Ocular Trauma — MCQs

Q: The commonest cause of vitreous hemorrhage in young adults is:

Trauma. ***Trauma*** - **Ocular trauma** is the **leading cause of vitreous hemorrhage in young adults** (age <40 years), directly damaging retinal blood vessels or causing retinal tears resulting in bleeding into the vitreous. - This can include blunt or penetrating injuries, leading to the sudden onset of **decreased vision** and **floaters**. - In younger populations, trauma accounts for the majority of vitreous hemorrhage cases. *Diabetes* - **Diabetic retinopathy**, characterized by fragile new blood vessels (**neovascularization**), is the **commonest cause overall in older populations** and across all age groups combined. - These abnormal vessels (proliferative diabetic retinopathy) can rupture easily, particularly with sudden increases in intraocular pressure, Valsalva maneuvers, or during sleep. - However, in young adults specifically, trauma surpasses diabetes as the primary etiology. *Hypertension* - While **severe hypertension** can lead to retinal hemorrhages, it is a less common direct cause of vitreous hemorrhage compared to other etiologies. - Hypertensive retinopathy primarily affects the retinal vessels, which less frequently rupture into the vitreous cavity. *Lens extraction* - Complications from **cataract surgery** (lens extraction) can sometimes include vitreous hemorrhage, but this is a relatively rare occurrence. - It's typically due to iatrogenic damage to retinal vessels during the surgical procedure or rupture of pre-existing **fragile neovascular vessels** in patients with uncontrolled diabetes.

Q: Hyphaema, or blood in the anterior chamber, is suggestive of:

Intraocular trauma. ***Intraocular trauma*** - **Hyphaema**, or blood in the **anterior chamber**, is a classic sign of **intraocular trauma**, where eye structures are damaged, leading to bleeding. - This can result from blunt force or penetrating injuries that rupture blood vessels within the **iris, ciliary body**, or other anterior segment structures. *Posterior uveitis* - Posterior uveitis involves inflammation of the **choroid and retina**, not typically causing bleeding into the **anterior chamber**. - It presents with symptoms like **floaters** and **decreased vision**, without direct hyphaema. *Capillary hemangioma of the lid* - A capillary hemangioma is a **benign vascular tumor** on the eyelid and does not cause **intraocular bleeding** into the anterior chamber. - While it can disrupt vision by blocking the visual axis, it is an **external lesion**. *High grade myopia* - High grade myopia leads to a **stretched globe** and **retinal thinning**, increasing the risk of **retinal detachment** or **macular degeneration**. - It does not directly cause **hyphaema**, which is an anterior chamber bleeding event.

Q: The most toxic intraocular foreign body is a particle of:

Copper. ***Copper*** - **Copper** is considered the most toxic intraocular foreign body due to its rapid and severe inflammatory reaction, leading to **chalcosis oculi**. - This reaction can cause significant damage to ocular structures, such as the retina and optic nerve, resulting in **vision loss**. *Iron* - **Iron** foreign bodies cause **siderosis oculi**, a slower but progressive degeneration of ocular tissues due to iron deposition. - While damaging, **siderosis** is generally less acutely destructive than chalcosis oculi caused by copper. *Tantalum* - **Tantalum** is a relatively **inert** material and generally causes minimal to no inflammatory reaction when retained intraocularly. - It is often used in medical implants due to its **biocompatibility**. *Aluminium* - **Aluminium** is largely considered an **inert** intraocular foreign body, similar to tantalum. - It typically causes little to no inflammatory response and is less likely to lead to significant ocular damage.

Practice by Chapter

Classification of Ocular Trauma

Practice Questions

Blunt Trauma

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Penetrating and Perforating Injuries

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Intraocular Foreign Bodies

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Chemical Injuries

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Thermal and Radiation Injuries

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Orbital Trauma

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Traumatic Optic Neuropathy

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Ocular Manifestations of Child Abuse

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Sports-Related Eye Injuries

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Ocular Trauma Management Principles

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Rehabilitation After Ocular Trauma

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