Oculoplasty Practice Questions

Q: In congenital dacryocystitis, the blockage occurs at?

Nasolacrimal duct. ***Nasolacrimal duct*** - **Congenital dacryocystitis** is primarily caused by an obstruction in the **nasolacrimal duct**, specifically at the **valve of Hasner** at its distal end near the inferior meatus. - This blockage prevents the proper drainage of tears into the nasal cavity, leading to tear overflow (epiphora), mucoid discharge, and potential secondary infection. - Present in approximately **5-6% of newborns**, with most cases resolving spontaneously by 12 months of age. *Punctum* - Congenital **punctal agenesis** is rare and not the typical site of obstruction in congenital dacryocystitis. - The puncta are usually patent in this condition. *Lacrimal canaliculi* - Obstruction of the **lacrimal canaliculi** is uncommon in congenital cases. - Canalicular obstruction is more often acquired (trauma, infection, medications). *Lacrimal sac* - The **lacrimal sac** itself is not the site of primary obstruction in congenital dacryocystitis. - The sac may become distended due to downstream obstruction at the nasolacrimal duct.

Q: Hordeolum internum is?

Acute infection of Meibomian gland. ***Acute infection of Meibomian gland*** - A **hordeolum internum** is an acute, purulent infection of the **Meibomian glands**, which are sebaceous glands located within the tarsal plate of the eyelid. - The infection primarily manifests on the **inner surface of the eyelid** due to the gland's location, causing localized inflammation and pain. *Acute infection of Zeis gland* - An acute infection of a **Zeis gland** (a sebaceous gland connected to an eyelash follicle) is known as a **hordeolum externum**, or external stye. - Unlike a hordeolum internum, a **hordeolum externum** usually points externally at the lid margin. *Acute infection of Moll gland* - An acute infection of a **Moll gland** (apocrine sweat glands located near the lid margin) is also a type of **hordeolum externum**. - While it's an acute infection of an eyelid gland, it is not specifically referred to as a **hordeolum internum**. *Chronic infection of Zeis gland* - A chronic infection of a **Zeis gland** is not a typical designation for eyelid lesions; chronic inflammatory processes of sebaceous glands often lead to conditions like a **chalazion**, though chalazia are more commonly associated with Meibomian glands. - This option incorrectly identifies the gland for a hordeolum internum and specifies **chronic infection**, whereas a hordeolum is inherently **acute**.

Q: What is the preferred treatment for congenital ptosis with poor levator muscle function?

Muscle suspension technique. ***Muscle suspension technique*** - For congenital ptosis with **poor levator function** (typically 5 mm excursion). - It involves strengthening the existing levator muscle, which would be ineffective in cases of poor function. *Conservative management* - **Conservative management** is generally reserved for **mild ptosis** or when surgical intervention is not immediately necessary, often involving observation. - It is **not appropriate** for congenital ptosis with poor levator function that often leads to **amblyopia** if left untreated. *Direct muscle repair* - Direct muscle repair is not a standard term for ptosis surgery; surgical procedures like **levator resection** or **aponeurotic repair** modify the levator muscle. - In cases of **poor levator function**, directly repairing or strengthening a severely compromised muscle is **unlikely to yield effective eyelid elevation**.

Q: Bilateral ptosis is seen in all except which of the following?

Hyperthyroidism (Graves' disease). ***Hyperthyroidism (Graves' disease)*** - **Hyperthyroidism** causes eyelid retraction, leading to a **stare** or **lid lag**, rather than **ptosis**. - **Graves' ophthalmopathy** can cause proptosis (bulging eyes) and conjunctival injection, but does not typically manifest as ptosis. *Congenital* - **Congenital ptosis** is often present at birth due to improper development of the **levator palpebrae superioris muscle**. - It can be **bilateral** and is usually isolated, without other systemic symptoms. *Trauma* - **Traumatic ptosis** can occur if the **levator muscle**, **aponeurosis**, or **third cranial nerve** is damaged. - This can be **bilateral** depending on the nature and extent of the head trauma. *Myotonic dystrophy* - **Myotonic dystrophy** is a **hereditary muscle disorder** characterized by progressive muscle weakness. - **Bilateral ptosis** is a very common early sign of **myotonic dystrophy**, often accompanied by **facial weakness** and **myotonia**.

Q: Most common malignant tumour of eyelid is ?

Basal cell carcinoma. ***Basal cell carcinoma*** - **Basal cell carcinoma (BCC)** accounts for approximately 85-95% of all eyelid malignancies, making it the most common type. - It often presents as a **pearly nodule** with telangiectatic vessels, frequently affecting the lower eyelid. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the second most common eyelid malignancy, but it is significantly less frequent (5-10%) than BCC. - SCC has a **higher metastatic potential** compared to BCC. *Malignant melanoma* - **Malignant melanoma** is a rare but highly aggressive eyelid tumor, accounting for less than 1% of all eyelid malignancies. - It is characterized by its **pigmented appearance** and rapid growth pattern. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** is a relatively uncommon, but aggressive, tumor of the eyelid, comprising about 1-5% of cases. - It often mimics benign lesions like a **chalazion** or chronic blepharitis, leading to delayed diagnosis.

Q: Massaging of nasolacrimal duct is done in ?

Congenital dacryocystitis. ***Congenital dacryocystitis*** - **Massaging the nasolacrimal duct** (Crigler massage) is a primary treatment for congenital dacryocystitis to promote the opening of the **valve of Hasner**. - This condition is due to incomplete canalization of the nasolacrimal duct, leading to tearing and discharge in infants. *Acute dacryocystitis* - This is an **acute infection of the lacrimal sac**, and massaging can worsen the condition by spreading the infection. - Treatment typically involves **antibiotics** and, if necessary, incision and drainage of any abscess. *Conjunctivitis* - **Conjunctivitis** is inflammation of the conjunctiva and is not related to obstruction of the nasolacrimal duct. - Massaging the nasolacrimal duct has no therapeutic role in treating conjunctivitis. *None of the options* - This option is incorrect because **congenital dacryocystitis** is a condition where nasolacrimal duct massage is a standard and effective treatment.

Q: The commonest fungal lesion of the eyelid is:

None of the options. ***None of the options*** - The **commonest fungal lesion of the eyelid** is **dermatophytosis (tinea)**, caused by dermatophyte fungi such as *Trichophyton*, *Microsporum*, or *Epidermophyton*. - **Tinea palpebrae** or **tinea faciei** affecting the eyelid presents with **erythematous, scaly patches** with a **raised border**, often with itching. - Since dermatophytes are not listed among the options, **"None of the options"** is the correct answer. *Sporothrix* - **Sporotrichosis** of the eyelid is a **rare** lymphocutaneous infection following trauma with contaminated plant material. - While it can cause nodular lesions that ulcerate and spread along lymphatic channels, it is **not the most common** fungal eyelid infection. *Candida* - **Candidiasis** of the eyelid can occur but is less common than dermatophyte infections. - It typically affects **immunocompromised patients** or occurs as part of **angular blepharitis** or **candidal blepharoconjunctivitis**. *Aspergillosis* - **Aspergillosis** of the eyelid is **extremely rare** and usually represents extension from **invasive orbital or sinus disease** in severely immunocompromised patients. - It is an aggressive deep tissue infection rather than a common superficial eyelid lesion.

Q: What is the term for the plication of the lower lid retractors performed in lower lid surgery?

Quickert. ***Quickert*** - The **Quickert procedure** involves horizontal shortening of the lower lid combined with plication of the **lower lid retractors**, aiming to correct involutional entropion by tightening both horizontal and vertical components of the eyelid. - This technique directly addresses the underlying pathologies of involutional entropion, re-establishing the proper anatomical relationship between the eyelid margin and the globe. *Weiss* - The **Weiss procedure** typically refers to a full-thickness lid resecting procedure that is used to repair an eyelid defect, often after tumor removal or trauma. - It does not specifically involve plication of the lower lid retractors as its primary mechanism of action for correcting entropion. *Modified Wheeler's* - The **modified Wheeler procedure** for entropion involves an **orbicularis oculi muscle flap** to evert the lid margin. - While it addresses lower lid malposition, its primary mechanism is not the plication of the lower lid retractors, but rather the repositioning of the orbicularis muscle. *Jones* - The **Jones procedure** is primarily a technique to correct **conjunctivochalasis**, which is the redundant conjunctiva and not directly related to lower lid retractor plication. - It involves excising excess conjunctiva and does not typically focus on tightening the lower lid retractors for entropion correction.

Q: Which of the following medications is not associated with causing canalicular stenosis?

Atropine. ***Atropine*** - **Atropine** is an **anticholinergic drug** that primarily acts by blocking muscarinic acetylcholine receptors. It is not known to cause canalicular stenosis. - Its effects include pupillary dilation (mydriasis), reduction of secretions, and increased heart rate, with **no direct association with lacrimal drainage system damage**. *5-fluorouracil* - **5-fluorouracil** (5-FU) is a chemotherapeutic agent known to cause **canalicular stenosis** as a significant ocular side effect, particularly when administered systemically or periocularly. - The mechanism involves its cytotoxic effect on the **canalicular epithelium**, leading to inflammation and fibrosis. *Docetaxel* - **Docetaxel** is another chemotherapeutic agent that has been reported to cause **canalicular stenosis** and epiphora (excessive tearing). - Its mechanism of action involves microtubule stabilization, which can lead to damage and inflammation of the **lacrimal drainage system**. *Epinephrine* - Topical **epinephrine** eye drops, particularly when used long-term for conditions like glaucoma, are associated with the risk of **canalicular stenosis**. - Its metabolism can lead to the formation of **pigmentary deposits** (melanin-like) within the canaliculi, causing obstruction and inflammation.

Question 1

In congenital dacryocystitis, the blockage occurs at?

Accepted Answer

Nasolacrimal duct

Answer

Punctum

Answer

Lacrimal canaliculi

Answer

Lacrimal sac

Question 2

Hordeolum internum is?

Accepted Answer

Acute infection of Meibomian gland

Answer

Chronic infection of Zeis gland

Answer

Acute infection of Moll gland

Answer

Acute infection of Zeis gland

Question 3

What is the preferred treatment for congenital ptosis with poor levator muscle function?

Accepted Answer

Muscle suspension technique

Answer

Muscle advancement procedure

Answer

Conservative management

Answer

Direct muscle repair

Question 4

Bilateral ptosis is seen in all except which of the following?

Accepted Answer

Hyperthyroidism (Graves' disease)

Answer

Trauma

Answer

Congenital

Answer

Myotonic dystrophy

Question 5

Most common malignant tumour of eyelid is ?

Accepted Answer

Basal cell carcinoma

Answer

Malignant melanoma

Answer

Squamous cell carcinoma

Answer

Sebaceous gland carcinoma

Question 6

Massaging of nasolacrimal duct is done in ?

Accepted Answer

Congenital dacryocystitis

Answer

Acute dacryocystitis

Answer

Conjunctivitis

Answer

None of the options

Question 7

The commonest fungal lesion of the eyelid is:

Accepted Answer

None of the options

Answer

Aspergillosis

Answer

Candida

Answer

Sporothrix

Question 8

What does the term 'telecanthus' refer to?

Accepted Answer

Increased distance between medial canthi with normal interpupillary distance

Answer

Increased distance between the eyes

Answer

Separation of the medial orbital walls

Answer

Separation of the nose from the medial canthi

Question 9

What is the term for the plication of the lower lid retractors performed in lower lid surgery?

Accepted Answer

Quickert

Answer

Weiss

Answer

Modified Wheeler's

Answer

Jones

Question 10

Which of the following medications is not associated with causing canalicular stenosis?

Accepted Answer

Atropine

Answer

Docetaxel

Answer

Epinephrine

Answer

5-fluorouracil

Oculoplasty — MCQs

Oculoplasty — MCQs

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