Ocular Trauma Practice Questions

Q: Name the condition shown in the image.

Gartner cyst. ***Gartner cyst*** - The image shows a cystic lesion located on the **lateral wall of the vagina**, consistent with the typical presentation of a Gartner cyst. - Gartner cysts are remnants of the **mesonephric (Wolffian) duct** found along the anterolateral vaginal wall. *Bartholin cyst* - A Bartholin cyst would be located in the **posterior-inferior portion of the labia majora**, near the vaginal introitus, as it arises from the obstruction of the Bartholin gland duct. - The image depicts a lesion higher up on the lateral vaginal wall, not in the typical Bartholin gland location. *Nabothian cyst* - Nabothian cysts are **mucus-filled cysts on the surface of the cervix**, which would not be visible on an external or low vaginal examination as shown. - They result from blocked cervical glands and are typically small and asymptomatic. *Chocolate cyst* - A chocolate cyst is an **endometrioma**, a type of ovarian cyst filled with old, dark blood, resembling melted chocolate. - These are intra-abdominal or pelvic masses and are not externally visible vaginal lesions.

Q: Sympathetic ophthalmia is due to

Penetrating trauma. ***Penetrating trauma*** - **Sympathetic ophthalmia** is a rare, bilateral granulomatous panuveitis that occurs after **penetrating trauma** or surgery to one eye (the exciting eye). - The injury exposes **uveal antigens** to the immune system, leading to a delayed hypersensitivity reaction affecting both the injured and the uninjured (sympathizing) eye. *Chemical injury* - Chemical injuries to the eye typically cause corneal damage, conjunctivitis, and uveitis, but do not commonly lead to the bilateral immune response characteristic of **sympathetic ophthalmia**. - The mechanism of injury in chemical trauma does not involve the exposure of hidden ocular antigens in a way that triggers **autoimmune uveitis**. *Blunt trauma* - **Blunt trauma** to the eye can cause various issues like hyphema, retinal detachment, or orbital fractures. - While it can cause significant damage, it generally does not typically breach the globe in a manner that exposes uveal tissue to the systemic immune system, leading to **sympathetic ophthalmia**. *Retained intra ocular Iron foreign body* - An intraocular **iron foreign body** can cause **siderosis bulbi**, a condition where iron deposition leads to pigmentation and degeneration of ocular tissues. - This is a direct toxic effect of iron and is distinct from the immune-mediated inflammation seen in **sympathetic ophthalmia**.

Q: A patient sustained blunt trauma to the eye, after which he developed sudden loss of vision with deep anterior chamber. Most likely cause is:

Lens dislocation. ***Lens dislocation*** - **Blunt trauma** can cause **zonular rupture**, leading to **lens dislocation** into the vitreous or anterior chamber. - A dislocated lens in the vitreous space results in a **deep anterior chamber** and sudden vision loss due to loss of the refractive power of the lens. *Retinal haemorrhage* - While blunt trauma can cause **retinal haemorrhage**, it typically does not present with a **deep anterior chamber**. - Vision loss from retinal haemorrhage depends on its size and location, but it's not directly associated with changes in anterior chamber depth. *Berlin's oedema* - Also known as **commotio retinae**, this condition involves **retinal oedema** due to blunt trauma, causing sudden vision loss. - However, Berlin's oedema is a retinal condition and does not typically alter the **depth of the anterior chamber**. *Recession of angle of AC* - **Angle recession** is a common consequence of blunt trauma, where the ciliary body detaches from the scleral spur, causing a widening of the **anterior chamber angle**. - While it can lead to **secondary glaucoma** over time, it typically does not cause **sudden profound vision loss** immediately after trauma and does not necessarily result in a *deep* anterior chamber.

Q: In a patient with a metallic foreign body in the eye, which investigation should NOT be done?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** is contraindicated in patients with suspected **metallic foreign bodies** in the eye. - The powerful magnetic fields of an MRI can cause the metallic object to move, potentially leading to further **tissue damage** or even loss of vision. *X-ray* - **X-rays** are often the initial investigation of choice for detecting **radio-opaque foreign bodies** within the eye. - They can effectively localize larger metallic objects and are readily available in most emergency settings. *CT* - **Computed Tomography (CT)** scans provide detailed cross-sectional images and are excellent for precisely localizing **intraocular foreign bodies**, especially smaller ones. - CT can differentiate between metallic and non-metallic objects and assess for associated injuries like orbital fractures. *USG* - **Ultrasound (USG)** of the eye can be useful for detecting **intraocular foreign bodies**, especially if they are non-metallic or located in the posterior segment. - It can also assess for associated complications such as **retinal detachment** or vitreous hemorrhage.

Q: In a worker engaged in stone breaking with a chisel and hammer, the most common foreign body which can be lodged in his eye is:

Particle from the chisel. ***Particle from the chisel*** - When a **chisel** is struck by a **hammer**, small fragments or splinters can break off from either tool due to the impact and wear, especially if the tools are made of **hardened steel**. - These high-velocity fragments are a common source of **intraocular foreign bodies** in occupations involving striking metals or stone, such as stone breaking. - The **chisel tip** experiences maximum stress during impact and is positioned directly between the hammer and stone, making its fragmentation the **most frequent cause** of penetrating ocular injury in this scenario. *Stone particle* - While **stone fragments** can be dislodged and enter the eye, they typically have lower velocity compared to metal fragments. - Stone particles more commonly cause **superficial corneal foreign bodies** rather than penetrating injuries. - The direct metal-on-metal impact between hammer and chisel produces more dangerous high-velocity projectiles. *Piece from the hammer* - A **hammer** can shed small pieces, particularly if worn or improperly hardened. - However, the chisel is positioned between the hammer and target, making chisel fragmentation more likely to be propelled towards the worker's eye. - Hammer fragments are less common than chisel fragments in this occupational setting. *Dust particle* - **Dust** and fine debris are common in stone-breaking work but typically cause minor **superficial irritation** rather than serious foreign body injuries. - Dust particles rarely penetrate the eye and are easily flushed out, unlike high-velocity metal fragments. - While dust exposure is frequent, it's not the **most common cause of significant ocular foreign body injury** requiring medical attention in this scenario.

Q: Diameter of the Vossius's ring is

Smaller than the normal pupil. ***Smaller than the normal pupil*** - The **Vossius's ring** is a deposition of pigment on the anterior lens capsule, formed by contact with the iris during trauma. - Due to the **constriction of the pupil** at the time of impact, the imprinting tends to be *smaller* than the resting pupil size. *Equal to normal pupil* - This is incorrect because the ring represents the imprint of the **pupillary margin** against the lens during a moment of **miosis (pupil constriction)** following trauma, not the normal resting pupil size. - The transient nature of the trauma-induced miosis means the imprinted diameter will be less than the typical **resting/normal pupil diameter**. *Much larger than the normal pupil* - This is incorrect because trauma usually causes **pupillary spasm and miosis**, which would result in a *smaller* imprint, not a larger one. - A larger imprint would imply a **dilated pupil** at the time of impact, which is contrary to the typical physiological response. *Slightly larger than the normal pupil* - This is incorrect as the trauma-induced **miosis** would make the imprint *smaller* than the normal pupil, not larger. - Even a slight increase in size would contradict the mechanism of formation, which involves temporary **pupillary constriction**.

Q: Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?

Traumatic iritis. ***Traumatic iritis*** - A **Vossius ring** is a circular pigment deposit on the anterior lens capsule, formed by the impact of the iris during **ocular trauma**. - Its presence is a clear indicator of **blunt globe trauma**, which often leads to traumatic iritis. *Angle closure glaucoma* - This condition involves an **acute increase in intraocular pressure** due to the iris blocking the drainage angle. - While it can cause severe pain and vision loss, it does not involve the formation of a **Vossius ring**. *Retinal detachment* - This condition involves the separation of the sensory retina from the underlying retinal pigment epithelium. - Symptoms include **flashing lights**, **floaters**, and a **"curtain" vision loss**, with no association with a Vossius ring. *Corneal ulcer* - A corneal ulcer is an **open sore on the cornea**, typically caused by infection or injury. - It presents with **pain**, **photophobia**, **redness**, and **discharge**, without the characteristic lens pigment deposit.

Q: A young 23-year-old black African man presents with a hyphema in the right eye after blunt injury. All of the following are acceptable initial treatments except?

Carbonic anhydrase inhibitor pressure drops. ***Carbonic anhydrase inhibitor pressure drops*** - **Carbonic anhydrase inhibitors** are generally avoided in patients with **sickle cell trait or disease** because they can cause **acidosis**, which may induce RBC sickling within the anterior chamber and worsen secondary hemorrhage or complications like **increased intraocular pressure (IOP)**. - The patient's presentation as a **young black African man** increases the suspicion for **sickle cell trait/disease**, making this treatment potentially harmful. *Sleep with the head elevated* - Elevating the head of the bed helps to settle red blood cells and debris inferiorly in the anterior chamber, which can prevent them from obstructing vision and potentially **reduce rebleeding rates**. - This position can also contribute to **reducing intraocular pressure** by promoting aqueous outflow and preventing pooling of blood. *Cyclopentolate dilating drops* - **Cyclopentolate** is a **cycloplegic agent** that helps to relieve ciliary spasm and pain associated with trauma. - It also dilates the pupil, which helps to prevent **posterior synechiae formation** (adhesions between the iris and lens) and allows for better examination of the fundus. *Prednisolone steroid eye drops* - **Topical corticosteroids** like prednisolone are used to reduce intraocular inflammation that often accompanies a hyphema. - Anti-inflammatory effects help to decrease the risk of **secondary hemorrhage** and improve overall healing by stabilizing damaged blood vessels.

Question 1

Name the condition shown in the image.

Accepted Answer

Gartner cyst

Answer

Bartholin cyst

Answer

Nabothian cyst

Answer

Chocolate cyst

Question 2

Perforating injuries with retained intraocular foreign body are more serious than those without because of:

Accepted Answer

Deleterious effects of foreign bodies

Answer

All of the options

Answer

More chances of infection

Answer

More chances of sympathetic ophthalmitis

Question 3

Sympathetic ophthalmia is due to

Accepted Answer

Penetrating trauma

Answer

Chemical injury

Answer

Blunt trauma

Answer

Retained intra ocular Iron foreign body

Question 4

A patient sustained blunt trauma to the eye, after which he developed sudden loss of vision with deep anterior chamber. Most likely cause is:

Accepted Answer

Lens dislocation

Answer

Retinal haemorrhage

Answer

Berlin's oedema

Answer

Recession of angle of AC

Question 5

In a patient with a metallic foreign body in the eye, which investigation should NOT be done?

Accepted Answer

MRI

Answer

X-ray

Answer

CT

Answer

USG

Question 6

In a worker engaged in stone breaking with a chisel and hammer, the most common foreign body which can be lodged in his eye is:

Accepted Answer

Particle from the chisel

Answer

Stone particle

Answer

Piece from the hammer

Answer

Dust particle

Question 7

Diameter of the Vossius's ring is

Accepted Answer

Smaller than the normal pupil

Answer

Equal to normal pupil

Answer

Much larger than the normal pupil

Answer

Slightly larger than the normal pupil

Question 8

Which of the following ophthalmologic conditions shows 'Vossius ring' during examination?

Accepted Answer

Traumatic iritis

Answer

Angle closure glaucoma

Answer

Retinal detachment

Answer

Corneal ulcer

Question 9

All are true about eight-ball hyphema EXCEPT

Accepted Answer

Blackball hyphema causes less pupillary block and less angle closure

Answer

AC completely filled with bright red blood is total hyphema, blackball hyphema if dark red blood

Answer

Also called Eight ball hyphema

Answer

The black colour is suggestive of impaired aqueous circulation and decreased oxygen

Question 10

A young 23-year-old black African man presents with a hyphema in the right eye after blunt injury. All of the following are acceptable initial treatments except?

Accepted Answer

Carbonic anhydrase inhibitor pressure drops

Answer

Sleep with the head elevated

Answer

Cyclopentolate dilating drops

Answer

Prednisolone steroid eye drops

Ocular Trauma — MCQs

Ocular Trauma — MCQs

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