Oculoplasty — MCQs

Oculoplasty Indian Medical PG Practice Questions and MCQs

Question 71: Surgery of choice for chronic acquired dacryocystitis

A. Dacryocystorhinostomy (Correct Answer)
B. Dacryocystectomy
C. Conjunctivo-cystorhinostomy
D. None of the options

Explanation: ***Dacryocystorhinostomy*** - This procedure creates a new connection between the **lacrimal sac** and the **nasal cavity**, bypassing the obstructed nasolacrimal duct. - It is the **surgery of choice** for chronic acquired dacryocystitis as it provides a permanent solution for tear drainage. *Dacryocystectomy* - This involves **excision of the lacrimal sac**, which can relieve symptoms of infection but eliminates the sac's function. - It is generally reserved for cases where dacryocystorhinostomy is contraindicated or has failed, and is **not the primary choice** for restoring tear flow. *Conjunctivo-cystorhinostomy* - This procedure creates a bypass from the **conjunctiva** directly to the **nasal cavity**, typically used when the canaliculi are also obstructed. - It is a more complex surgery indicated for **proximal lacrimal system obstruction** (e.g., canalicular block) rather than isolated nasolacrimal duct obstruction. *None of the options* - **Dacryocystorhinostomy** is the well-established and most effective surgical intervention for chronic acquired dacryocystitis. - Therefore, this option is incorrect as there is a suitable surgical choice available.

Question 72: Bilateral ptosis is seen in all except which of the following?

A. Trauma
B. Hyperthyroidism (Graves' disease) (Correct Answer)
C. Congenital
D. Myotonic dystrophy

Explanation: ***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**.

Question 73: Most common malignant tumour of eyelid is ?

A. Basal cell carcinoma (Correct Answer)
B. Malignant melanoma
C. Squamous cell carcinoma
D. Sebaceous gland carcinoma

Explanation: ***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.

Question 74: The commonest fungal lesion of the eyelid is:

A. Aspergillosis
B. Candida
C. Sporothrix
D. None of the options (Correct Answer)

Explanation: ***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.

Question 75: What is the term for the plication of the lower lid retractors performed in lower lid surgery?

A. Weiss
B. Modified Wheeler's
C. Quickert (Correct Answer)
D. Jones

Explanation: ***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.

Question 76: Which of the following medications is not associated with causing canalicular stenosis?

A. Docetaxel
B. Epinephrine
C. Atropine (Correct Answer)
D. 5-fluorouracil

Explanation: ***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 77: 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?

A. Diplopia may occur
B. Response rate is over 95% (Correct Answer)
C. Botulinum toxin type A is the most effective treatment.
D. Need repeat injections

Explanation: ***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 78: Stye is a suppurative inflammation of which gland?

A. Meibomian
B. Lacrimal
C. Zeis (Correct Answer)
D. Gland of Moll

Explanation: ***Zeis*** - A **stye (hordeolum externum)** is an acute suppurative inflammation of the **sebaceous glands of Zeis**, which are associated with the eyelash follicles at the eyelid margin. - This infection typically presents as a painful, red, swollen lump on the eyelid margin. - The **glands of Zeis are the most commonly affected** and are classically cited as the cause of external hordeolum. *Meibomian* - Inflammation of the **Meibomian glands** (which are modified sebaceous glands located within the tarsal plate) causes an **internal hordeolum** when acutely infected. - A **chalazion** is a chronic, non-tender, sterile granulomatous inflammation of the Meibomian gland, distinct from the acute infection of internal hordeolum. - Both conditions affect the deeper structures of the eyelid, not the eyelid margin like an external hordeolum. *Lacrimal* - The **lacrimal gland** produces tears and its inflammation is called **dacryoadenitis**. - Dacryoadenitis presents as swelling and pain in the **superotemporal aspect of the orbit**, not on the eyelid margin as with a stye. *Gland of Moll* - The **glands of Moll** are modified apocrine sweat glands located near the eyelash follicles at the eyelid margin. - While infections of Moll's glands can also present as external hordeolum clinically, the **classical definition of a stye specifically refers to infection of the sebaceous glands of Zeis**. - In practice, both Zeis and Moll gland infections present identically and are managed the same way.

Question 79: In congenital ptosis, surgery should be performed at the earliest to prevent amblyopia. Which of the following operations is not typically used for the correction of congenital ptosis?

A. Blaskowics' operation
B. Everbusch's operation
C. Frontalis sling operation
D. Modified Burrow's operation (Correct Answer)

Explanation: ***Modified Burrow's operation*** - The **Modified Burrow's operation** is primarily used in oculoplastic surgery for the correction of **entropion** or **ectropion**, and to resect redundant skin and muscle, not for ptosis correction. - It involves removing a strip of skin and orbicularis muscle, which does not address the underlying levator muscle weakness or disinsertion typical of congenital ptosis. *Blaskowics' operation* - This procedure involves an **anterior approach** to resect and advance the **levator aponeurosis** and Müller's muscle. - It is used for **mild to moderate congenital ptosis** with residual levator function (levator function >4-5 mm). *Everbusch's operation* - An **external approach** to resect the **levator muscle** or aponeurosis to elevate the eyelid. - It is used for **moderate congenital ptosis** where there is some residual levator function. *Frontalis sling operation* - This is a **suspension procedure** that connects the eyelid to the **frontalis muscle** using autogenous fascia lata, silicone rod, or other materials. - It is the procedure of choice for **severe congenital ptosis with poor levator function** (<4 mm), allowing the patient to use the frontalis muscle to elevate the eyelid.

Question 80: Distichiasis is a condition characterized by:

A. Abnormal inversion of eyelashes
B. Abnormal extra row of cilia (Correct Answer)
C. Abnormal eversion of eyelashes
D. Misdirected cilia

Explanation: ***Abnormal extra row of cilia*** - **Distichiasis** is a congenital or acquired condition characterized by the presence of a double row of eyelashes, where the extra row emerges from the **Meibomian gland orifices**. - These accessory eyelashes can be the same length as normal lashes or appear finer and shorter, often causing **ocular irritation**, corneal abrasion, and epiphora due to their abnormal growth direction. *Abnormal inversion of eyelashes* - This description typically refers to **trichiasis**, where normally positioned eyelashes grow inwards towards the eye. - While both can cause irritation, **trichiasis** involves misdirection of existing lashes, whereas distichiasis involves an *extra* row. *Abnormal eversion of eyelashes* - Eversion of eyelashes is not a recognized abnormality in this context; rather, **ectropion** refers to the outward turning of the eyelid margin, which may expose the eyelashes but is not a primary cilial abnormality. - This condition is more about eyelid positioning than the eyelashes themselves. *Misdirected cilia* - While distichiasis does involve cilia growing in an abnormal direction, the key feature of distichiasis is the presence of an *additional* row of lashes, not just misdirection of the primary row. - **Trichiasis** is the more appropriate term for misdirected cilia from the normal lash line.

Practice by Chapter

Eyelid Anatomy and Physiology

Practice Questions

Ptosis

Practice Questions

Entropion and Ectropion

Practice Questions

Eyelid Tumors

Practice Questions

Facial Nerve Palsy

Practice Questions

Blepharospasm and Hemifacial Spasm

Practice Questions

Blepharitis and Meibomian Gland Dysfunction

Practice Questions

Lacrimal System Disorders

Practice Questions

Orbital Inflammations

Practice Questions

Orbital Tumors

Practice Questions

Thyroid Eye Disease

Practice Questions

Anophthalmic Socket Management

Practice Questions

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