Oculoplasty Practice Questions

Q: A patient with ptosis, where the upper eyelid covers 4 mm of the cornea, is classified as having which grade of ptosis?

Moderate. ***Moderate*** - A ptosis in which the upper eyelid covers **4 mm of the cornea** is classified as **moderate ptosis**. - Moderate ptosis often correlates with a **margin-reflex distance 1 (MRD1)** between 1 to 2 mm. *Mild* - **Mild ptosis** is defined by the upper eyelid covering **2 mm or less of the cornea**. - This corresponds to an **MRD1 measurement** of 3 mm or more. *Severe* - **Severe ptosis** typically involves the upper eyelid covering **5 mm or more of the cornea**. - This degree of ptosis is associated with an **MRD1 of 0 mm or less**. *Profound* - "Profound" is not a standard grading term for ptosis based on precise corneal coverage measurements. - Ptosis is generally categorized as mild, moderate, or severe based on the extent of **corneal obstruction** or **MRD1**.

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: 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: 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: 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.

Q: A 24-year-old girl with a history of head trauma presented with multiple lacerations on the face and eyelids and a base of skull fracture. It was noticed she wasn't able to pass tears. The probable cause is injury to-

Inferior Canaliculus. ***Inferior Canaliculus*** - The **inferior canaliculus** is a common site of injury given its anatomical position and the common mechanisms of trauma to the eyelids. Obstruction or laceration of this structure can prevent tears from draining into the nasolacrimal sac, leading to **epiphora** (overflowing tears). - Given the patient's **multiple lacerations on the eyelids** and inability to pass tears, injury to the drainage system, specifically the inferior canaliculus, is the most probable cause. *Lacrimal Gland* - The **lacrimal gland** is responsible for producing tears. An injury to the lacrimal gland would typically result in a **decrease in tear production**, rather than an inability to pass existing tears. - While head trauma can affect the lacrimal gland, the symptom of "not able to pass tears" specifically points to a problem with the **tear drainage system**. *Superior Canaliculus* - The **superior canaliculus** also plays a role in tear drainage, but it contributes less significantly than the inferior canaliculus, especially in maintaining basal tear drainage. - While injury to the superior canaliculus can impair tear drainage, the **inferior canaliculus** is typically the primary route and its obstruction would more readily result in noticeable issues with tear passage. *Upper eyelid* - Lacerations to the **upper eyelid** itself, without affecting the lacrimal drainage structures, would primarily cause cosmetic deformities, swelling, or visual obstruction. - An isolated injury to the upper eyelid generally would not prevent the passage of tears unless it directly involved the lacrimal gland's ducts (unlikely) or caused severe swelling that secondarily obstructed the drainage system.

Q: A middle-aged female is having essential blepharospasm and is planned to be treated with botulinum toxin. Which of the following statements is not true regarding the treatment?

Response rate is over 95%. ***Response rate is over 95%*** - While botulinum toxin is highly effective for **essential blepharospasm**, the response rate typically ranges from **70-90%**, not over 95%. - A response rate this high is optimistic and not universally observed in clinical practice. *Need repeat injections* - **Botulinum toxin** effects are temporary, usually lasting for **3 to 4 months**, necessitating repeat injections for sustained relief. - The medication works by temporarily **paralyzing the orbicularis oculi muscle**, and as its effect wears off, symptoms recur. *Diplopia may occur* - **Diplopia** (double vision) can occur as a side effect if the toxin spreads to affect adjacent extraocular muscles, particularly the **superior rectus muscle**. - This is a known, though generally uncommon, complication of injections around the eye. *Botulinum toxin type A is the most effective treatment.* - **Botulinum toxin type A** (e.g., Botox, Xeomin, Dysport) is considered the **first-line and most effective treatment** for essential blepharospasm. - It works by blocking the release of **acetylcholine** at the neuromuscular junction, reducing involuntary muscle spasms.

Question 1

A patient with ptosis, where the upper eyelid covers 4 mm of the cornea, is classified as having which grade of ptosis?

Accepted Answer

Moderate

Answer

Severe

Answer

Profound

Answer

Mild

Question 2

Massaging of nasolacrimal duct is done in ?

Accepted Answer

Congenital dacryocystitis

Answer

Acute dacryocystitis

Answer

Conjunctivitis

Answer

None of the options

Question 3

Most common malignant tumour of eyelid is ?

Accepted Answer

Basal cell carcinoma

Answer

Malignant melanoma

Answer

Squamous cell carcinoma

Answer

Sebaceous gland carcinoma

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

The commonest fungal lesion of the eyelid is:

Accepted Answer

None of the options

Answer

Aspergillosis

Answer

Candida

Answer

Sporothrix

Question 6

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 7

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 8

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

Accepted Answer

Atropine

Answer

Docetaxel

Answer

Epinephrine

Answer

5-fluorouracil

Question 9

A 24-year-old girl with a history of head trauma presented with multiple lacerations on the face and eyelids and a base of skull fracture. It was noticed she wasn't able to pass tears. The probable cause is injury to-

Accepted Answer

Inferior Canaliculus

Answer

Lacrimal Gland

Answer

Superior Canaliculus

Answer

Upper eyelid

Question 10

A middle-aged female is having essential blepharospasm and is planned to be treated with botulinum toxin. Which of the following statements is not true regarding the treatment?

Accepted Answer

Response rate is over 95%

Answer

Diplopia may occur

Answer

Botulinum toxin type A is the most effective treatment.

Answer

Need repeat injections

Oculoplasty — MCQs

Oculoplasty — MCQs

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