Rehabilitation After Ocular Trauma — MCQs
A case of injury to right brow due to a fall from scooter presents with sudden loss of vision in the right eye. The pupil shows absent direct reflex but a normal consensual pupillary reflex is present. The fundus is normal. The treatment of choice is:
A patient presents with acute appendicitis. What is NOT to be done?
Which of the following is the first visual field defect in open-angle glaucoma?
Which of the following is not a standard treatment for myopia?
In infants of diabetic mothers (IDM), when is ophthalmologic evaluation indicated?
A 25-year-old person developed right corneal opacity following injury to the eye. Keratoplasty of right eye was done and vision was restored. Medico-legally such injury is:
Sympathetic ophthalmia is due to
Berlin's edema is due to
Hyphaema, or blood in the anterior chamber, is suggestive of:
True about acid injury to eye are all except?
Rehabilitation After Ocular Trauma Indian Medical PG Practice Questions and MCQs
Question 1: A case of injury to right brow due to a fall from scooter presents with sudden loss of vision in the right eye. The pupil shows absent direct reflex but a normal consensual pupillary reflex is present. The fundus is normal. The treatment of choice is:
- A. Pulse methyl Prednisolone 250 mg four times daily for three days
- B. Emergency optic canal decompression
- C. Oral Prednisolone 1.5 mg/kg body weight
- D. Intensive intravenous corticosteroids as prescribed for spinal injuries to be instituted within six hours (Correct Answer)
Explanation: ***Intensive intravenous corticosteroids as prescribed for spinal injuries to be instituted within six hours*** - The sudden **loss of vision** with a **traumatic brow injury** and **afferent pupillary defect** (absent direct reflex, normal consensual) suggests **traumatic optic neuropathy (TON)**. - While the efficacy of corticosteroids is debated, high-dose intravenous corticosteroids, often following the **National Acute Spinal Cord Injury Study (NASCIS)** protocols (similar to spinal injury treatment), are a common initial treatment for TON, especially when administered within 6-8 hours of injury to reduce inflammation and edema around the optic nerve. *Pulse methyl Prednisolone 250 mg four times daily for three days* - This dosage regimen is a form of **pulse steroid therapy**, but the specific dose and frequency may not align with the standard high-dose IV corticosteroid protocols used for TON (e.g., typically 1g methylprednisolone daily). - While corticosteroids are used, the precise protocol and optimal dosing for TON are critical and vary from this option. *Emergency optic canal decompression* - **Optic canal decompression surgery** is considered in cases of TON where there is direct compression of the optic nerve or a lack of response to corticosteroid therapy. - It is not the initial treatment of choice for all TON cases and carries significant surgical risks; corticosteroid therapy is usually attempted first. *Oral Prednisolone 1.5 mg/kg body weight* - **Oral corticosteroids** are generally not sufficient for the acute, severe inflammation seen in traumatic optic neuropathy. - **Intravenous administration** is preferred for its rapid and higher systemic bioavailability to achieve therapeutic levels at the optic nerve.
Question 2: A patient presents with acute appendicitis. What is NOT to be done?
- A. Give antibiotics
- B. Do primary survey
- C. Perform appendectomy
- D. Check for visual acuity (Correct Answer)
Explanation: ***Check for visual acuity*** - **Visual acuity** assessment is not relevant to the diagnosis or management of **acute appendicitis**. - This examination is typically performed in cases of suspected eye injury, vision changes, or neurological issues that affect vision. - In the context of acute appendicitis, checking visual acuity would be inappropriate and waste valuable time. *Give antibiotics* - **Antibiotics** are crucial in managing **acute appendicitis** to prevent progression to perforation and reduce postoperative infection risk. - They are typically administered preoperatively and continued postoperatively, especially in cases of complicated appendicitis. - Broad-spectrum antibiotics covering **gram-negative organisms and anaerobes** are standard practice. *Do primary survey* - A **primary survey** (ABCDE approach) is essential in any emergent patient presentation to assess and manage immediate **life-threatening conditions**. - While appendicitis itself may not be immediately life-threatening, ensuring patient stability and ruling out other serious conditions is critical. - This is standard emergency medicine practice and should always be performed. *Perform appendectomy* - **Appendectomy** (surgical removal of the appendix) is the definitive treatment for **acute appendicitis**. - This is the standard of care and should be performed once the diagnosis is confirmed and the patient is stable. - Either open or laparoscopic approach can be used depending on clinical factors and surgeon expertise.
Question 3: Which of the following is the first visual field defect in open-angle glaucoma?
- A. Ring scotoma
- B. Paracentral scotoma (Correct Answer)
- C. Bitemporal hemianopia
- D. Tunnel vision
Explanation: ***Paracentral scotoma*** - This is the **earliest visual field defect** detected in open-angle glaucoma, typically appearing in the **Bjerrum area** (10-20° from fixation). - Most commonly occurs as a **superior or inferior arcuate scotoma** in the nasal field. - Results from damage to the **retinal nerve fiber layer** around the **optic disc**, which is particularly vulnerable to elevated intraocular pressure. - These scotomas respect the **horizontal raphe** and follow the arcuate nerve fiber bundle pattern. *Ring scotoma* - A **ring scotoma** (Bjerrum scotoma) typically occurs later in the progression of glaucoma, when superior and inferior arcuate defects coalesce to form a ring-like pattern. - This represents **advanced glaucomatous damage** and is not an early finding. *Bitemporal hemianopia* - This visual field defect is characteristic of **optic chiasm compression**, commonly due to a **pituitary tumor** or other suprasellar lesions. - It is **not associated with glaucoma**, which causes damage to the optic nerve fibers within the eye, not at the chiasm. *Tunnel vision* - **Tunnel vision** represents severe, **end-stage glaucoma**, where only a small central island of vision remains. - It indicates extensive loss of peripheral visual field and is a late finding, not an early one.
Question 4: Which of the following is not a standard treatment for myopia?
- A. Phakic intraocular lens
- B. Radial Keratotomy
- C. Holmium laser thermoplasty (Correct Answer)
- D. LASIK
Explanation: ***Holmium laser thermoplasty*** - This procedure was explored for the treatment of **hyperopia**, not myopia, as it aims to steepen the cornea to increase its refractive power. - It involves using a holmium laser to apply heat to the peripheral cornea, causing **collagen shrinkage** and steepening, which is the opposite of what is needed for myopia correction. *LASIK* - **LASIK (Laser-Assisted in Situ Keratomileusis)** is a common and effective surgical procedure for correcting myopia by reshaping the cornea to reduce its refractive power. - It involves creating a **corneal flap** and using an excimer laser to remove tissue from the underlying stromal bed. *Phakic intraocular lens* - **Phakic intraocular lenses (IOLs)** are implanted into the eye without removing the natural lens and are a standard treatment for moderate to high myopia, especially in patients not suitable for LASIK. - They work by adding refractive power to the eye, allowing light to focus correctly on the retina. *Radial Keratotomy* - **Radial Keratotomy (RK)** was an early surgical procedure for myopia, involving making radial incisions in the cornea to flatten it and reduce its refractive power. - Although largely replaced by LASIK due to its unpredictable outcomes and potential for glare and night vision problems, it was historically a standard treatment for myopia.
Question 5: In infants of diabetic mothers (IDM), when is ophthalmologic evaluation indicated?
- A. At the time of diagnosis
- B. Only if visual symptoms develop (Correct Answer)
- C. After 5 years routinely
- D. After developing diabetes
Explanation: ***Only if visual symptoms develop*** - Unlike **retinopathy of prematurity**, infants of diabetic mothers (IDMs) do not have a higher incidence of **retinopathy** or other **ocular abnormalities** at birth or in early infancy. - **Ophthalmologic evaluation** is generally reserved for IDMs who develop specific **visual symptoms** or signs of ocular pathology. *At the time of diagnosis* - Routine ophthalmologic screening at the time of diagnosis of IDM is **not standard practice**, as the risk of **congenital ocular anomalies** is not substantially elevated to warrant universal screening. - Initial management focuses on metabolic stability, especially **glucose control**, and screening for other common IDM-related complications like **cardiac defects** or **respiratory distress**. *After 5 years routinely* - There is **no evidence or recommendation** for routine ophthalmologic screening of IDMs specifically at the age of 5 years. - Regular **well-child check-ups** include basic vision screening, which would identify significant refractive errors or strabismus, but not specifically for diabetes-related ocular issues. *After developing diabetes* - While it is true that individuals with **type 1 or type 2 diabetes** require regular **ophthalmologic evaluations** for **diabetic retinopathy**, this refers to the child developing diabetes later in life, not being an IDM. - Being an IDM is a **risk factor for developing diabetes** later in life, but it doesn't automatically mean they have diabetes-related ocular issues from birth.
Question 6: A 25-year-old person developed right corneal opacity following injury to the eye. Keratoplasty of right eye was done and vision was restored. Medico-legally such injury is:
- A. Dangerous
- B. Grievous
- C. Simple (Correct Answer)
- D. Non-grievous
Explanation: ***Simple*** - The injury resulted in corneal opacity that was **successfully treated with keratoplasty and vision was restored**. - Under IPC Section 320, **grievous hurt** requires **permanent privation of sight**, not temporary visual impairment. - Since vision was restored after treatment, there is **no permanent damage**, making this a **simple injury**. - Simple injuries may require medical treatment and cause temporary incapacitation, but do not result in permanent impairment. *Grievous* - Grievous hurt under IPC Section 320 includes **permanent privation of the sight of either eye**. - The key word is **permanent** - since vision was restored after keratoplasty, the visual loss was temporary, not permanent. - This injury does not meet the criteria for grievous hurt despite requiring surgical intervention. *Dangerous* - "Dangerous" is not a specific medico-legal classification of injury under IPC Section 320. - This term may describe the potential severity but is not used to categorize injuries legally. *Non-grievous* - While technically correct (as non-grievous means not grievous), the proper legal term is **"simple injury"**. - In medico-legal practice, injuries are classified as either grievous or simple, not as "non-grievous".
Question 7: Sympathetic ophthalmia is due to
- A. Chemical injury
- B. Blunt trauma
- C. Retained intra ocular Iron foreign body
- D. Penetrating trauma (Correct Answer)
Explanation: ***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**.
Question 8: Berlin's edema is due to
- A. Blunt trauma to eye (Correct Answer)
- B. Choroidal melanoma
- C. Pars planitis
- D. Extradural hemorrhage
Explanation: ***Blunt trauma to eye*** - **Berlin's edema**, also known as **commotio retinae**, is a form of **retinal edema** that occurs after **blunt trauma to the eye**. - The trauma causes a disruption of the photoreceptor outer segments and retinal pigment epithelium, leading to extracellular and intracellular fluid accumulation. *Choroidal melanoma* - This is a **malignant tumor** arising from the melanocytes in the choroid, not caused by trauma. - Presents as a pigmented mass in the choroid and can lead to **retinal detachment** or **vision loss** due to tumor growth. *Pars planitis* - This is a form of **intermediate uveitis**, characterized by inflammation of the pars plana, ciliary body, and peripheral retina. - It is an **inflammatory condition**, not directly caused by acute trauma, and often presents with **floaters** and **blurred vision**. *Extradural hemorrhage* - This refers to bleeding between the inner surface of the skull and the dura mater, typically in the brain. - It is a **neurological emergency** usually caused by head injury, and its direct effect is not Berlin's edema in the eye.
Question 9: Hyphaema, or blood in the anterior chamber, is suggestive of:
- A. Intraocular trauma (Correct Answer)
- B. Posterior uveitis
- C. Capillary hemangioma of the lid
- D. High grade myopia
Explanation: ***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.
Question 10: True about acid injury to eye are all except?
- A. more destructive than alkali injuries (Correct Answer)
- B. steroids are used to control inflammation
- C. makes a barrier and prevent deeper penetration
- D. glaucoma is most preventable complication following acid injury
Explanation: ***more destructive than alkali injuries*** - This statement is **false**. **Alkali burns** are generally more severe than acid burns because alkalis have **liquefactive necrosis**, which allows them to penetrate deeper into ocular tissues. - Acids cause **coagulative necrosis**, which forms a protective barrier that limits further penetration, making them typically less destructive than alkali injuries. *steroids are used to control inflammation* - **Topical corticosteroids** are commonly used in the management of ocular chemical burns, including acid injuries, to help **control inflammation** and reduce the risk of secondary complications. - However, their use must be carefully monitored due to potential side effects like increased intraocular pressure and delayed corneal healing. *makes a barrier and prevent deeper penetration* - **Acidic substances** cause **coagulative necrosis** of the superficial tissues, which creates a protective barrier of denatured proteins. - This barrier helps to prevent the acid from penetrating deeper into the ocular structures, thus often limiting the extent of damage compared to alkali burns. *glaucoma is most preventable complication following acid injury* - **Glaucoma** is indeed a significant complication of ocular acid injuries and can be prevented through **immediate copious irrigation**, control of inflammation, and monitoring of intraocular pressure. - While various complications can occur (corneal opacification, symblepharon, limbal stem cell deficiency), glaucoma prevention through early intervention and appropriate medical management is a key focus in acute management, making this statement acceptable as true.
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