Pediatric Ophthalmology and Strabismus — MCQs

Pediatric Ophthalmology and Strabismus Indian Medical PG Practice Questions and MCQs

Question 301: Esotropia is commonly seen in which type of refractive error?

A. Myopia
B. Hypermetropia (Correct Answer)
C. Astigmatism
D. Presbyopia

Explanation: ***Hypermetropia*** - **Esotropia**, or convergent strabismus, is commonly associated with **uncorrected hypermetropia**, especially in children. - The constant effort to **accommodate** to see clearly for hypermetropic individuals can lead to excessive convergence, causing the eye to turn inward. *Myopia* - Myopia, or **nearsightedness**, rarely causes esotropia. - In some cases, high myopia can be associated with **exotropia** (divergent strabismus) due to reduced accommodative effort. *Astigmatism* - **Astigmatism** causes blurry vision at all distances due to an irregularly shaped cornea or lens, but it is not directly linked to specific forms of strabismus like esotropia or exotropia. - While it can contribute to **amblyopia** if severe and uncorrected, it does not typically cause the eyes to turn inward. *Presbyopia* - **Presbyopia** is an age-related loss of the eye's ability to focus on nearby objects due to stiffening of the lens. - It affects accommodation but does not cause strabismus such as esotropia; it typically begins around age 40.

Question 302: What conditions can be diagnosed using the cover-uncover test?

A. Eye alignment disorders including strabismus and heterophoria (Correct Answer)
B. Convergent strabismus (Esotropia)
C. Latent misalignment (Heterophoria)
D. Strabismus (Squint)

Explanation: ***Eye alignment disorders including strabismus and heterophoria*** - The **cover-uncover test** is a clinical procedure used to detect and differentiate both **strabismus** (manifest deviation) and **heterophoria** (latent deviation) by observing eye movements when vision is occluded and then re-exposed. - This test is a fundamental tool for assessing **ocular alignment** and binocular vision, revealing if an eye deviates and how it recovers. - **This is the most comprehensive answer** as it includes both manifest and latent deviations. *Convergent strabismus (Esotropia)* - Although the cover-uncover test can diagnose **esotropia** (a type of strabismus where the eye turns inward), this option is **too specific** and does not cover all the conditions assessable by this test. - The test can diagnose **all types of strabismus** (esotropia, exotropia, hypertropia, hypotropia) and heterophoria, not just convergent strabismus. - Esotropia is characterized by the **deviating eye failing to spontaneously realign** when uncovered, as it is a constant, manifest deviation. *Latent misalignment (Heterophoria)* - While the cover-uncover test **can detect heterophoria**, this option is **incomplete** as it does not include strabismus (manifest deviation). - Heterophoria manifests when the covered eye deviates and then **refixes** when uncovered, indicating a latent deviation normally controlled by fusion. - The alternate cover test is more sensitive for detecting heterophoria, but the cover-uncover test can identify it as well. *Strabismus (Squint)* - The cover-uncover test is used to diagnose **strabismus**, but this option is **incomplete** and does not include **heterophoria**, which is also diagnosable by the test. - Strabismus is identified when the eye that was *not* covered deviates, or the covered eye does not refixate upon uncovering, indicating a manifest turn. - This option only covers manifest deviations and misses latent deviations.

Question 303: Esotropia is most commonly associated with:

A. Hyperopia (Correct Answer)
B. Presbyopia
C. Astigmatism
D. Myopia

Explanation: ***Hyperopia*** - **Hyperopia** (farsightedness) requires greater accommodative effort to focus on distant and near objects, which is coupled with **convergence**. This excessive convergence can lead to **esotropia** (inward turning of the eye). - Accommodative esotropia is a common type of strabismus directly linked to uncorrected hyperopia. *Presbyopia* - **Presbyopia** is an age-related loss of the eye's ability to focus on nearby objects due to stiffening of the lens, typically occurring after age 40. - It affects accommodation but does not primarily cause esotropia; rather, it makes near work difficult, and patients may prefer to hold objects further away to see them. *Astigmatism* - **Astigmatism** is a refractive error where the eye does not focus light evenly onto the retina due to an irregularly shaped cornea or lens, leading to blurred or distorted vision at all distances. - While it can cause visual discomfort and eye strain, it is not directly associated with the development of esotropia. *Myopia* - **Myopia** (nearsightedness) is a refractive error where distant objects appear blurry because light focuses in front of the retina. - High myopia can sometimes be associated with **exotropia** (outward turning of the eye) due to divergence excess, rather than esotropia.

Question 304: What is the MOST common cause of amblyopia?

A. Cataracts
B. Strabismus (Correct Answer)
C. Refractive errors
D. None of the options

Explanation: ***Strabismus*** - **Strabismic amblyopia** is the **MOST common cause of amblyopia**, accounting for approximately **50% of cases**. - When the eyes are misaligned, the brain suppresses the image from the deviating eye to avoid **diplopia** (double vision). - The prolonged suppression during the critical period of visual development leads to poor visual acuity in the affected eye. - Early detection and treatment (occlusion therapy, correction of refractive errors, alignment surgery) are crucial. *Refractive errors* - **Refractive amblyopia**, particularly **anisometropia** (significant difference in refractive power between eyes), is the **second most common cause**. - The brain suppresses the blurry image from the eye with greater refractive error, leading to poor visual development. - **Bilateral high refractive errors** (isoametropic amblyopia) can also cause amblyopia, though less commonly than anisometropia. *Cataracts* - **Deprivation amblyopia** results from obstruction of the visual axis (congenital cataract, ptosis, corneal opacity). - This is a **less common but more severe** form of amblyopia requiring urgent treatment. - If untreated during the critical period, it can cause **irreversible vision loss**. *None of the options* - Incorrect, as strabismus is a well-established and the most common cause of amblyopia.

Question 305: Following an accident, a man developed a paralytic squint. Regarding paralytic squint, which of the following is TRUE?

A. Diplopia (Correct Answer)
B. Tunnel vision
C. Vitreous hemorrhage
D. Floaters

Explanation: ***Diplopia*** - **Diplopia**, or **double vision**, is a hallmark symptom of paralytic squint due to the misalignment of the visual axes, causing two images of a single object to be perceived. - The inability of the affected eye to move in coordination with the unaffected eye results in the perception of two distinct images. *Tunnel vision (loss of peripheral vision)* - **Tunnel vision** is a feature of conditions affecting the peripheral visual field, such as **glaucoma** or **retinitis pigmentosa**, not typically associated with paralytic squint. - Paralytic squint primarily affects the **alignment of the eyes** and **ocular motility**, not the visual field extent. *Vitreous hemorrhage (bleeding within the eye)* - **Vitreous hemorrhage** involves bleeding into the **vitreous humor**, leading to blurred vision or sudden vision loss, often due to **trauma**, **diabetic retinopathy**, or **retinal tears**. - It is a structural problem within the eye and is not a direct consequence or typical symptom of paralytic squint, which is a **neuromuscular condition** affecting eye movement. *Floaters (visual disturbances from vitreous humor)* - **Floaters** are small specks or strands that drift across the visual field, commonly caused by **vitreous degeneration** or **posterior vitreous detachment**, often benign. - While they can be a nuisance, floaters are not directly related to the **paralysis of extraocular muscles** characteristic of paralytic squint.

Question 306: Which of the following is a hallmark feature of Duane retraction syndrome?

A. Hyperopia
B. Retraction of globe (Correct Answer)
C. Head tilt
D. None of the options

Explanation: ***Retraction of globe*** - **Globe retraction** upon attempted adduction and/or abduction is a classic sign due to co-contraction of the antagonistic rectus muscles. - This abnormal innervation causes the eye to pull back into the orbit and narrow the palpebral fissure. *Hyperopia* - **Hyperopia** (farsightedness) is a refractive error and not a primary diagnostic feature of Duane retraction syndrome. - While it can co-occur, it is not a hallmark of the syndrome's motor abnormalities. *Head tilt* - A **head tilt** can be adopted by patients with Duane syndrome to compensate for the limited eye movements and maintain binocular vision, but it is a compensatory mechanism, not a hallmark feature itself. - It's a secondary sign that helps manage the primary problem of ocular motility impairment. *None of the options* - This option is incorrect because **globe retraction** is indeed a hallmark feature of Duane retraction syndrome.

Question 307: A 10-year-old child presents with inward turning of the right eye, and examination shows limited abduction of the affected eye. What is the most likely diagnosis?

A. Concomitant strabismus
B. Paralytic squint (Correct Answer)
C. Exotropia
D. Hypertropia

Explanation: ***Paralytic squint*** - The key finding is an **inward turning of the right eye** (**esotropia**) combined with **limited abduction** of that eye, strongly suggesting paralysis or weakness of the **lateral rectus muscle**. - A paralytic squint is characterized by an **underacting extraocular muscle**, leading to a deviation that varies with the direction of gaze and often results in **diplopia** (double vision) and a compensatory head turn. *Concomitant strabismus* - In concomitant strabismus, the **degree of ocular deviation is constant** in all directions of gaze, and there is no limitation of eye movement. - It typically results from an **imbalance in the binocular visual system** rather than a muscle paralysis. *Exotropia* - **Exotropia** refers to an **outward turning of the eye**, which is the opposite of the inward turning (**esotropia**) described in the clinical presentation. - While it is a type of strabismus, its direction of deviation does not match the patient's symptoms. *Hypertropia* - **Hypertropia** is an **upward deviation of one eye**, meaning the affected eye is higher than the other. - This condition is also not consistent with the reported inward turning of the eye.

Practice by Chapter

Amblyopia

Practice Questions

Esotropia

Practice Questions

Exotropia

Practice Questions

Vertical Deviations

Practice Questions

Special Forms of Strabismus

Practice Questions

Nystagmus in Children

Practice Questions

Pediatric Cataract

Practice Questions

Retinopathy of Prematurity

Practice Questions

Pediatric Glaucoma

Practice Questions

Pediatric Neuro-ophthalmology

Practice Questions

Genetic Eye Diseases in Children

Practice Questions

Pediatric Ocular Trauma

Practice Questions

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