This defect is usually due to a lesion **posterior to the optic chiasm**, such as in the optic tract, lateral geniculate nucleus, optic radiations, or visual cortex. *None of the options* - Pituitary enlargement has a distinct and classic visual field defect associated with it due to its anatomical proximity to the optic chiasm. - Therefore, one of the provided options accurately describes this common presentation.

Question 423: Dalen-Fuchs nodules are seen in which of the following?

A. Retinal detachment
B. Spring catarrh
C. Sympathetic ophthalmitis (Correct Answer)
D. Vogt-Koyanagi-Harada disease

Explanation: ***Sympathetic ophthalmitis*** - **Dalen-Fuchs nodules** are characterized by accumulations of **lymphocytes, epithelioid cells, and pigment** in the choroid, specifically between Bruch's membrane and the retinal pigment epithelium. - They are a **pathognomonic sign** of sympathetic ophthalmitis, an autoimmune inflammatory reaction in the contralateral eye after penetrating trauma or surgery to the other eye. - These nodules represent a **granulomatous inflammatory response** and are a key histopathological finding. *Retinal detachment* - This condition involves the **separation of the neurosensory retina** from the underlying retinal pigment epithelium. - It is typically characterized by symptoms such as **flashes of light, floaters**, and a **darkening peripheral visual field**, rather than specific nodular formations in the choroid. *Spring catarrh* - Also known as **vernal keratoconjunctivitis**, this is a severe, chronic, bilateral inflammation of the conjunctiva, primarily affecting children and young adults, often with a history of atopy. - Its characteristic features include **papillae on the upper tarsal conjunctiva** and **Trantas dots** (collections of eosinophils and epithelial cells) at the limbus, not Dalen-Fuchs nodules. *Vogt-Koyanagi-Harada disease* - While VKH disease can also show Dalen-Fuchs nodules as it shares similar granulomatous uveitis features, it is a **distinct bilateral panuveitis** with systemic manifestations including **poliosis, vitiligo, dysacusia, and meningismus**. - The key differentiating factor is that **sympathetic ophthalmitis requires prior trauma or surgery to one eye**, whereas VKH disease has no such requirement and presents with characteristic extraocular manifestations.

Question 424: First sign of raised intracranial pressure in fundoscopy is:

A. Dilatation of vessels
B. Nasal shifting of blood vessels
C. Cupping of the optic disc
D. Blurring of disc (Correct Answer)

Explanation: ***Blurring of disc*** - The earliest sign of **papilledema** due to raised intracranial pressure is often a **blurring of the optic disc margins**, specifically the nasal border, due to edema. - This occurs because the optic nerve sheath is continuous with the **dura mater**, allowing CSF to transmit high pressure to the optic nerve head, leading to axoplasmic flow stasis and edema. *Cupping of the optic disc* - **Optic disc cupping** is typically associated with **glaucoma**, caused by damage to the optic nerve fibers and subsequent excavation of the optic disc. - This is an indicator of optic nerve damage and not raised intracranial pressure. *Dilatation of vessels* - While central retinal veins can become engorged and dilated in later stages of papilledema, this is usually **not the first sign** observed. - Initial changes are more subtle, primarily involving disc margin edema. *Nasal shifting of blood vessels* - **Nasal shifting of blood vessels** is a morphological change associated with **optic disc coloboma** or other congenital anomalies of the optic nerve head. - It is not a sign of raised intracranial pressure.

Question 425: Retinitis pigmentosa is a feature of all except which of the following?

A. NARP
B. Refsum's disease
C. Hallervorden-Spatz disease (Correct Answer)
D. Abetalipoproteinemia

Explanation: ***Hallervorden-Spatz disease*** - Also known as **Pantothenate kinase-associated neurodegeneration (PKAN)**, this disorder primarily causes **extrapyramidal symptoms** such as dystonia and parkinsonism due to iron accumulation in the basal ganglia. - While it is a neurodegenerative disorder affecting the brain, **retinitis pigmentosa** is not a characteristic feature of Hallervorden-Spatz disease. *Refsum's disease* - This is an **autosomal recessive peroxisomal disorder** characterized by the accumulation of **phytanic acid**, which is toxic to various tissues. - **Retinitis pigmentosa** is a classic symptom, often presenting with night blindness and progressive vision loss, along with **ataxia**, **polyneuropathy**, and **ichthyosis**. *NARP* - **NARP (Neuropathy, Ataxia, Retinitis Pigmentosa)** is a rare mitochondrial disorder caused by mutations in the **MT-ATP6 gene**, leading to energy production deficits. - **Retinitis pigmentosa** is a core feature, contributing to visual impairment, alongside **sensory neuropathy**, **ataxia**, and **developmental delay**. *Abetalipoproteinemia* - This is an **autosomal recessive disorder** characterized by the inability to synthesize **apolipoprotein B**, essential for the formation of chylomicrons and VLDL, leading to severe **malabsorption of fat-soluble vitamins** (A, D, E, K). - Prolonged deficiency of **vitamin E** can result in progressive neurological dysfunction, including **ataxia** and **retinitis pigmentosa**, due to oxidative damage to photoreceptors and nervous tissue.

Question 426: In Sturge-Weber syndrome, the MOST characteristic ocular manifestations include:

A. Lisch nodules
B. Pulsating exophthalmos
C. Hemangioma of choroid and glaucoma (Correct Answer)
D. Choroidal hemangioma

Explanation: ***Hemangioma of choroid and glaucoma*** - **Sturge-Weber syndrome** is a neurocutaneous disorder characterized by a **port-wine stain** on the face, usually involving the V1 distribution of the trigeminal nerve. - The most characteristic ocular manifestations include **choroidal hemangioma** and **glaucoma**, which occur together in this syndrome. - **Glaucoma** develops due to increased episcleral venous pressure or angle abnormalities and is a major cause of vision loss in affected individuals. - This option is the **most complete answer** as it includes both key ocular features. *Choroidal hemangioma* - While **choroidal hemangioma** is indeed present in Sturge-Weber syndrome, this option is **incomplete** as it does not mention the equally important association with **glaucoma**. - **Glaucoma** is a critical complication that requires monitoring and management in these patients. - Choosing this option would miss the full clinical picture. *Pulsating exophthalmos* - **Pulsating exophthalmos** is typically associated with a **carotid-cavernous fistula**, where arterial blood shunts into the cavernous sinus, causing pulsatile protrusion of the eyeball. - This is not a classic ocular feature of **Sturge-Weber syndrome**. *Lisch nodules* - **Lisch nodules** (iris hamartomas) are pathognomonic for **Neurofibromatosis type 1 (NF1)**, a different neurocutaneous disorder. - They are not associated with **Sturge-Weber syndrome**.

Practice by Chapter

Diabetes Mellitus

Practice Questions

Hypertension

Practice Questions

Autoimmune Disorders

Practice Questions

Thyroid Disease

Practice Questions

HIV and AIDS

Practice Questions

Hematological Disorders

Practice Questions

Neurological Disorders

Practice Questions

Dermatological Conditions

Practice Questions

Pregnancy-Related Eye Changes

Practice Questions

Metabolic Disorders

Practice Questions

Ocular Toxicity of Systemic Medications

Practice Questions

Infectious Systemic Diseases

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free