Question: Elsching pearls is seen in

After cataract is also known as 'secondary cataract' . Types of after cataract : Thickened posterior capsule opacification(PCO) Dense membranous after cataract Soemmering's ring which refers to a thick ring of after cataract formed behind the iris, enclosed between the two layers of capsule Elsching's pearls in which the vacuated subcapsular epithelial cells are clustered like soap bubbles along the poster capsule. Ref;A.K.Khurana; 6th edition; Page no:214 QUESTION REPEATED


Question: Hypopyon corneal ulcer is caused by

Since pneumococcus invariably causes hypopyoin, its called Hypopyon Corneal ulcer.


Question: Hamarlopia is seen in

Hamarlopia (day blindness) is due to congenital deficiency of cones  and central corneal and central lenticular Opacities.


Question: Temporal lobe tumors may produce


Question: Refractive index of nucleus and Cortex are Respectively

Refractive index of nucleus and Cortex are Respectively are 1.42 and 1.39.


Question: Drug of choice for intermediate uveitis is

Treatment includes: 1. Coicosteroids administered systemically and as repeated periocular injections may be effective in some cases. 2. Immunosuppressive drugs may be helpful in steroid-resistant cases. 3. Peripheral cryotherapy is also repoed to be effective. with most forms of uveitis, coicosteroids are the mainstay of therapy. Topical therapy with prednisolone acetate 1% or prednisolone sodium phosphate 1% is only helpful in the treatment of the anterior segment inflammation. Ref: Khurana; 4th edition; Pg.No.161


Question: Not an absolute contraindication for corneal transplantation is

Tubercular meningitis is a relative contraindication for corneal transplantation as the cornea may not be damaged and disease is not transmissible by this procedure. Contraindications : Death from unknown cause. Infections -HIV, viral hepatitis, syphilis, congenital rubella, tuberculosis, septicaemia and active malaria. Prior high-risk behaviour Commercial sex wrokers, Men who have sex with men, IV drug abusers Within the last 12 months: sex with someone with high-risk behaviour, lives in Africa, or received blood clotting factor concentrates; tattooing, acupuncture or ear/body piercing; imprisonment. Infectious/possibly infectious diseases of CNS,- prion diseases, SSPE, PML, encephalitis, Dementias, Alzheimers, Parkinsons, MS and MND. Receipt of a transplanted organ. Receipt of human pituitary-derived growth hormone. Brain or spinal surgery before 1992. Most haematological malignancies. Ocular disease- likely to compromise graft outcome Rabies


Question: Rosette cataract is seen after

Cataract Features Sunflower Wilson's disease / chalcosis **Keyser - Fleisher ring - characteristic of Wilson's disease Snow flake DM Christmas tree Myotonic dystrophy Oil drop Galactosemia Rosette shapes Blunt trauma Other features of blunt trauma 1. Commotio retina (berlin's edema)- milky white cloudiness involving the posterior pole with a cheer red spot in the foveal region 2. Vossius's ring - circular ring of brown pigment seen on the anterior capsule FABRY's disease Propeller / spoke like Complicated cataract Mostly posterior sub capsular cataract Bread crump appearance Polychromatic lusture Punctate / blue dot cataract M/C congenital cataract in children No loss of vision Atopic dermatitis Shield cataract Anterior sub capsular cataract


Question: The most common causative organism of canaliculitis is

Chronic canaliculitis is an uncommon condition, frequently caused by Actinomyces israelii, anaerobic Gram-positive bacteria. Occasionally scarring and canalicular obstruction may result. Presentation is with unilateral epiphora associated with chronic mucopurulent conjunctivitis refractory to conventional treatment. There is pericanalicular redness and oedema, and mucopurulent discharge on pressure over the canaliculus. A 'pouting' punctum may be a diagnostic clue in mild cases. In contrast to dacryocystitis, there is no lacrimal sac involvement. Concretions (sulfur granules) are metabolic products of Actinomyces and other hydrogen sulfide-utilizing bacteria, and classically are expressed on canalicular compression or following canaliculotomy


Question: Area of Cornea indented in Goldman Applanation  tonometer  for measuring IOP

Area of Cornea indented in Goldman Applanation  tonometer  for measuring IOP is 3.06mm.


Question: Sudden painful loss of vision seen in

Sudden painful loss of vision : Acute congestive glaucoma Acute iridocyclitis Chemical injuries to the eyeball Mechanical injuries to the eyeball Reference : AK KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition 4, Page-462

Anatomy, Development and clinical examination


Question: Distichiasis means

Distichiasis: Congenital distichiasis: It is a rare anomaly in which an extra row of cilia occupies the position of Meibomian glands which open into their follicles as ordinary sebaceous glands. These cilia are usually directed backwards and when rubbing the cornea, should be electroepilated or cryoepilated. Acquired distichiasis (metaplastic lashes): occurs when due to metaplasia and differentiation, the meibomian glands are transformed into hair follicles. The most impoant cause is late stage of cicatrizing conjunctivitis associated with chemical injury, Stevens-Johnson syndrome and ocular cicatricial pemphigoid. Ref:- A K KHURANA; pg num:-342,343

Increased number of eyelashes in the lower lid

Diseases of orbit, Lids and lacrimal apparatus


Question: Swimming pool conjunctivitis is caused by

ADULT INCLUSION CONJUNCTIVITIS Etiology : Inclusion conjunctivitis is caused by serotypes D to K of Chlamydia trachomatis. The primary source of infection is urethritis in males and cervicitis in females. The transmission of infection may occur to eyes either through contaminated fingers or more commonly through contaminated water of swimming pools (hence the name swimming pool conjunctivitis). Reference :- A K KHURANA;6th edition , page:- 68


Question: Blindness in child is most commonly due to

Most common cause of childhood blindness is vitamin A deficiency Refer: Khurana 6th edition page number 382


Question: Retrobulbar injection is given in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 444) *Retrobulbar injection:- Injection in retrobulbar space inside the muscle cone *Peribulbar injection:- Injection in peribulbar/retrobulbar space outside the muscle cone *Sub-tenon injection:- Injection beneath the tenon capsule, i.e. in subtenon space. It is also called parabulbar block Retrobulbar block involves depositing local anesthetic inside the muscle cone. It aims to block the ciliary nerves, the ciliary ganglion, and cranial nerves III, IV, and VI.


Question: Stocker's line is seen in

Ans is 'b' i.e. Pterygium Stocker's line is line of iron deposition in the corneal epithelium seen adjacent to the head of the pterygium.Pterygium and Pinguecula are degenerative conditions of the cornea.PingueculaAre areas of bulbar conjunctival thickening, near the limbus in the palpebral fissure area.These are triangular, horizontally oriented with apex away from the cornea.These are white to yellow in color, often having a fatty appearance. (The name pinguecula is derived from fat- pinguis)Usually found in elderly persons, especially those exposed to strong sunlight, dust, wind etc.Usually bilateralUsually nasalEtiology is not well known, however good evidence exists, of an association with increasing age and ultraviolet light exposure.Pinguecula do not cause any symptom, apart from cosmetic defect and sometimes inflammation (pingueculitis). Hence no treatment is required. However rarely, simple excision may be done for cosmetic reasons or for chronic pingueculitis.PterygiumPterygium is a wing shaped fibrovascular growth of the conjunctiva encroaching upon the cornea.It occurs in the palpebral fissure area, usually nasally but may also occur on the temporal side.Elevated whitish opacities ("islets of Vogt") and an iron deposition line ("Stocker") may delineate the head of the Pterygium on the cornea.Like pinguecula, pterygium is associated with ultraviolet light exposure. It occurs at highest prevalence and most severely in tropical areas near the equator and to a lesser and milder degree in cooler climates. The predominantly nasal location is related to reflection of light from the nose onto the nasal conjunctiva.Usually the pterygium is symptomless, so no treatment is required.Indications for surgery are:cosmetic deformityimpaired vision due to encroachment into the pupillary area of the corneasignificant astigmatismrestriction of ocular motilitySimple excision is done.Recurrence of the pterygium after surgical excision is the main problem. Methods to prevent recurrence areconjunctival autografting andmitomycin C application.Is Pinguecula precursor of Pterygium?This is controversial.Parson writes- "A Pterygium frequently follows a Pinguecula"But Yanoff Ophthalmology contradicts this and writes- "Current information, however, suggests that pinguecula does not progress to Pterygium and that the two are distinct disorders."Pterygium and PseudopterygiumPterygium resembles pseudopterygium. Pseudopterygium is conjunctival adhesion to the cornea secondary to previous trauma or inflammation such as peripheral corneal ulceration. A pseudopterygium often has an atypical position and is not adherent at all points, so a probe can be passed beneath it peripherally.


Question: Most common benign tumour of eye lids

Simple Papilloma
Usually ocurs at lid margin
most common tumour.


Question: Gene involved in Retinoblastoma

Retinoblastoma - 13Q14
Wilm's tumor - 11P13


Question: Diabetic retinopathy, most likely present with

B i.e. NIDDM with 2 years duration Diabetic Retinopathy (DR) is commoner in type 1 or IDDM (40%) than in type 2 (NIDDM) diabetes mellitus (20%) Duration of diabetes is most impoant risk factor Q for DR. DR rarely develops within 5 years of the onset of diabetes or before pubey, but about 5% of type 2 (NIDDM) diabetics have DR at presentation.


Question: Muscles responsible for accommodation are innervated by nerves passing through.

Ans. (b) Edinger-westphal nucleusRef. Parson's 22/e, p. 35Pathway of accommodation reflex: The afferent impulses extend from the retina to the parastriate cortex via the optic nerve, chiasma, optic tract, lateral geniculate body, optic radiations, and striate cortex. From the parastriate cortex the impulses are relayed to the Edinger- Westphal nucleus of both sides via the occipito-mesencephalic tract and the pontine centre for convergence.


Question: Lens sutures are formed in

Development of Lens Surface ectoderm Classification of nucleus formed during lens development Embryonic (0-3 months) Fetal (3 months to gestation) Infantile (from bih to pubey) Adult (adult life) Sutures Seen in fetal nucleus Anterior Y shaped Posterior inveed Y shaped


Question: Ring scotoma is seen in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 233) The scotoma is a defect in the visual field and corresponds to the degenerated zones of the retinaAnnular or ring-shaped scotoma is a typical feature which corresponds to the degenerated equatorial zone of the retinaRing scotoma is seen in retinitis pigmentosa, high myopia, POAG, aphakic spectacle correction and after panretinal photocoagulation.


Question: Final common pathway for horizontal gaze

Horizontal Conjugate Gaze Pathway : Components of Pathway For both eyes to look at a side: Contralateral Frontal Eye Field (Brodmann area 8) Ipsilateral PPRF (Paramedial Pontine Reticular Formation) Ipsilateral CN VI Nucleus Contralateral Medial Longitudinal Fasciculus (MLF) Contralateral CN III Nucleus Reference: AK khurana 7th edition

Anatomy, Development and clinical examination


Question: The water content in the lens is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 181)The lens is composed of 64% water, 35% protein, and 1% lipid, carbohydrate and trace elements. The protein concentration in the lens is actually the highest amongst body tissues. The main types of proteins are alpha (31%), beta (55%) and gamma (2%) crystallins, and insoluble albuminoids (12%)


Question: Vossius ring occurs in


Question: Haab striae are seen in

Haab striae are seen in buphthalmos ( congenital glaucoma ). These are curvilinear healed breaks in Descemet membrane. Buphthalmos is a large eye as a result of stretching due to elevated IOP prior to the age of 3 years. Ref: kanski's clinical ophthalmology, 8th edition, page no.386


Question: Most common malignant eyelid tumor


Question: Chorioretinitis in AIDS is caused by


Question: "Ferry line" is found in

Ferry line is found in sclera Ferry&;s Li Reference: AK Khurana 7th edition

Anatomy, Development and clinical examination


Question: Tomato ketchup retina is seen in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 271 - 272)Central Retinal Vein Occlusion (CRVO)FeaturesNon-Ischemic CRVO Ischemic CRVO Epidemiology Most common (75%)Moderate visual acuity lossLess common (25%)Severe visual acuity lossPathogenesis Slight RAPD with mild touosity & dilatation of retinal veins Marked RAPD with severe touosity & engorgement of retinal veins Fundus finding Hemorrhages Dot blot & Flame shaped in all 4 quadrants & most numerous in periphery Extensive retinal hemorrhages (Blood & Thunder fundus)Cotton wool spots Few Numerous Disc & Macular edema Mild Severe with hyperemia Fundus Fluorescein Angiography Venous stasis Masking of retinal vascular bed by retinal hemorrhages & extensive area of capillary nonperfusion Prognosis Good Poor Management Treat predisposing factor Pan retinal photocoagulation


Question: Most common cause of blepharoconjunctivitis

The most common cause of blepharoconjuctivitis is staph aureus Staphylococcus epidermidis is an innocuous flora of lid and conjunctiva. It can also produce blepharoconjunctivitis. Moraxella lacunata is most common cause of angular conjunctivitis and angular blepharoconjunctivitis. Corynebacterium diphtheriae causes acute membranous conjunctivitis


Question: Thinnest layer of tear film

Thickest - Aqueous layer.
Thinnest - Mucus layer.


Question: Patient with fixed dilated pupil, with iris atrophy and secondary glaucoma after penetrating keratoplasty is suggestive of.

Ans. d. Urrets Zavalia syndrome A fixed dilated pupil following penetrating keratoplasty is a well recognized if rare postoperative complication. The mydriasis following penetrating keratoplasty was first described by Castroviejo but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy. and secondary glaucoma. The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, paicularly if dilating drops are used. In addition to the pupil and iris abnormalities, Urrets-Zavalia also described other features__ iris ectropion, pigment dispersion, anterior subcapsular cataract and posterior synechiae. Urrets Zavalia Syndrome Urrets Zavalia Syndrome is characterized by triad of: Secondary glaucoma + Iris atrophy + Fixed dilated pupil') Urrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy. It is a poorly understood complication following penetrating keratoplasty for keratoconus. Posner Shlossman syndrome It is also called as glaucomatocyclitic crisis. Episodic unilateral mild anterior uveitis, photophobia, reduced vision and colored rings around lights (from secondary corneal edema Benedict's Syndrome If red nucleus is involved, tremors and jerky movements occur in contralateral side of the body. This condition combined with ipsilateral 3rd nerve paralysis is called as Benedict's syndrome. McKusick-Kaufmann Syndrome McKusick-Kaufman syndrome: A rare genetic disorder characterized by hydrometrocolpos (fluid buildup in vagina and uterus), extra fingers and congenital hea defects


Question: Chyriasis is deposition of

Chryiasis is deposition of gold in stroma of cornea. Type of Pigment Name of Deposit Disorder Location in Cornea Iron Stocker's line Pterygium Epithelium Hudson-Stahli line In old age Epithelium Ferry's line Filtering bleb Epithelium Fleischer's ring Keratoconus Epithelium Coat's white ring Previous Metallic foreign body injury Bowman's layer Siderosis Stroma Blood staining of cornea Stroma Copper Kayser-Fleischer ring Wilsons's Disease Descement's membrane Melanin Krukenberg's spindle Pigment dispersion syndrome Endothelium Silver Argyrosis Stroma Gold Chrysiasis Stroma


Question: Most common site of metastasis in intraorbital melanoma is

Blood-borne metastasis usually occurs in liver and is the commonest cause of death. Lymphatic spread is usually not known. Ref: khurana page no. 174


Question: Most common extraocular muscle involved in Grave's disease


Question: Haemorrhagic conjunctivitis is caused by

Acute haemorrhagic conjunctivitis It is an acute inflammation of conjunctiva characterised by multiple conjunctival haemorrhages, conjunctival hyperaemia and mild follicular hyperplasia. The disease is caused by Picornavirus (enterovirus type 70) which are RNA viruses of small (pico) size. Ref;A.K.Khurana; 6th edition; Page no:76


Question: The most common tumor that spread to orbit from intracranial cavity is

Sphenoid wing meningiomas are slow growing tumors that originate from outer arachnoid meningeal epithelial cells.


Question: Treatment for mild ptosis is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 381) Fasanella-Servat operation: It is performed in cases having mild ptosis (1.5-2mm) and good levator function. In it, upper lid is eveed and the upper tarsal border along with its attached Muller's muscle and conjunctiva are resected. Fasanella Servat procedure. 4-0 silk suture is placed through the eyelid margin for a traction suture. The eyelid is eveed over a Desmarres retractor. Additional local anesthesia is placed transconjunctivally. It is determined that a 3 mm tarsal resection and a 3 mm conjunctival and mullers muscle resection will be performed. These marks are made with the monopolar cautery corresponding to the central third of the eyelid. Tooth forceps are then used to grasp the superior border of the tarsus. A 4-0 silk traction suture is then placed at the superior boarder of the tarsus in a locking running fashion. The traction suture then holds the eyelid in position and in this case curved hemostats are used to clamp at the previous markings on the tarsus. A Putterman clamp can be used here as well which is probably more efficient. A 6-0 chromic suture is then placed in a running mattress fashion on the other side of the curved hemostats. This suture is placed across the eyelid and then turned around to complete the passes. There is significant discussion around the most appropriate suture to use as well as whether to place these sutures transcutaneous. The 15 blade is then used to make metal on metal contact with the curved hemostats to excise the tissue. The tissue is removed and the suture is tied. Since the knot is on the inside of the eyelid, a contact lens will be placed later. Inspection of the resected tissues shows the tarsus as well as the conjunctiva and mullers muscle. Measurement of this shows an approximate height of 6-7 mm. The contact lens is placed, the traction sutures are removed, and antibiotic drops are placed into the eye. Ref khurana 6th edition pg 344

Diseases of orbit, Lids and lacrimal apparatus


Question: Most common type of colour blindness is

Protanopes - Red is defective.
Tritanopes - blue is defective.
Deuteranopes - Green is defective.


Question: Strongest force of bonding b/w retina an RPE

D i.e. IPM Interphotoreceptor matrix (IPM) is the strongest mechanism for bonding the retina to retinal pigment epithelium (RPE)Q. It also provide physical suppo of photoreceptors and transfer nutrients and visual pigment. The quality of these functions is controlled by RPE through the synthesis of matrix materials, transpo of proteins, ions and water. Because acute alteration in degree of hydration / dehydration changes its bonding propey & viscosity. The strength of adhesion is constantly and acutely dependent on metabolism (i.e., adhesion force drops to 0 after death & reversibly restored or enhanced by tissue oxygenation). Vitreous gel pressure, intraocular fluid pressure & RPE water transpo also help in retinal adhesion.


Question: A wave in ERG is due to the activity of

Normal record of ERG consists of the following waves : a-wave. It is a negative wave possibly arising from the rods and cones. b-wave. It is a large positive wave which is generated by Muller cells but represents the activity of the bipolar cells. c-wave. It is also a positive wave representing the metabolic activity of pigment epithelium. Both scotopic and photopic responses can be elicited in ERG. Foveal ERG can provide information about the macula. REFERENCE : AK KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4,Page-489

Anatomy, Development and clinical examination


Question: Maximum density of goblet cells is seen in

Goblet cells form the mucus layer of the tear film They are maximum nasally and least superiorly REF:Refer Khurana 6th edition page number 59


Question: Earliest drug used in acute angle closure glaucoma

Ans. is 'a' i.e Diamox (Acetazolamide) As already explained in Nov 99, Acetazolamide is used even earlier than Pilocarpine.


Question: Late onset endophthalmitis after cataract surgery is caused by

Bacterial endophthalmitis: This is one of the most dreaded complications with an incidence of 0.2 to 0.5 percent. The principal sources of infection are contaminated solutions, instruments, surgeon&;s hands, patient&;s own flora from conjunctiva, eyelids and air-borne bacteria. Symptoms and signs: Present between 48 and 72 hours after surgery and include: ocular pain, diminshed vision, lid oedema, conjunctival chemosis and marked circumciliary congestion, corneal oedema, exudates in pupillary area, hypopyon and diminished or absent red pupillary glow. Delayed chronic postoperative endophthalmitis : is caused when an organism of low virulence (Propionobacterium acne or staph epidermidis) becomes trapped within the capsular bag. It has an onset ranging from 4 weeks to years (mean 9 months) postoperatively. Ref:- A K KHURANA; pg num:-200,201


Question: Koeppe nodules are located at

In uveitis, Iris nodules develop at

Base of Iris known as Busacca nodules.
Pupillary border of Iris known as Koeppe Nodules.


Question: Not a sign of Fuch's heterochomic iridocyclitis

Posterior synechiae are not seen in Fuch's heterochromic iridocyclitis Fuchs Heterochromic Iridocyclitis * Heterochromic uveitis * Chronic, unilateral iridocyclitis , in young adults. * Amsler sign ( also known as amsler verrey sign): Hyphaema during intraoperative manipulation due to blood vessels at angle are seen * 50 % develop PSC ( Posterior subcapsular cataract)


Question: Most common cause of Neonatal conjunctivitis is

Most common cause of Neonatal conjunctivitis is Chlamydia.


Question: The orbital extension in choroid melanoma is treated with

(Exenteration) (165-Khurana) (326-Kanski 5th) (356-P)Malignant melanoma of choroid - It is the most common primary intraocular tumour of adults (40-70 years) of age.TREATMENT1. Conservative treatment using cobalt plaques photocoagulation or cryocoagulation may be tried in small (under 7 mm) non progressive, posteriorly located melanomas.2. Enucleation - It is indication for glaucomatous stage and for longer tumours (more than 7 mm) in quiescent stage3. Exenteration or, Debulking with chemotherapy and radiotherapy is required in the stage of extraocular spread4. Chemotherapy and immunotherapy - may be of some use in patients with distant metastasis.ENUCLEATIONEVISCERATION* It is excision of the eyeball. It can be performed under LA in adults and under GA in children.* It is the removal of the contents of the eyeball leaving behind the sclera* Frill evisceration is preferred over simple evisceration.Indication(i) Absolute indications - are retinoblastoma and malignant melanoma(ii) Relative indications are painful blind eye following absolute glaucoma, endophthalmitis, mutilating ocular injuries, Anterior staphyloma and phthisis bulbiIndications includes Panophthalmitis, expulsive choroidal haemorrhage, bleeding anterior staphyloma.Exenteration of the orbit is indicated for patients with extensive extraocular extension at the time of diagnosis or for orbital recurrences following enucleation (326-Kanski 5th)Best answer is Exenteration & radiotherapy.Orbital spread of the malignant melanoma necessitates exenteration but metastasis elsewhere can be treated by enucleation and radiation (356-P)


Question: Treatment of Choice for prophylaxis of Right eye in case of primary open angle glaucoma of Left eye

Treatment of Choice for prophylaxis of healthy eye when follow eye has primary open angle glaucoma is laser trabeculoplasty.


Question:
A 26yr old female presented with complaints of coloured
halos, matted and sticky eyelids since 3 days. On examination,
visual acuity was normal. Most common organism causing
this condition is

The Clinical scenario gives the diagnosis of Acute mucoopurulent conjunctivitis which is most commonly caused by Staphylococcus aureus.


Question: The vitamin A supplement admistered in Prevention of Nutrition blindness in Children programme contain

1 lakh IU is given on 0,1 and 14th day REF:Refer Khurana 6th edition page number 480


Question: Best to visualize corneal endothelium

Ans. b (Specular microscopy). (Ref. Parson Diseases of Eye/19th/pg. l 13)SPECULAR MICROSCOPY# It is vital to count and study morphology of corneal endothelial cells, especially in the cases of cataract with suspected endothelial dystrophy.# Normal cell count is 2000-2500 cells/mm2.# IOL implantation is contraindicated if the cell count is < 1500/mm2.# Specular reflection by slit lamp biomicroscope (specular microscopy) allows visualization of corneal endothelium by viewing light reflected back from this interface, count of endothelial cells is possible using an Elser grid.


Question: Laser trabeculoplasty is done for

Laser Trabeculoplasty is useful in patients with primary or secondary open angle glaucoma. It acts by producing a thermal energy at the point of application which will produce micro scars. As the micro scars contract, surrounding un-lasered tissue is stretched there by allowing for better drainage. Repopulation of the trabecular meshwork by stimulation of the cellular division is another possible mechanism. New formed cells are more efficient at allowing drainage. In the given options, Pseudoexfoliation syndrome and Uveitic glaucoma are secondary open angle glaucoma. Uveitic glaucoma patients require control of the uveitis and usually medical treatment of glaucoma. Surgical intervention including laser treatment can worsen the uveitic component of the disease. Pseudo exfoliation syndrome (PES) is characterized by deposition of an amorphous grey dandruff-like material on the pupillary border, anterior lens surface, posterior surface of iris, zonules and ciliary processes. Secondary open-angle glaucoma is associated in about 50% of the cases. Exact mechanism of rise of IOP is also not clear. Trabecular blockage by the exfoliative material is considered as the probable cause. Clinically, the glaucoma behaves like POAG and is managed by Laser Trabeculoplasty (Increases Trabecular Outflow) Laser trabeculoplasty causes damage, inflammation and scarring of trabecular mesh work causing opening up of trabecular spaces. Since it causes a lot of inflammation it is not used for cases where already there is a lot of inflammation like uveitic glaucoma and neovascular glaucoma.


Question: Not a feature of conjunctivitis

Impaired pupillary reaction is seen in optic nerve disorders or extensive retinal detachment . It is not seen in conjuvtivitis. C/F of conjunctivitis * Discharge: Watery, Mucoid, mucopurulent, Severe purulent * Hyperemia: Bacterial /viral infection. * Hemorrhage: Viral (enteroviral/ adenoviral / trauma). * Chemosis(swelling of conjunctiva): Viral/ Bacterial. . Normal pupillary reaction * Pseudomembrane/true membrane: Pseudomembrane doesnot bleed on removal * Infiltration * Subconjunctival scarring: Loss of goblet & accessory lacrimal glands (trachoma) lead to fibrosis . colored halos


Question: Most common cause diminision of vision in Peterygium is

Most common cause of diminision of vision in Peterygium is Astigmatism.


Question: Most common site of bony metastases in retinoblastoma

Answer-A. Skull bonesThe most frequently identified sites of metaststic involvement in children with retinoblastoma include skull bones, distal bones, brain, spinal cord, lymph nodes and abdominal viscera.


Question: Iris cyst are induced by


Question: Earliest clinical feature of Senile cataract

Earliest clinical feature of Senile cataract is Glare
Most common symptom at presentation is Frequent change of glasses


Question: Structure with highest refractive index

Lens - 1.41 Aqueous humor - 1.34 Cornea - 1.38 Vitreous humor - 1.34


Question: The most common malignant tumor of the eyelids is


Question: Contraindication of topical beta blockers


Question: Treatment of Gonococcal ophthalmica neonatoram do not include

Treatment of Gonococcal ophthalmica neonatoram do not include

Topical Atropine
Ceftriaxone im
Topical Bacitracin


Question: Fixation reflex develops at the age of

Fixation reflex 2-4 months.
Macular differentiation 4-6 months.
Stereopsis 5-7 years.


Question: Hirschberg test is used to detect

Hirschberg corneal reflex test: It is a rough but handy method to estimate the angle of manifest squint. In it the patient is asked to fixate at point light held at a distance of 33 cm and the detion of the corneal light reflex from the centre of pupil is noted in the squinting eye. Roughly, the angle of squint is 15deg and 45deg when the corneal light reflex falls on the border of pupil and limbus, respectively. Ref:- A K KHURANA; pg num:-327


Question: Glaucoma flecken is

Vogt's triad may be seen in patients with any type of post congestive glaucoma and in treated cases of acute congestive glaucoma. It is characterized by: _ Glaucoma flecken (anterior subcapsular lenticular opacity), _ Patches of iris atrophy, and _ Slightly dilated non-reacting pupil (due to sphincter atrophy). Glaukomflecken are gray-white epithelial and anterior coical lens opacities that occur following an episode of markedly elevated IOP , Ref: Khurana; 4th edition; Pg. 230


Question: Bitemporal hemianopia is caused by lesions at

(Central lesion of the Chiasma) (290-Khurana 4rd) (35-P)LESIONS OF THE VISUAL PATHWAY1. Lesions of the optic nerve - Marked loss of vision or complete blindless on the affected side associated with abolition of the direct light reflex on the ipsilateral side and consensual on the contralateral side.Common causes - Optic atrophy, Traumatic avulsion of the optic nerve, Indirect optic neuropathy and acute optic neuritis2. Lesions through proximal part of the optic nerve - Ipsilateral blindness, contralateral hemianopia and abolition of direct light reflex on the affected side and consensual on the contralateral side, Near reflex is intact.3. Sagittal (Cental) lesions of the Chiasma - Bitemporal hemianopia and bitemporal hemianopic paralysis of the pupillary reflexes.Common causes - Suprasellar aneurysm, tumours of the pituitary glands*, Craniopharyngioma, suprasellar Meningioma, glioma of third ventricle, third ventricular dilatation due to obstructive hydrocephalus and chronic chiasmal arachnoiditis.4. Lateral chiasmal lesions - Binasal hemianopia associated with binasal hemianopic paralysis of the pupillary reflexes.Common causes are - Distension of third ventricles causing pressure on each side of the chiasma, and atheroma of the carotids or posterior communicating arteries.5. Lesions of the optic tract - in congruous homonymous, hemianopia associated with contralateral hemianopic pupillary reactions {Wernicke's reaction)Common causes are - syphilitic meningitis or gumma, TB and tumours of optic thalamus and aneurysms of superior cerebellar or posterior cerebral arteries.6. Lesion of the lateral geniculate body - homonymous hemianopia with sparing of pupillary reflexes and may end in partial optic atrophy7. Lesions of optic radiation(I) Inferior quadrantic hemianopia {Pie on the floor) - lesions of parietal lobe(II) Superior quadrantic hemianopia {Pie in the sky) lesions of the temporal lobes


Question: Avascular coat in the eye is

The cornea is a transparent, avascular, watch-glass like structure. It forms anterior one-sixth of the outer fibrous coat of the eyeball. It gets its nutrition from aqueous humor predominantly.Ref: Khurana; 4th edition; Pg: 89


Question: Most common cause of rubeosis iridis is

Rubeosis iridis is a condition in which new blood vessels form on the anterior surface of the iris. It occurs in diabetics of long standing and in thrombosis of the retinal vein.


Question: Fluorescent dye for ophthalmological diagnosis is injected in

The technique of FFA comprises rapidly injecting 5 ml of 10 percent solution of sterile sodium fluorescein dye in the antecubital vein and taking serial photographs (with fundus camera) of the fundus of the patient who is seated with pupils fully dilated. The fundus camera has a mechanism to use blue light (420-490 nm wavelength) for exciting the fluorescein present in blood vessels and to use the yellow-green filter for receiving the fluorescent light (510-530 nm wavelength) back for photography. Reference : A K KHURANA Comprehensive Ophthalmology; edition 4; page-487

Anatomy, Development and clinical examination


Question: A56 years old patient presents after three days of cataract surgery with a history of increasing pain and decrease of vision after an initial improvement the most likely cause would be

Pain which is increasing along with decrease in vision paicularly after only three days of cataract surgery strongly suggest endophthalmitis


Question: Salt and pepper fundus occurs in

C i.e. Rubella Congenital syphilis show dusty discrete pigmentation of peripheral retinae where multitude of black & white spots appears ('pepper & salt fundus' Q) + anterior retinitis + interstitial keratitis


Question: Krukenberg spindles

Deposition of pigment granules in posterior surface of cornea is called krukenbergs spindle it is seen in pigment dispersion syndrome.


Question: On performing retinoscopy, movement of red reflex does not occur with the movement of retinocope in

In > 1D Myopia, movement of red reflex occurs against the movement of retinoscope. In rest, it occurs with the movement of retinoscope.


Question: Antimicrobial resistance in frequent lens user is due to

The contaminated contact lens provides Pseudomonas aeruginosa an idea site for attachment and biofilm production Continuous contact of the eye to the biofilm-infested lens can lead to serious ocular diseases, such as keratitis (corneal ulcers) The biofilm also prevent effective penetration of the antibiotics, which increase the chances of antibiotic resistance. Reference : AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 50


Question: Mydriatic used in children for refraction is


Question:
Most common ocular feature in Reiter
Syndrome is

Reiter syndrome is characterised by

Urethritis
Arthritis
Conjunctivitis>>> Urethritis


Question: Corneal endothelium was seen by

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 95 - 96)Corneal endothelium:It consists of single layer of polygonal (mainly hexagonal cells)They are visualized by slit lamp bio-microscope and appear like a mosaicThe cell density is 30000 cells/mm2 in young adults and decreases with ageThese cells contain active pump mechanism


Question: Number of pericytes in diabetic retinopathy

In diabetic retinopathy loss of pericytes in capillaries cause leakage of vessels. The onset of diabetic retinopathy is characterized by morphologic alterations of the microvessels, with thickening of the basement membrane, loss of inter-endothelial tight junctions and early and selective loss of pericytes, together with increased vascular permeability, capillary occlusions, microaneurysms Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 335


Question: Most common cause of unilateral proptosis is

A i.e. Thyrotoxicosis Grave's ophthalmopathy is most common cause of U/L or B/L proptosis in adults Q between age of 25-50 yrsQ


Question: One meridian focussed on retina, other meridian focussed behind retina is seen in


Question: SAFE strategy is used for

Trachoma blindness Trachoma is a leading cause of preventable blindness. Effective interventions have been demonstrated in developing nations using the &;SAFE strategy&;. SAFE strategy: &;S&;urgery to correct lid deformity and prevent blindness, &;A&;ntibiotics for acute infections and community control, &;F&;acial hygiene, &;E&;nvironmental change including improved access to water and sanitation and health education. Reference :- A K KHURANA 7th edition ; page:-447


Question: Earliest clinical feature of orbital extension of the basal cell carcinoma of the eyelid is


Question: Contraindicated in glaucoma is

(Atropine): Ref: 222-KH (147-P)* Topical beta blockers are the first drug choice for medical therapy of primary open angle glaucoma (POAG) E.g. Timolol maleate, Betaxolal, Levobunolol, carteolol* Pilocarpine: - Contracts longitudinal muscle of ciliary body and opens spaces in trabecular mushwork, thereby mechanically increased aqueous outflow.* Dorzolamide: - topically carbonate anhydrase inhibitor* Latanoprost: - (prostaglandins F2a) decreases the IOP by increading the uveo-scleral out flow of aqueous.* Adrenergic drugs- Epinephrine, Apraclonidine and brimonidine* Atropine - are contraindicated in individuals with narrow iridocorneal angle - may precipitate acute congestive glaucoma, however marked rise in IOP its rare in patients with wide angle of glaucoma (100-KDT)


Question: Most common cause of bilateral internuclear ophthalmoplegia is

U/L INO - Diabetes mellitus.
B/L INO - Multiple sclerosis.


Question: Lens develops from.

Ans. (b) Surface ectodermSurface EctodermNeural EctodermMesodermNeural Crest* Conjunctival Epithelium* Corneal Epithelium* Lacrimal gland* Tarsal gland* Lens* Smooth muscle of Iris* Iris Epithelium* Ciliary Epithelium* Retina & its pigment epithelium* Optic nerve fibre* Part of vitrous* EOM* Sclera* Iris* Vascular endothelium* Choroid* Part of vitrous* Corneal stroma* Ciliary ganglion* Schwann cell* Uveal and conj melanocytes* Meningeal sheath of ON* Part of vitrous


Question: Frequent changes of reading glasses in a 60yr old male patient is a feature of

Frequent changes of reading glasses is a feature of Primary open angle glaucoma.


Question: Wavelength of Femtosecond laser is

Femtosecond - 1053 nm
nd - Yag - 1064 nm.


Question: Fasanella servat operation is done for

The Fasanella-Servatprocedure is used for the repair of mild to moderate ptosis. ... RESULTS: Ptosis was classified as involutional, occurring after intraocular surgery, congenital, due to Horner's syndrome present after levator surgery, and myogenic/other. Ref khurana 6/e


Question: Marcus Gunn sign is seen in

Grading of hypeensive retinopathy:Keith and Wegner (1939) have classified hypeensive retinopathy changes into following four grades:_ Grade I: It consists of mild generalized aeriolar attenuation, paicularly of small branches, with broadening of the aeriolar light reflex and vein concealment._ Grade II: It comprises marked generalized narrowing and focal attenuation of aerioles associated with deflection of veins at aeriovenous crossings (Salus' sign)._ Grade III: This consists of Grade II changes plus copper-wiring of aerioles, banking of veins distal to aeriovenous crossings (Bonnetsign), tapering of veins on either side of the crossings (Gunn sign) and right-angle deflection of veins (Salu's sign). Flame-shaped hemorrhages cotton-wool spots and hard exudates are also present._ Grade IV: This consists of all changes of Grade III plus silver-wiring of aerioles and papilloedema.Ref: Khurana; 4th edition; Pg. 258


Question: Vitreous floaters are seen in

Choroiditis refers to inflammation of the choroid which in most cases also involves the adjacent retina resulting in chorioretinitis. clinical features: -Painless visual symptoms like photopsia -Vitreous Floaters : black spots in front of the eyes - represent the vitreous inflammation - opacities that cast shadows on the retina - can be seen in any condition associated with vitritis - intermediate or posterior uveitis -Micropsia or macropsia -Positive scotoma Fundus examination reveals vitreous opacities with active healed stage of retinitis. Treated by systemic steroids


Question: First change in Visual field seen in Glaucoma

First change in Visual field seen Glaucoma is Isopter Contraction but is Visually insignigficant.


Question: Satellite nodule on a corneal ulcer is seen due to

(Fungal infection) (100- Khurana 4th)FUNGAL - KERATITIS - caused by filamentous fungiSign.* It is dry looking grayish- white with elevated rolled out margins* Delicate feathery finger like extension are present into the surrounding stroma under the intact epithelium* A sterile immune-ring (yellow line of demarcation) may be present* Multiple small satellite lesions may be present around the ulcer* Usually a big hypopyon unlike bacterial ulcer may not be sterile and the fungi can penetrate into the anterior chamber without perforation* Perforation in mycotic ulcer is rare but can occure* Corneal vascularization is consipicusly absent


Question: Not a risk factor for primary open angle glaucoma among the following is

Myopia is a risk factor for primary open angle glaucoma, not Hypermetropia.


Question: Visual field defect in a woman with pituitary adenoma compressing the optic chiasma

Ref: Kanski: Clinical Ophthalmology; 7th edition.Explanation:Normal chiasmal position is seen in 80%Prefixed chiasma - placed in front of the pituatory fossa - 10%Postfixed chiasma - placed posteriorly above the pituatory fossa-10%.


Question: "Snowflakes" cataract is seen

A. (Diabetes) (181 - Khurana 4th)True Diabetic Cataract - It is also called "snow- flake cataract" or "snow storm cataract". It is rare condition usually occurring in young adults due to osmotic overhydration of the lens. Initially a large number of fluid vaccoules appears underneath the anterior and posterior capsules. Which is soon following by appearance of bilateral "snow - flake white opacities in the cortex* Clasical diabetic cataract consists of snow flake cortical opacities occurring in young diabetics (166 - K)* Galectosaemic cataract - bilateral cataracts oil droplet central lens opacities*** Wilson's disease - "Sunflower cataracts"*** Dystrophia - myotonica - "Christmas tree" patternTreatment of advanced diabetic retinopathy include - Seal the tear and reattach the retina, vitrectomy, exophotocoagulation***


Question: Best method of detection of retained glass intraocular foreign body is

In CT or MRI, accurate foreign body localization is possible.


Question: Snellen's chart is based on


Question: Von Herick angle grade '3' of anterior chamber denotes


Question: Radiation induced cataract is

Radiation can cause Posterior subcapsular cataract Lens is the most sensitive pa of eye for radiation induced damage Miscellaneous Cataract impoant for PGMEE * Sunflower cataract: Wilson disease, chalcosis. * Polychromatic Lusture- Complicated cataract * Coicosteroid: Posterior subcapsular cataract. (Topical steroids cause glaucoma, systemic steroids cause cataract more) * Galactosemia: Oil drop cataract * Anterior lenticonus- Alpo * Posterior Lenticonus- Lowe Syndrome * Rosette Cataract: Blunt trauma * Shield cataract- Atopic dermatitis. * Radiation can cause PSC cataract. * Persistent hyaloid aery: Cause of Posterior polar cataract * Myotonic Dystrophy: Christmas Tree Cataract (mimics the lights on a christmas tree) * Posterior polar cataract: Persistent hyperplastic primary vitreous * Snow storm/Snow flake cataract: Diabetes


Question: Cataract in a diabetic patients is because of accumulation of sorbital in lens. The enzyme responsible for this is

B i.e. NADPH + dependent aldolase reductase Lens Q, peripheral nerves, renal glomeruli & RBC's are the tissues where glucose can enter without the help of insulin. In diabetics, concentration of glucose rise with in lens which is conveed into sorbitol & fructose. Sorbitol does not easily diffuse through cell membrane & thus accumulate. It causes damage to lens protein and leads to cataract.


Question: Earliest change in diabetic retinopathy is

(C) Microaneurysms and pin point haemorrhages # Non-proliferative diabetic retinopathy (NPDR)> Ophthalmoscopic features of NPDR include: Microaneurysms in the macular area*(the earliest detectable lesion). Retinal haemorrhages both deep (dot and blot haemorrhages) and superficial haemorrhages (flame-shaped). Hard exudates -yellowish-white waxy-looking patches are arranged in clumps or in circinate pattern. These are commonly seen in the macular area. Retinal oedema characterised by retinal thickening. Cotton-wool spots (if>8, there is high risk of developing PDR). Venous abnormalities, beading, looping and dilatation. Intraretinal microvascular abnormalities (IRMA). Dark-blot haemorrhages representing haemorrhagic retinal infarcts.


Question: Contraindication of LASIK among the following is

Any corneal defect is a contraindication for LASIK. Laser in-situ keratomileusis (LASIK) Currently, this procedure is being considered the refractive surgery of choice for myopia up to -12D. In this technique first, a flap of 130-160 micron thickness of anterior corneal tissue is raised. After creating a corneal flap midstromal tissue is ablated directly with an excimer laser beam, ultimately flattening the cornea. Patient selection criteria are: 1. Patients above 20 years of age 2. Stable refraction for at least 12 months 3. Motivated patient 4. The absence of corneal pathology: Presence of ectasia or any other corneal pathology and a corneal thickness less than 450 mm is an absolute contraindication for LASIK. Because keratoconus is a degenerative corneal disease that causes thinning of the cornea and leads to unpredictable and irregular changes in the shape of the front surface of the eye, LASIK generally is not recommended for anyone with keratoconus Reference: AK khurana 7th edition page 256


Question: NOT a feature of Behcet's disease among the following is

Behcet's disease is characterised by bilateral non granulomatous Anterior Uveitis.


Question: A 65 year old man complains of difficulty in reading newspaper with his left eye, three weeks after sustaining a gunshot injury to his Right eye. Diagnosis is

It is a serious bilateral granulomatous panuveitis which follows a penetrating ocular trauma.


Question: Mild dilated fixed pupil seen in


Question: Absence of tear film is seen in

Ans. is 'd' i.e. Keratoconjunctivitis sicca. Keratoconjunctivitis sicca: A condition in which there is deficiency of the aqueous tears.Causes are:Sjogren's syndromeCongenital alacrimaParalytic hyposecretionIdiopathic hyposecretionAbsence of tear film is not seen in lacrimal gland removal because :"It must be remembered that xerosis or dryness of the conjunctiva does not result from extirpation of the superior and inferior lacrimal glands, the moistening of the conjunctiva by Krause's glands and its own mucous cells being sufficient to prevent it."


Question: Iris cyst formation induced by

Local side-effects are encountered more frequently with long-acting miotics. These include problems due to miosis include myopia and frontal headache, retinal detachment, lenticular opacities, iris cyst formation, mild iritis, lacrimation and follicular conjunctivitisAmong the given drugs pilocarpine is Parasympathomimetic drugs (Miotics)


Question: Perimetry is a test to assess the

The visual field is a three-dimensional area of a subject's surroundings that can be seen at any one time around an object of fixation. The extent of the normal visual field with a 5 mm white color object is superiorly 50 degree, inferiorly 70 degree, nasally 60 degrees and temporally 90o degree. The field for blue and yellow is roughly 10 degrees less and that for red and green color is about 20 degrees less than that for white. Perimetry with a red color object is paicularly useful in the diagnosis of bitemporal hemianopia due to chiasmal compression and in the central scotoma of retrobulbar neuritis. Image : Goldmann perimetry Reference : AK KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4, Page-481

Anatomy, Development and clinical examination


Question: The toxic agent in 'Tobacco amblyopia' is

(Cyanide): Ref: 296-KH (92-P)TOBACCO AMBLYOPIA: -Toxic agent involved cyanide fond in tobacco.Excessive tobacco smoking Decreased cyanide detoxification due to alcoholics dietary deficiency of sulphur rich proteins| |Excessive cyanide in blood | Degeneration of ganglion cells particularly of the macular region | Degeneration of papillo-macular bundle in the nerve | Toxic amblyopia * Bilateral gradually progressive impairment in the central vision* Visual field examination - Bilateral centrocaecal scotomas* Fundus examination is essentially normal or there may be slight temporal pallor of the disc.


Question: Sixth cranial nerve palsy of left eye causes

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 336 - 361)Sixth nerve supplies lateral rectus, therefore its palsy results in abduction weakness (not adduction weakness).In left gaze, there is the abduction of left eye and adduction of the right eye. If there is paralysis of lateral rectus of the left eye (6th nerve paralysis), abduction of left eye will not be possible in left gaze, while adduction of the right eye is normal. Therefore, there will be diplopia in left gaze.


Question: A 58 year old male with history of Ipsilateral facial paralysis and contralateral hemiplegia. Plain CT scan head is given below. The diagnosis is

(A) MCA stroke # Stroke syndromes:> Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen.> The MCA is the most common site for the occurrence of ischemic stroke.> Middle Cerebral Artery Pneumonic: "CHANGes" Contralateral paresis and sensory loss in the face and the arm Homonymous Hemianopsia Aphasia Neglect Gaze preference toward the size of the lesion# Signs and Symptoms:> Hemiparesis or hemiplegia of the lower half of the contralateral face> Hemiparesis or hemiplegia of the contralateral upper and lower extremities> Sensory loss of the contralateral face, arm and leg> Ataxia of contralateral extremities> Speech impairments/aphasia: Broca's, Wernicke's or Global aphasia as a result of a dominant hemisphere lesion (usually the left brain)> Perceptual deficits: hemispatial neglect, anosognosia, apraxia, and spatial disorganization as a result of a non-dominant hemi- sphere lesion (usually the right brain)> Visual disorders: deviation conjuguee, a gaze preference towards the side of the lesion; contralateral homonymous hemianopsia> Radiographic features:> Generally the features are those of cerebral infarction, similar to those seen in any other territory.> There are however certain features specific to middle cerebral artery infarct, and these are discussed below. For both CT and MRI it is worth dividing the features according to time course.> It should also be noted that middle cerebral artery infarcts are often incomplete affecting only perforator branches or one or more distal branches. As such in many cases only parts of the middle cerebral artery territory is affected.> CT: The earliest finding of middle cerebral artery occlusion is: Hyperdense middle cerebral artery sign 3 seen immediately and represents direct visualisation of the thromboembolism. Presence of calcification is important as it is a contraindication to angioplasty> Early parenchymal signs include subtle blurring, decreased attenuation and swelling of the grey-white matter junction of affected regions. It should be noted that deep grey matter structures are affected before the cortex due to lenticulostriate arteries being end arteries, and cytotoxic oedema (intracellular fluid accumulation) occurring earlier 2,4: lentiform nucleus; caudate nucleus as early as 1 hour after occlusion 4 visible in 75% of patients at 3 hours 4 insular ribbon although cortical it is the furthest cortex from collateral circulation and is therefore also affected early 4 the insular ribbon sign describes loss of normal grey-white differentiation surface cortex (including peri-rolandic cortex) collateral flow retards development of CT signs with only 20% of cases demonstrating changes at 3 hours 4> With time the hypo-attenuation and swelling become more marked, and in patients with the majority of the MCA territory affected the mass effect is often dramatic and life threatening, sometimes requiring a decompressive craniectomy.> As time passes the infarct undergoes gradual reduction in swelling and mass effect (see cerebral infarction).> Treatment and prognosis. Treatment of middle cerebral artery infarcts is the same as infarcts anywhere else (see cerebral infarction) except that due to the size of the involved territory the degree of mass effect resulting form infarction can be marked and life threatening. As such decompressive craniectomy is advocated by many as a life saving procedure.


Question: Distance of patient w hile reading Snellen chart is

(C) 6 meters # SNELLEN CHART is an eye chart that can be used to measure visual acuity.> Visual acuity = Distance at which test is made / distance at which the smallest optotype identified subtends an angle of 5 arcminutes.> In the most familiar acuity test, a Snellen chart is placed at a standard distance: 6 metres (or 20 ft). At this distance, the symbols on the line representing ""normal"" acuity subtend an angle of five minutes of arc, and the thickness of the lines and of the spaces between the lines subtends one minute of arc. This line, designated 6/6 (or 20/20), is the smallest line that a person with normal acuity can read at a distance of 6 metres (20 ft).


Question: Commonest ocular sign of hypothyroidism is

Cataract - hypothyroidism
Darlymple sign - Graves disease.


Question: Unilateral water discharge from the eye of a newborn with no edema or chemosis is due to

Chemical conjuctivitis occurs due to silver nitrate eye drops given in children to prevent gonorrhea infection REF:Refer Khurana 6th edition page number 65


Question: Ascorbic acid transpo in cornea is mediated by

Metabolism of Cornea *Main Metabolic pathway: Aerobic *Ascorbic acid transpo: Na K ATPase > Myoinositol *Cornea becomes edematous due to lactate accumulation that happens during hypoxic conditions such as prolonged contact lens use. *Oxygen is derived from environment & glucose from aqueous humor. *Vitamins and amino acids are also provided by the limbal cappilaries


Question: Ophthalmia nodosa is seen with

*Ophthalmia nodosa: Conjunctival inflammatory nodule due to caterpillar hair or tarantula hair *Can lead to chronic conjunctivitis and visually disabling corneal scars , cataract, vitritis and macular edema *Treatment: removal of the offending agent and managing inflammation through coicosteroid treatment.


Question: Development of eye completes at

Development of eye begins at 3 weeks period of gestration.
Development of eye eompletes at 9 - 10 weeks period of gestation.


Question: For a neonate with Threshold Retinopathy of prematurity, most appropriate Rx would be

If threshold disease is present, perform ablative surgery. Ablative therapy currently consists of cryotherapy or laser surgery to destroy the avascular areas of the retina. The average gestational age (GA) at which surgery is necessary is usually 37-40 weeks Figure : Retina of the right and left eye, showing borders of the three zones and clock hours used to describe the location and extent of retinopathy of prematurity. Reference : Khurana 6th edition page 214

Anatomy, Development and clinical examination


Question: Eale's disease is best treated with


Question: Muscae volitantes are seen in

These are physiological opacities and represent the residues of primitive hyaloid vasculature.
Patient perceives them as fine dots and filaments, which often drift in and out of the visual field, against a bright background (e.g., clear blue sky).

Remains of primitive hyaloid vasculature


Question: Voex vein invasion is commonly seen in

Voex vein invasion is common in malignant Melanoma where does optic nerve invation is common in retinoblastoma Refer khurana 6/e p 420

Diseases of orbit, Lids and lacrimal apparatus


Question: Blow up out fracture of zygomatic arch cause

Blow out fracture is the fracture of floor due to blunt trauma. Floor is formed of zygomatic arch ,maxillary bone and small palatine bone Refer khurana 6/e 403

Diseases of orbit, Lids and lacrimal apparatus


Question: Christmas tree cataract is seen in

Christmas tree cataract is seen in myotonic dystrophy Christmas tree cataract These are polychromatic and highly reflective, needle-shaped opacities in the lens seen in myotonic dystrophy. Usually it does not disturb vision.


Question: Cornea veicillata is caused by

Cornea veicillata: *This is a whorl-like opacity in the corneal epithelium seen in patients on long-term treatment with medication such as amiodarone, chloroquine, phenothiazines, and indomethacin. *It is also seen in patients with Fabry disease and its carrier state. *The condition is generally asymptomatic, harmless and reversible on stopping the drug. *The whorl-like pattern shows the direction of migration of corneal epithelial cells. *Occasionally the condition has been known to cause glare and surface discomfo which responds to topical lubricants. Cornea veicillata, also called voex keratopathy or whorl keratopathy, is a condition characterised by corneal deposits at the level of the basal epithelium forming a faint golden-brown whorl pattern. It is seen in Fabry disease or in case of prolonged amiodarone intake Ref- Parson's; 21st edition; Pg No. 214


Question: Most common ocular complication of Diphtheria is

A i.e. Paralysis of accommodation In diptheria ciliary muscle never escape, hence there is almost always paralysis of accommodation Q. Pupils often escapes hence pupillary reflex is normal. Isolated ocular palsies are common External opthalmoplegia is rare.


Question: Besides its propeies of decreasing intraocular pressure, timolol is preferred in the treatment of glaucoma because it

Ans. is 'a' i.e., Produces no miosis Advantages of topical n-blockers (timolol) over miotics (pilocarpinel No change in pupil size (no miosis) - No fluctuation in I.O.T. No induced myopia - Convenient once/twice daily applications No ciliary spasm (no spasm of accomodation) - Few systemic side effects.

Is a selective beta-adrenoceptor blocker


Question: Most common type of astigmatism in keratoconus is

Keratoconus usually have irregular astigmatism * B/L Non inflammatory ectatic condition of cornea Clinical Presentation * Young females with constantly changing power of glasses with myopia & high cylinder and irregular astigmatism SIGNS IN KERATOCONUS Munson sign Enlarged corneal nerves Oil droplet reflex( on DDO) Rizutti sign Hydrops Fleischer ring


Question: In cystoid macular edema fluid collects in the macular region at the level of

Between pigment epithelium and neurosensory retina


Question: Human retina consists about

(A) 100 million Rods & 5 million Cones # Total number of cones in fovea:> Approximately 200,000. There are 17,500 cones/degree> Rod free area is approximately 10 thus there are 17,500 cones in the central rod-free fovea.> Total number of cones in the retina. - 6,400,000> Total number of rods in the retina. - 110,000,000 to 125,000,000> Rod distribution.> Rods peak in density 180 or 5mm out from the center of the fovea in a ring around the fovea at 160,000 rods/mm2> No rods in central 200 pm.> Average 80-100,000 rods/mm2> Rod acuity peak is at 5.20 or 1.5 mm from foveal center where there are 100,000 rods/mm2


Question: Ophthalmia neonatorum presenting within 24 hours of bih is most likely due to

Chemical conjunctivitis Time of onset of chemical conjuctivitis: Immediately after bih Ophthalmia Neonatorum *B/L Conjunctival swelling in a neonate in first 4 weeks of life Signs Pain and tenderness in the eyeball. Conjunctival discharge Conjunctiva shows hyperaemia & chemosis. Eyelids are usually swollen. Corneal involvement may occur in herpes simplex ophthalmia neonatorum. CAUSES Chlamydia trachomatis Neisseria gonorrhoeae Haemophilus species Streptococcus pneumoniae Staphylococcus aureus BACTERIAL Staphylococcus epidermidis Streptococcus viridans Escherichia coli Pseudomonas aeruginosa VIRAL Adenovirus Herpes simplex virus CHEMICAL CONJUNCTIVITIS Crede's solution Time of Onset *Chemical : Immediately *C. Trachomatis: upto 2 weeks *N. Gonorrhea: 24-48 hours *Staphylococcus, H. influenzae, Streptococcus, enterococcus: 2-5 days *Viral: within one week Just on the basis of the time of onset, it is difficult to make a diagnosis sometimes, other relevant clinical history and clinical findings have to be taken in consideration


Question: Uveitis with raised intraocular tension is best managed by


Question: The golden period of eye donation is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 136)"Donor corneas are harvested from cadaveric donors within 6 hours after death, sometimes up to 12 hours after death in countries with cold climates".


Question: Granulomatous uveitis is seen in

UVEITIS (INFLAMMATION OF UVEA) Pathological Classification: 1)Non-granulomatous: Common systemic disorders associated with acute non-granulomatous anterior uveitis are: sacroiliitis, ankylosing spondylitis, Reiter&;s syndrome, psoriasis, ulcerative colitis and Crohn&;s disease. 2)Granulomatous: Impoant causes of granulomatous uveitis are: Tuberculosis, Leprosy, Syphilis, Herpetic uveitis, Brucellosis, Histoplasmosis, cryptococcosis, Sarcoidosis, Vogt-Koyanagi-Harada&;s disease, Sympathetic ophthalmitis, Lens induced uveitis, and Foreign body uveitis. Ref:- A K Khurana; pg num:-138,140,141


Question: Most impoant factor for development of diabetic retinopathy is

Duration of diabetes is most impoant factor for development of diabetic retinopathy. Other Risk Factors: Duration of DM Hyperlipidemia Nephropathy Pregnancy Hypeension

co morbid conditions like hypeension & hyperlipidemia


Question: Ocular bobbing centre is

Ocular bobbing centre is pons. Characterised by conjugate eye movements, beginning with a fast downward movement followed by slow drift back to midline. Causes : -comatose patient with massive pontine lesion - metabolic encephalopathy.


Question: The main corneal mechanism holding the LASIK flap in place after surgery is

In LASIK surgery after creating a corneal flap and ablating the midstromal tissue , the flap is reposited back without sutures. The main mechanism holding the flap is corneal endothelial pumps.


Question: Most common etiology of recurrent vitreous heamorrhage in young patient

M/C cause of vitreous haemorrhage in Adults & Children - trauma.
M/C cause of recurent VH in elderly - PDR.
M/C cause of recurrent VH in young - Eales disease.


Question: Not a function of eye collection centre

Processing of donor eyes are done by eye bank Functions of eye collection centre A. Local publicity B. Registration of voluntary donors C. Arrangement for collection of eyes after death D. Transpoation of eye to eye bank


Question: Treatment modalities for myopia are

Treatment of myopia 1. Optical treatment of myopia 2. Surgical treatment of myopia Radial keratotomy (RK) Photorefractive keratectomy (PRK) Laser in-situ keratomileusis (LASIK) Extraction of clear crystalline lens Phakic intraocular lens Intercorneal ring (ICR) implantation Ohokeratology 3. General measures-include balanced diet rich in vitamins and proteins and early management of associated debilitating disease. 4. Low vision aids (LVA) 5. Prophylaxis (genetic counselling). Reference : A K KHURANA OPHTALMOLOGY,Edition4, page-35,36,47,48


Question: Not a feature of paralytic squint

Paralytic squint

Diplopia
Confusion
Ocular deviation
Nausea & vertigo.


Question: Adei's atonic pupil is due to

(B) (Loss of parasympathetic nerve supply) (313- Khurana 5th)ADIE'S TONIC PUPIL - caused by post ganglionic parasympathetic pupillo motor damage* Usually unilateral associated with absent knee jerk, common in young woman* Reaction to light is absent and to near reflex is very slow and tonicComparison bwtween Argyll-Robertson pupil and Adie's pupilFeaturesARPAdie' pupilVisionGoodGoodPupilConstrictedDilated (Anisocoria)LateralityBilateral, may be unilateralUnilateral, may become bilateralEffect of illuminationNilLarger in bright lightLight reflex (Direct and consensualAbsentAbsent /poorNear reflex (Accomodation)BriskTonicAtropineNo mydriasisMydriasisMioticConstrictConstrict with, very weak solutionLesionPretectalCiliary ganglionARP- first described in neuro-syphilis, but this may be seen in several conditions affecting the midbrain including Encephalitis, CVA, M.S etcHutchinson's pupil- developed after the head injury (H tor H)There is widely dilated immobile pupil on the same side as the head injury. Both the direct and the concensual reflexes to light are lost


Question: Secondary glaucoma associated with angle recession is seen in

A i.e. Concussion injury Angle recession involves rupture of face of ciliary body, the poion that lies between the iris root and the scleral spur. It is detected gonioscopically as widening of ciliary body band. It is seen in large number of blunt trauma Q patients but glaucoma Q develops in 6-9%.


Question: Emmetropia is associated with

Emmetropia (optically normal eye) is a state of refraction when the parallel rays of light coming from infinity are focused at the sensitive layer of the retina with accommodation at rest. At bih, the eyeball is relatively sho and thus most infants are born with +2 to +3 D hypermetropia. This is gradually reduced and by the age of 5 to 7 years usually, the eye becomes emmetropic in a person with absent refractive error. Ametropia (a condition of refractive error), is defined as a state of refraction when the parallel rays of light coming from infinity (with accommodation at rest), are focused either in front or behind the sensitive layer of the retina, in one or both the meridians. The ametropia includes myopia, hypermetropia, and astigmatism. Emmetropia is the state of vision in which a faraway object at infinity is in sharp focus with the eye lens in a neutral or relaxed state. That condition of the normal eye is achieved when the refractive power of the cornea and the axial length of the eye balance out, which focuses rays exactly on the retina, resulting in perfect vision. A human eye in a state of emmetropia requires no corrective lenses; the vision scores well on a visual acuity test (such as an eye cha test). For example, on a Snellen cha test, emmetropic eyes score at "6/6"(m) or "20/20"(ft) vision, meaning that at a distance of 20 ft (the first number) they see as well as a normal eye at a distance of 20 ft (the second number). Either myopic (near-sighted) eyes or hyperopic (far-sighted) eyes would score worse, e.g. 20/40 (visual acuity roughly half normal). Exceptionally acute vision (excellent cornea and lens and better than standard retina) might be 20/15 Emmetropia is the state of the eye in which no refractive error is present, there is no need for glasses or contact lenses. In emmetropia, the curvature of the cornea, the shape of the lens and their distances from each other all work together to focus the rays of light to create a sharp image on the retina Reference : Khurana comprehensive ophthalmology; 4th edition; P: 28,29


Question: 5% guanethidine is used for


Question: Drug of choice for treatment of intermediate uveitis is

Treatment for Intermediate uveitis : Intravitreal or Posterior Subtenon's Steroid injections : Triamcinolone acetonide Steroids may also be given by subconjuntival route or by Subtenon's route


Question: Macula is


Question: Swimmer after coming out from swimming pool presents with redness and mucopurulent discharge. There is no history of contact lens wear. On examination, no corneal involvement seen. Probable diagnosis is

Answer- B. Adult inclusion conjunctivitisis a type of follicular conjunctivitis caused by serotypes D to K of chlamydia trachomatis in sexually active young adults.Transmission may occur either through contaminated fingers or through contaminated water of swimming pools (Swimming pool granuloma).


Question: Indications to use Collagen cross linking

Riboflavin is used in collagen cross linking for keratoconus COLLAGEN CROSS LINKING C3R: Principle: Using riboflavin, we build up collagen cross links and provide cornea the strength to maintain its curvature f/b use contact lenses for few days. UV-A radiation 370 nm is used for 45 minutes. Indication: Keratoconus Post lasik ectasia Fungal corneal ulcer Corneal ectatic disorders CONTRAINDICTION Herpes infection Pachymetry less than 400 nm Severe dry eye


Question: The refractive power of emmatropic eye is

(58-D) (26-Khurana4rd)* The total dioptric power is +58 D, of which cornea contributes + 43 D and the lens + 15 DDimensions of an adult eyeballAnterior posterior diameter24 mmHorizontal diameter23.5 mmVertical diameter23 mmCircumference75 mmVolume6.5 mlWeight7 gm.


Question: Weakest poion of sclera is

D i.e. Behind rectus inseion The sclera is thickest (1mm) at the posterior pole near the optic nerveQ and thinnest (0.3mm) just behind the inseion of rectus muscleQ.

Anterior to attachment of superior rectus


Question: The commonest cause of rubeosis iridis is


Question: Ideal cure for subacute angle closure glaucoma is

B i.e. Peripheral iridectomy Nd: Yag Laser iridotomy is the Treatment of choice but is not an option here, so the answer is Peripheral iridectomy which is the 2nd choice treatment. Treatment of choice for primary angle closure glucoma (fellow eye Q, latent stage, subacute or intermittent stage Q, chronic stage) is laser iridotomy or peripheral surgical iridectomy. Q In acute congestive stage of PACG drug of choice is Pilocarpine, till the time laser iridotomy can be performed. Q


Question: Coca cola bottle sign is seen in

The Coca-Cola bottle sign refers to the appearance of the muscles of the orbit inthyroid eye disease. The belly of the muscle enlarges with sparing of the tendinous inseion, giving the appearance of the traditional Coca-Cola bottle. The nature of the enlargement is impoant as it is one of the chief findings to differentiate it from orbital pseudotumor, in which the tendinous inseion is also involved and enlarged, unlike in thyroid eye disease. Hyperostosis seen in case of spehnoid wing meningioma on CT scan


Question: Betts classification is used for

Ans. (a) Ocular TraumaRef: International society of Ocular Trauma Official Website'Betts' in the betts classification refers to 'Birmingham Eye Trauma Terminology System'


Question: Intact cornea can be penetrated by

A few species of bacteria are capable of penetrating an intact corneal epithelium -

i. Neisseria gonorrhoea
ii. Corynebacterium diphtheriea
iii. Haemophilus agyptus
iv. Neisseria meningitidis
v. Listeria species  Bacteria which cause comeal ulcer after epithelial injuries are -
i. Pseudomonas
ii. Pneumococcus
iii. Staphylococcus aureus
iv. Morexella
v. Streptococcus epidermids
vi. Enterobacterias  Most common bacterial cause of keratitis;comeal ulcer →
Staphylococcus aureus,  Most common cause of keratitis/comeal ulcer in a contact lens wearer → Pseudomonas o Most common viral cause of keratitis/comeal ulcer → HSV


Question: Scarpa's Staphyloma is seen in

Ans. (b) MyopiaRef: Clinical ophthalmology By Sandeep Saxena 2/e, p. 445'The presence of posterior staphyloma (Scarpa's Staphyloma) is pathognomonic of pathologic myopia'


Question: The power of reduced eye is


Question: Range of accommodation is the distance between

Ans. Far point and near point of the eye


Question: Posterior subcapsular stellate cataract seen in

(C) Myotonic Dystrophy > Sunflower cataract - Occurs in Wilson's disease -Concussion may cause an 'imprinting' of iris pigment on the anterior lens capsule (Vossius ring) as well as striking flower shaped cortical opacities (rosette cataract).> Trauma is he most common cause of unilateral cataract in young individuals> Snow flake or snow storm cataract - Diabetes Shield like anterior subcapsular cataract - Atopic dermatitis> Stellate posterior subcapsular cataract - Myotonic dystrophy> Punctate subcapsular cataract - Down syndrome


Question: Haab&;s striae are seen in

Buphthalmos: In this condition, IOP is raised and the eyeball is enlarged as a whole. The enlarged cornea is usually associated with central or peripheral clouding and Descemet's tears (Haab's striae). Haab's striae, or Descemet's tears, are horizontal breaks in the Descemet membrane associated with congenital glaucoma. It is named after Otto Haab. Ref: Khurana; 4th edition; Pg. 91


Question: Placido disc is used for

It is a disc painted with alternating black and white circles. Used to assess the smoothness and curvature of corneal surface. It shows irregularity of circles in keratoconus. Ref khurana page no.126


Question: CRAO may be seen in

D i.e. Orbital mucormycosis - Most of central retinal aery obstruction (CRAO) are caused by atherosclerotic thrombus formation at or just proximal to the lamina cribrosaQ (-80%) followed by emboli (20%). Inflammation in form of vasculitis (eg varicella infection), optic neuritis or even orbital disease (eg mucormycosis)Q, local trauma and radiation may also cause CRAO. Vascular tropism/ invasion is the hallmark of orbital mucomycosis. This along with thrombosis b/o inflammatory process results in CRAO. In CRAOQ, when obstruction to blood flow is not complete, the flow may be paially restored in the course of a few days in which case gentle pressure upon the globe may break up the column of venous blood (in retinal veins)Q into red beads separated by clear interspaces. The beads move in jerky fashion sometimes in normal direction of blood flow & sometimes in the opposite direction - The "Cattle Truck Appearance". Central retinal aery occlusion characteristically presents with sudden (not gradual) painless loss of vision, cherry red spotQ and cattle truck appearanceQ of retinal veins (usually).


Question: Exotropia occurs due to

Answer- A. Third nerve palsyCauses and associations ofexotropia (Divegent squint)Third nerve palsyCongenitalPrevious strabismus surgeryThyroidophthalmopathyIatrogenic trauma following retinal detachment surgery


Question: Not a cause of panuveitis

Syphillis is not a common cause for panuveitis Panuveitis: Inflammation of all the layers of uveal tissue iris, ciliary body and choroid. Diseases causing granulomatous panuveitis. *Tuberculosis *Vogt Kayanaga Harada *Behcet's syndrome *Sarcoidosis *Sympathetic Ophthalmitis


Question: Not a complication of orbital cellulitis

Retinal detachment is not a complication of orbital cellulitis Orbital Cellulitis Inflammation of orbital septum Complications Exposure keratopathy Compression of optic nerve Central retinal aery occlusion Orbital Abscess Intracranial spread of infections Septicemia


Question: A patient has a right homonymous hemianopia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the

Right nomonymous hemianopia with saccadic pursuit movements and detective optokinetic nystagmus confirms the diagnosis of perietal lobe lesion.
Optokinetic Nystagmus: - It can be elicited in all normal individuals.
Defect in optokinetic nystagmus and lesions of brain associated with it.
In a case of hemianopia due to lesions of the parietal lobe optokinetic nystagmus is absent.
Other lesions where optokinetic Nystagmus is defective:-

Frontal lobe lesions - it inhibits this response only temporarily.
Brainstem lesions - it results in asymmetry of this response in vertical plane.


Question: Mittendorf dots may be associated with

Ans. (a) AMittendorf dots are remnants of tunica vasculosa lentis at its anterior end i.e. the posterior end of the lens - thus causing posterior polar cataract.


Question: Lens contains the oldest cells in

Ans. is 'a' ie Nucleus Parson writes - "It is important to bear in mind that the central nucleus of the lens consists of the oldest cells and the periphery or cortex of the youngest."


Question: A young 25 year old man following A presented with proptosis (pulsatile in nature) ,chemosis and pain in right eye after 4 days. On Examination there was bruit on forehead and right eye. The probable diagnosis is


Question: Muscle not paralysed in retrobulbar block

Answer- A. Superior obliqueA retrobulbar block is a regional anaesthesic nerve block in the retrobulbar space, the area located behind the globe ofthe eye. Injection oflocal anaesthesic into this space constitutes the retrobulbar block.Cranial nerve IV lies outside the muscle cone,but is blocked by diffusion of the local anaesthetic.Superior oblique is supplied by cranial nerve IV.


Question: Gonioscope is used for visualization of

Gonioscopy: Owing to lack of transparency of corneoscleral junction and total internal reflection of light (emitted from angle structures) at the anterior surface of cornea it is not possible to visualize the angle of anterior chamber directly. Therefore, a device (goniolens) is used to dive the beam of light and this technique of biomicroscopic examination of the angle of the anterior chamber is called gonioscopy. Types of goniolens: (i) Indirect goniolens provides a mirror image of the opposite angle, e.g., Goldmann and the Zeiss goniolens (ii) Direct goniolens provides a direct view of the angle. Koeppe goniolens is the most popular type. The angle structures seen from behind forwards are: 1. The root of the iris 2. The anteromedial surface of the ciliary body (ciliary band), 3. Scleral spur 4. Trabecular meshwork and Schlemm's canal and 5. Schwalbe's line Applications of gonioscopy: 1. Classification of glaucoma into open angle and closed angle based on the configuration of the angle. 2. Localization of foreign bodies, abnormal blood vessels or tumors in the angle. 3. Demonstration of the extent of peripheral anterior synechiae and hence planning of glaucoma surgery. Ref: Khurana comprehensive ophthalmology; 4th edition Pg: 546


Question: The earliest Cataract in the development of Senile Cortical Cataract is

The earliest Cataract in the development of Senile Cortical Cataract is Incipient cataract.


Question: Horner Trantas spots are seen in

Horner Trantas spots are Eosinophils It is seen on the hyperophied papilla in the upper limbus REF:Refer Khurana 6th edition page number 70


Question: Lesion in the optic chiasma causes


Question: Surface ectoderm form


Question: After blunt trauma to eye a patient develops circumcorneal congestion. The further test done is

Blunt or penetrating ocular trauma leads to vision loss through glaucoma.
Thus, next step is to measure IOP


Question: Most common primary tumor of orbital cavity presenting as proptosis is


Question: Acute hemorrhagic conjunctivitis is seen in infection of

ACUTE HAEMORRHAGIC CONJUNCTIVITIS It is an acute inflammation of conjunctiva characterized by multiple conjunctival hemorrhages, conjunctival hyperemia, and mild follicular hyperplasia. Etiology: The disease is caused by picornaviruses (enterovirus type 70) which are RNA viruses of small(pico) size. The disease is very contagious and is transmitted by direct hand-to-eye contact. Clinical picture: The disease has occurred in an epidemic form in the Far East, Africa, and England and hence the name 'epidemic hemorrhagic conjunctivitis (EHC)' has been suggested. An incubation period of EHC is very sho (1-2days). Symptoms include pain, redness, watering, mild photophobia, transient blurring of vision and lid swelling. Signs of EHC are conjunctival congestion, chemosis, multiple hemorrhages in bulbar conjunctiva, mild follicular hyperplasia, lid edema and pre-auricular lymphadenopathy. Corneal involvement may occur in the form of fine epithelial keratitis. Treatment: *EHC is very infectious and poses major potential problems of cross-infection. Therefore, prophylactic measures are very impoant. *No specific effective curative treatment is known. *However, broad-spectrum antibiotic eye drops may be used to prevent secondary bacterial infections. Usually, the disease has a self-limiting course of 5-7 days. Acute hemorrhagic conjunctivitis is primarily caused by enterovirus 70 and a variant of coxsackievirus A24; however, other enteroviruses, including echoviruses 7 and 11, coxsackieviruses B1 and B2, and several adenoviruses can also cause acute hemorrhagic conjunctivitis, sporadic conjunctivitis and keratoconjunctivitis Ref- Khurana; 4th edition; Pg. No. 69


Question: Feature of coical blindness is

D i.e. Normal direct and consensual reflex

Absent direct and intact consensual reflex

Absent consensual but positive direct reflex


Question: The commonest malignant tumour of the lids is

MALIGNANT TUMOURS Basal-cell carcinoma It is the commonest malignant tumour of the lids (90%) usually seen in elderly people. It is locally malignant and involves most commonly lower lid (50%) followed by medial canthus (25%), upper lid (10-15%) and outer canthus (5-10%). Clinical features: It may present in four forms: Noduloulcerative basal cell carcinoma is the most common presentation. It stas as a small nodule which undergoes central ulceration with pearly rolled margins. The tumour grows by burrowing and destroying the tissues locally like a rodent and hence the name rodent ulcer. Ref:- A K KHURANA; pg num:-360


Question: Drug of choice for Nummular keratitis

Ans. (b) Topical SteroidsRef: Kanski 7/e, p. 189Nummular keratitis is characterized by fine granular subepithelial deposits, surrounded by a halo of stromal haze. Develops 10 days after onset of rash.Only Topical steroids are given for treatment.


Question: Stellwagg's sign of graves disease is

Lid lag - Von graefe's sign.
Fullness of eyelids - Enroth's sign.


Question: The instrument is used for

Ans. (b) Fundus ExaminationOption a - Optic disc can be examined by the Direct ophthalmoscope, but it is one part of the fundus view Option b - Ophthalmoscopy is a clinical examination of the posterior segment of the eye/ Fundus examination. (Fundus is a view of the inner lining of the eye made up of the Sensory Retina, the Retinal Pigment Epithelium, Bruch's Membrane, and the Choroid).Option c - Cornea may be examined, but the role is no more than of a torch.Option d - Gonioscopy is done for it.

Examination of the Angle of Anterior Chamber


Question: Nummular keratitis is seen in

Ans. (b) Herpes zoster keratitisRef: A.K. Khurana 6th ed. /108-109


Question: The arrow marked sign is due to deposition of

lron deposition anterior to advancing head of pterygium is called as Stocker's line.


Question: Percentage of endothelial cell loss during Descent's membrane stripping in automated penetrating keratoplasty

C i.e. 30-40% The incidence of endothelial cell loss in donor tissue of Descemet stripping endothelial keratolplasty is nearly 36%, mainly in the central area of graft. Compared with penetrating keratoplasty, EK involves more donor-tissue manipulation including lamellar dissection and folding, which could potentially damage donor endothelium. On the other hand EK grafts are usually larger (8-9 mm diameter compared with typical PK diameter of 7 - 8mm) and provide a larger reservoir of healthy donor endothelium. However, several recent repos suggest that endothelial cell loss in first few years after EK is similar to that experienced after PK.


Question: The most common cause of Macular edema is

Macular edema refers to the collection of fluid in the outer plexiform(Henle's layer) and an inner nuclear layer of the retina, centered around the foveola.EtiologyIt is associated with a number of disorders. A few common causes are as follows:1. As postoperative complication following cataract extraction and penetrating keratoplasty.2. Retinal vascular disorders e.g., diabetic retinopathy and central retinal vein occlusion.3. Intraocular inflammations e.g., pars planitis, posterior uveitis, Behcet disease.4. As a side-effect of drugs e.g., following use of adrenaline eyedrops, especially for aphakic glaucoma.5. Retinal dystrophies e.g., retinitis pigmentosa.Ref: Khurana; 4th edition; Pg.No. 273


Question: Color blindness transmitted through

(A) X-linked recessive # COLOR BLINDNESS> Gross cases occur in 3%--4% of males, but are rare in females (0.4%); milder cases are more common in males.> Colour blindness is an inherited condition, being transmitted as X-linked recessive through the female who is usually unaffected, and is probably due to the absence of one of the photo-pigments normally found in the foveal cones.> In most cases reds and greens are confused, so that the defect is a source of danger in certain occupations, such as in engine- drivers and sailors. The red-green cases fail into two chief groups, protanopes and deuteranopes.


Question: A newborn is hypermetropic by

* (N) REFRACTIVE error at bih 2-3 D hypermetropic' * BY the age of 5-7 years the eye is emmetropic and remains so till the age of about 50 years* After 50 years of age there is tendency to develop hypermetropia again which gradually increase the extreme of life by which the eye has the same +2 TO +3 with which it staed. this senile hypermetropia is due to change in the lens.


Question: Lacquer cracks in pathological myopia is due to breaks in

Lacquer cracks in pathological myopia is due to breaks in Bruch's membrane.


Question: Chalcosis is caused by

“Chalcosis refers to specific changes made by copper containing alloys in eye” Features of chalcosis are:
√ KF rings on descement membrane of cornea
√ Sunflower cataract
√ Golden brown metallic sheen plaques on the retinal pole


Question: The corneal transparency is maintained by


Question: Contraindication for lasik is

Patient selection criteria are:  Patients above 20 years of age,  Stable refraction for at least 12 months.  Motivated patient.  Absence of corneal pathology Reference : A K KHURANA; 6th edition;Page no: 53


Question: Most common orbital tumors in children is

Rhabdomyosarcoma is a tumor arising from the pleuripotential mesenchymal cells which later develops in striated muscle Refer khurana 6/e

Diseases of orbit, Lids and lacrimal apparatus


Question: Surgery of choice in patient with congenital ptosis with good levator action is

SURGICAL CORRECTION * Levator resection : very commonly done in congenital ptosis with moderate and severe grades of ptosis * Fascia lata sling surgery : done in patients having severe ptosis with no levator function. In Marcus Gunn Jaw Winking Ptosis , LPS excision is combined with frontalis sling operation and in Congenital Ptosis with bad elevation we do Sling surgery. * Fasanella Servat operation : - done in patients having mild ptosis with good levator function - it is also done in Horners syndrome *Avoid ptosis surgery in Myasthenia Gravis and Paial third nerve palsy induced ptosis as they usually resolve with medical treatment and with time


Question: Commonest cause of uniocular diplopia

In Unilocular diplopia an object appears double from the affected eye even when the normal eye is closed. CAUSES Subluxated clear lens. Subluxated intraocular lens. Keratoconus (irregular refraction from corneal surface) Double pupil (congenital / large iridectomy / iridodialysis) Incipient cataract (this usually causes polyopia - due to irregular refraction due to multiple water clefts within the lens) Ref;A.K.Khurana; 6th edition; Page no:344


Question: Epithelial xerosis of the conjunctiva is caused by

Epithelial xerosis:  It occurs due to hypovitaminosis -A.
Epithelial xerosis may be seen in association with night blindness or as a part and parcel of the xerophthalmia (the term which is applied to all ocular manifestations of vitamin A deficiency which ranges from night blindness to keratomalacia


Question: For Sudden, painless monocular blindness select the site of the lesion of cerebrovascular disease,

Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).

Penetrating branch, middle cerebral aery


Question: Longest extraocular muscle is

Superior oblique is the longest extraocular muscle Extraocular muscles: Shoest tendon among rectus- MR Muscle having least distance from limbus - MR Superior oblique is longest muscle Inferior oblique is smallest muscle


Question: A homonymous upper quadrantic field defect is typical of lesion in


Question: Acute haemorrhagic conjunctivitis is caused by


Question: The Arrow points towards

The structure marked is the trochlea and the muscle is superior oblique


Question: The clinical findings differentiating ophthalmic aery occlusion from central Retinal aery occlusion is

Within a few hours of CRAO the retina loses its transparency, becoming opaque and milky-white, especially in the neighbourhood of the disc and macula. At the fovea centralis, where the retina is extremely thin, the red reflex from the choroid is visible and appears as a round cherry-red spot, presenting a strong contrast to the cloudy white background. As choroid derives its blood supply from the ophthalmic aery, in ophthalmic aery occlusion even choroidal circulation is affected and hence a cherry-red spot is not clearly visible


Question: Sunflower cataract is caused by

Chalcosis is copper alloy in the eye Refer: Khurana 6th edition page number 194


Question: Rosette shaped catraract is seen in

Rosette cataract is most typical form of concussion cataract.


Question: The diagnostic triad of exophthalmos, diabetes insipidus and bone lesions is characteristic of

Hand-Schuller-Christian disease: It is a chronic disseminated form of histiocytosis involving both soft tissues and bones in older children of either sex. It is characterised by a triad of proptosis, diabetes insipidus and bony defects in the skull. Ref:- A K KHURANA; pg num:-397


Question: Most common type of Congenital cataract with significant visual disability

Most common type of Congenital cataract is blue dot Cataract.
Most common type of Congenital cataract with significant visual disability Lamellar Cataract.


Question: Haab's striae are seen in


Question: Elsching pearls are seen in

After cataract: It is also known as 'secondary cataract'. It is the opacity which persists or develops after extracapsular lens extraction.Causes. (i) Residual opaque lens matter may persist as after cataract when it is imprisoned between the remains of the anterior and posterior capsule, surrounded by fibrin (following iritis) or blood(the following hyphaema). (ii) Proliferative type of after cataract may develop from the left-out anterior epithelial cells. The proliferative hyaline bands may sweep across the whole posterior capsule.Clinical types. After cataract may present as a thickened posterior capsule, or dense membranous after cataract or Soemmering's ring which refers to a thick ring of after cataract formed behind the iris, enclosed between the two layers of the capsule or Elschnig's pearls in which the vacuolated subcapsular epithelial cells are clustered like soap bubbles along the posterior capsule.Treatment is as follows :i. Thin membranous after cataract and thickened posterior capsule are best treated by YAG-laser capsulotomy or desiccation with cystitome or Zeigler&;s knife.ii. Dense membranous after cataract needs surgical membranectomy.iii. Soemmering's ring after cataract with clean central posterior capsule needs no treatment.iv. Elschnig's pearls involving the central pa of the posterior capsule can be treated by YAG laser capsulotomy or desiccation with cystitome.Ref: Khurana; 4th edition; Pg. 201


Question: Circumcorneal vascularization is observed in deficiency of

Ans. c. Riboflavin ye changes in Riboflavin Deficiency Riboflavin deficiency leads to superficial interstitial keratitis and corneal vascularization In the earlier changes, the superficial layers of the cornea are invaded by the capillaries. Interstitial inflammatory infiltration and exudation follow, producing opacities and sometimes, ulcerations of corneal surface. Other Changes of Riboflavin Deficiency Cheilosis is usually the first and most characteristic sign of riboflavin deficiency. It begins as areas of pallor at the angles of the mouth. Later, cracks or fissures may appear, radiating from the corners of the mouth, which tend to become secondarily infected. With glossitis, the tongue becomes atrophic, taking on a magenta hue strongly resembling the red-blue colour of cyanosis. A greasy, scaling dermatitis over the nasolabial folds may extend into a butterfly distribution to involve the cheeks and skin about the ears. Scrotal and vulvar lesions are common.


Question: Critical age for development of fixation reflex is

Impoant milestones in development of eye : Postnatal period Fixation stas developing in first month and is completed in 6 months. Macula is fully developed by 4-6 months Fusional reflexes, stereopsis and accommodation are well developed by 4-6 months Cornea attains normal adult diameter by 2 years of age. Lens grow throughout life Reference : A.K.Khurana; 6th edition; Page no:13

Anatomy, Development and clinical examination


Question: The veical diameter of an adult eye is

Dimensions of an adult eyeball Anteroposterior diameter 24mm Horizontal diameter 23.5mm Veical diameter 23 mm Circumference 75 mm Volume 6.5 ml Weight 7 gm Reference: A.K.Khurana; 6th edition; Page no:3

Anatomy, Development and clinical examination


Question: Normal intraocular pressure is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 223)The intraocular pressure (IOP) refers to the pressure exeed by intraocular fluids on the coats of the eyeball. The normal IOP varies between 10 and 21 mmHg.


Question: The embryonic vascular layer of the eye is derived from

(Mesoderm) (8-9-Khurana 4th) (5-Parson 20th)Structures derived from the Embryonic layers1. Surface ectoderm2. Neural ectoderm(a) The crystalline lens(b) Epithelium of the cornea(c) Epithelium of the conjunctiva(d) Lacrimal glands(e) Epithelium of eyelids and its derivatives, viz.: cilia, tarsal glands, and conjunctival glands.(f) Epithelium lining the lacrimal apparatus (Lacrimal glands, Tarsal glands)(a) Retina with its pigment epithelium(b) Epithelial layers of ciliary body(c) Epithelial layers of iris(d) * Sphincter and dilator papillae muscles(e) Optic nerve (neuroglia and nervous elements only)(f) Melanocytes - Retinal pigment epithelium(g) Secondary vitreous(h) Ciliary zonules3. Associated paraxial mesoderm(a) ** Blood vessels of choroid, iris, ciliary vessels, central retinal artery, other vessels (Vascular endothelium of eye and orbit)(b) Primary vitreous(c) Substantia propria, Descemet's membrane, and endothelium of cornea(d) The sclera(e) Stroma of iris(f) Ciliary muscle(g) Sheaths of optic nerve(h) Extraocular muscle(i) Fat, ligaments and other connective tissue structures of the orbit(j) Upper and medial walls of the orbit(k) Connective tissue of the upper eyelid4. Visceral mesoderm of maxillary process below the eye(a) Lower and lateral walls of orbit(b) Connective tissue of the lower eyelid.


Question: Minimum thickness of lens capsule is found in

Minimum thickness of lens capsule is found in posterior pole ( 3-4  μm ).


Question: Treatment of nasolacrimal duct obstruction  a) Syringing  b) Probing   c) DCR  d) Dacryocystectomy  e) Antibiotic

All are treatment options for dacryocystitis.


Question: Yoke muscle for right superior rectus is

Yoke muscles Yoke muscles (contralateral synergists) are a pair of muscles (one from each eye) which contract simultaneously during version movements. Different pairs of yoke muscles are as follows: 1) Right medial rectus and left lateral rectus 2)Right lateral rectus and left medial rectus 3)Right superior rectus and left inferior oblique 4)Right inferior rectus and left superior oblique 5)Right superior oblique and left inferior rectus 6)Right inferior oblique and left superior rectus. Reference :- A K KHURANA; pg num:- 537

Anatomy, Development and clinical examination