Oculoplastic Surgeries — MCQs
Blow out fracture of orbit commonly involves:-
Which surgery is indicated for ptosis in Horner's syndrome?
The primary indication for enucleation is:
Surgery of choice for chronic acquired dacryocystitis
The SAFE strategy is used for elimination of?
Fasanella-Servat operation is done for:
Distichiasis is a condition characterized by:
The muscle first affected in thyroid ophthalmopathy is:
What is the most common malignant tumour of eyelid?
Massaging of nasolacrimal duct is done in ?
Oculoplastic Surgeries Indian Medical PG Practice Questions and MCQs
Question 1: Blow out fracture of orbit commonly involves:-
- A. Medial wall is involved first as it is the thinnest
- B. Floor is involved first (Correct Answer)
- C. Roof is involved first as it bears the maximum impact
- D. The patient is not able to look up due to inferior rectus entrapment
Explanation: ***Floor is involved first*** - The **orbital floor** (composed mainly of the maxillary bone and portions of the palatine and zygomatic bones) is the most common site for a **blowout fracture** due to its relative weakness. - Trauma to the globe increases **intraorbital pressure**, causing the weakest part of the orbit, which is commonly the floor, to fracture and displace fragments into the maxillary sinus. *Medial wall is involved first as it is the thinnest* - While the **medial wall** (primarily the lacrimal bone and the lamina papyracea of the ethmoid bone) is indeed the **thinnest** portion of the orbit, it is structurally supported by the ethmoid air cells, making it less prone to fracture from direct globe impact compared to the floor. - Fractures of the medial wall can occur but are less common as the primary site of injury than the orbital floor. *The patient is not able to look up due to inferior rectus entrapment* - While **inferior rectus muscle** entrapment in orbital floor fractures does cause restricted upward gaze, this is a **complication** of the fracture, not what the fracture "commonly involves" anatomically. - The question asks which **anatomical structure** is commonly involved, not the clinical presentation. - Inferior rectus entrapment occurs in blowout fractures but doesn't answer which orbital wall is most commonly fractured. *Roof is involved first as it bears the maximum impact* - The **orbital roof** (formed by the frontal bone) is the strongest part of the orbit and rarely fractures from globe impact alone; it typically requires high-energy trauma to the forehead. - If the roof were involved, it would likely be due to direct impact to the supraorbital region, not from compression of the globe which usually affects the floor or medial wall.
Question 2: Which surgery is indicated for ptosis in Horner's syndrome?
- A. Blaskovics operation
- B. Frontalis sling
- C. Levator resection
- D. Fasanella-Servat (Correct Answer)
Explanation: ***Fasanella - servat*** - This procedure involves resecting the **tarsus**, **Müller's muscle**, and conjunctiva, effectively shortening the posterior lamella of the eyelid. - It is particularly useful for **mild ptosis** with good levator function, often seen in cases secondary to sympathetic denervation like **Horner's syndrome**. *Blaskovics operation* - This is a more complex external approach that involves the resection of the **levator aponeurosis** and Müller's muscle, which is generally reserved for more severe ptosis. - It is typically indicated for patients with **poor levator function** or significant ptosis that cannot be corrected by less invasive methods. *Frontalis sling* - This procedure is used for severe ptosis with **very poor or absent levator function**, often seen in congenital ptosis or oculomotor nerve palsy. - It involves using a sling material to connect the eyelid to the **frontalis muscle**, allowing the eyebrow to lift the eyelid. *Levator resection* - This operation is performed when there is moderate to severe ptosis with **some levator function** present. - It involves shortening the **levator palpebrae superioris muscle** to elevate the eyelid margin.
Question 3: The primary indication for enucleation is:
- A. Malignant melanoma
- B. Glaucoma
- C. Retinoblastoma (Correct Answer)
- D. Phthisis bulbi
Explanation: ***Retinoblastoma*** - **Retinoblastoma** is the most common intraocular malignancy in children and the **primary indication for enucleation** in ophthalmology - Enucleation is indicated in advanced cases (Group D/E) where the eye cannot be salvaged, to prevent metastasis and save life - Given its aggressive nature and potential for life-threatening spread, **enucleation** remains the definitive curative treatment for advanced retinoblastoma *Malignant melanoma* - While intraocular melanoma can require enucleation, it is not the primary indication - Smaller tumors are often managed with globe-preserving treatments like **brachytherapy** or **proton beam radiation** - Enucleation is reserved for large melanomas, treatment failures, or eyes with severe pain and no vision *Glaucoma* - **Glaucoma** is primarily managed with medications, laser therapy, or filtering surgeries to lower intraocular pressure - Enucleation for glaucoma is exceedingly rare, considered only for intractable pain in a blind eye when all other treatments have failed *Phthisis bulbi* - **Phthisis bulbi** is a shrunken, non-functional eye resulting from severe trauma, inflammation, or disease - Enucleation may be performed for cosmetic reasons or pain relief, but this is a secondary indication - It represents end-stage ocular damage, not a primary life-saving indication like retinoblastoma
Question 4: 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 5: The SAFE strategy is used for elimination of?
- A. Bacterial conjunctivitis
- B. Trachoma (Correct Answer)
- C. Onchocerciasis
- D. Viral conjunctivitis
Explanation: ***Trachoma*** - The **SAFE strategy** (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) is the World Health Organization's primary intervention for eliminating blinding **trachoma**. - It addresses the various aspects of **trachoma transmission** and progression, from treating active infection to preventing reinfection and managing trichiasis. *Bacterial conjunctivitis* - This condition is typically treated with **topical antibiotics** and does not require a comprehensive, multi-component public health strategy like SAFE. - It is generally self-limiting and rarely leads to **blinding complications** or necessitates surgical intervention. *Onchocerciasis* - Also known as **river blindness**, this parasitic disease is primarily controlled through mass drug administration with **ivermectin**. - While it can cause severe visual impairment, its transmission cycle and treatment differ significantly from those addressed by the SAFE strategy. *Viral conjunctivitis* - This is usually a **self-limiting condition** for which there is no specific antiviral treatment, and management is primarily supportive. - It does not involve bacterial infection, chronic inflammation leading to fibrosis, or require the **public health interventions** outlined in the SAFE strategy.
Question 6: Fasanella-Servat operation is done for:
- A. Myasthenia gravis
- B. Congenital ptosis (Correct Answer)
- C. Drug induced ptosis
- D. Horner syndrome
Explanation: ***Congenital ptosis*** - The **Fasanella-Servat operation** is indicated for **mild to moderate ptosis with good levator function** (levator function >10mm). - This includes cases of **mild congenital ptosis** where the levator muscle has adequate function. - The procedure involves resecting a portion of the **conjunctiva, Müller's muscle, and upper tarsus** to elevate the eyelid. - It provides approximately **2-3mm of lid elevation** and is particularly useful when levator function is preserved. *Horner syndrome* - Horner syndrome causes ptosis due to **denervation of Müller's muscle** (sympathetic dysfunction). - The Fasanella-Servat operation **resects Müller's muscle**, which would be counterproductive when this muscle is already dysfunctional. - Ptosis in Horner syndrome is typically managed with **levator resection** or observation, not Fasanella-Servat. *Myasthenia gravis* - Ocular manifestations of **myasthenia gravis** are treated with **acetylcholinesterase inhibitors** and immunomodulatory therapies. - The underlying **neuromuscular junction defect** causes variable ptosis that fluctuates throughout the day. - Surgical correction is not appropriate as the condition requires medical management of the autoimmune process. *Drug induced ptosis* - **Drug-induced ptosis** is a reversible condition that resolves with **discontinuation of the offending medication**. - Common culprits include topical prostaglandin analogs and certain systemic medications. - Surgical intervention like the Fasanella-Servat operation is not indicated as the cause is reversible.
Question 7: 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.
Question 8: The muscle first affected in thyroid ophthalmopathy is:
- A. Medial rectus
- B. Lateral rectus
- C. Inferior rectus (Correct Answer)
- D. Superior rectus
Explanation: ***Inferior rectus*** - The **inferior rectus** is the extrinsic eye muscle most commonly and earliest affected in **thyroid ophthalmopathy**, making it difficult to look upwards. - This involvement leads to **fibrosis** and **restriction**, causing **diplopia** and **proptosis**. *Medial rectus* - While the medial rectus can be affected in thyroid ophthalmopathy, it is typically involved later or less severely than the **inferior rectus**. - Involvement may lead to **difficulty with adduction** (moving the eye medially). *Lateral rectus* - The **lateral rectus** is generally one of the **least affected muscles** in thyroid ophthalmopathy. - Its involvement would primarily impact **abduction** (moving the eye laterally). *Superior rectus* - The **superior rectus** can be affected in thyroid ophthalmopathy, but it is less frequently the initial muscle involved compared to the **inferior rectus**. - Dysfunction would primarily cause **difficulty looking downwards**.
Question 9: What is the most common malignant tumour of eyelid?
- A. Sebaceous gland carcinoma
- B. Squamous cell carcinoma
- C. Melanoma
- D. Basal cell cancer (Correct Answer)
Explanation: ***Basal cell cancer*** - **Basal cell carcinoma (BCC)** is by far the most common malignant tumor of the eyelid, accounting for approximately **90% of all eyelid malignancies**. - It typically appears as a **slow-growing nodule** with rolled borders, central ulceration, and telangiectasias, most commonly affecting the **lower eyelid and medial canthus**. - BCC is strongly associated with **chronic UV radiation exposure** and rarely metastasizes, but can cause significant local tissue destruction if untreated. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** (also known as meibomian gland carcinoma) is a rare but aggressive malignant tumor arising from the sebaceous glands of the eyelid. - It accounts for approximately **1-5% of eyelid malignancies** and has a higher risk of metastasis compared to BCC. - More common in **Asian populations** and often masquerades as chronic blepharoconjunctivitis, leading to delayed diagnosis. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the **second most common** malignant eyelid tumor, accounting for approximately **5-10% of cases**. - It presents as a firm, erythematous nodule or plaque and has a higher metastatic potential than BCC. - Associated with **UV exposure, HPV infection**, and immunosuppression. *Melanoma* - **Melanoma** is a rare malignant tumor of the eyelid, accounting for less than **1% of eyelid malignancies**. - It arises from melanocytes and carries a significant risk of metastasis and mortality. - Presents as a pigmented lesion with irregular borders, but amelanotic variants can also occur.
Question 10: Massaging of nasolacrimal duct is done in ?
- A. Acute dacryocystitis
- B. Congenital dacryocystitis (Correct Answer)
- C. Conjunctivitis
- D. None of the options
Explanation: ***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.
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