Question: The characteristic field defect seen in pituitary tumors is

Ans. (d) Bitemporal hemianopiaRef: Harrison's 19th ed. /198-199"Bitemporal hemianopia is usually caused by tumors in the region of the sells turcica, pressure by a suprasellar aneurysm or by chronic arachnoiditis; these press upon the chiasma so that the fibers going to thenasal halves of each retina are destroyed. Tumors of the pituitary body are most common.


Question: Neovascularization in uveal tissue is most commonly caused by

Answer- A. Diabetic Retinopathy It is a secondary angle closure glaucoma which results due to formation of neovascular membrane over the iris i.e., neovascularization of iris (rubeosis iridis).Causes of rubeosis iridis are:-Common :- Diabetic retinopathy (most common cause), central retinal vein occlusion), Eale's disease, sickle-cell retinopathy.


Question: Foster kennedy syndrome seen with

Answer- C. Frontal lobe tumorFoster - kennedy syndrome :- The frontal lobe, pituitary and middle ear tumor such as meningiomata of the oflactor groove are sometimes associated with Ipsilateral pressure atrophy of the optic nerve and contralateral papilloedema.


Question: Circumcorneal vascularization is seen in deficiency of


Question: Earliest sign of Diabetic retinopathy is

(Microaneurysm) (295-Person 20th) (260-62-Khurana 4th)* Earliest detactable lesion is microaneurysm in the macular area in NPDRDIABETIC RETINOPATHYOphthalmoscopic features of Non-proliferativediabetic retinopathy (NPDR)* Microaneurysm at the macular area (the earliest detectable lesion)*** Retinal haemorrhage both deep (dot and blot haemorrhage) and superficial haemorrhages (flame shaped)* Hard exudates** - yellowish- white- waxy looking patches are arranged in clumps or in the circinate pattern - seen in macular area* Retinal oedema characterized by retinal thickening* Cotton -wool spots** (if >8, there is high risk of PDR)* Venous abnormalities - beading, looping and dilatation* Intraretinal microvascular abnormalities (IRMA)* Dark-blot haemorrhages representing haemorrhagic retinal infarctsThe hall mark of proliferative diabetic retinopathy (PDR) is the occurrence of neovascularization over changes of very severe NPDRComments cause of moderate (diminuation) of vision is Macular oedema*** Advanced diabetic eve disease - It is marked by complication such as- Persistent vitreous haemorrhage**- Tractional retinal detachment**- Neovascular glaucoma**Most common cause of vitreous hemorrhage in adults is - Diabetes (PDR) (297-Parson 20th)HARD EXUDATES - seen in -DR, Hypertensive retinopathy, coat's disease, circinate retinopathySoft exudates seen in - Hypertensive retinopathy DR, Toxemic retinopathy of pregnancy, Anemia, collagen vascular disease like- SLE, PAN, SclerodermaManagement of diabetic retinopathyType of retinopathyTherapy* Background* MaculopathyCSME* Difuse leak around macula- Circinate* Preproliferative retinopathy* Proliferative retinopathy* Advanced diabetic eye diseaseControl of diabetic, regular reviewFocal photocoagulation- Grid laserFocal photocoagulation**- Frequent reviewPan retinal photocoagulation**- Vitreo, retinal surgery** with photocoagulation* Gentamicin - can cause macular or retinal toxicity even at therapeutic and low doses when given intravitreally* NIDDM with history of DM for years should have an ophthalmic examination - As early as feasible in IDDM- 5 years after the onset of diabetes


Question: In homocystinuria, lens subluxates in

Homocystinuria. It is an autosomal recessive, inborn error of metabolism. In it the lens is usually subluxated inferior and nasally. Systemic features Fair complexion, malar flush, mental retardation, fits and poor motor control Diagnosis is established by detecting homocysteine in urine by sodium nitro-prusside test. Ref;A.K.Khurana; 6th edition; Page no:216 QUESTION REPEATED


Question: The normal pH of tear is (REPEATED)

pH of tear is 7.4 Refer: Khurana 6th edition page number 366


Question: Pilocarpine eye drops act as

Ans. (b) Directly acting mioticRef: KDT 7/e, p. 105It is a cholinomimetic alkaloid and acts directly on muscarinic receptors and also on ganglionic muscarinic receptors causing miosis, ciliary muscle contraction and fall in IOP.


Question: Intraocular lenses are made up of

A i.e. PMMA The Optic pa of non foldable lenses are made up of PMMA (Poly methyl methacrylate) Q where as foldable lenses are made up of silicon, hydrophobic or hydrophilic acrylic.Q The Haptic pa of both is made of polypropylene, PMMA, acrylic. Lens Made up of Contact lens: 1. Hard PMMA (Polymethyl methaacrylate) Q 2. Soft HEMA (Hydroxy methyl methaacrylate) Q 3. Semi soft PMMA + Silicon + CAB Intraocular lens: 1. Optic pa Non foldable PMMA Q Foldable Silicone, Hydrophilic & Hydrophobic acrylic 2. Haptic pa Polypropylene, PMMA, Acrylic


Question: Zonular cataract is seen in

Lamellar or Zonular cataract It is a developmental cataract in which the opacity occupies a discrete zone in the lens. It is the most common type of congenital cataract presenting with visual impairment. Characteristic features. Typically, this cataract occurs in a zone of foetal nucleus surrounding the embryonic nucleus. The main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel(riders) which may be seen towards the equator. Occasionally two such rings of opacity are seen. It is usually bilateral and frequently causes severe visual defects. Ref;A.K.Khurana; 6th edition; Page no:184


Question: Lamina Cribrosa is absent in

Morning glory syndrome is a birth defect of optic nerve that resembles flower known as morning glory.


Question: Confocal scanning laser ophthalmoscope uses

Confocal scanning laser ophthalmoscope It is an instrument using a confocal laser system to provide and analyze a three-dimensional image of the optic nerve head, peripapillary retina, and macular region It uses a 670 nm diode laser and measures the amount of light reflected from a series of 16-64 sections in depth and reconstructs them to show the anatomy of the optic nerve head and reconstruct the anatomy of the retinal nerve fiber layer. Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 461 - 462


Question: Axial proptosis is associated with

Ans. (a) Optic gliomaRef Kanski 7/e, chapter 3, Jakabisc 3/e, p. 2886* Space-occupying lesions within the muscle cone, such as cavernous haemangiomas and optic nerve tumours cause axial proptosis.


Question: The epithelium is absent in lens on

There is no posterior epithelium, as these cells are used up in filling the central cavity of lens vesicle during The epithelium development of the lens.


Question: Dalrymple’s sign is seen in

o Ocular signs of thyroid ophthalmopathy
i) Bilateral exophthalmos with associated exposure keratitis.
ii) Dalrymple’s sign - There is peculiar stare due to retraction of the upper lid.
iii) Von Graefe’s sign - Upper lid lags on downward movments of the eyeball.
iv) Stellwag’s sign - There is infrequent and incomplete blinking.
v) Mobius’s sign - There is weakness of convergence .
vi) Jellinek’s sign - There is increased pigmentation of lids.
vii) Joffroy’s sign - There is poor forehead wrinking on looking up
viii) Enroth’s sign - Fullness of eyelids (Puffy edematous).
ix) Grifford’s sign - Difficulty in eversion of upper lid


Question: Leber's amourotic optic neuropathy inheritance is

Ans. a. Mutation in mitochondrial DNALeber hereditary optic neuropathy (LHON) is rare ganglion cell degeneration.Papillomacular bundle is particularly affected in this case.The condition is caused by maternally inherited mitochondrial DNA point mutations, most frequently (50-90%) at nucleotide position 1178 (G to A) in theMT-ND4 gene.Most commonly affects age group 15-35 years.


Question: Hyaloid artery starts to regress at

Hyaloid artery starts to regress at 3 - 4 months of period of gestation.


Question: Forced duction test is to find out

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 353 - 354) Forced duction testIt is performed to differentiate between the incomitant squint due to paralysis of extraocular muscle and that due to the mechanical restriction of the ocular movements.FDT is positive (resistance encountered during passive rotation) in cases of incomitant squint due to mechanical restriction and negative in cases of extraocular muscle palsy.


Question: Rosette cataract develops in the

It is seen as feathery lines of Opacities in the posterior cortex.


Question: These instruments are used for the surgery of

CHALAZION CLAMP is used to fix the chalazion and achieve haemostasis during the incision and curettage operation CHALAZION SCOOP it is used to scoop out contents of the chalazion during incision and curettage.


Question: Not an anti oxidant in Lens

β Carotenoids (precursor of Vitamin A) is an anti oxident in Lens, not Vitamin A.


Question: In Recurrent Chalazion histopathological examination is done to rule out

(Sebaceous cell carcinoma): (430- Nema 6th edition/457-Parson 21st)CHALAZION* Malignant changes occur but rare, However in all cases with recurrences or those occurring in elderly individuals the lesion should be biopsied to rule out a meibomian cell carcinoma. (444- Parson 21st/ed)* A recurring chalazion, histopathological examination to rule out adenocarcinoma of the meibomian gland* Meibomian gland carcinoma may be seen in elderly people (368- Khurana 5th/ed)Sebaceous gland carcinoma (385.Khurana 5th) - arising from meibomian glands. However Indian, literature reports the sebaceous gland carcinoma being the commonest malignancy of eyelid followed by basal and sequamous cell carcinoma.Common malignant tumours of the eyelidTypeCommon locationClinical featuresSpreadTherapyBasal cell carcinomaMedial canthus.lower lidNodule, central ulceration with pearly surface, telangiectasiaLocalResection, radiationSquamous cell carcinomaLower lid, from previous actinic keratosis- Ulcer with thickened margins, keratosis- PapillomatousLocal, lymph nodesResection, radiation cryotherapySebaceous cell carcinomaUpper lid- Nodule resembling chalazion, multifocal, females > males, recurrences commonLocal, intraeptielial, lymph nodesResection, cryotherapy exenterationMalignant melanomaPrevious nevi> 6 mm size pigmented lesion, vascularization, inflammationLocal, vascular, lymph nodesResction exnteration


Question: Persistent hyperplastic primary vitreous is associated with

Associated with patau syndrome (Trisomy 13).


Question: Anterior lenticonus may be associated with

Lenticonus: It refers to cone-shaped elevation of the anterior pole (lenticonus anterior) or posterior pole (lenticonus posterior) of the lens. Lenticonus anterior may occur in Alpo&;s syndrome and lenticonus posterior in Lowe&;s syndrome. Slit-lamp examination confirms the diagnosis. Ref:- A K Khurana; pg num:-204


Question: Not a feature of Vogt Kayanagi Harada Syndrome is

Features of Vogt Kayanagi Harada Syndrome include Mental retardation.


Question: Visual cycle refers to

Visual cycle In the retina of living animals, under constant light stimulation, a steady state must exist under which the rate at which the photochemicals are bleached is equal to the rate at which they are regenerated. This equilibrium between the photodecomposition and regeneration of visual pigments is referred to as visual cycle. Reference :- A K KHURANA; pg num:-14,15

Photodecomposition and regeneration of visual pigments

Anatomy, Development and clinical examination


Question: Topical antifungal in keratomycos s is

Natamycin Three main groups of antifungal agents are effective against corneal fungal infection These are: ANTIFUNGAL ANTIBIOTICS Agent Route Polyenes Amphotericin B Topical Subconjunctival Intracameral Natamycin Topical suspension Imidazoles Clotrimazole Topical Ketoconazole Topical Oral Miconazole Topical suspension Topical cream Subconjunctival Triazoles Fluconazole Topical Oral Itraconazole Topical Oral Pyrimidines Flucytosine Topical Oral Polyenes - i.e. Amphotericin B & Natamycin are the first agents of choice in keratomycosis. Amphotericin B? - is paicularly efective against yeasts but less effective against filamentous organisms. - it is therefore the first agent of choke against yeasts. Natamycin? - it is effective against yeasts and has broad spectrum of activity against filamentous organisms. - it is therefore the first agent of choice against filamentous organisms. Amphotericin B and Natamycin can be alternated on an hourly basis for infections which fail to respond to single-agent. The azoles and flucytosine are used as alternative agents for advanced fungal infections or infections failing to respond to polyenes. If fungal keratitis fails to respond to medical therapy surgical intervention is needed.


Question: Bitemporal hemianopia is associated with lesions of the

Sagittal (central) lesions of the chiasma These are characterised by bitemporal hemianopia and bitemporal hemianopic paralysis of pupillary reflexes. These usually lead to paial descending optic atrophy. Common causes of central chiasmal lesion are: suprasellar aneurysms, tumours of pituitary gland, craniopharyngioma, suprasellar meningioma and glioma of third ventricle, third ventricular dilatation due to obstructive hydrocephalus and chronic chiasmal arachnoiditis. Ref:- A K KHURANA; pg num:-290


Question: Not a feature of Mature Senile Cataract among the  following is

Iris shadow is absent in mature senile cataract.


Question: Most common type of scleritis is

Scleritis can be classified as follows: I. Anterior scleritis (98%) 1. Non-necrotizing scleritis (85%) (a) Diffuse (b) Nodular 2. Necrotizing scleritis (13%) (a) with inflammation (b) without inflammation (sclero malacia perforans) II. Posterior scleritis (2%) The most common form, anterior scleritis, is defined as scleral inflammation anterior to the extraocular recti muscles. Posterior scleritis is defined as involvement of the sclera posterior to the inseion of the rectus muscles. Ref. UGkhurana 4th edition Pg.129


Question: Subconjunctival hemorrhage does not occur in


Question: Flower petal appearance in fundus flourescein angiography is in

Flower petal appearance  - CME.
Smoke stack pattern or Ink blot sign - Central serous retinopathy.


Question: Surgery used to treat posterior capsular Opacification is

Posterior Capsular opacification is a complication of Cataract surgery.
Treatment is Nd : YAG laser posterior capsulotomy.


Question: Duane syndrome involves

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 357) Duane retraction syndrome represents the most frequent and most prominent congenital cranial dysinnervation disorder (CCDD)It is due to fibrosis of the lateral rectus or an innervational anomaly with Co-contraction of the lateral and medial rectiThere is a deficiency of abduction, associated with impaired adduction, contraction of palpebral fissure and oblique movements of the eye


Question: Circumcorneal congestion is not seen in

Acute bacterial conjunctivitis Conjunctival congestion, which is more marked in palpebral conjunctiva, fornices and peripheral pa of bulbar conjuctiva, giving the appearance of fiery red eye. The congetion is typically less marked in circumcorneal zone. Ref;A.K.Khurana; 6th edition; Page no:63 REF IMG


Question: The most common retrobulbar mass in adults is

Cavernous hemangioma is a non encapsulated seen most commonly inside the muscle cone. Refer khurana 6/e p 411

Diseases of orbit, Lids and lacrimal apparatus


Question: Mutton fat keratic precipitates are seen in


Question: Krukenberg spindles are found in

Pigment dispersion syndrome *Krukenberg spindle- Pattern formed on posterior surface of cornea by pigmented iris cells which are deposited as result of currents of the aqueous humor. Found In Pigment dispersion Trauma Pseudoexfoliation syndrome


Question: Normal corneal endothelial count in a young adult is

Ans. (b) 2500/mm2Ref Parson's 21/e, p. 120* The cell density of endothelium is around 2800cells/mm2(2400-3000cells/mm2) in young adults, which decreases with the advancing age.


Question: Chalazion is

An acute suppurative staphylococcal infection of glands of zeis or moll

A chronic non-infective, non-suppurative lipo-granulomatous inflammation of meibomian gland

An acute primary staphylococcal infection of meibomian gland

A viral infection commonly affecting children


Question: Treatment of primary angle closure glaucoma is


Question: Treatment of choice for the other eye in open angle glaucoma is

Ans. (b) Laser trabeculoplasty* Please refer to above explanation* Treatment of choice for primary angle closure glaucoma (fellow eye, latent stage, subacute or intermittent stage , chronic stage) is laser iridotomy* Peripheral surgical iridectomy can also be used.* In acute congestive stage of PACG drug of choice is Pilocarpine, till the time laser iridotomy can be performed. Treatment of choice for fellow eye | | |Primary open angle glaucoma Primary angle closure glaucoma | | Laser trabeculoplasty Nd YAG Laser Iridotomy


Question: Area of fundus seen with direct ophthalmoscope


Question: Commonest manifestation of retinoblastoma is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 303) Leukocoria or amaurotic cat's eye reflex this is the most common manifestation. The leukocoria or the white glow in the pupil is caused by reflection of light from the white intraocular tumor Leukocoria. Leukocoria (also white pupillary reflex) is an abnormal white reflection from the retina of the eye. Because of the potentially life-threatening nature of retinoblastoma, a cancer, that condition is usually considered in the evaluation of leukocoria.


Question: Pseudopapillitis is seen in

Pseudopapillitis = small optic disc with ill defined margins.


Question: KISA% is associated with

Answer- A. KeratoconusThe KISA index is used in cases ofkeratoconus and is derived using 4 indices:Central keratometry KInferior- Superior keratometry (I-S)Astigmatism Index (AST)


Question: First sign of raised intracranial pressure in fundoscopy is


Question: Standard in perimetry is

Goldmann's perimeter: It consists of a hemispherical dome. Its main advantage over the tangent screen is that the test conditions and the intensity of the target are always the same. It permits greater reproducibility, Goldmann perimeter stimuli I through V. Unless otherwise instructed, the equivalent to Goldmann size III (4 mm2) white target. Reference : AK KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4, Page-483,484

Anatomy, Development and clinical examination


Question: Circinate retinopathy is seen in

Answer- A. Diabetic RetinopathyCircinate retinopathy is a feature of Diabetic Retinopathy. It is a feature of diabetic macular edema.Circinate retinoiathy a condition markedby a circle ofwhite spotsenclosing the macular area,leading to complete foveal blindness.


Question: Binasal hemianopia is seen in

Central chiasma - Bitemporal hemianopia.
B/ L Lateral chiasma - Binasal hemianopia.


Question: Satellite nodule on a corneal ulcer is seen in

A i.e. Fungal infection Feature Found in Satellite lesion Fungal keratitis (corneal ulcer) C e.g. Aspergillus, Candida Sympathetic opthalmitis Q Dalen fuch's nodule, B/L granulomatous uveitis Dendritic & Geographic ulcer Herpes simplex Q Snow ball opacity in vitreous Pars planitis (intermediate uveitis), sarcoid Q, amyloid, candidiasis, lyme disease Fleischer ring, Munson's sign, Vogt lines, Oil droplet reflex Keratoconus Q Invasion of normal corneal epithelium N. gonorrhoea & Corynebacterium diptheria Q Horner Trantas dots, Cobble stone (pavement stone) papillary hyperophy, no follicles, shield ulcer, Maxwell lyon sign (sting or ropy discharge) Spring catarrh Herbe's pit, Arlt's line, papillary hyperplasia, follicles, pannus, SAFE treatment strategy Trachoma Habb's striae, lens anteroposteriorly flattened & displaced Q Bupthalmos


Question: S shaped eyelid is seen in

Plexiform neurofibromas - Bag of worm consistency and S shaped eyelid deformity.


Question: Minimum number of Goblet cells in Conjunctiva is found at

Upper temporal conjunctiva has minimum number of Goblet cells in Conjunctiva.
Nasal bulbar conjunctiva has maximum number of Goblet cells in Conjunctiva.


Question: Hypermature morgagnian cataract most commonly leads to

Hypermature morgagnian cataract most commonly leads to Phacolytic glaucoma. LENS INDUCED GLAUCOMA Phacoanaphylactic glaucoma (phacoantigenic glaucoma)is due to anaphylactic reaction to lens protein that is a cryptic antigen. It can be through any intraocular surgery or trauma during which lens material comes in contact of anterior chamber & there is a sudden bout of inflammation associated with rise of IOP. In phacolytic glaucoma lens capsule is intact. There are micropores through which lens proteins leak. Phacomorphic glaucoma is a secondary angle closure glaucoma due to intumescent cataract. It is more common than phacolytic glaucoma. Lens dislocation in anterior chamber or microspherophakia also causes lens induced glaucoma due to angle closure.


Question: Shadow test is used in

Shadow test in Retinoscopy : Fundal reflex casting shadow in pupillary area.


Question: Ameboid ulcer is a feature of

Ans. is c i.e., Herpetic corneal ulcer Herpetic Keratitis Most of the ocular infection are caused by HSV-1 except in neonates where eye infection can be caused by HSV2 through infected genitalia of mother. Ocular involvement by HSV may occur in two forms : - Primary herpes : - Typically is a unilateral blepharoconjunctivitis which is characterized by vesicles on the skin of lids, follicular conjunctivitis, preauriculars adenopathy and sometimes punctate keratitis. Recurrent ocular herpes : - After primary infection, recurrent disease may involve any or all layers of the cornea. Recurrent herpatic keratitis is divided into : ? 1) Epithelial keratitis : - Manifestations of epithelial keratitis include : - Corneal vesicles : - Vesicles coalesce and erupt to form dendritic or geographic ulcer. Superficial punctate keratitis Dendritic ulcer: - It is the most common presentation and is a typical lesion of herpes keratitis. There is an associated marked diminution of sensation. Geographic ulcer (amoeboid ulcer) 2) Stromal keratitis : - Stromal keratitis may be of two types : - Disciform keratitis : - This is due to damage to endothelial cells as a result of hypersensitivity reaction to the HSV antigen. Diffuse stromal necrotic keratitis : - Caused by active viral invasion and tissue destruction. 3) Metaherpatic keratitis (Epithelial sterile trophic ulceration) : - It is not an active disease, but is a mechanical healing problem at the site of previous herpetic ulcer.


Question: Pars planitis is also known as

Ans. a (Intermediate uveitis) (Ref. Parson's 19th/pg. 360 & Basak's Ophthalmology, 2nd /p. 151; Q. 157 of MH-2007)INTERMEDIATE UVEITIS (PARS PLANITIS)# Thought to be immunological reaction# 2nd to 4th decade# Usually trilateral (80%)# Floaters & blurring of vision# Snow-ball vitreous opacities# Snow-bank exudates over pars plana ('SNOW-BANKING')# Moderate aqueous cells & flare# Moderate to severe cases need sub-tenon steroid inj or systemic steroids or cryotherapy


Question: 30 year old young male came with sudden onset visual loss with no h/o trauma and the fundus details cant be appreciated with no significant systemic history. The other eye has evidence of sheathing of vessels in periphery. A diagnosis of Eale's disease is made. The most common presenting symptom of this disease is

EALES DISEASE -Bilateral, Idiopathic, Occlusive, Peripheral periphlebitis -also known as angiopathia retinae juvenilis, periphlebitis retinae, primary perivasculitis of the retina. -Recurrent Vitreous Hemorrhage in young and is the most impoant and pathognomic identifying feature -There can be subtle signs of sheathing of vessels and exudates in the fellow eye -Few evidence in literature suggests of possible association with TB


Question: Organism invading intact corneal membrane is

Intact corneal epithelium cannot be penetrated by any organism EXCEPT, Neisseria gonorrhea Neisseria meningitides Corynebacterium diphtheriea


Question: Most common intraocular malignancy of childhood is

Retinoblastoma arises from primitive retinal cells, presented commonly in first two years of life. Inheritance Pattern In hereditary retinoblastoma, mutations in the RB1 gene appear to be inherited in an autosomal dominant pattern. Autosomal dominant inheritance means that one copy of the altered gene in each cell is sufficient to increase the risk of cancer. Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 407


Question: Temporal lobe tumours may produce


Question: Duane Retraction Syndrome is most commonly characterised by

Answer- A. Deficiency in action of 6th nerve characterized by difficult abductionDuane retraction syndrome represents the most frequent and most prominent congenital (CCDD). cranial dysinnervation d.isorderDuane retraction syndrome is a congenital strabismus that is usually caused by failure of normal development of the abducens nerve (the sixth cranial nerve). There is absence ofthe abducens nerve and fascicle with anomalous innervation of the lateral rectus muscle by the oculomotor nerve.

Presence of acute increase in intraocular pressure


Question: Commotio retinae is

(B) Oedema of retina following blunt trauma # COMMOTIO RETINAE (Berlin's oedema): Common occurance following a blow on the eye"> Manifests as milky white cloudiness involving a considerable area of the posterior pole with a 'Cherry - red spot' in the foveal region.> It may disappear after some days or may be followed by pigmentary changes.


Question: Fluctuating refractive errors with cataract are seen in

B i.e. Diabetic cataract Feature Found in Frequent change of presbyopic glasses Open angle glucoma Q Second sight (index myopia neutralizes the plus power of presbyopia & patient is able to see small prints without spectacles) Nuclear cataractQ Fluctuation of refractory error (high level of aqueous glucose is metabolized by aldose reductaseQ into sorbitol which then accumulates with in lens resulting in secondary osmotic over hydration of lens. Hypeglycemia leads to fluctuating myopia) Diabetic cataract Q Shield like cataract A topic dermatitis Q


Question: &; Angry sun appearance &; in fundoscopy seen in

Angry sun appearance &; in fundoscopy is a feature of -papilloedema. Ref AK khurana 6/e <img alt="" src=" />


Question: The most common organism causing chorioretinitis in HIV is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 470 - 472)Cytomegalovirus (CMV) is the most common cause of chorioretinitis in patients who are HIV positive


Question: Net power of Cornea

Power of anterior surface of Cornea = +48D
Power of posterior surface of Cornea= –5D
Net power of Cornea= +48D –5D = +43D


Question: Tonometer with variation in application surface

Ans. d. Maklakov tonometer Indentation tonometry Indentation tonometry was devised by SchiotzQ. Because of its simplicity, reliability, low price and relative accuracy, it is the most widely used tonometer in the world. For repeated use in multiple patients it can be sterilized by dipping the footplate in ether, absolute alcohol, acetone or by heating the footplate in the flame of spirit. The greatest accuracy is attained if the deflection of lever is between 3-4. Its main disadvantage is that it gives a false reading when used in eyes with abnormal scleral rigidity') False low level of 10P are obtained in eyes with low scleral rigidityQ seen in high myopes and following ocular surgery Applanation tonometry The concept of Applanation tonometry was introduced by GoldmannQ is 1954. It is best on lmbe-Fick lawQ. Currently, it is the most popular and accurate tonometerQ


Question: 'Cobble stone' appearance of conjunctiva is seen in

(A) Spring catarrh > Each papilla is polygonal with a flat fop and contains tufts of capillaries and dense fibrous tissue. The hyaline degeneration imparts bluish-white or milky colour to the papilla.# Vernal keratoconjunctivitis or spring catarrh is a recurrent, bilateral, interstitial self limiting allergic inflammation of conjunctiva having a periodic seasonal incidence:> Vernal conjunctivitis or Spring catarrh;> Predisposing factors: Age: 4-20 years Sex: More in boys than girls Season: More common in summer (Name is a misnomer as it is more common in summer rather than spring)> Agent: is produced in response exogenous allergen (dust, pollen, heat)> Laterality: is bilateral> Presentation: Most marked symptom is itching (Photophobia and lacrimation arc also seen) Ropy discharge : Maxwell Lyon sign (containing eosinophills) Conjunctival SignsBulbarCorneal SignsPalpebralGelatinous thickening around LimbusEpithelial erosionCobble stone appearanceHorner Trantas spots (composed of degenerated eosinophils)Supepethelial punctate erosion and scarringPapillary hypertrophy into polygonal papillaDusky red triangular congestionsPseudogerantoxon with classic cupid bow outlineFollicle are not seen in vernal conjunctivitis Ulcer may be present.


Question: Frequency of USG used in ophthalmics is

Ultrasonic frequency in the range of 10MHz are used for ophthalmic diagnosis Ref khurana 6/e

Diseases of orbit, Lids and lacrimal apparatus


Question: A patient presented with pain in left eye associated with visual distrubance, also a history of blunt trauma to eye 4 month back, first investingation of choice is

A i.e. Intraocular tension This is a case of angle recession glaucoma


Question: Epiretinal membrane is seen in

Answer- A. Posterior vitreous detachmentEpiretinal membrane is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. It is also called macular pucker.Immune system response to protect the retina, cells converge in the macular area as the vitreous ages and pulls away in posterior vitreous detachment (PVD).


Question: Most common ocular involvement in sarcoidosis is


Question: Modified wheeler's operation is done for

Entropion management

Jones, Reech and wobing operation
Modified wheeler's operation
Weiss operation
Bick's operation.


Question: Dendrites on the cornea may be seen with.


Question: A cherry red spot is seen in fundus in


Question: Most common method of anterior capsulotomy in phacoemulsification

Answer- C. CapsulorhexisThe most commonly used technique for anterior capsulotomy during phacoemulsification is continuous curvilinear capsulorhexis (CCC).


Question: Chalcosis is assosciated with

Chalcosis is copper deposition whereas gold deposition is called Chrisiasis Long term intake of gold of more than 1000mg leads to corneal deposits and anterior subscapular cataract Refer: Khurana 6th edition page number 434


Question: Treatment of 13/1 retinoblastoma is


Question: Treatment of choice for eales disease is

Eales' diseaseIt is an idiopathic inflammation of the peripheral retinal veins. It is characterized by recurrent vitreous hemorrhage; so also referred to as primary vitreous hemorrhage.Treatment of Eales' disease comprises:1. Medical treatment. A course of oral coicosteroids for extended periods is the mainstay of treatment during active inflammation. A course of antitubercular therapy has also been recommended in selective cases.2. Laser photocoagulation of the retina is indicated in the stage of neovascularization.3. Vitreoretinal surgery is required for non-resolving vitreous hemorrhage and tractional retinal detachment.Ref: Khurana; 4th edition; Pg. 254


Question: Not a feature of Congenital rubella syndrome is

Anterior Uveitis is Not a feature of Congenital rubella syndrome.


Question: Sarcoidosis is associated with

Sarcoidosis -Can cause - Anterior uveitis (M /C)- Posterior uveitis- Intermediate uveitis- Pan uveitis M/C presentation - B/L Lymphadenopathy2nd m/c - uveitis C/F - Mutton fat keratic precipitates - Koppe's / busacca's nodules - Bilateral uveitis - Infiltration - Snowball/ string of pearl appearance - Candle wax drippings ( VASCULITIS) - DX - KVEIM TEST + Increase ACE


Question: Melanocytes in conjunctiva are derived from

Neural ectoderm : Retina with its pigment epithelium Epithelial layers of ciliary body Epithelial layers of iris Sphincter and dilator pupillae muscles Optic nerve (neuroglia and nervous elements only) Melanocytes Secondary vitreous Ciliary zonules (teiary vitreous) Reference : A K KHURANA OPHTHALMOLOGY, Edition4 , Page-10

Anatomy, Development and clinical examination


Question: Dalen Fuch's nodules seen in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 163, 437)Dalen Fuch's nodules are seen in sympathetic ophthalmitisDalen-Fuchs' are formed due to the proliferation of the pigment epithelium (of the iris, ciliary body, and choroid) associated with invasion by the lymphocytes and epithelioid cells. Retina shows perivascular cellular infiltration (sympathetic perivasculitis)


Question: A patient with this condition , presents with retraction of eye lid on chewing. This represents

Marcus gunn Jaw winking syndrome Marcus Gunn Jaw Winking Ptosis is a congenital ptosis Associated with synkinetic movements of upper lid on masticating movements of the jaw. It is usually unilateral but rarely presents bilaterally. Affects males and females in equal propoion . Etiology This synkinetic movement results from a congenital aberrant connection between motor branches of trigeminal nerve controlling muscles of mastication and superior division of oculomotor nerve controlling the levator palpebrae superioris Ref : ak khurana 7th ed


Question: Pupillary reaction to light is still normal in lesion/injury to

Ans. (b) Optic disc* Optic disc is not involved in papillary light reflex.* Pathway of papillary light reflex:Retina - Optic Nerve - Optic Chiasma - Optic Tract - Prerectal Nucleus - Edinger Westphal Nucleus - Inferior Division of 3rd Nerve - Ciliary Ganglion - Short Ciliary Nerves - Sphincter Pupillae


Question: Stocker&;s line is seen in

Pterygium It presents as a triangular fold of conjunctiva encroaching the cornea in the area of the palpebral apeure, usually on the nasal side, but may also occur on the temporal side. Deposition of iron seen sometimes in corneal epithelium anterior to advancing head of the pterygium called as stocker's line. Pas. A fully developed pterygium consists of three pas: i. Head (apical pa present on the cornea), ii. Neck (limbal pa), and iii. Body (scleral pa) extending between limbus and the canthus. Stocker's line in pterygium. Pterygium is a fibrovascular proliferative disorder in which conjunctival tissue grows medially to cover the clear cornea. On slit-lamp examination showed marked pterygium that extend from the nasal side of bulbar conjunctiva onto the cornea in the left eye Ref: Khurana; 4th ed; Pg 80


Question: Most common site of rupture of the globe


Question: The most common retrobulbar orbital mass in adults

C i.e. Cavernous haemangioma The cavernous haemangioma is the most common benign orbital tumor in adultsQ, with a female preponderance of 70%. Although it may develop anywhere in orbit, it most frequently occurs with in the muscle cone just behind the globeQ.


Question: Hyaluronic acid is present in

Vitreous is composed of water, collagen and hyaluronic acid. Vitreous Humour. Vitreous humor is the fluid-like gel, composed of approximately 98-99% water with trace amounts of hyaluronic acid, glucose, anions, cations, ions, and collagen, located in the posterior chambers of the eyes Reference: khurana 6th edition pg 567

Anatomy, Development and clinical examination


Question: Cataract associated with convulsion is seen in

C i.e. Galactosemia Galactosemia presents with B/I., oil droplet cataract, convulsion, Hepatosplenomegaly, ascitis, jaundice, and reluctance to ingest breast milk Q.


Question: Gonioscopy is used for

Gonioscopy describes the use of a goniolens in conjunction with a slit lamp or operating microscope to gain a view of the iridocorneal angle, or the anatomical angle formed between the eye&;s cornea and iris. Reference: AK Khurana 7th Edition

Anatomy, Development and clinical examination


Question: Ramu, age 10 yr present with itching in his eye, foreign body sensation, & ropy discharge since several months. These symptoms are more prominent in summer. Most probable diagnosis is


Question: Paralysisof 3rd, 4th, 6th nerves with involvement of ophthalmicdivisionof5thnerve, localizes the lesion to

Ipsilateral ophthalmoplegia  causing diplopia occur due to 3rd, 4th  & 6th cranial nerves.
6th nerve passes through cavernous sinus and others are related to the lateral wall of cavernous sinuses.


Question: Beaded margin of eyelid is seen in

Lipoid proteinosis is a rare, recessively inherited disorder, characterized by infiltration of the skin, oral cavity and larynx. Patients with this genodermatosis can usually be recognized instantly because of husky voice, inability to protrude tongue and thickened eyelids.

Diseases of orbit, Lids and lacrimal apparatus


Question: Drug required for dilatation of eye in patient of children with squint


Question: Most common presentation of Basal cell carcinoma of Lid

M/c - Noduloulcerative
M/c histological pattern is solid basal cell carcinoma with characteristic peripheral palisaded appearance.


Question: Intraocular calcification in the eye in a child is seen in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 303) *In retinoblastoma, there are areas of necrosis and calcification *In the presence of calcification, endophytic retinoblastoma gives the typical 'cottage cheese' appearance


Question: In senile nuclear cataract, type of myopia seen is

Index myopia results from an increase in the refractive index of the crystalline lens associated with nuclear sclerosisVisual deterioration due to senile cataract has some typical features. It is painless and gradually progressive in nature. Patients with central opacities (e.g., cupuliform cataract) have early loss of vision. These patients see better when the pupil is dilated due to dim light in the evening (day blindness). In patients with peripheral opacities (e.g. cuneiform cataract) visual loss is delayed and the vision is improved in bright light when the pupil is contracted. In patients with nuclear sclerosis, distant vision deteriorates due to progressive index myopia. Such patients may be able to read without presbyopic glasses. This improvement in near vision is referred to as 'second sight&;. As opacification progresses, vision steadily diminishes, until the only perception of light and accurate projection of rays remains in the stage of mature cataract.Ref: Khurana comprehensive ophthalmology 4th ed; Pg179


Question: Sudden increase in blood sugar in a diabetic causes


Question: Secondary detion is more than primary detion is a feature of

Broadly, strabismus can be classified as below:I. Apparent squint or pseudostrabismus.II. Latent squint (Heterophoria)III. Manifest squint (Heterotropia)1. Concomitant squint2. Incomitant squint INCOMITANT SQUINTIt is a type of heterotropia (manifest squint) in which the amount of detion varies in different directions of gaze. It includes following conditions:1. Paralytic squint,2. 'A' and 'V' pattern heterotropias,3. Restrictive squint PARALYTIC STRABISMUSIt refers to ocular detion resulting from complete or incomplete paralysis of one or more extraocular muscles Primary detion. It is detion of the affected eye and is away from the action of the paralyzed muscle, e.g., if lateral rectus is paralyzed the eyeis converged.2. Secondary detion. It is a detion from the normal eye seen undercover when the patient is made to fix with the squinting eye. It is greater than the primary detion. This is due to the fact that the strong impulse of innervation required to enable the eye with the paralyzed muscle to fix is also transmitted to the yoke muscle of the sound eye resulting in a greater amount of detion. This is yoke muscles. In Paralytic squint, the secondary detion is more than the primary detion. Reference: Khurana Ophthalmology; 4th edition; Strabismus and Nystagmus

Anatomy, Development and clinical examination


Question: Afferent component of corneal reflex is mediated by

Ans. (c) Trigeminal nerveRef: Fuller Neurological examination made easy 3/e, p. 102The afferent component of corneal reflex is mediated through the ophthalmic branch of the trigeminal nerve (Vth nerve).The efferent component is mediated through the facial nerve (VIIth nerve).Following corneal stimulation:* Failure of either side of face to contract = Nasociliary nerve lesion* Failure of only one side to contract = Facial nerve lesion.


Question: Jaegers cha is used to measure

Jaeger's cha is used for measuring Near Vision The Jaeger cha is an eye cha used in testing near vision acuity. It is a card on which paragraphs of text are printed, with the text sizes increasing from 0.37mm to 2.5mm. This card is to be held by a patient at a fixed distance from the eye dependent on the J size being read. The smallest print that the patient can read determines their visual acuity


Question: Downward and lateral gaze is action of


Question: Accommodation is maximum at the age of


Question: Stye is inflammation of

Ans. b (Glands of Zeis or Moll) (Ref. Parson's diseases of Eye 22nd/p 467).# An infection of a Zeis gland is known as a "hordeolum" or "stye."# A chalazion is the result of obstruction of the duct of a meibomian gland, which is usually idiopathic, with secondary lipogranulomatous inflammation.# A stye (external hordeolum) is acute inflammation of the Zeis or Moll glands with pain and swelling.# Similarly painful inflammation of the meibomian glands is called an internal hordeolum.TEAR FILM# The lipid component of the tear film is produced by sebaceous glands known as "Meibomian" glands (located in the tarsal plates along the eyelid margins) and the glands of "Zeis" (which open into the hair follicles of the eyelashes).# Below the lipid layer is located the lacrimal or aqueous layer of the tear film.# This middle layer is the thickest of the three tear layers, and it is formed primarily by the glands of "Krause" and "Wolfring" and secondarily by the "lacrimal" gland, all of which are located in the eyelids.HORDEOLUM# Definition: Hordeolum is an acute bacterial infection of one or more eyelid glands .# Epidemiology and etiology: Staphylococcus aureus is a common cause of hordeolum. Hordeolum is often associated with diabetes, gastrointestinal disorders, or acne.# Symptoms and diagnostic considerations:- Hordeolum presents as painful nodules with a central core of pus.- External hordeolum appears on the margin of the eyelid where the sweat glands are located.- Internal hordeolum of a sebaceous gland is usually only revealed by everting the eyelid and usually accompanied by a more severe reaction such as conjunctivitis or chemosis of the bulbar conjunctiva.- Pseudoptosis and swelling of the preauricular lymph nodes may also occur.# Rx:- Antibiotic ointments and application of dry heat (red heat lamp) will rapidly heal the lesionCHALAZIONDefinition: Is a chronic granulomatous inflammation of the meibomian gland.Clinical features# There is no age or sex predisposition.# There is a higher incidence of chalazion in seborrheic dermatitis, rosacea, and diabetes mellitus.# The appearance is of a pale, round, firm lesion of the lid.# Astigmatism with a reduction in vision can be induced by pressure on the eyeball.Treatment# An intralesional injection of triamcinolone acetonide may help in the resolution of smaller chalazia. If the chalazion does not resolve, or there is a large chalazion, it should be incised and curetted.# Very hard chalazia are occasionally met with, particularly near the canthi, which may be adenomata of the glands and require excision. Malignant changes occur but are rare. However, in all cases with recurrences or those occurring in elderly individuals, the lesion should be biopsied to rule out a meibomian cell carcinoma.Q


Question: Brown's syndrome involves

Brown's syndrome is due to fibrous tightening of the superior oblique tendon.


Question: A 60 year old woman presents after 4 days of cataract surgery with history of pain and decrease in vision after an initial Improvement. Diagnosis is

Bacterial endophthalmitis is most dreaded complication over all.
Pain, diminition of vision after improvement s/o endopthalmitis.


Question: PASCAL is used for

Laser photocagulations RETINAL INSTRUMENTS * OCT: Measure RNFL thickness, Ganglion cell volume, Optic nerve head parameters & retinal layers. Cystoid Macular edema is classified according to OCT classification. * OCT- Angio that shows retinal vasculature without the use of dye. * PASCAL- Patterned scanned laser used for photocoagulation. * Spectralis- can do FA, OCT, ICG in same machine. * Retcam 3- Seeing & documenting pediatric retinal diseases, (ROP, Choroidopathies & Dystrophies) * Fugo blade- Used for both anterior, posterior capsulorrhexis & PHPV.


Question: Most B/L multifocal retinoblastoma require

D i.e. Multi Modality therapy Multi Modality Therapy Most children with bilateral retinoblastoma, multifocal RB, or bothQ, and occasion children with unilateral RB, are managed by multimodality therapy.


Question: Vitamin A supplementation in a 10 month old child with xeropthalmia is

The three doses are given on 0,1 and 14th day In less than 1 year ago oral dose is 1 lakh IU whereas injectable is 50,000IU Refer Khurana 6th edition page number 467


Question: Marcus Gunn pupil is a feature of

OPTIC NEURITIS Signs: 1. Visual acuity is usually reduced markedly. 2. Colour vision is often severely impaired. 3. Pupil shows ill-sustained constriction to light. Marcus Gunn pupil which indicates relative afferent pupillary defect (RAPD) is a diagnostic sign. It is detected by the swinging flash light test. Swinging flash light test: It is performed when relative afferent pathway defect is suspected in one eye (unilateral optic nerve lesion with good vision). To perform this test, a bright flash light is shone on to one pupil and constriction is noted. Then the flash light is quickly moved to the contralateral pupil and response noted. This swinging to-and-fro of flash light is repeated several times while observing the pupillary response. Normally, both pupils constrict equally and the pupil to which light is transferred remains tightly constricted. In the presence of relative afferent pathway defect in one eye, the affected pupil will dilate when the flash light is moved from the normal eye to the abnormal eye. This response is called 'Marcus Gunn pupil' or a relative afferent pupillary defect (RAPD). It is the earliest indication of optic nerve disease even in the presence of normal visual acuity. Ref:- A K KHURANA; pg num:-294,474,475


Question: Cotton wool spots of Hypertensive retinopathy is present in

Flame shaped hemorrhages & cotton wool spots are present in nerve fibre layer.


Question: Mizuo phenomenon is seen in

Oguchi disease also called as congenital stationary night blindness * Mizuo- nakamura phenomenon: Patient sees better in dark than during day. * Genetic: AR, Mutation in rhodopsin kinase gene * Fundus is normal in dark but loses its sheen in day light * Delayed dark adaptation time * Cause: impaired rods activity (overstimulation of rod cells)


Question: Circulus aeriosus iridis major is formed by the anastomosis of

Anterior ciliary aeries: These are derived from the muscular branches of ophthalmic aery. These aeries pass anteriorly in the episclera, give branches to sclera, limbus and conjunctiva; and ultimately pierce the sclera near the limbus to enter the ciliary muscle; where they anastomose with the two long posterior ciliary aeries to form the circulus aeriosus major, near the root of iris. Reference :- A K KHURANA; pg num:-136

Long posterior ciliary aeries with sho posterior ciliary aeries

Long posterior ciliary aeries with anterior conjunctival aeries

Long posterior ciliary aeries with anterior ciliary aeries

Anterior ciliary aeries with sho posterior ciliary aeries

Anatomy, Development and clinical examination


Question: Visual axis is

Axes of the eyes: 1. The optical axis is the line passing through the center of the cornea (P), the center of the lens (N) and meets the retina (R) on the nasal side of the fovea. 2. Visual axis is the line joining the fixation point (O), nodal point (N), and the fovea (F). 3. Fixation axis is the line joining the fixation point (O) and the center of rotation (C). simple definition of the visual axis is: " A straight line that passes through both the centre of the pupil and the centre of the fovea". There is also a stricter definition (in terms of nodal points) which is impoant for specialists in optics and related subjects Image : The Visual Axis of the eye Reference : Khurana comprehensive ophthalmology; 4th edition ; Page27


Question: Tabular vision is caused by

Ans. a (Retinitis pigmentosa). (Ref Basak, Ophthalmology, 2nd ed., 203)As the primary OAG advances the glaucomatous field defect due to generalized constriction of peripheral field along with double arcuate scotoma leads to tubular vision, in which only central vision remains.Causes of tubular vision include:# CRAO with sparing of cilioretinal artery.# High myopia# POAG# Retinitis pigmentosa}(Mnemonic: CHOR)


Question: The curvature of the cornea can be measured by

The 'keratometry' or 'ophthalmometry' is an objective method of estimating corneal astigmatism by measuring the curvature of the central cornea. The keratometry readings are not of much value in routine refraction for prescribing glasses but are of utmost value for prescribing contact lenses and for calculating the power of the intraocular lens to be implanted. Principle. Keratometer is based on the fact that the anterior surface of the cornea acts as a convex mirror; so the size of the image produced varies with its curvature. Therefore, from the size of the image formed by the anterior surface of the cornea (first Purkinje image), the radius of curvature of the cornea can be calculated. The accurate measurement of the image size is obtained by using the principle of visible doubling. Reference : A K KHURANA Comprehensive Ophthalmology edition 4,page-554

Anatomy, Development and clinical examination


Question: Distant direct ophthalmoscopy is done at

Ans. (b) 25 cmDistant direct ophthalmoscopy is done from a distance of 20 - 25 cm, and the features of the red reflex are noted.Option a/d are the same (mathematical conversion), so rule them out distance for retionscopy.Option c - distance for Direct ophthalmoscopy.


Question: Blood supply of prelaminar optic nerve is


Question: A patient came to the casualty with acute attack of asthma after starting treatment of glaucoma. The causative drug is

Ans. (a) Timolol(Ref: Kanski 7/e, p. 383; Katzung 12/e, p. 158)Timolol is a non-selective beta blocker and thus acts on Beta 2 receptors also, leading to broncospasm and exacerbation of asthmaBetaxolol is a cardioselective (beta 1 blocker) and thus is free from this side effect


Question: Salt and pepper fundus is seen in


Question: Iris pearls are pathognomonic for

Iris pearls are seen as glistening white beads at the pupillary margin. They are compared of bacilli within histiocytes and are pathognomonic for Lepromatous uveitis.


Question: The common cause of bilateral internuclear ophthalmoplegia is

Multiple sclerosis It is a demyelinating disorder of unknown etiology, affecting women more often than men, usually in the 15-50 years age group. Pathologically, the condition is characterised by a patchy destruction of the myelin sheaths throughout the central nervous system. Clinical course of the condition: It is marked by remissions and relapses. In this condition, optic neuritis is usually unilateral. Other ocular lesions include bilateral internuclear ophthalmoplegia and vestibular or cerebellar nystagmus. Ref:- A K KHURANA; pg num:- 310


Question: Wernicke&;s hemianopic pupillary reaction indicates lesions at the level of

Lesions of optic tract: These are characterised by incongruous homonymous hemianopia associated with contralateral hemianopic pupillary reaction (Wernicke's reaction). These lesions usually lead to paial descending optic atrophy and may be associated with contralateral third nerve paralysis and ipsilateral hemiplegia. Common causes of optic tract lesions: Include syphilitic meningitis or gumma, tuberculosis and tumours of optic thalamus and aneurysms of superior cerebellar or posterior cerebral aeries. Ref:- A K KHURANA; pg num:-290


Question: Intravenous Mannitol is indicated in

* Iv mannitol is an hyperosmotic agents which acts by increasing the osmotic pressure in the plasma thereby imbibing water from the vitreous . Indications:- * Acute rise in IOP --> Primary angle closure glaucoma, Secondary angle closure glaucoma , Posner Schlossman syndrome * In the pre-operative period to reduce IOP in case of lens induced glaucomas, trabeculectomy, etc. Dosage:- * 1-2 mg /kg body weight ; 20% solution Adverse Effects:- * Volume overload in cardiac patients * Increase in BP Other Hyperosmotic Agents: - * Glycerol - increases blood glucose, Contraindicated in Diabetics. * Urea - not routinely used * Isosorbide Ref:- Parson's Diseases of the eye 22nd edition; pg num:- 53,76


Question: A girl has pain and blurring of vision while reading

(A) (Asthenopia) (341, 346 Khurana 5th)Asthenopia (aesthenopia) from the Greek word "asthen-opia : aoGsv-Gma" or eye strain is an ophthalmological condition that manifests itself through nonspecific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache and occasionaldouble vision. Symptoms often occur after reading, computer work, or other close activities that involve tedious visual tasks.When concentrating on a visually intense task, such as continuously focusing on a book or computer monitor, the ciliary muscletightens. This can cause the eyes to get irritated and uncomfortable. Giving the eyes a chance to focus on a distant object at least once an hour usually alleviates the problem.Sometimes, asthenopia can be due to specific visual problems, for example, uncorrected refraction errors or binocular vision problems such as accommodative insufficiency orheterophoria. It is often caused by the viewing of monitors such as those of computers or phones.ESOPHORIAEXOPHORIA* Common in younger group*** Increased accommodation* Excessive use of convergence may cause esophoria(as occurs in bilateral congenital myopes )* Dissociation factor such as prolonged constant use of one eye may result in exophoria (as occurs in individuals using uniocular microscope and watch makers using uniocular magnifying glass)* Elderly* Decreased accommodation* Decreased use of convergence is often associated with exophoria (as seen in presbyopes)Symptoms1. Muscular fatigue -(i) Headache(ii) Difficulty inchanging the focus(iii) Headache and eyeache(iv) Photophobia2. Symptoms of failure to maintain binocular single vision**(i) Blurring or crowding of words while reading(ii) Intermittent diplopia* Intermittent squint (without diplopia)3. Symptoms of defective postural sensation cause problems in judging distances and positions especially of the moving objects. This difficulty may be experienced by cricketers, tennis players and pilots during landing* Concomitant convergent squint - Esotropia* Concomitant divergent squint - Exotropia* Vertical squint - Hypertropia* Uncrossed diplopia is seen in convergent squint -(Esotropia)* Crossed diplopia is seen divergent squint -(Exotropia)CORTICAL BLINDNESS- Bilateral infarction in the distal posterior cerebral arteries* Direct and concensual reflexes are present in both the eyes**


Question: Fincham test differentiates cataract from

The colored halos in glaucoma must be differentiated from those found in acute purulent conjunctivitis and early cataractous changes. In conjunctivitis, the halos can be eliminated by irrigating the discharge. The halos of glaucoma and immature cataract may be differentiated by Fincham&;s test in which a stenopaeic slit is passed across the pupil. During this test glaucomatous halo remains intact, while a halo due to cataract is broken up into segments.Ref: Khurana; 4th edition; Pg. 228


Question: Treatment of choice in acute congestive glaucoma

B i.e. Laser iridotomy In acute congestive glaucoma stage of primary angle closure glaucoma the fellow eye require prophylactic peripheral iridotomy or surgical iridectomy Q (as PACG is usually a B/L disease and the fellow eye is in latent, subacute or intermittent stage).


Question: Most resistant layer of Neurosensory retina

Most resistant Layer - RPE.
Most resistant layer of Neurosensory retina - Ganglionic cell layer.


Question: The specific topical remedy suggested for angular cojunctivitis is


Question: Miotics are used in the treatment of

Ans. is 'b' i.e., Angle closure glaucoma * Treatment of choice for acute congestive glaucoma - Laser iridotomy (1st choice), Peripheral iridectency (2nd choice).* Drug of choice for acute congestive glaucoma - Pilocarpine .* Initially IOP is controlled (first drug used) - Systemic mannitol or acetazolamide.


Question: Pseudopapilitis is seen in

The clinical picture in a patient with hypermetropia is as follows: Symptoms In patients with hypermetropia, the symptoms vary depending upon the age of the patient and the degree of refractive error. These can be grouped as under: 1. Asymptomatic 2. Asthenopic symptoms: These include tiredness of eyes, frontal or a frontotemporal headache, watering and mild photophobia. These asthenopic symptoms are especially associated with near work and increase towards evening. 3. Defective vision with asthenopic symptoms: The patients complain of defective vision which is more for near than distance and is associated with asthenopic symptoms due to sustained accommodative effos. 4. Defective vision only: When the amount of hypermetropia is very high, the patients usually do not accommodate (especially adults) and there occurs marked defective vision for near and distance. Signs 1. Size of the eyeball may appear small as a whole. 2. The cornea may be slightly smaller than the normal. 3. The anterior chamber is comparatively shallow. 4. Fundus examination reveals a small optic disc which may look more vascular with ill-defined margins and even may simulate papillitis (though there is no swelling of the disc, and so it is called pseudopapillitis). The retina as a whole may shine due to the greater brilliance of light reflections (shot silk appearance). 5. A-scan ultrasonography (biometry) may reveal a sho anteroposterior length of the eyeball. Disease Pseudopapilledema is defined as anomalous elevation of one or both optic discs without edema of the retinal nerve fiber layer Papilledema, on the other hand, is a swelling of the optic disc due to increased intracranial pressure. It is impoant to distinguish pseudopapilledema from true papilledema, which can be the first sign of disease process with the potential for vision loss, neurological impairment, or death. Patients thought to have papilledema are often subjected to lumbar puncture, MRI, and extensive laboratory studies to find the underlying cause. In this aicle, we will cover multiple causes of pseudopapilledema and how to differentiate them from true papilledema. Reference : Khurana comprehensive ophthalmology; 4th edition ; Page: 29, 30


Question: lridocorneal endothelial syndrome is associated with

GLAUCOMAS ASSOCIATED WITH IRIDOCORNEAL ENDOTHELIAL SYNDROMES Iridocorneal endothelial (ICE) syndromes include three clinical entities: 1) Progressive iris atrophy, 2) Chandler's syndrome, and  3) Cogan-Reese syndrome. Pathogenesis: The common feature of the ICE syndromes is the presence of abnormal corneal endothelial cells which proliferate to form an endothelial membrane in the angle of anterior chamber. Glaucoma is caused by secondary synechial angle-closure as a result of contraction of this endothelial membrane. Clinical features: The ICE syndromes typically affect middle-aged women. The raised IOP is associated with characteristic features of the causative condition.  1) In 'progressive iris atrophy', iris features predominate with marked corectopia, atrophy and hole formation. 2) While in Chandler's syndrome, changes in iris are mild to absent and the corneal oedema even at normal IOP predominates. 3) Hallmark of Cogan-Reese syndrome is nodular or diffuse pigmented lesions of the iris (therefore also called as iris naevus syndrome) which may or may not be associated with corneal changes. Treatment: Medical treatment is often ineffective.  Trabeculectomy operation usually fails,  Aificial filteration shunt may control the IOP. Ref:- A K KHURANA; pg num:-237

Deposition of glycosaminoglycan in Descemet's membrane

Deposition of collagen in Descemet's membrane

Bilateral stromal oedema of iris and cornea


Question: Iris shadow is sign of

Iris shadow is a sign of immature cataract When an oblique beam of light is thrown on pupil, a crescentic shadow of pupillary margin of iris will be formed on the greyish opacity of the lens, as long as clear coex is present between the opacity and pupillary margin. When lens is completely transparent or opaque, no iris shadow is formed. Hence presence of iris shadow is a sign of immature cataract..


Question: Most common intracranial tumour encroaching the orbit is

The intracranial meningiomas which secondarily invade the orbit are arising from the sphenoid bone. Orbital invasion may occur through: floor of anterior cranial fossa, superior orbital fissure and optic canal. Ref khurana page no.423


Question: Wilson's KF ring is associated with following

(D) Sun Flower cataract# Wilson's disease is an autosomal recessive, multisystem disorder due to impaired hepatic excretion of copper.> There is excessive accumulation of copper in the CNS, liver, kidneys, cornea, and other organs.> This accumulating copper leads primarily to damage of the liver and brain.> Predominant presentation includes dystonias, tremor, dysphasia, dysarthria, gait & limb ataxia, and neuropsychiatric manifestations> Kayser-Fleischer ring, a brownish coloration of the outer margin of the cornea in Descemef s membrane, is diagnostic of Wilson's disease, which regresses on treatment with metal chelating drugs.> Sunflower cataract was first described in Wilson's disease by Seimerling and Oloff.# Types of cataracts: Blunt trauma/Concussion (Rosette Cataract) Infrared irradiation (Glass Blower's Cataract) Diabetes (Snow Storm Cataract) Galactosemia (Oil Drop Cataract) Wilson's Disease Chalcosis, Penetrating trauma with retention of Cu (Snow flake /Sunflower/ Petals of flower Cataract) Atopic Dermatitis (Syndermatotic Cataract) Posterior Subcapsular (Cupuliform) Congenital (Coronary, Coralliform, etc) Senile (Cuneiform) Blue-Dot (Cataracta caerulea) Black (Cataracta nigra) Brown (Cataracta brunescnence) Red (Cataracta rubra) Vossious ring on anterior surface of lens, Myotonia dystrophia (Christmas tree cataract) Dust like lenticular opacity Galactosemia (Oil drop cataract) (Posterior cortical) bread crumb appearance, Polychromatic luster/Rainbow cataract Complicated cataract (secodary to any eye diseases) Hypermature Senile cataract (Morgagnian cataract)


Question: Tear film is absent in

Keratoconjunctivitis sicca is deficiency of the aqeous layer of tear film REF:Khurana 6th edition page number 366


Question: Density of cells in adult corneal endothelium is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 95 - 96)The cell density of corneal endothelium is around 3000 cells/mm2 in young adults, which decreases with the advancing age

Diseases of orbit, Lids and lacrimal apparatus


Question: Probing and irrigation is not done in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 392 - 395)Contraindications to probing and irrigation The main contraindications are acute dacryocystitis and acute canaliculitisIn the setting of active infection, probing and irrigation is more likely to cause trauma because the lacrimal sac wall is inflamed and friable; it also can cause unnecessary pain and anxiety for the patient Treatment with oral antibiotics (eg, amoxicillin-clavulanate) is appropriate. Cultures of the lacrimal fluid may be helpful. The presence of a lacrimal sac mucocele in adults mandates treatment even if asymptomatic. The treatment of choice is a dacryocystorhinostomy whether the patient is symptomatic or not

Diseases of orbit, Lids and lacrimal apparatus


Question: Duochrome test is used for

Refining the sphere : The spherical correction is refined after refining the cylinder power and axis . It is done by following tests : Fogging technique Duochrome test Pin-hole test Reference : A.K.Khurana; 6th edition; Page no: 578


Question: Best method of treatment for segmental trichiasis

Cryoepilaion
Cryoprobe with -20oc is applied for 20-25 seconds.


Question: Calcification in retinoblastoma is due to

Calcification in retinoblastoma is due to retinal pigment epithelium metaplasia.


Question: Posterior capsulotomy after cataract is done using

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 214 - 215)After cataract, if thin, can be cleared centrally by Nd: YAG laser capsulotomy. Dissection with cystitome or Zeigler&;s knife also be used. Thick membranous after cataract needs surgical membranectomy.


Question: Unilateral papilloedema with optic atrophy on the other side is a feature of

(Foster kennedy syndrome): Ref: 241-P, 285-KH (34-KH 4th) (545-Ghai 7th)* Unilateral papilloedema with or without optic atrophy on the other side suggests a tumour of the opposite olfactory groove or orbital surface of the frontal lobe or of the pituitary body - FOSTER - KENNEDY - SYDNROME


Question: Treatment of metastatic disease in retinobastoma is

A i.e. Chemotherapy Treatment Plan of Retinoblastoma The factors influence the management include size, location & laterality of tumor, vision of affected & unaffected eye, age & health of child and any associated ocular problem such as retinal detachment, vitreous haemorrhage, neovascularization of iris & secondary glaucoma. Chemotherapy (CT) It is primary treatment option in children with bilateral retinoblastomaQ. Initial treatment in children with unilateral disease when the affected eye is believed to be salvageable. 6 cycles of Carboplatin, etopasaide & vincristine (CEV) +- cyclosporine is most common regimen. Paially regressed tumors that are still ble following the 2nd cycle of chemotherapy & any new tumors that develop during the course of chemotherapy must be treated by obliterative local therapies (cryotherapy, laser therapy, and episcleral plaque radiation therapy). Residual or recurrent vitreous seeds following chemotherapy and focal (local) treatments usually require external beam radiation therapy if eye is to be salvaged. Chemotherapy is also used to treat extraocular tumor extension at presentation, or detected on histopathology of enucleated eye, orbital tumor recurrence after enucleation, intracranial invasion by tumor & metastatic diseaseQ. Inspite of popularity of CT as the primary t/ t for RB, enucleation remains impoant option especially in - Unilateral advanced intraocular diseaseQ. - B/L for advanced disease not amenable to any eye preserving therapy. - For more severely affected eye in markedly asymmetrical bilateral cases. The principle route of exit of tumor cells from the eye is along the optic nerveQ Enucleation is usually curative in RB if an optic nerve section longer than 5mm is obtained with globe - Surgeon should attempt to obtain optic nerve section 10-15 mm long in every case. External Beam Radiation Therapy 40-50 Gy radiation (in multiple fractions of 150-200 cGy over 4-5 weeks) is given using a linear acclelerator to Eyes containing one or more tumors that involve optic disc. Eyes that show dffuse vitreous seeding. Eyes for which prior chemotherapy or local treatments such as laser therapy, cryotherapy, photocoagulation or plaque radiotherapy, failed. - Vitreous seeds generally do not respond well to , because of their relative hypoxic status. - Cataract (at least after 6 months usually after 1-1.5 years) is likely to develop. Rarely retinopathy, neovascular glaucoma, orbital bone growth arrest and second malignancy may develop.


Question: A recurrent chalazion should be subjected to histopathologic evaluation to exclude the possibility of

CHALAZION complications: Malignant change into meibomian gland carcinoma may be seen occasionally in elderly people. Sebaceous gland carcinoma : It is a rare tumour arising from the meibomian glands. Clinically, it usually presents initially as a nodule(which may be mistaken for a chalazion). Which then grows to form a big growth. Rarely, a diffuse tumour along the lid margin may be mistaken as chronic blepharitis. Surgical excision with reconstruction of the lids is the treatment of choice. Recurrences are common. Ref:- A K KHURANA; pg num:-346,361


Question: Treatment of Phlyctenular conjunctivitis is

It's an endogenous allergy treated by anti allergics and mild topical steroids Refer: Khurana 6th edition page number 83


Question: Pseudoproptosis caused by

Answer- A. Buphthalmoscauses are:Buphthalmos (congenital glaucoma),High myopia,Upper lid retraction,Paralysis of the extrinsic muscles,Stimulation of muller muscle by cocaine,Shallow orbit as in craniofacial dysostosis