Question: In retinoscopy with plane mirror at 1 meter distance, if retinal glow moves in opposite direction of the mirror, the person has myopia of

Ans. c (> 1 D) (Ref. Khurana Ophthalmology 2nd/pg. 67; Parsons' Diseases of the Eye 20lh/pg. 63).Under the actual conditions of retinosopy at 1 m distance with a plane mirror, when the mirror is titled towards the right side, the immediate source of light moves to the left, and1. in the hypermetropic eye, the circle of light on the fundus moves to the right and the shadow seen in the pupil moves to the right in the same direction as the mirror;2. in the myopic eye (above-1 D) the circle of light on the fundus moves to the right, and the luminous reflex of the fundus seen in the patients's pupil and the shadow seen in the pupil moves against this to the left; in the opposite direction to the mirror'3. in the myopic eye of-l D there is no shadow and the pupil is uniformly illuminated;4. in emmetropic and myopic of less than -1 D there is a very faint shadow moving to the rightMYOPIA (SHORTSIGHTEDNESS)# A discrepancy between the refractive power and axial length of the eye such that parallel incident light rays converge at a focal point anterior to the retina# Whereas parallel incident light rays converge at a focal point on the retina in emmetropic eyes, they converge at a focal point anterior to the retina in myopic eyes. This means that no sharply defined images appear on the retina when the patient gazes into the distance.# The myopic eye can only produce sharply defined images of close objects from which the light rays diverge until they enter the eye.# The far point moves closer; in myopia of -1 diopter it lies at a distance of 1 m.# In myopia, the far point (distance from the eye = A) can be calculated using the formula: A (m) = 1/D, where D is myopia in diopters.# Possible causes include an excessively long globe with normal refractive power (axial myopia) and, less frequently, excessive refractive power in a normal-length globe (refractive myopia).# A difference in globe length of 1 mm with respect to a normal eye corresponds to a difference of about 3 diopters in refractive power.


Question: Treatment of choice of prophylaxis of Left eye in a case of Acute Angle Closure glaucoma of right eye

Treatment of choice of prophylaxis of healthy eye when fellow eye has Acute Angle Closure glaucoma is Laser Iridotomy or surgical peripheral Iridotomy.


Question: lesion producing incongrous Homonymous Hemianopia with Wernicke's Hemianopia pupil


Question: Staphyloma involves

Staphyloma refers to a localised bulging of weak and thin outer tunic of the eyeball (cornea or sclera), lined by uveal tissue which shines through the thinned out fibrous coat. Types of staphyloma - Anterior staphyloma Intercalary staphyloma Ciliary staphyloma Equatorial staphyloma Posterior staphyloma Ref;A.K.Khurana; 6th edition; Page no:144


Question: Drug among the following causing cataract is

Drugs causing cataract:i. Coicosteroidsii. Phenothiazines and other antipsychoticsiii. Topical mioticsiv. Amiodaronev. StatinsRef. Aravind FAQs in Ophthalmology(first edition) Pg-310


Question: A patient with homonymous hemianopia is found to have asymmetric optokinetic nystagmus. The location of the lesion is

Optokinetic nystagmus (OKN), elicited with a rotating striped optokinetic drum, useful in localizing cause of an isolated homonymous hemianopia. Physiological OKN involves smooth pursuit of a target, followed momentarily by a saccade in the opposite direction to fixate on the next target. If a homonymous hemianopia is due to a lesion in the parietal lobe, smooth pursuit pathways towards the side of the lesion are likely to be affected, making this component of OKN defective. OKN will therefore be asymmetrical: erratic when the drum is rotated towards the side of the lesion, but regular when the drum is rotated away from the side of the lesion. If the lesion is in the occipital lobe, smooth pursuit pathways are intact and OKN will be symmetrical - this is the Cogan dictum, which also states that the parietal lobe lesion is more likely to be a tumour and the occipital lesion an infarction. optokinetic drum


Question: Puscher's retinopathy is seen in patients with

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 428 - 432)Puscher 's retinopathyThe occurrence of bilateral patches of retinal whitening and hemorrhage around the optic disc in patients who suffered massive head trauma was first described by Puscher and is called Puscher's retinopathy. Puscher's retinopathy is a disease where pa of the eye (retina) is damaged. Usually associated with severe head injuries, it may also occur with other types of trauma, such as long bone fractures, or with several non-traumatic systemic diseases. However, the exact cause of the disease is not well understood


Question: Ulcer serpans is caused by

The characteristic hypopyon corneal ulcer caused by Pneumococcus is called ulcus serpens. Characteristic features of ulcus serpens are : Ulcus serpens is a greyish white or yellowish disc - shaped ulcer occurring near the centre of cornea The ulcer has a tendency to creep over the cornea in a serpiginous fashion. Violent iridocyclitis is commonly associated with a definite hypopon Hypopon increases in size very rapidly and often results in secondary granuloma Ulcer spreads rapidly and has a great tendency for early perforation. Ref;A.K.Khurana; 6th edition; Page no:102 REF IMG


Question: The treatment of choice of fellow eye of acute angle closure glaucoma is


Question: A child presents with sudden loss of vision with painful ocular movements. The eye is white and there are no obvious signs on ophthalmoscopy. The most likely diagnosis is


Question: Most common primary intraocular tumor in children

Ans. (a) RetinoblastomaRef: Kanski 7/e, p. 510Retinoblastoma - most common intraocular tumor in children.Rhabdomyosarcoma - most common orbital malignant tumor in children.


Question: Common ocular manifestation in Trisomy 13 is

B i.e. Bilateral micropthalmos Patau's syndrome (trisomy 13)Q present with microcephaly, mental retardation and micropthalmos Q Patau's Syndrome Ocular Manifestations - Micropthalmos Q/ Anopthalmos - Anterior segment dysgenesis - Cyclopia - Corneal opacity - Cataract / congenital glaucoma - Coloboma - Persistent hyperplastic primary vitreous - Retinal dysplasia - Hypeelorism Other Features - Microcephaly/mental retardation - Cleft lip & palate - Polydactyly - Cardiac defects - Umbilical hernia - Renal defects - Rocker bottom feet


Question: Macular involvement is common in

Decreased visual acuity may occur as a result of macular involvement or severe vitreous inflammation. ... An active toxoplasmic retinochoroiditis is whitish and moderately exudative with ill-defined borders and involves the macula in a majority of patients. Ref khurana 6/e


Question: A newborn baby presents with h/o seizures, hepatomegaly and following feature was noted on ophthalmic examination. Most probable diagnosis is

Deficiency of Galactose 1 phosphate Uridly transferase

Maternal exposure of X - ray in Antenatal period


Question: Type of cataract in chalcosis is


Question: Eye of newborn is

Eye at bih Anteroposterior diameter of eyeball is about 16.5 mm Corneal diameter is about 10 mm Anterior chamber is shallow and angle is narrow Pupil is small and doesnot dilate fully. Lens is spherical at bih Retina is fully differentiated at bih. Macula differentiates 4-6 months after bih Myelination of optic nerve fibres has reached the lamina cribrosa Refractive status. Newborn is usually hypermetropic by +2 to +3 D Orbit is more divergent(50o) as compared to adult (45o) Lacrimal gland is still underdeveloped and tears are not secreted. Reference: A.K.Khurana; 6th edition; Page no:13

Anatomy, Development and clinical examination


Question: On touching cornea of Right eye, only right eye blinks. Same response is seen on touching the left eye. The lesion is at

(B) Left 5th nerve palsy# Corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), though could result from any peripheral stimulus.> Stimulation should elicit both a direct and consensual response (response of the opposite eye).> Reflex occurs at a rapid rate of 0.1 seconds.> Purpose of this reflex is to protect the eyes from foreign bodies and bright lights (the latter known as the optical reflex). The blink reflex also occurs when sounds greater than 40-60 dB are made.> The reflex is mediated by: Nasociliary branch of the ophthalmic branch (V1) of the 5th cranial nerve (trigeminal nerve) sensing the stimulus on the cornea, lid, or conjunctiva (i.e., it is the afferent).> Temporal and zygomatic branches of the 7th cranial nerve (Facial nerve) initiating the motor response (i.e., it is the efferent).> Centre (nucleus) in the pons of brain stem. Use of contact lenses may diminish or abolish the testing of this reflex.> The optical reflex, on the other hand, is slower and is mediated by the visual cortex, which resides in the occipital lobe of the brain.> Reflex is absent in infants under 9 months. The examination of the corneal reflex is a part of some neurological exams, particularly when evaluating coma.> Damage to the ophthalmic branch (V1) of the 5th cranial nerve results in absent corneal reflex when the affected eye is stimulated.> Stimulation of one cornea normally has a consensual response, with both eyelids normally closing.


Question: Apex national institute of ophthalmology is

Dr RP Centre for Ophthalmic Sciences, New Delhi has been designated as the apex national institute of ophthalmology.

Dr. R P Centre for Ophthalmic Sciences , Delhi


Question: Most common cause of rubeosis iridis

it develops following retinal ischemia which is a common feature of:
●proliferative diabetic retinopathy
●central retinal vein occlusion
●sickle cell retinopathy
●Eale's disease


Question: A 1 year old child having leucocoria was detected to be having a unilateral, large, retinoblastoma having the large globe. Current therapy would involve

Conservative mode of treatment is indicated only in tumors of small size that is less than 6 mm in height Refer khurana 6/e p 303

Direct laser ablation using a photodynamic crytherapy

Scleral radiotherapy followed by chemotherapy

Diseases of orbit, Lids and lacrimal apparatus


Question: Treatment of choice in basal cell carcinoma at inner canthus of eye is

D i.e. Wide excision and reconstruction Basal cell carcinoma is the most common malignant eyelid tumor Q accounting for 90% of all cases. Radiotherapy & cryotherapy are contraindicated in medial canthus BCC Q. Basal Cell CA (BCC) Basal cell CA is the most common tumor of eyelid Q In most frequently arise from lower eyelid > medial canthus > upper eyelid > lateral canthus. Xeroderma pigmentosa (AR disorder characterized by skin damage on exposure to natural sunlight, progressive cutaneous pigmentation, skin malignancy & bird like facies) & Gorlin-Goltz syndrome are predisposing conditions.


Question: Homonymous hemianopsia is associated with lesion at

(C) Optic tract > It is difficult to localize a postchiasmal lesion accurately, because injury anywhere in the optic tract, lateral geniculate body, optic radiations, or visual cortex can produce a homonymous hemianopia, i.e., a temporal hemifield defect in the contralateral eye and a matching nasal hemifield defect in the ipsilateral eye


Question: Most common type of retinal detachment seen in proliferative diabetic retinopathy

Tractional Retinal Detachment Due to tractional forces (due to fibrosis/ contracture) the retina is pulled from its bed resulting in retinal detachment Causes *Proliferative Diabetic Retinopathy *Retinopathy Of prematurity *Vasculitis *Sickle hemoglinopathies Tractional retinal detachment Concept * Rhegmatogenous RD is because of rhegma holes * Fibrous bands cause tractional RD * Serous fluid behind retina cause Exudative RD


Question: Left superior oblique and left inferior rectus are

Synergists: It refers to the muscles having the same primary action in the same eye; e.g., 1) superior rectus and inferior oblique of the same eye act as synergistic elevators. 2) Inferior rectus and superior oblique of the same eye act as synergistic depressors. Ref:- A K KHURANA; pg num:-316


Question: Aniseikonia refers to

ANISEIKONIA Aniseikonia is defined as a condition wherein the images projected to the visual coex from the two retinae are abnormally unequal in size and/or shape. Etiological types: 1. Optical aniseikonia: may occur due to either inherent or acquired anisometropia of high degree. 2. Retinal aniseikonia: may develop due to displacement of retinal elements towards the nodal point in one eye due to stretching or oedema of the retina. 3. Coical aniseikonia: implies asymmetrical simultaneous perception inspite of equal size of images formed on the two retinae. Symptoms : 1. Asthenopia, i.e., eyeache, browache and tiredness of eyes. 2. Diplopia due to difficult binocular vision when the difference in images of two eyes is more than 5 percent. 3. Difficulty in depth perception. Figure : Schematic presentation of the ocular sources determining aniseikonia and the visualization of a visual field angle a (for simplicity the optical and visual axis are assumed equal here). Reference :- A K KHURANA; pg num:-39


Question: Persistent pupillary membrane originates from

Ans. (a) CollaretteRef: Paediatric Ophthalmology by Wright and Speigel, p. 444PPM is the most common developmental abnormality of the iris. They are believed to the vestiges of precursor vessels and associated structures derived from tunica vasculosa lentis.The formation of a PPM is a normal embryological process and starts at the Iris Collarette (thickest part of the iris).


Question: Xerostomia, Xerophthalmia area part of

Ans. (a) Sjogren syndromeRef: Kanski 7/e, p. 124-126Sjogren syndrome is characterized by autoimmune inflammation and destruction of lacrimal and salivary glands - thus causing dryness of mouth and Xerosis or xerophthalmia.


Question: Dangerous area of the eye is

Any trauma to the ciliary body can cause sympathetic ophthalmitis ; hence it is considered the dengerous area of the eye


Question: Anterior lenticonus is found in

Alpos syndrome is familial hemorrhagic nephritis Refer: Khurana 6th edition page number 218


Question: A 12 year old boy presents with recurrent attacks of conjunctivitis for the last 2 years with intense itching and ropy discharge. The diagnosis is


Question: Shortest acting Mydriatic and Cycloplegic is

Shortest acting Mydriatic and Cycloplegic is Tropicamide.
Phenylephrine is only mydriatic with no cycloplegic property.


Question: Normal endothelial cell count in Corneal endothelium is

Normal endothelial cell count in Corneal endothelium is 2500-3000 cells / sq.mm


Question: Giant papillary conjunctivitis is caused by

Ans: A (Contact lens) Ref: Kanski clinical ophthalmology 6th edition; page 218, 234Explanation:Conjunctiva] papillae: Hyperplasic conjunctival epithelium with fibrovascular core and subepithelial infiltration with inflammatory cells.Three types of papillae:Micropapillae - mosaic like red dotsMacropapillae - < 1 mm in sizeGiant papillae - > I mm in sizeCauses of Giant Papillary ConjunctivitisRepeated mechanical irritation of the conjunctivaOcular prosthesesExtruding scleral bucklesExposed ocular suturesFiltering blebElevated corneal scars- Giant papillary conjunctivitis symptoms and signs, such as papillary changes in the tarsal conjunctiva, have been associated with the use of all types of contact lenses (eg. rigid, hydrogel, silicone hydrogel, piggyback, scleral, prosthetic).Incidence of giant papillary conjunctivitis with various types of contact lensesSoft contact lens wearers: 1% to 45%'Conventional soft contact lens: 34%Extended wear disposable soft contact lens wearers -5%Frequent replacement contact lens (every one day to twelve weeks): 21.27%Rigid gas permeable lens wearers: Very low (1 % to 5%).

Inflammations of Conjunctiva - Allergic and Granulomatous


Question: Grave's ophthalmopathy mostly presents as September 2010

Ans. A: Proptosis Graves' ophthalmopathy (also known as thyroid eye disease (TED), dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, reduce dpower convergence and bulging eyes (proptosis).


Question: Drug of choice for treatment of Acute attack of primary Angle Closure glaucoma is


Question: A one month old infant presents with a spongy purplish eyelid mass. The most likely diagnosis is

Capillary hemangioma is the most common eyelid tumor in children. Capillary hemangioma (strawberry naveus) It presents sholy after bih as a unilateral, raised bright red lesion usually in the upper lid; a deeper lesion appears purplish . frequently associated with ptosis. In majority of cases(75%), lesions resolve by age of 7 years It may be Associated with PHACES SYNDROME The lesion blanches on pressure & may swell on crying. Treatment -propranolol/Intralesional injection of triamcinolone, and vincristine (for resistant cases) - Neurofibroma Lids & orbits are commonly affected in neurofibromatosis type-1 (von Recklinghausen's disease).The tumor is usually of plexiform type resulting in mechanical ptosis & 'S'- shape deformity of upper lid - Rhabdomyosarcoma :presents as rapidly progressive proptosis of sudden onset in a child of 7-8 years . The clinical presentation mimics an acute inflammatory process. - Metastatic Ewing's sarcoma: metastasize M/C to lungs .rarely to eyes


Question: Not a function of district blindness control society

Training of ophthalmologists are included in the teiary care hospitals District blindness Control Society * Planning -preparation of district Micro-plan * Implementation of programme * Monitoring of programme * Financial and material management * Social mobilization * Creating public awareness * Procurement of consumable and non-consumable items * Arrangement of screening camp * Record keeping and maintaining


Question: Most common type of scleritis among the following is

Scleritis refers to a chronic inflammation of the sclera proper. It is a comparatively serious disease which may cause visual impairment and even loss of the eye if treated inadequately. It usually occurs in elderly patients (40-70 years) involving females more than the males. It can be classified as follows:I. Anterior scleritis (98%)1. Non-necrotizing scleritis (85%)(a) Diffuse(b) Nodular2. Necrotizing scleritis (13%)(a) with inflammation(b) without inflammation (scleromalacia perforans)II. Posterior scleritis (2%) REF:Comprehensive ophthalmology,AK Khurana,4th edition,pg no.129.


Question: The power of Cornea is

The power of Cornea +43 — +45D
The power of Lens is +15 — +17D
The power of the Eye : +60D


Question: Iridocyclitis is a feature of

C. i.e. Seronegative pauciaicular juvenile rheumatoid ahritis

Juvenile rheumatoid ahritis with systemic involvement

Seropositive, pauciaicular, juvenile rheumatoid ahritis

Seropositive, polyaicular juvenile rheumatoid ahritis


Question: Complication of vernal keratoconjunctivitis is

Keratoconus (conical cornea) is a noninflammatory bilateral (85%) ecstatic condition of the cornea in its axial pa. It usually stas at pubey and progresses slowly. Keratoconus may be associated with :Ocular conditions e.g. ectopia lentis, congenital cataract, aniridia, retinitis pigmentosa, and vernal keratoconjunctivitis (VKC). Systemic conditions e.g., Marfan's syndrome, atopy, Down's syndrome, Ehlers-Danlossyndrome, osteogenesis imperfecta, and mitral valve prolapse. Treatment. Falling vision may not be corrected by glasses due to irregular astigmatism. Contact lenses (rigid gas permeable) usually improve the vision in early cases. In later stages penetrating keratoplasty may be required. Intacs, the intracorneal ring segments, are repoed to be useful in early cases. Keratoconus can occur in patients with vernal keratoconjunctivitis due to repeated rubbing of the eye. early complications: This constant damage to the cornea may cause severe complications, including shield ulcers and vernal plaques, keratoconus, corneal scarring, microbial keratitis, and limbal epithelial stem cell deficiency. As some of these complications occur during the first decade of life, they may result in amblyopia. Ref khurana 16th edition pg 256 Ref: Khurana; 4th ed; Pg 119


Question: In complicated cataract opacity develops in

Answer-C. Posterior subcapsularComplicated cataract refers to the lens opacification secondary to some other intraocular disease, Anterior uveitis is the most common cause.Posterior coical complicated cataract : - This type of cataract is due to affections of posterior segment. This cataract is located in a posterior subcapsular cataract and typically opacification stas in the posterior pa of the coex in the axial region.


Question: standard sutureless cataract surgery done with phacoemulsification and foldable intraocular lens has an incision of

The incision size in phacoemulsification is 3.2 mm refer Khurana 6th edition page number 197


Question: Gonioscopy is used to study

C i.e. Angle of anterior chamber Gonioscopy is examination of angle of anterior chamber Q.


Question: Visual acuity in infants is tested with the help of


Question: The Uveitis associated with vitiligo & auditory defects occurs in

Ans. is 'c' i.e Vogt Koyanagi Harada Syndrome * Vogt Koyanagi Harada Syndrome is a multisystem disorder characterized by Cutaneous lesionsOtological:VitiligoDeafnessAlopeciaTinnitusPoliosisVertigo Neurological lesionsOcular:Encephalopathy, MeningismusUveitisRetinal detachmentAssociated with HLA DR4 & DW15Bechet's Syndrome is characterized bv *Recurrent uveitisApthous ulcerationsGenital ulcerationsErythema multiformeAssociated with HLA B5 *Steven's Johnson Syndrome - is a cutaneous drug reaction.Clinical features include-Initial feature is always sore throat, malaise feverLesions involve 2 mucous memb. sites.Small blisters on dusky purpuric maculesTotal percent of body surface area blistering and eventual detachment is less than 10% (Note >=30% is seen in TEN, Toxic Epidermal Necrosis, the most serious cutaneous drug reaction)


Question: The normal pH of tear is

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


Question: Treatment of choice for pseudotumor

Steroids are the treatment of choice for pseudotumor Orbital Pseudotumor Most common cause of painful orbital mass, present like tumor histopathology - Polymorphous lymphoid infiltrate with varied amount of fibrosis Optic nerve compression may occur in massive posterior involvement May lead to frozen orbit in cases of chronic involvement and fibrosis More common seen unilaterally On MRI sequences it has both Muscle belly + Tendon involvement Rx: Oral prednisolone after confirmation is treatment of choice. Radiotherapy,methotrexate andTNF alpha inhibitors are used in recalcitrant cases


Question: Subconjunctival cyst is seen in QUESTION REPEATED

Parasitic cysts such as subconjuctival cyst is seen in Cysticercosis . Hydatid cyst and filarial cust are not infrequent in development countries. Common cystic lesions of conjunctiva are : Congenital cystic lesions Lymphatic cysts of conjunctiva Retention cysts Epithelial implantation cyst (traumatic cyst) Aqueous cyst Pigmented epithelial cyst Parasitic cysts Ref;A.K.Khurana; 6th edition; Page no: 92


Question: Uveitis with auditory and cutaneous problems occurs in

A. i.e. (Vogt - Koyanagi - Harada syndrome)VOGT- KOYANAGI- HARADA (VKH) Syndrome* Idiopathic multisystem disorder HLA- DR4 and DW-15Clinical features1. Cutaneous lesions include - alopecia, poliosis and vitiligo2. Neurological lesions are in the form of meningism, encephalopathy, tinnitus, vertigo and deafness3. Ocular- features - are bilateral chronic granulomatous anterior uveitis, posterior uveitis and exudative retinal detachment* Uveitis with ankylosing spondyitis is characteristically an acute, recurrent, non granulomatous type of iridiocyclitis* Behcet's disease - idiopathic multi system disease characterized by recurrent non granulomatous uveitis, aphthous ulceration, genital ulceration and erythema multiforme* Persistent primary hyperplastic vitreous (PHPV) is seen in association with Trisomy 13 (Patau syndrome**) and Trisomy 22, Norries disease, walker Warburg syndrome**LDH in aqueous humor is increased in Retinoblastoma


Question: Vogt&;s triad is indicative of

Vogt&;s triad of clinical signs of past acute angle closure glaucoma includes sector iris atrophy, pigment dispersion on corneal endothelium and anterior subcapsular cataractous changes called Glaukomflecken. Ref:- Parsons diseases of eye; pg num:-298

Past attack of herpes zoster ophthalmicus

Past attack of acute-angle closure glaucoma


Question: Most common senile cataract causing glaucoma is

Morgagnian cataract complicates into phacolytic glaucoma Refer: Khurana 6th edition page number 187


Question: Most common type of optic nerve glioma is

Pilocytic means that the tumor cells are hair like. pilocytic astrocytoma is the most common type Refer khurana 6/e 410

Diseases of orbit, Lids and lacrimal apparatus


Question: Topical drug that can cause Heterochromia Iridis

Latanoprost, a PG analogue can cause heterochromia iridis in patients.


Question: Site of secretion of aqueous humor

Pars plicata is the site for production of aqueous humor It drains through trabecular meshwork and uveoscleral outflow


Question: Snow blindness is caused by

In snowblindness the cause and symptoms are similar to photophthalmia, for the ultraviolet rays are reflected from snow surfaces. Snow blindness, also called arc eye or photokeratitis, is a painful eye condition caused by overexposure to ultraviolet (UV) light. When too much UV light hits the transparent outer layer of your eyes, called the cornea, it essentially gives your cornea a sunburn. Snow blindness symptoms can be disorienting. Ref-Parson's; 21st edition; Pg No. 214


Question: Posterior capsule opacities are treated by

Ans. is c i.e., Nd:YAG Laser * Nd:YAG Laser is used for treatment of posterior capsular opacities commonly seen after cataract surgeries.


Question: Umbrella configuration on fluorescein angiography is seen in

Fundus fluorescein angiography helps in confirming the diagnosis. Two patterns are seen:_ Ink-blot pattern: It consists of a small hyperfluorescent spot which gradually increases in size._ Smoke-stack pattern: It consists of a small hyperfluorescent spot which ascends veically like a smoke-stack and gradually spreads laterally to take a mushroom or umbrella configuration.Ref: Khurana; 4th edition; Pg.No. 272


Question: Microanuerysms in diabetic retinopathy is present in

Microaneurysms and dot blot hemorrhages - inner nuclear layer.
Hard exudates - Outer plexiform layer.


Question: Percentage of endothelial loss in Descemets stripping automated endothelial keratoplasty

Ans. (c) 30 - 40%Ref: Cornea: July 2007- Volume 26 - Issue 6 p. 670 - 674)Reported mean endothelial cell loss (usually at 6 months post op) varies from 24-59% (with standard deviations) across the studies.


Question: Visual field defect in pituitary tumour with supracellar extension is


Question: Acanthamoeba keratitis is associated with

Acanthamoeba keratitis Mode of infection. Corneal infection with acanthamoeba results from direct corneal contact with any material or water contaminated with the organism. Following situations of contamination have been described: Contact lens wearers using home-made saline Non contact lens related situations include mild trauma with contaminated vegetable matter, salt water diving, wind blown contaminant and hot tub use Oppuunistic infection. Acanthamoeba keratitis can also occur as oppounistic infection in patients with herpetic keratitis, bacterial keratitis, bullous keratopathy and neuroparalytic keratitis. Reference: A.K.Khurana;6th Edition; Page no: 113.

Anatomy, Development and clinical examination


Question:
3
rd
 cranial nerve suppliesa) Lateral rectusb) Medial rectus, Levator palpabrae superiorisc) Superior rectusd) Superior obliquee) Inferior oblique

Occulomotor (3rd) nerve supplies all extraocular muscles (except superior oblique and lateral rectus)and levator palpebrae superioris.
Occulomotor nerve also supply the sphinctor pupillae and ciliary muscle through the parasympathetic general visceral efferent fibers.


Question: Soft contact lens is made up of

B i.e. HEMA Types of Contact Lens Hard Gas permeable (Rigid or semisoft) Soft Made of PMMA (poly methyl metha acrylate) Q Copolymer of PMMA, silicon containing vinyl monomer and cellulose acetate butyrate (CAB) HEMA (hydro? xy methyl metha acrylate) Q Oxygen delivery Poor Moderate to high High Deposits Few Few More Visual clarity Good Clear Need to refocus after a blink Use in astigmatism Possible Possible Less suitable Adaptation Required Required Not required Durability May scratch Do not scratch or tear Tear


Question: Most common presentation of Retinoblastoma

Leucocoria (60%)
Strabismus (22%)
Decreased vision (5%).


Question: The periphery of the retina is visualized with

The technique of examining the fundus of the eye is called ophthalmoscopy. In indirect ophthalmoscopy, a real and inveed image is formed between the condensing lens and the observer. The advantage of stereopsis (depth perception) and a larger field of view makes indirect ophthalmoscope (IDO) more useful both in retina clinics and during posterior segment surgeries. Reference : A K KHURANA Comprehensive Ophthalmology; edition 4; page-567

Anatomy, Development and clinical examination


Question: Specific term used for granulomatous inflammation of superior orbital fissure is

Tolosa Hunt Syndrome Specific term used for granulomatous inflammation of superior orbital fissure Painful Ophthalmoplegia Present as either Superior Orbital fissure syndrome/ Orbital apex syndrome Superior Orbital Fissure Syndrome Retro orbital Pain Sensory disturbances in ophthalmic division of 5th nerve Ipsilateral ophthalmoplegia due to 3rd , 4th, 6th nerve Ptosis due to 3rd nerve palsy Orbital Apex Syndrome Symptom complex produced by involvement of structures passing through superior orbital fissure and optical canal The features are similar to Superior orbital fissure syndrome Features of optic nerve involvement like early visual loss and RAPD are also present


Question: Retinoblastoma is

(Autosomal dominant) (280- Khurana 4th)RETINOBLASTOMA - Most common intraocular tumour of childhood and malignant melanoma of choroid in adults*** Identified as band on the long arm of chromosome 13(13ql4)* Most hereditary cases are multifocal* Inheritance is autosomal dominant and the risk of transmitting the gene mutation is 50%* Leukocoria ox yellowish - while pupillary reflex** (also called as amaurotic cat's eye appearance) is the commonest features* In the presence of calcification it gives the typical "Cottage- cheese " appearance* Calcification occurs in 75% is almost pathognomic of Retinoblastoma* Enucleation is the treatment of choice when* Tumour involves more than half of the retina* Optic nerve is involved* Glucoma is present and anterior chamber is involved* External beam radiation therapy spares vision and the cosmetic use of the globe* Palliative therapy (chemotherapy, surgical debulking of the orbit or orbital exentration and External beam radiotherapy (EBRT) is given in following cases where prognosis for life is dismal in spite of aggressive treatment* Retinoblastom with orbital extension* Retinoblastoma with intracranial extension* Retinoblastoma with distant metastasis


Question: An object located in the panum's area stimulates

Panum's area of fusion stimulates stereopsis.


Question: Maximum Number of cones are seen in

(A) Fovea centralis # Human retina contains on average 4.6 million cones and 92 million rods, although there is significant inter-individual variation (Curcio et al 1990).# Retina:> Fovea centralis: It lies in the center of macula lutea. Cones are highly concentrated in the fovea. It is responsible for visual acuity.> Although cones populate the whole retina, their density is highest in the foveola, where approximately 7000 cones reach an average density of 199,000 cones/mm2: this area is entirely rod free.> Going outwards from the foveola, rod numbers rise, reaching a peak density in a horizontal elliptical ring at the eccentricity of the optic disc, before declining once more toward the periphery.> Cone density is 40-45% higher in the nasal compared to the temporal retina, and slightly higher interiorly than superiorly.


Question: Fincham's test differentiates cataract from


Question: Dendritic ulcer is produced by

Epithelial Herpes simplex Virus keratitis - Symptoms Redness Pain Photophobia Tearing Decreased vision Signs Three distinct patterns of epithelial keratitis seen are : punctate Epithelial keratitis dendritic ulcer geographical ulcer Ref;A.K.Khurana; 6th edition; Page no:108 REF IMG


Question: Sunflower cataract is Seen in

A typical 'sunflower cataract' is seen in disorder of copper metabolism (Wilson's disease). It is produced by deposition of copper under the posterior capsule of the lens. It is brilliant golden green in colour and arranged like the petals of a sun flower. Ref:- A K Khurana; pg num:-410,476,


Question: NOT an etiology for Myopia is

Decreased radius of curvature of Cornea is an etiology for myopia, not increased radius of curvature.


Question: 8 year old boy presented with swelling in the left eye of three months duration examination revealed proptosis of the left eye with preserved vision right eye is normal CT Scan revealed incredible extraconal mass lesion biopsy revealed embryonal rhabdomyosarcoma metastatic workup was normal the standard line of treatment is

Rhabdomyosarcoma is very responsive to radiotherapy Refer khurana 6/e p 425

Diseases of orbit, Lids and lacrimal apparatus


Question: Vogt's triad of primary Angle closure glaucoma does not include

Vogt's triad of primary Angle closure glaucoma include

Glaucoma flackens.
Pigment deposition on Corneal endothelium.
Patches of Iris atrophy.


Question: A 35 year old male complains of headaches and inability to read near objects. Most probable diagnosis

Hypermetropia presents with complains of difficulty in near vision. When the amount of hypermetropia is such that it is not fully corrected by the voluntary accommodative effos, then the patients complain of defective vision which is more for near than distance and is associated with asthenopic symptoms due to sustained accommodative effos. Myopia and astigmatism generally doesn't present with complains of inability to read near objects. Presbyopia presents after age of 40 years.


Question: A 60 year old man with optic disc swelling in the right eye and optic atrophy in left eye optic atrophy most likely has

This is a case of pseudo foster Kennedy syndrome.- It is characterized by occurrence of unilateral papilloedema associated with raised intracranial pressure (due to any cause) and a pre-existing optic atrophy (due to any cause) on the other side. It is caused most commonly by bilateral sequential anterior ischemic optic neuropathy. Foster-Kennedy syndrome.- It is associated with olfactory or sphenoidal meningioma and frontal lobe tumors (anterior fossa tumours) In this condition, there occurs pressure optic atrophy on the side of lesion and papilloedema on the other side (due to raised intracranial pressure). It is classically associated with frontal lobe meningioma which is absent in above case. Sphenoid wing meningiomas are common in 5th decade of life in women whereas the clinical scenario provided is of 60 year old male patient


Question: Cicatrising trachoma is seen in

Grading of trachoma:McCallan&;s classification by McCallan in 1908, divided the clinical course of the trachoma into following four stages:Stage I (Incipient trachoma or stage of infiltration): It is characterized by hyperemia of palpebral conjunctiva and immature follicles.Stage II (Established trachoma or stage of florid infiltration): It is characterized by an appearance of mature follicles, papillae, and progressive corneal pannus.Stage III (Cicatrising trachoma or stage of scarring): It includes obvious scarring of palpebral conjunctiva.Stage IV (Healed trachoma or stage of sequelae): The disease is quite and cured but sequelae due to cicatrization give rise to symptoms.Ref: Khurana; 4th edition; Pg no. 65


Question: Field defect seen in papilloedema

In papilloedema, as the condition progresses vision worsens with an enlargement of the blind spot owing to separation of the retina around the disc by the oedema and a progressive contraction of the visual field due to atrophy of the optic nerve. Ref: Parson's 22 nd edition, page no. 352


Question:
Most common cause of Neonatal conjunctivitis causing
blindness is

Most common cause of Neonatal conjunctivitis causing blindness is Gonococcus.


Question: The normal value of Arden index is

Arden ratio = (Maximum height of light peak/Minimum height of dark trough) x 100 Normal curve values are 185 or above. Subnormal curve values are less than 150. Flat curve values are less than 125. Reference : AK KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4 , Page-490

Anatomy, Development and clinical examination


Question: Toughest layer of Cornea is

Toughest layer of Cornea is Pre descement membrane.


Question: Cataracta brunescens result due to deposition of

Nuclear senile cataract: The usual degenerative changes are intensification of the age- related nuclear sclerosis associated with dehydration and compaction of the nucleus resulting in a hard cataract. It is accompanied by a significant increase in water insoluble proteins. However, the total protein content and distribution of cations remain normal. There may or may not be associated deposition of pigment urochrome and/or melanin derived from the amino acids in the lens. The nucleus may become diffusely cloudy (greyish) or tinted (yellow to black) due to deposition of pigments. In practice, the commonly observed pigmented nuclear cataracts are either amber, brown (cataracta brunescens) or black (cataracta nigra) and rarely reddish (cataracta rubra) in colour. Ref:- A K Khurana; pg num:- 176,178


Question: Gyrate Atrophy patient with defective ornithine aminotransferase will be benefited by

Ans is 'b' i.e. Arginine free diet Gyrate atrophy of the choroid and retina is a slowly progressive, diffuse, bilateral chorioretinal dystrophy with an autosomal recessive mode of inheritance.Gyrate dystrophy is caused by a deficiency of OAT (ornithine aminotransferase) also k/a ornithine keto acid aminotransferase.Deficiency of OAT leads to increased level of omit Bine (hyperomithemia).Ornithine, a nonessential amino acid, is an intermediate compound in the formation of urea. It is formed from Arginine.Arginine is converted to ornithine then to glutamate-y-semialdehyde by OAT.Deficiency of OAT leads to hyperomithemia causing gyrate atrophy.Patients develop nyctalopia during the second to third decade of life. Visual acuity is preserved until later stages. Treatment:Since ornithine is produced from other amino acids, mainly arginine a low protein diet, including near total elimination of arginine with supplementation of essential amino acids has been found to be beneficial in gyrate atrophy.Gene for the enzyme OAT has been mapped to chromosome 10q26.Replacement of the abnormal gene, or genetic engineering to produce a supply of normal enzyme, may result in a reduction of ornithine levels without dietary restrictions.


Question: A 4 year old child presents with complaints of watering and itching in the eye, and on examination the eyes was seen as given below. His last immunization was found to be incomplete. Probable organism causing the condition is

Membrane that bleeds on peeling and incomplete immunization history in a child denotes Acute membranous conjunctivitis, which in children is most commonly caused by Corynebacterium diphtheria.


Question: The most frequent cataract type seen in adult retinitis pigmentosa patient is

Ans. (a) PSCRef: Yanoff and Duker 2/e, p. 818; Kanski 7/e, p. 654* Retinitis pigmentosa is associated with posterior subcapsular cataract (PSC)Retinal pigment degeneration such as retinitis pigmentosa, Usher's syndrome and gyrate atrophy are associated with cataract, which are usually subscapular opacities.


Question: The swinging light test is positive in

Retrobulbar neuritis: a common cause of visual loss with normal fundus. Presence of a definite or relative afferent pupillary defect (RAPD) and VER are diagnostic. Swinging flashlight test: It is performed when relative afferent pathway defect is suspected in one eye (unilateral optic nerve lesion with good vision). 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 flashlight 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. In the swinging flashlight test, a light is alternately shone into the left and right eyes.Thus, light shone in the affected eye will produce less pupillary constriction than light shone in the unaffected eye. Anisocoria is absent. A Marcus Gunn pupil is seen, among other conditions, in optic neuritis. Ref: Khurana; 4th edition; Pg.No. 307, 474


Question: Maximum refraction occurs at

Ans. a (Anterior surface of cornea) (Ref: A K Khurana, 2nd/pg. 50, and Basak's Ophthalmology 2nd/pg. 4)Refractive mediumRefractive indexCornea1.38Aqueous humor1.33Lens1.4Vitreous humor1.34Air1Maximum refraction occurs at anterior surface of cornea because:1. Anterior surface of cornea has greater curvature and2. There is greater difference between refractive indices of air and cornea.Refractive surfaceRefractive PowerAnterior surface of cornea+48DPosterior Surface of cornea-4DLens of eye (Vivo)+15DLens of eye (taken out)+150D


Question: Lisch nodule is seen in

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 309)Lisch nodules are the most common type of ocular involvement in NF-1. These nodules are melanocytic hamaomas, usually clear yellow to brown, that appear as well-defined, dome-shaped elevations projecting from the surface of the iris.


Question: Steroids are contraindicated in

D i.e. Dendritic ulcer Since fungal corneal ulcer is not an option here, so, the obvious answer is dendritic ulcer.


Question: "Elschnig Pearl" in papillary aperture is a sign of

Ans. c (After cataract) (Ref. Basak, Ophthalmology, 2nd ed., 182)AFTER CATARACT# Posterior capsular opacification following ECCE & discission of congenital/traumats cataract.# More common in children# Elschning's pearl (Balloon lens-cell)# Soemerring's ring (Ring behind iris formed by lens fibers)# Treatment:- Discission or needling- Capsulotomy/membranectomy Nd-YAG Laser capsulotomy (safe, noninvasive & quick OPD procedure)


Question: Volume of the orbit is

Volume of the orbit is 30ml Orbit" can refer to the bony socket, or it can also be used to imply the contents. In the adult human, the volume of the orbit is 30 millilitres (1.06 imp fl oz; 1.01 US fl oz), of which the eye occupies 6.5 ml (0.23 imp fl oz; 0.22 US fl oz). Ratio of volume of orbit to eyeball is 4.5:1 Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 577

Anatomy, Development and clinical examination


Question: Angle recession glaucoma occurs in

A. i.e. (Concussion injury in the globe) (235 - Khurana 4th) (290 - Parson 20th)Angie - recession (cleavage) glaucoma - due to disruption of trabecular mesh work followed by fibrosis - seen in Traumatic glaucoma (Perforating as well as blunt injuries)(i) Symptom - Diminuation of vision(ii) Anterior segment - Mydriasis, tears of the iris sphincter, iridodialysis(iii) Gonioscopy - anterior recession >180deg(iv) Intraocular pressure - Moderate to high(v) Optic nerve head - Granulomatous cupping if chronic(vi) Treatment - Medical and surgery* Intractable secondary glaucoma is seen in - Diffuse iris melanoma**


Question: Vossius ring is seen on

Vossius ring is the Iris pigments inprinted on the anterior capsule of the lens in shape of Pupil It is due to blunt trauma Refer: Khurana 6th edition page number 430


Question: Zonular cataract

i.e. (Developmental cataract): (265-Parson 21st) (172-Khurana 4th)ZONULAR OR LAMELLAR CATARACT - refers to the developmental cataract in which the opacity occupies a discrete zone in the lensMost common types of congenital cataract presenting with visual impaiment*** Usually bilateral* Lineal opacities like spikes of a wheel (called riders) may run outwards towards the equator- Other most common types of developmental cataract- Punctate cataract- Fusiform cataract- Nuclear cataract- Coronary cataract- Anterior capsular (polar) cataract- Posterior capsular (polar) cataract


Question: Macular sparing is seen in a lesion of

Retention of macular function in spite of losses in the adjacent visual field. Example: In homonymous hemianopia due to an occipital lobe lesion (e.g. an interference in the blood flow in the middle cerebral aery). Reason: Macula has a dual blood supply of both MCA and PCA Visual Field Defects - Left Hemianopia with Macular Sparing. Left hemianopia with macular sparing is a paial loss of vision in the same half of both eyes with the center, the macula, spared. A lesion of both the dorsal radiation and Meyer&;s loop in the occipital lobe causes this blindness Reference: khurana 6th edition pg 677

Anatomy, Development and clinical examination


Question: Giant papillary conjunctivitis is seen

It is the inflammation of conjunctiva with formation of very large sized papillae. Etiology :It is a localised allergic response to a physically rough or deposited surface (contact lens, prosthesis, left out nylon sutures). Probably it is a sensitivity reaction to components of the plastic leached out by the action of tears. ref: A K KHURANA OPHTALMOLOGY,E4, Page-77


Question: Most common intraocular foreign body retained is

Common foreign bodies responsible for such injuries include: chips of iron and steel (90%), paicles of glass, stone, lead pellets, copper percussion caps, aluminium, plastic and wood. It is impoant to note that during chopping a stone with an iron chisel, it is commonly a chip of the chisel and not of the stone which enters the eye. Ref khurana 6/e p433


Question: Paralytic squint is

Ans. is 'a' i.e., Incomitant squint Incomitant squint is a squint in which the angle of detion differs depending upon the direction of gaze i.e, amount of detion varies in different directions of gaze . There are many type of incomitant squints (paralytic, restrictive, 'A' & 'V' pattern), however the most common type is Paralytic squint and the word incomitant squint is usually used for paralytic squint.Therefore, I will explain paralytic squint here.


Question: Sauce and cheese retinopathy is seen in

Cytomegalovirus (CMV) Retinitis is an acquired immunodeficiency syndrome (AIDS)-related oppounistic infection that can lead to blindness Ref AK khurana 6/e


Question: The following Rosenbaum chart is used to test for visual acuity at a distance of

(C) 36 cm # VISUAL ACUITY:> Snellen chart is used to test acuity at a distance of 6 m (20 ft). For convenience, a scale version of the Snellen chart called the Rosenbaum card is held at 36 cm (14 in.) from the patient.> The Rosenbaum card is a miniature, scale version of the Snellen chart for testing visual acuity at near.> When the visual acuity is recorded, the Snellen distance equivalent should bear a notation indicating that vision was tested at near, not at 6 m (20 ft), or else the Jaeger number system should be used to report the acuity.> All subjects should be able to read the 6/6 m (20/20 ft) line with each eye using their refractive correction, if any.> Patients who need reading glasses because of presbyopia must wear them for accurate testing with the Rosenbaum card. If 6/6 (20/20) acuity is not present in each eye, the deficiency in vision must be explained.> If it is worse than 6/240 (20/800), acuity should be recorded in terms of counting fingers, hand motions, light perception, or no light perception.> Legal blindness is defined by the Internal Revenue Service as a best corrected acuity of 6/60 (20/200) or less in the better eye or a binocular visual field subtending 20deg or less.> For driving the laws vary by state, but most states require a corrected acuity of 6/12 (20/40) in at least one eye for unrestricted privileges. Patients with a homonymous hemianopia should not drive.


Question: Purtscher's retinopathy is due to

It is a hemorrhagic vasculopathy associated with severe head trauma.


Question: SMILE is

SMILE is bladeless Flapless LASIK Types of LASIK *Conventional LASIK: The LASIK flap is made by microkeratome blade and then EXCIMER laser is used for stromal ablation *Epi LASIK or Photorefractive Keratectomy: Laser ablation is done after removal of epithelium without the creation of flap *SMILE- is small incision lenticular extraction , a new technique in lasik using femtolaser. No Flap is made and it is bladeless. *I lasik: bladeless lasik. Creation of Flap is by Femtolaser LASIK procedure


Question: Brush fire appearance of fundus is seen in


Question: A soft contact lens users has corneal keratitis cause is


Question: Organism not invading intact cornea

Answer- D. PseudomonasThe organisms which can penetrate intact corneal epithelium are Neisseria gonorrhoea, Haemophilus aegyptus, corynebacterium diphthriae, Listeria species and Neisseria meningitidis.


Question: The optic canal is a pa of

*The optic nerve leaves the orbit is the optic canal to enter the cranial vault *The optic canal is the most posterior landmark of the orbit. It measures 10mm in length *The thin piece of bone separating the optic canal from the superior orbital fissure is the optic strut *The optic strut and optic canal are a pa of the lesser wing of the sphenoid bone Fig - Foramina and bony landmarks of the sphenoid wings and pterygoid process. Reference : AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 310

Anatomy, Development and clinical examination


Question: Extra layer of cilia posterior to grey line


Question: The following rosette cataract is seen with


Question: Most common cause for rubeosis iridis is

Neovascularization of the iris (NVI) or rubeosis iridis is a peculiar condition that occurs commonly in eyes having proliferative diabetic retinopathy or central retinal vein obstruction. It is characterized by the development of new, branching and enlarged vessels in the iris, the neovascularization being frequently accentuated towards its root and in the angle of the anterior chamber. The new vessels leak protein and give rise to turbid aqueous. NVI may be associated with signs of iritis. Rubeosis iridis, is a medical condition of the iris of the eye in which new abnormal blood vessels (formed by neovascularization) are found on the surface of the iris. Ref.Parson's; 21st edition; Pg. 247


Question: Glaucoma is characterised by apoptosis of

Multifactorial optic neuropathy characterised by Retinal Ganglionic cell death by the apoptosis.


Question: Primary aim of retinal detachment surgery

D i.e. Encirclage The main objective of the treatment of retinal detachment is to seal and suppo the retinal breakQ.


Question: Most sensitive pa of retina to light is

It is located in the center of the macula lutea of the retina. The fovea is responsible for sharp central vision (also called fovealvision), which is necessary in humans for activities for which visual detail is of primary impoance, such as reading and driving It is sensitive pa for light Ref AK khurana 6/e p 25


Question: The immune ring is a feature of

A typical fungal corneal ulcer has following salient features: The corneal ulcer is dry-looking, greyish white, with elevated rolled out margins. Delicate feathery finger-like extensions are present into the surrounding stroma under the intact epithelium. A sterile immune ring (yellow line of demarcation) may be present where fungal antigen and host antibodies meet. Multiple, small satellite lesions may be present around the ulcer. Usually, a big hypopyon is present even if the ulcer is very small. Perforation of mycotic ulcer is rare but can occur. Corneal vascularization is conspicuously absent. The term fungal keratitis refers to a corneal infection caused by fungi. One type of fungus that can infect the cornea is Fusarium.This increased occurrence of fungal keratitis is a result of the frequent use of topical coicosteroids along with antibacterial agents in treating patients with keratitis Ref: Khurana; 4th edition; Pg no.100


Question: Maximum refraction takes place between


Question: Continuous contact lens wear may lead to

Answer- A. Giant papillary conjunctivitisCorneal complications : - Corneal abrasion, Corneal edema, Corneal vascularization, Microbial keratitis (pseudomonas, acanthamoeba), Sterile corneal infiltrate.Giant papillary conjunctivitis


Question: Most commotion etiology of Uveitis is

Most commotion etiology of Uveitis is Autoimmune.


Question: Treatment of choice for acute angle closure glaucoma is


Question: Tachyphylaxis is an adverse effect of

Dipevifrine, an a adrenergic agonist has adverse effect of Tachyphylaxis.


Question: Most common cause of infectious keratitis in a contact lens user

Most common cause of infectious keratitis in a contact lens user is pseudomonas Commonest causative organism associated with keratitis - pneumococcus Hypopyon ulcer / ulcus serpens - pneumococcus acanthamoeba : attacks contact lens that are washed with water.


Question: Final center for horizontal movements of the eye is

Subcoical centre for lateral/horizontal conjugate gaze lies in the abducent nucleus In pons, though some authors take it to be PPRF (para-median pontine reticular formation) and others as nucleus prepositus hypoglossi. This centre receives input from the contralateral frontal eye field and moves ipsilateral lateral rectus and contralateral medial rectus muscle projections of MLF (medial longitudinal fasciculus) PPRF lesion leads to inactivity of saccadic movements by lateral rectus and contralateral medial rectus. There is loss of horizontal saccades directed towards the side of the lesion but pursuit and vergence movements are preserved. One and a half syndrome: Unilateral abducent and bilateral MLF lesion. On attempted lateral gaze, the only muscle functional is the intact lateral rectus. MLF connects the nuclei controlling eyeball muscles--(LR6 SO4)3 and mediates nystagmus and lateral conjugate gaze. Its fibers originate in vestibular nucleus and terminate in abducent, trochlear and oculomotor nuclei. It coordinates eyeball movements with the head. Trochlear nucleus is concerned with veical gaze movements. Nucleus prepositus hypoglossi (and not hypoglossal nucleus), is involved in the gaze circuitry.


Question: Esotrotropia is most commonly associated with

Near vision impaired they try to compensate by increasing their accomodation Infants are hyperopic by 2.5 D they are esotropic at bih ref : ak khurana 7th ed


Question: Treatment of choice for Eale’s disease

1. Medical treatment. Course of oral corticosteroids for extended periods is the main stay 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 stage of neovascularizion.
3. Vitreoretinal surgery is required for non- resolving vitreous haemorrhage and tractional retinal detachment.


Question: YAG laser is used in

Posterior capsular opacity/after cataract treated by ND-YAG capsulotomy A Yag capsulotomy is a special laser treatment used to improve your vision after cataract surgery. It is a simple, commonly performed procedure which is very safe. During your cataract operation, the natural lens inside your eye that had become cloudy was removed. Yag laser capsulotomy is the only way to treat this. Reference: khurana 6th edition pg 233

Anatomy, Development and clinical examination


Question: Distance of Muscle 5 from Limbus

5.5 mm (Muscles shown: 1 Superior rectus, 2 Lateral rectus, 3 Inferior rectus, 4 Inferior Oblique, 5 Medial rectus, 6 Superior oblique)


Question: A Middle aged man brought to casualty with unilateral headache, right eye congested and painful, with sudden vision loss. The diagnosis is

(A) Angle Closure Glaucoma# Angle-closure glaucoma, also known as narrow-angle glaucoma, is caused by blocked drainage canals in the eye, resulting in a sudden rise in intraocular pressure.> This is a much more rare form of glaucoma, which develops very quickly and demands immediate medical attention. Symptoms of angle-closure glaucoma may include:> Hazy or blurred vision: The appearance of rainbow-colored circles around bright lights Severe eye and head pain Nausea or vomiting (accompanying severe eye pain) Sudden sight loss


Question: Best X ray view to visualize superior orbital fissure is

Caldwell luc view is posterioanterior view(PA) Refer khurana 6/e

Diseases of orbit, Lids and lacrimal apparatus


Question: Highest density of cones are present in

The highest density of cones is present in fovea which helps in clear vision when fixation object image falls there. In the fovea, cone density increases almost 200-fold, reaching, at its center, the highest receptor packing density anywhere in the retina. This high density is achieved by decreasing the diameter of the cone outer segments such that foveal cones resemble rods in their appearance. Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 15

Anatomy, Development and clinical examination


Question: Exudative retinal detachment occurs in

Myopia and trauma causes rhegmatogenous retinal detachment proliferative diabetic retinopathy causes tractional retinal detachment PIH causes bilateral exudative retinal detachment. Ref:khurana 6th edition, page no. 298


Question: " Polychromatic luster" is a feature of

Ans. d (Complicated cataract) (Ref. Basak's ophthalmology 2nd ed., 181)COMPLICATED CATARACTS# It is a complication of any protracted intraocular inflammation, especially heterochromia, chronic iridocyclitis, retinal vasculitis, and retinitis pigmentosa.# Complicated cataract results from a disturbance of the lens metabolism due to inflammatory or degenerative diseases.# The result is a "pumice-like posterior subcapsular cataract" that progresses axially toward the nucleus.# Vision is much impaired even in early stage, due to position of the opacity near nodal point of eye.# The opacity usually commences in posterior cortex in the axial plane (posterior cortical cataract).# The opacity appears grayish with "bread-crumb" appearance in oblique illumination.# This form of cataract produces extreme light scattering.# On slit lamp, the opacity shows a characteristic rainbow display of colors, the polychromatic luster.# Rx: Operative and visual prognosis in complicated cataract is usually poor.Note: Riders ("spoke wheel") are seen in lamellar cataract, which is the most common type of congenital cataract.


Question: Illuminated Frenzel glasses are used in detecting

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 358 - 362)Illuminated Frenzel glasses (+20 lenses) are useful for abolishing fixation and thus revealing peripheral vestibular nystagmus


Question: A patient of glaucoma with bronchial asthma presents to the emergency with status asthamaticus, causative agent might have been)

Ans. is 'b' i.e. Timolol eye drops Timolol maleate is the most widely used drug for open angle glaucoma.It is non-selective B blocker (Blocks both B1 and B2B2 is responsible for bronchodilation, therefore blocking B2 would aggravate asthma.Instead of Timolol, Betaxolol can be used because it is a selective B1 blocker and causes less respiratory side effects.

Primary Open-Angle Glaucoma and Related Conditions


Question: Not a cause of enlarged corneal nerves

CAUSES OF ENLARGED CORNEAL NERVES *Leprosy *Keratoconus (prominent) *Neurofibromatosis *Riley day dysautonomia *MEN *Posterior Polymorphous Membrane Dystrophy


Question: Rapid change of presbyopic glasses is seen in

PRIMARY OPEN ANGLE GLAUCOMAAs the name implies, it is a type of primary glaucoma, where there is no obvious systemic or ocular cause of the rise in the intraocular pressure. It occurs in eyes with an open angle of the anterior chamber.Primary open angle glaucoma (POAG) also known as chronic simple glaucoma of adult onset and is typically characterized by slowly progressive raised intraocular pressure(>21 mmHg recorded on at least a few occasions) associated with characteristic optic disc cupping and specific visual field defects.Reading and close work often present increasing difficulties owing to accommodative failure due to constant pressure on the ciliary muscle and its nerve supply. Therefore, patients usually complain of frequent changes in presbyopic glasses.Ref: UG Khurana; 4th edition; Pg. 215


Question: Keratomalacia is associated with

Vitamin A deficiency and Keratomalacia The condition is usually bilateral. The cornea becomes dull and insensitive, hazy, and yellow infiltrates form until finally the whole tissue undergoes necrosis and seems to melt away (Keratomalacia) with in few hrs. A characterstic feature is the absence of inflammatory reaction. It is often precipitated by an acute systemic illness such as measles, pneumoniae and severe diarrhoea. Treatment: Ref:- Parsons diseases of eye; pg num:-218


Question: Drug of choice of choroiditis is

C i.e. Steroids Steroids Q are the main stay of treatment in anterior uveitis (iridocyditis) as well as posterior uveitis (choroiditis) Condition Treatment of choice Primary angle closure glaucoma (fellow eye, latent, subacute, intermittent stage) Laser iridotomy Q > Surgical peripheral iridectomy Q Acute congestive stage of primary angle closure glaucoma Pilocarpine (drug of choice) Q to gain time f/b laser iridotomy Q Primary open angle glaucoma /3-blocker (timolol) Q topical Normal / low tension glaucoma /31-blocker (betaxolol) Q topical Anterior uveitis (iridocyclitis) & posterior uveitis (choroiditis) Steroid Q > Cycloplegic-mydriatic (atropine) Q Posner-Schlossman Syndrome (Glaucomatocyclitic crisis) Steroids Q > Aqueous suppressants


Question: Tetracyclines ointment for mass prophylaxis

Tetracyclines:
These are broad-spectrum bacteriostatic agents with considerable action against both gram-positive and gram-negative organisms as well as some fungi, rickettsiae and chlamydiae.
This group includes tetracycline, chlortetracycline and oxytetracycline.


Question: Most common metastatic tumor in orbit in adult male is due to

Lung carcinoma is the most common cause of metastasis to orbit in adult Most common orbital tumor in adults Primary Benign: Cavernous hemangioma Primary Malignant: Lymphoma Metastatic Tumor: Carcinoma Lung (male) , Carcinoma Breast (Female)


Question: Corneal hysteresis is studied using

Corneal hysteresis assesses the biomechanical strength of the cornea and is assessed by Dynamic Contour Tonometry(DCT). Dynamic contour tonometry (DCT) is a contin- uous (dynamic) and direct tonometric principle. It reads the IOP at the interface between the sensitive tonometer tip and the surface of the cornea. Ref khurana 6th edition pg 345


Question: Equatorial diameter of the lens is

The lens continues to grow throughout life. At bih, it measures about 6.4 mm equatorially and 3.5 mm anteroposteriorly and weighs approximately 90 mg. The adult lens typically measures 9 mm equatorially and 5 mm anteroposteriorly and weighs approximately 255 mg. Ref. AAO Sec.11 (2011-2012) Pg.No. 7


Question: Posterior staphyloma is seen in

Ans. (d) Degenerative myopiaRef: A.K. Khurana 6th ed. /144* Posterior staphyloma is seen in conditions like pathological myopia, posterior scleritis and perforating injuries.Important Features Associated with Myopia* Simple/developmental myopia is the commonest type of myopia.* Foster fucks flecks is the choroidal haemorrhage in the macular region.* Lacquer cracks are breaks in the bruchs membrane* Retinal detachment is the most serious complication of myopia.


Question: Founder members of vision 2020 are A/E

International Agency for prevention of blindness


Question: Fluorescein dye study is done to detect

A fluorescein angiography is a medical procedure in which a fluorescent dye is injected into the bloodstream. The dye highlights the blood vessels in the back of theeye so they can be photographed.Retinal vascular disorders e.g., diabetic retinopathy and central retinal vein occlusion Reference : A K KHURANA Comprehensive Ophthalmology; edition 4; page-273

Anatomy, Development and clinical examination


Question: Glaukomflecken is

Acute congestive angle closure may cause small anterior grey-white subcapsular or capsular opacities, glaukomflecken to form within the pupillary area. These represent focal infarcts of the lens epithelium and are almost pathognomonic of prior acute angle-closure glaucoma. Ref: kanski's clinical ophthalmology, 8th edition , page no. 273


Question: Last visual field to be lost in Glaucoma is

Last visual field to be lost in Glaucoma is Temporal field of vision.


Question: Treatment of choice for phlyctenular keratoconjunctivitis is

Treatment of choice for phlyctenular keratoconjunctivitis is Topical Steroids.


Question: The ocular hypotensive agent causing apnoea in infants is

Brimonidine:- * Selective alpha 2 agonist * MOA:- decreases aqeous production & increases the uveoscleral outflow * Neuroprotective Effect Adverse Effects:- Ref:- A K Khurana Comprehensive Ophthalmology 7th edition; pg num:- 469


Question: MC retained foreign body intraocularly

B i.e. Iron The foreign bodies most likely to penetrate and be retained in the eye are minute chips of iron or steel (accounting for 90% all foreign bodies in industry)Q In chipping stone with an iron chisel, it is commonly a chip of the chisel and not of the stone() which enters the eye


Question: Bitemporal hemianopia is seen in


Question: Most commonly associated Fungus with orbital cellulitis in patients with Diabetic Ketoacidosis is

(B) MucorRhino - Orbital mucormycosis:Mucormycosis is a very rare opportunistic infection caused by fungi of the family Mucoraceae, which typically affects patients with diabetic ketoacidosis or immunosuppression. This aggressive and often fatal infection.Specific infections - rhinocerebral mucormycosis:Fungal infection caused by order of mucorales (mucor, rhizopus, absidia).Usually seen in diabetic ketoacidosis.Fungus inhaled into paranasal sinuses, germinates and invades palate, sphenoid, cavernous sinus, orbit, brain.Neurological deficits occur when fungus involves vessels.Proptosis, visual loss ophthalmoplegia, cranial nerve palsies occur. #SIS CLASSIFICATION OF MUCORMYCOSIS & ASPERGILLOSIS AspergillosisMucormycosis (rhino-orbital cerebral mucormycosis)OrderOrder EurotialesOrder MucoralesGenus Aspergillus SpeciesAspergillus fumigatusRhizopus orzae (most common - 90%)Aspergillus flavusAbsidiaAspergillus nigerMucor Rhizomucor pusillus Apophysomyces elegansHyphaeSeptate with dichomatous branches at 45degNon septate filamentous fungi branched at 45degThis is a purulent inflammation of the cellular tissue of the orbit.It is due most frequently to extension of inflammation from the neighbouring parts, especially the nasal sinuses; other less common causes are deep injuries, especially those with a retained foreign body, septic operations, posterior extension of suppurative infections of the eyelids or the eyeball such as panophthalmitis, facial erysipelas, or metastases in pyaemia.In diabetics a particularly fulminant infection with Mucor or Aspergillus is possible.Biopsy to find out non-septate broad branching hiphae.Treatment:Correction of underlying metabolic defect.Intra venous antifungal, antibiotics, E.g., Amphotericin-BWide excision of devitalized necrotic tissues exenteration may be required.Hyperbaric oxygen.Phacomycosis:Mucormycosis is rare a aggressive & often fatal infection caused by the fungus of family Mucoraceae, infection acquired by inhalational of spores.Other Options[?]Candida Ophthalmic Infections:The eye infections that may be caused by Candida species range from extraocular (keratitis, orbital cellulitis) to intraocular (endophthalmitis, panophthalmitis).[?]Aspergillus:Aspergillosis is caused by fungus in the order Eurotiales and genus Aspergillus.[?]Histoplasma:Presumed ocular histoplasmosis syndrome (POHS) occurs secondary to infection with the yeast form of Histoplasma capsulatum. The disease is characterized by atrophic chorioretinal scars, peripapillary atrophy (PPA) & the absence of vitritis.


Question: Vitrectomy should be considered if the vitreous haemorrhage is not absorbed within

VITREOUS HAEMORRHAGE Fate of vitreous haemorrhage 1. Complete absorption may occur without organization and the vitreous becomes clear within 4-8 weeks. 2. Organization of haemorrhage with formation of a yellowish-white debris occurs in persistent or recurrent bleeding. 3. Complications like vitreous liquefaction, degeneration and khaki cell glaucoma (in aphakia) may occur. 4. Retinitis proliferans may occur which may be complicated by tractional retinal detachment. Treatment : 1. Conservative treatment consists of bed rest, elevation of patient's head and bilateral eye patches. This will allow the blood to settle down. 2. Treatment of the cause. Once the blood settles down, indirect ophthalmoscopy should be performed to locate and fuher manage the causative lesion such as a retinal break, phlebitis, proliferative retinopathy, etc. 3. Vitrectomy by pars plana route should be considered to clear the vitreous, if the haemorrhage is not absorbed after 3 months. Ref:- A K KHURANA; pg num:-246


Question: Children with apathy, general weakness, loosening of the skin, marasmic features also has X3B Xerophthalmia features. Eye finding will be

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 467 - 470)X3A Corneal ulceration/keratomalacia affecting less than a one-third corneal surfaceX3B corneal ulceration/keratomalacia affecting more than a one-third corneal surfaceXS corneal scar due to xerophthalmia XF Xerophthalmic fundus


Question:
Sudden painful diminition of vision in
Anterior Uveitis is due to

Due to ciliary muscle spasm, convexity of lens increases leading to blurred vision and pain due to spasm.


Question: Most sensitive part of retina is

Ans. is 'b' i.e Fovea Centralis Fovea centralis, is a depression or pit situated at the posterior pole of eye, 3 mm to the temporal side of the optic disc.Here the retinal layer consists only of cones and other layers are completely absentFovea is the most sensitive part of retinaFovea is surrounded by a small area, the macula lutea, which although not so sensitive, in more so than other parts of retina.


Question: Polychromatic lustre is seen in

COMPLICATED CATARACT It refers to opacification of the lens secondary to some other intraocular disease. Etiology: 1. Inflammatory conditions. These include uveal inflammations (like iridocyclitis, parsplanitis, choroiditis), hypopyon corneal ulcer and endophthalmitis. 2. Degenerative conditions such as retinitis pigmentosa and other pigmentary retinal dystrophies and myopic chorioretinal degeneration. 3. Retinal detachment. 4. Glaucoma (primary or secondary). 5. Intraocular tumours such as retinoblastoma or melanoma may give rise to complicated cataract in late stages. Clinical features: Typically the complicated cataract stas as posterior coical cataract. Lens changes appear typically in front of the posterior capsule. The opacity is irregular in outline and variable in density. In the beam of slit- lamp the opacities have an appearance like 'bread- crumb'. A very characteristic sign is the appearance of iridescent coloured paicles the so-called 'polychromatic lustre' of reds, greens and blues. A diffuse yellow-haze is seen in the adjoining coex. Slowly the opacity spreads in the rest of the coex, and finally the entire lens becomes opaque, giving chalky white appearance. Deposition of calcium is common in the later stages. Ref:- A K KHURANA; pg num:-181,182


Question: The most common variety of scleritis is

SCLERITIS Scleritis refers to a chronic inflammation of the sclera proper. Classification : It 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 (scleromalacia perforans) II. Posterior scleritis (2%) Clinical features : Symptoms: Patients complain of moderate to severe pain which is deep and boring in character and often wakes the patient early in the morning . Ocular pain radiates to the jaw and temple. It is associated with localised or diffuse redness, mild to severe photophobia and lacrimation. Occasionally there occurs diminution of vision. Signs: The salient features of different clinical types of scleritis are as follows: 1. Non-necrotizing anterior diffuse scleritis: It is the commonest variety, characterised by widespread inflammation involving a quadrant or more of the anterior sclera. The involved area is raised and salmon pink to purple in colour. 2. Non-necrotizing anterior nodular scleritis: It is characterised by one or two hard, purplish elevated scleral nodules, usually situated near the limbus. Sometimes, the nodules are arranged in a ring around the limbus (annular scleritis). Ref:- A K KHURANA; pg num:-129,130

Anterior necrotizing without inflammation


Question: The layer of the retina in touch with vitreous humor

Internal limiting layer is in touch with vitreous LAYERS OF RETINA 1. Inner limiting membrane 2. Nerve fiber layer 3. Ganglion cell layer 4. Inner plexiform layer 5. Inner nuclear layer 6. Outer plexiform layer 7. Outer nuclear layer 8. External limiting membrane 9. Photoreceptor layer 10. Retinal pigment epithelium.


Question: Most common cause of fungal orbital cellulitis in diabetes

Ans. (c) MucormycosisRef: Kanski 7/e, p. 91, Parson's 22/e, p. 242Mucormycosis often affects patients with diabetic ketoacidosis or immunosuppression.


Question: Phoria is a type of

Phoria are type of latent squint Types of Phoria Esophoria Exophoria Hyperphoria Hypophoria They are seen in times of stress when the fusional amplitudes are insufficient to maintain alignment Cover uncover test is done to diagnose it


Question: The strongest attachment of the vitreous body to the surrounding structures is at the level of

Vitreous humour Vitreous humour is an ine, transparent, jelly-like structure that fills the posterior four-fifth of the cavity of eyeball and is about 4 ml in volume. It is a hydrophilic gel that mainly serves the optical functions. In addition, it mechanically stabilizes the volume of the globe and is a pathway for nutrients to reach the lens and retina. Attachments: The pa of the vitreous about 4 mm across the ora serrata is called as vitreous base, where the attachment of the vitreous is strongest. The other firm attachments are around the margins of the optic disc, foveal region and back of the crystalline lens by hyloidocapsular ligament of Wieger. Image : Cross-sectional view of the human eye depicting different substructures of the vitreous body. The most anterior vitreous is a thin collagenous layer called the anterior hyaloid. The vitreous core comprises the entire central region of the vitreous body. This poion of the vitreous is more aqueous in contrast to the vitreous base, which is viscous enough to be grasped by forceps and is firmly attached to the underlying ciliary body and retina. Encompassing the vitreous core is a very thin collagenous shell called the vitreous coex. Reference: A K KHURANA; pg num:-243

Anatomy, Development and clinical examination


Question: Iris cysts are prevented by


Question: Conjunctival epithelium is

Histologically, conjuctiva consists of three layers namely,epithelium,adenoid layer and fibrous layer. Epithelium. This is a 2-5 layered, non- keratinised epithelium. The layer of epithelial cells in conjunctiva varies from region to region amd in its different pas as follows: Marginal conjuctiva has 5- layered stratified squamous type of epithelium. Tarsal conjunctiva has 2-layered epithelium Fornix and bulbar conjunctiva have 3 layered epithelium Limbal conjunctiva has again many layered (5 to 6 ) stratified squamous epithelium. 2. Adenoid layer 3. Fibrous layer Ref;A.K.Khurana; 6th edition; Page no: 60


Question: In patient with anterior uveitis, decrease in vision due to involvement of posterior segment can occur because of


Question: The term anisometropia indicates


Question: Best irrigating fluid for phacoemulsification  is

Best irrigating fluid for phacoemulsification  is Basal salt solution with Glutathione.


Question: Fleischer ring is characteristic of

D i.e. Keratoconus Corneal Pigmentation Condition Deposited Material Site Of Deposition Argyrosis Sliver nitrate (AgNO3) Brown discolouration of descement's membrane Fleischer ring Iron Epithelial iron deposits at the base of Keratoconus Chalcosis (Kayser Fleischer ring) Cu Grayish-green or golden brown discolouration of stroma of peripheral cornea Wilson's disease/Hepatolenticular degeneration (Kayser Fleischer ring) Cu Grayish-green or brown ring is seen just inside the limbus due to Cu deposition between Descemet's membrane and endothelium Siderosis Fe (hemosiderin) - Green or brown discolouration of deeper layers of cornea. Blood staining can follow massive hyphaema either from contusion or surgery - Fleischer's ring representing deposition of haemosiderin is found in keratoconus Q Hudson-Stahli line Elderly Brown horizontal line in inferior third or cornea Krukenberg's spindle Myopic men Veical spindle shaped brown uveal pigment deposition Topical epinephrine Used for glucoma Result in black cornea.


Question: Exudative retinopathy in hypeensive is due to

C i.e. Renal aery stenosis Renal retinopathy describes the retinal changes seen in chronic renal failure. These may mimic a hypeensive retinopathy of grade III or IV but the tendency to exudates formation is marked paicularly at the macula.Q Severe hypeension in eclampsia may precipitate a florid retinopathy of grade IV often with exudative retinal detachment. This detachment clears rapidly with the termination of pregnancy when the hypeension is under control.


Question: Oil droplet cataract is seen in

Galactosaemic cataract It is associated with an inborn error of galactose metabolism. Galactosaemia is frequently associated with the development of bilateral cataract (oil droplet central lens opacities). The lens changes may be reversible and occurrence of cataract may be prevented if milk and milk products are eliminated from the diet when diagnosed at an early stage. Galactosemia is a disorder that affects how the body processes a simple sugar called galactose. A small amount of galactose is present in many foods. It is primarily pa of a larger sugar called lactose, which is found in all dairy products and many baby formulas Reference : Khurana; Comprehensive Ophthalmology; 4th edition; Page no: 181

Anatomy, Development and clinical examination


Question: 'Berlin's edema' is seen in

Ans. a (Blunt eye trauma) (Ref. Ophthalmology by Basak 4th/414)# Berlin's edema is edema after blunt trauma to the globe.Blunt Injury to EyeInjury to eyelids, conjunctiva cornea & scleraInjury to ACHyphaema (8-ball or black ball hyphaema)Injury to irisA. Iridodialysis (Partially torn iris with D-shaped pupil)B. Irideremia (traumatic aniridia)C. Retroflexion (Total inversion of iris)D. Iridoschisis (Partial thickness iris tear)E. IridocyclitisCiliary body# Spasm of accomodation# Angle recessionLens# Vossius's ring# Rosette cataract# DislocationRetina# Commotio retinae (Berlin's edema)# Macular degeneration# Ret h'ge & tears# Rhegmatous RD.


Question: Parenchymatous xerosis of conjunctivitis is caused by

A i.e. Trachoma Vit A deficiency causes epithelial xerosisQ. Parenchymal xerosis is caused by widespread destructive interstitial conjunctivitis as seen in trachoma Q, diptheria, Steven Jonson Syndrome, pemphigus or pemphigoid conjunctivitis, thermal, chemical or radiational burns of conjunctiva Q and exposure of conjunctiva.


Question: UGH syndrome is commonly due to

Ans. (a) ACIOLRef: Cornea by Mark J Mannis/p. 196UGH syndrome is caused by mechanical excoriation of the iris from an IOL haptic or optic that results in uveitis, glaucoma, and hyphema.It is most commonly due to use of ACIOL, though it can also be seen with use of PCIOL (if a malpositioned haptic is present).


Question: In bacterial endophthalmitis systemic steroids should be

Ans. Staed after 12-24 hours of intensive antibiotic therapy

Given after 7 days of intensive antibiotic therapy


Question: Gyrate atrophy is a retinal degenerative disease involving deficiency of ornithine transcarbamoylase enzyme. Such patients are benefited by


Question: SIte of bleeding after cataract surgery is

After cataract surgery, posterior ciliary vessels are the common sites of bleeding. Ref AK khurana 6/e p 215


Question: Lattice retinal degeneration seen in

Ans is 'a' i.e. . Myopia. Lattice degeneration of retina is seen in Myopia or more specifically, pathological myopia.Myopia is clinically of 3 types:-Developmental myopic -a congenital stationary* condition in which a child is bom with an abnormally long eye.Simple myopia :Commonest type of myopiaPathological myopia:is a degenerative and progressive conditionRefractive changes appear in childhood, and increases rapidly during the period of active growth upto 20 to 30 D by the age of 25 yrs*.the eyeball gets elongated essentially due to the degeneration of the posterior half of sclera often leading to a scleral bulge at the posterior pole (.Posterior staphyloma)*Fundus changes Myopic crescent*:-present at the temporal edge of the optic disc (Optic disc is large and pale). Fosterfunch9s spots*:-these are dark red circular patches due to choroidal Haemorrhage and subretinal neovascularization.Posterior staphyloma*.Vitreous degenerations & Haemorrhage*Chorioretinal atrophic patches at posterior pole.Retinal haemorrhages and lattice degenerates* leading to retinal detachment*.


Question: Dalen Fuchs nodules are seen in

Dalen-Fuchs nodules are seen in Sympathetic ophthalmitis and also in Vogt- koyanagi- harada( VKH) syndrome. These are formed due to proliferation of pigment epithelium( of the iris , ciliary body and choroid ) associated with invasion by the lymphocytes and epithelioid cells. Located between Bruch membrane of choroid and the retinal pigment epithelium. Ref: kanski's clinical ophthalmology,8th edition, page no. 418


Question: In central serous retinopathy, in the macular region, there occurs

Ans. . Spontaneous detachment of neuro-sensory retina


Question: Eale's disease

It is an idiopathic inflammation of the peripheral retinal veins, characterised by recurrent vitreous hemorrhage. Etiology not exactly known, but consider to be a hypersensitivity reaction to tubercular protiens. Bilateral disease, typically affecting young adult males. Ref : khurana 6 th edition , page no. 265 Eales disease (ED) is an idiopathic, inflammatory retinal venous occlusive disease characterized by 3 stages: vasculitis, occlusion and retinal neovascularization, leading to recurrent vitreous hemorrhages and vision loss. Ref AK khurana 6/e p240


Question: Assistance for the National Blindness Control Programme is done by

Danish International Development Agency (DANIDA) is providing assistance for the development of services under national blindness control programme. A comprehensive National Programme for Control of Blindness was launched in 1976 with the goal of reducing prevalence of blindness to 0.3 per cent by 2000 AD. (iii) DANIDA agreed to assist NPCB since 1978 (Phase I). (iv) National Survey was undeaken by the GOI / WHO in 1986-89. Park 23e pg: 924


Question: Lattice degeneration is seen in

Lattice degeneration is an impoant cause of retinal detachment in young myopic individuals. Peripheral retina becomes atrophic in a lattice pattern and may develop tears, breaks, or holes, which may fuher progress to retinal detachment. Lattice degeneration is a disease of the human eye wherein the peripheral retina becomes atrophic in a lattice pattern and may develop tears, breaks, or holes, which may fuher progress to retinal detachment. It is an impoant cause of retinal detachment in young myopic individuals Reference: Khurana 4th edition PG: 269

Anatomy, Development and clinical examination


Question: Most common intraorbital tumour in children is

M/c intraorbital tumour in adults - Cavernous hemangioma.
M/c intraorbital tumour in children - Rhabdomyosarcoma.


Question: Drug of choice of trachoma is

C i.e. Tetracycline Treatment of Trachoma Oral tetracycline, doxycycline, azithromycin, clarithromycin, erythromycin, rifampicin & sulfonamides Oral tetracycline cannot be given to children < 8 years, pregnant women or nursing mothers. Sulfonamides have high risk of stevens Johnson syndrome and erythema multiforme. Topical treatment with tetracycline or erythromycin or sulfacetamide (less preffered) is cheaper more effective and has no risk of systemic side effects.


Question: Most common orbital cyst in children is

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 417) Epidermal dermoid cyst (dermoid) is the most common orbital cystic lesion in children, accounting for over 40% of all orbital lesions of childhood and for 89% of all orbital cystic lesions of childhood that come to biopsy or surgical removal.the most impoant secondary cyst is a mucocele that can occur in children with cystic fibrosis Orbital dermoid cysts are benign congenital choristomas. They are common in pediatric population, developing adjacent to suture lines, most commonly located in antero-lateral fronto-zygomatic suture, and are slowly progressive. Complete surgical excision without rupture of cyst is the standard of care

Diseases of orbit, Lids and lacrimal apparatus


Question: The wavelength of the excimer laser used for corneal refractive surgery is

All clinical excimer lasers use are argon-fluorine (ArF) gas. The wavelength is in the UV region (193 nm), which has been determined to be safe for human ocular use.Therapeutic applications of excimer lasers are: photorefractive keratectomy (PRK), laser-assisted in-situ keratomileusis (LASIK) for correction of refractive errors and phototherapeutic keratectomy (PTK) for corneal diseases such as band-shaped keratopathyRef: Khurana; 4th ed; Page no: 431


Question: Viral Conjunctivitis is most commonly caused by

Viral Conjunctivitis is most commonly caused by Adenovirus.


Question: Refractive index of the cornea is

The corneal refractive index is 1.376 The index of refraction of the cornea is about 1.376. Rays pass from the cornea into the watery fluid known as the aqueous humor which has an index of refraction of about 1.336, so most of the refraction is at the cornea-air interface. Reference: khurana 6th edition pg 396

Anatomy, Development and clinical examination


Question: Normal IOP in population is

Normal IOP : 14-19 mm Hg Variables in Intraocular pressure (Those factors that can cause change in the intraocular pressure throughout day) More in morning than in evening in normal adults (Diurnal Variation) Hea rate Blood pressure Respiration


Question: 19 year old young girl with previous history of repeated pain over medial canthus and chronic use of nasal decongestants, presented with abrupt onset of fever with chills & rigor, diplopia on lateral gaze,moderate proptosis & chemosis. On examination optic disc is congested. Most likely diagnosis is

It Stas initially as a unilateral condition which soon becomes bilateral due to intercavernous connection. It should be differentiated from orbital cellulitis and panophthalmitis. Ref: ak khurana 6th edition pg no412

Diseases of orbit, Lids and lacrimal apparatus


Question: The most common cause of proptosis in adults is

Proptosis:- Ref:- A K Khurana Comprehensive Ophthalmology 7th edition; pg num:- 398

Diseases of orbit, Lids and lacrimal apparatus


Question: Pachymeter is used to measure

A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to refractive surgery, for Keratoconus screening, LRI surgery and is useful in screening for patients suspected of developing glaucoma among other uses. Ref khurana 6/e


Question: Ophthalmia neonatorum within first 48 hours of birth is caused by

Ans. b (Neisseria gonorrheae) (Ref: Parson's, 18th ed/140)DIFFERENTIAL DIAGNOSIS OF NEONATAL CONJUNCTIVITIS (OPHTHALMIA NEONATORUM)CauseOnsetFindingsCytology&lab tests(1)Toxic AgNO3- Silver nitrate (Crede's prophylaxis)Within hoursHyperemiaSlight watery to mucoid discharge. Negative culture(2)Gonococci (gonococcal conjunctivitis)2nd-4th day of lifeAcute purulent conjunctivitisIntracellular gram-negative diplococci.Positive culture on blood and chocolate agar(3)Other bacteria (Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae; Haemophilus)4th-5th day of lifeMucopurulent conjunctivitisCulture on bloodagar(4)Chlamydia (inclusion conjunctMtis)... most common5th-14th day of lifeMucopurulent conjunctivitisGiemsa-positive cytoplasmic inclusion bodies in epithelial cells.Negative culture.(5)Herpes simplex virus5th-7th day of lifeWatery blepharoconjunctivitis. Corneal involvement.Systemic manifestations.Multinucleated gaint cells, cytoplasmic inclusion bodies.Negative cultureEducational Points:Intact corneal epithelium cannot be penetrated b\ any organism EXCEPT-# Neisseria gonorrhoeae# Neisseria meningitides# Cornybacterium diphtheriaeConjunctivitis FeaturesAcute mucopurulent conjunctivitis# Staph, is commonest causative organism.Ophthalmia neonatorum# Chlamydia is most common causative organism (7-10 days)# Presents at birth/in a hour of birth (Chemical)# Treatment is Credes prophylaxis with 1% silver nitrateLigneous conjunctivitis# Membranous but repeated conjunctivitisAngular conjunctivitis# Caused by Moraxella. Treatment is zinc oxideFollicular conjunctivitis# Trachoma, drug induced,New Castle's conjunctivitis# Epidemic keratoconjunctivitis sicca (adenovirus)Acute herpetic conjunctivitis# occurs in young children infected from contagion of carrierVernal conjunctivitis (Spring catarrh)# Bulbar and palpebral conjunctivitis# Bilateral and recurrent# Ropy discharge# 'Cobble stone' palpebral conjunctiva# Gaint papilla # Horner-Trantas spots# Maxwell-Lion sign# Pseudogerontoxon# Treatment with steroids, acetyl cysteine and topical NSAIDEducational point:# Sulphacetamide eye drops used for ophthalmia neonatorum.


Question: The most effective treatment for Blepharospasm is

(C) Botulinum toxin # Botulinum toxin is currently the treatment of choice for blepharospasm. Botulinum toxin injections (Botox is a widely known example) have been used to induce localized, partial paralysis. Among most sufferers, botolinum toxin injection is the preferred treatment method.> Injections are generally administered every three months, with variations based on patient response and usually give almost immediate relief (though for some it may take more than a week) of symptoms from the muscle spasms. Most patients can resume a relatively normal life with regular Botulinum toxin treatments. A minority of sufferers develop minimal or no result from Botox injections and have to find other treatments.> Most effective surgical treatment has been protractor myectomy, the removal of muscles responsible for eyelid closure.> In some cases a dietary supplement of magnesium chloride has been found effective.

Surgical ablation of nerve to orbicularis

Dietary supplement of magnesium chloride


Question: Keratometer measures September 2010 September 2012, March 2013 (e)

Ans. C: Curvature of cornea A keratometer, also known as a ophthalmometer, is a diagnostic instrument for measuring the curvature of the anterior surface of the cornea, paicularly for assessing the extent and axis of astigmatism. A keratometer uses the relationship between object size (0), image size (I), the distance between the reflective surface and the object (d), and the radius of the reflective surface (R). If three of these variables are known (or fixed), the fouh can be calculated using the formula R = 2dI/0


Question: Pathognomonlc feature of trachoma is

TRACHOMA Trachoma (previously known as Egyptian ophthalmia) is a chronic keratoconjunctivitis, primarily affecting the superficial epithelium of conjunctiva and cornea simultaneously. It is characterised by a mixed follicular and papillary response of conjunctival tissue. It is still one of the leading causes of preventable blindness in the world. Clinical Signs : A. Conjunctival signs : 1. Congestion of upper tarsal and forniceal conjunctiva. 2. Conjunctival follicles. Follicles look like boiled sagograins and are commonly seen on upper tarsal conjunctiva and fornix; but may also be present in the lower fornix. Follicles may be seen on the bulbar conjunctiva (pathognomic of trachoma). 3. Papillary hyperplasia: Papillae are reddish, flat topped raised areas which give red and velvety appearance to the tarsal conjunctiva. Each papilla consists of central core of numerous dilated blood vessels surrounded by lymphocytes and covered by hyperophic epithelium. 4. Conjunctival scarring: which may be irregular, star-shaped or linear. Linear scar present in the sulcus subtarsalis is called Arlt&;s line. 5. Concretions may be formed due to accumulation of dead epithelial cells and inspissated mucus in the depressions called glands of Henle. Corneal signs : 1. Superficial keratitis may be present in the upper pa. 2. Herbe follicles refer to typical follicles present in the limbal area. These are histologically similar to conjunctival follicles. 3. Pannus i.e., infiltration of the cornea associated with vascularization is seen in upper pat. The vessels are superficial and lie between epithelium and Bowman&;s membrane. 4. Corneal ulcer. 5. Herbe pits: are the oval or circular pitted scars, left after healing of Herbe follicles in the limbal area 6. Corneal opacity may be present in the upper pa. It may even extend down and involve the pupillary area. It is the end result of trachomatous corneal lesions. Image: Features of Trachoma Reference :- A K KHURANA; 6th edition, page:-62,64,65


Question: Visual acuity of 6/60 is classified as

This means you can see at 6 metres what someone with standard vision could see from 60 metres away. The figures 6 / 60 or 3 / 60 are how the result of a Snellen test are written. The first number given is the distance in metres from the cha you sit when you read it Low vision is the term used to describe significant visual impairment that can&;t be corrected fully with glasses, contact lenses, medication or eye surgery. It includes: ... Tunnel vision (lack of vision in the periphery) and blind spots are examples ofvisual field loss. Legal blindness. Reference: AK khurana 7th edition


Question: A patient sustained blunt trauma to eye after that the developed sudden loss of vision with deep anterion chamber, Most likely causes is


Question: The sclera is thinnest at

The sclera is thickest near the optic nerve, where it is approximately 1 mm in thickness The sclera is thinnest (0.3 mm) posterior to the rectus muscle inseions and thickest (1.0 mm) at the posterior pole near the optic nerve head. Thinnest at the inseion of extraocular muscles (0.3 mm) Reference: khurana 6th edition pg 788

Posterior to attachment of superior rectus

Anatomy, Development and clinical examination


Question: Confirmatory investigation in retinitis pigmentosa is

Answer- D. ElectroretinogramAn accurate diagnosis of retinitis pigmentosa relies on the documentation of the progressive loss photoreceptor cell function, confirmed by a combination of visual field and visual acuity tests, fundus and optical coherence imagery, and electroretinography.


Question: In adult Pulsatile proptosis seen in

(A.V. fistula): (407-Khurana 5th edition; 551-Nema 6th/ed; 484-Parson 21st/ed)Causes of Pulsatile proptosis* Arterio - venous aneurysm (saccular aneurysm of ophthalmic artery)* Carotico- cavernous fistula (communication between ICA and cavernous)* Congenital meningocele or meningo encephaloele* Neurofibromatosis* Traumtic or operative hiatus* Embolization during arteriography is presently the treatment of choice* **Cavernous hemangiomaCapillary hemangioma* Most common benign tumour of the orbit in adult* Slowly progressive* Produces axial proptosis* Common ocular complications- Hyperopia- Optic nerve compression- Secondary glaucoma- Strabismus* Common tumour of childhood* Shows strawberry discolouration of the skin of eyelid* Usually involves the supreronasal quadrant of the orbit and medial part of upper lidCauses of PseudoproptosisHigh myopiaBuphthalmosRetraction of upperlid


Question: Most common cause of cataract is

Most common cause of acquired cataract is senile cataract Refer: Khurana 6th edition page number 190


Question: Indocyanine Green Angiography is most useful in detecting

Fundus fluorescein angiography and indocyanine green angiography help in detecting choroidal neovascularization (CNV) in relation to foveal avascular zone. Which may be subfoveal, juxta foveal or extrafoveal CNV. Reference : A K KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition4 , page-275

Occult Choroidal Neovascularization (Occult CNV)

Classic choroidal Neovascularization (Classic CNV)

Angioid streaks with choroidal Neovascularization (CNV)

Anatomy, Development and clinical examination


Question: Mildly dilated pupil is seen in

In acute congestive glaucoma, pupil is semidilated, veically oval and fixed. It is non reactive to both light and accommodation. Other signs include congestion, hazy cornea, shallow AC and IOP high( 60 - 70 mmhg ). Ref: khurana 6th edition , page no.244


Question: Amaurosis fugax does not occur in

Amaurosis fugax is due to transient failure of retinal circulation.
Occurs in papilledema but not in papillitis.


Question: Treatment of retinoblastoma is by

Ans. (b) Carboplatin + Etoposide + VincristineRef: Ryan's retina 6/e, p. 2392; Kanski 8/e, p. 502; Parson's 22/e, p. 381Chemotherapy agents commonly used for treatment of retinoblastoma are Age <= 36 monthsAge > 36 monthsVincristine0.05 mg/kg1.5 mg/m2Etoposide5 mg/kg150 mg/ m2Carboplatin18.6 mg/kg560 to 600 mg/m2

Cyclophosphamide + Etoposide + Vincristine

Cyclophosphamide + Doxorubicin + Etoposide