Question: Prescription of presbyopic lens to a 50 year old emmetropic individual is

Ans. (c) +1.50Ref: Khurana optics 2/e, p. 101, Elkington optics 4/e, p. 237Rough estimate for presbyopic add45 years: +1.00 to +1.25 D50 years: +1.50 to +1.75 D55 years: +2.00 to +2.25 DIn order to focus on an object at a reading distance of 25 cm, the emmetropic eye must accommodate by 4 D. However, for comfortable near vision one-third of the available accommodation must be kept in reserve. Therefore, the patient will begin to experience difficulty or discomfort for near vision at 25 cm when his accommodation has decayed to 6 D. This usually occurs between 40 and 45 years of age. A person experiencing such difficulty and discomfort for near vision due to reduced amplitude of accommodation is said to be presbyopic.


Question: Atropine is drug of choice in

C i.e. Iridocyclitis Steroid > Atropine is drug of choice for acute iridocyclitis (anterior uveitis).Q Atropine is contraindicated in glucomas where as pilocarpine is contraindicated in anterior uveitis. Q


Question: Wernicke's hemianopic reaction is due to lesions at the level of

Lesions of optic tract.
I/L direct and C/L consensual light reflexes are absent.


Question: In uraemic amaurosis the pupils are

Uraemic amaurosis It is a sudden, bilateral, complete loss of sight occurring probably due to the effect of ceain toxic materials upon the cells of the visual centre in patients suffering from acute nephritis, eclampsia of pregnancy and renal failure. The visual loss is associated with dilated pupils which generally react to light. The fundi are usually normal except for the coincidental findings of hypeensive retinopathy, when associated. Usually, the vision recovers in 12-48 hours. Ref:- A K KHURANA; pg num:-306


Question: Snow banking is not a feature of

Snow banking is seen in

Candidiasis
Multiple sclerosis
Sarcoidosis
Ocular toxocariasis
Para planitis


Question: Snow banking on fundus examination is the sign of

Pars planitis is intermediate uveitis M /c cause of pars planitis is idiopathic M/c symptom is FLOATERS Eye is usually quiet , fundus shows Snow ball opacities which may join together to form Snow banking .(Hallmark Feature) Snow Balls-are the infllamatory cells From Pars Plana thrown into vitreous causing vitreous floaters .these gravitate and sink down fotming Snow Banking.


Question: Alkali injury to eye causes

Symblepharon is adhesion of bulbar conjunctiva with palpebral conjunctiva Refer Khurana 6th edition page number 374


Question: Keratomalacia

Night blindness is a first feature of Vitamin A deficiency and is also a feature of retinitis pigmentosa Refer: Khurana 6th edition page number 468


Question: Amaurotic cat eye reflex is seen in


Question: Most common ocular foreign body is

most common occular foreign body is iron. And the most common mode is chissel and hammer Refer khurana 6/e p 421

Diseases of orbit, Lids and lacrimal apparatus


Question: Most common type of amblyopia is

Strabismic amblyopia

It is due to unilateral suppression in large squint.
It is the most common type.
It has best prognosis.


Question: Length of naso lacrimal duct is

Nasolacrimal duct is about 12 - 18 mm long.


Question: On measuring 3.5 to 4 mm posterior to the limbus in a phakic eye and plunging a 30 gauge needle perpendicular to sclera, you pass through

Intravitreal injections are given using 30G needle Piercing Pars Plana which is introduced at : In Phakic eye - .5mm from limbus Pseudo-Phakic eye- 4mm from limbus Aphakic eye - .5mm from limbus


Question: Non regenerative layer of Cornea is

Non regenerative layer of Cornea is Bowman's membrane.


Question: Not a characteristic of neovascularization of iris

Characteristics of Neovascularization - Fine and irregular Orientation across the angle - Bright red - Arborizing - Cross the scleral Spur - Can be seen near pupillary border - Indicate VEGF Secretion - Can be seen at Optic nerve head/ retina/ angle/ pupillary border

Can be seen on pupillary border or angle


Question: Corneal sensation is tested by

To test the corneal sensations, the patient is asked to look ahead; the examiner touches the corneal surface with a fine twisted cotton (which is brought from the side to avoid menace reflex) and observes the blinking response. Normally, there is a brisk reflex closure of lids. Always compare the effect with that on the opposite side. The exact qualitative measurement of corneal sensations is made with the help of an aesthesiometer. Reference: A K KHURANA COMPREHENSIVE OPHTHALMOLOGY, Edition 4, page-547

Anatomy, Development and clinical examination


Question: The most common complication of hypermature sclerotic cataract is

Subluxation of the lens is the most common complication of nuclear sclerotic hypermature cataract refer Khurana 6th edition page number 184


Question: SRK formula is used to calculate

Answer- A. Power of intraocular lensIntraocular lens power calculation :- Which requires Keratometry (K), Axial length of eyeball or Biometry (L) and aconstant (A). It is calculated by SRK formula:Power of IOL= A- 2.5L -0.9K


Question: Tear production in child begins at


Question: Best treatment for buphthalmos is

Ans. b (Goniotomy). (Ref. Parson, Diseases of Eye, 18th/pg.214)BUPHTHALMOSNormal IOT in Schiotz tonometer is 14-20 mmHg.Glaucoma Index =Initial IOP-----------Facility of outflow(Normal < 100)Treatment of choice for buphthalmos is goniotomy.Eventual success rate with goniotomy is 85%.However in resistant cases trabeculectomy and trabeculotomy are helpful.Trabeculotomy is useful when corneal clouding is present or when goniotomy fails.


Question: Most common cause of optic neuritis

M/C cause - Multiple sclerosis, Vit B12 deficiency, B2 deficiency.


Question: SAFE strategy use in

SAFE strategy - for prophylaxis against trachoma and prevention of blindness S - Surgery for trichiasis - Teiary prevention A - Antibiotic - AZITHROMYCIN (D/O/C) - secondary prevention F - Facial hygiene - primary prevention E - Environmental changes - primordial prevention


Question: Drug of choice for increased IOT in acute anterior uveitis

A i.e. Atropine Treatment of hypeensive uveitis is treatment of acute iridocyclitis (Mydriatic-cycloplegic-steroidantibiotics), topical (3 blocker (e.g. timolol), carbonic anhydrase inhibitor (acetazolamide) dipivefrine. Secondary glaucoma Q (due to posterior synechiae formation) is the m.c. complication of recurrent anterior uveitis. Miotics eg pilocarpine or other cholinergics are contraindicated in treatment of anterior uveitis Q as these increase chances of synechiae formation. It is also contraindicated in malignant glaucoma Q & post inflammatory glaucoma Q.


Question: Nerve carrying motor component of light reflex

Efferent pathway consists of parasympathetic fibres which arise from the Edinger -Westphal nucleus in the midbrain and travel along the third cranial nerve .
i.e, occulomotor nerve.


Question: Phacoemulsification is done with

Ans. b (Ultrasound) Ref: AK Khurana, 4th ed, p. 193In phacoemulsification nucleus is emulsified & aspirated by phacoemulsification. Phacoemulsifier acts through a titanium needle ( hollow 1 mm needle)It vibrates in its longitudinal axis at an ultrasonic speed of40000 times a second and thus emulsifies nucleusAdvantage: Very small corneoscleral incision (3.2-3.5 mm), hence sutureless surgeryNOTE:Various surgical techniques with length of corneoscleral incisionECCE- 7-8 mm (120deg)ICCE- 10-12 mm (180deg)Small incision cataract surgery (SICS) - 4-6 mmPhacoemulsification- 3.2-3.5 mm (30deg)


Question: Earliest manifestation of diabetic retinopathy is

D i.e. Microaneurysm Microaneurysms are located in the inner nuclear layer and are the earliest and most characteristic ocular lesion Q of diabetic retinopathy.


Question: Most common type of Benign Orbital tumour in Adults is

(C) Haemangioma# ORBITAL TUMORS in both age groups are mostly benign.> Most common benign orbital tumors in children are Dermoids and vascular lesions such as capillary hemangiomas, lymph-angiomas and cavernous hemangiomas.> Most common benign tumors in Adults are also blood vessel tumors such as Hemangiomas, lymphangiomas and arteriovenous malformations> Tumors of the nerves (Schwannomas), fat (Lipoma), as well as those that evolve from the surrounding sinuses (Mucocele) occur less commonly.> Orbital Malignancies in Childhood are unusual. Most common are rhabdomyosarcomas, other malignant lesions that may affect the orbit include Burkitt's lymphoma and granulocytic sarcoma. Neuroblastoma, Ewing sarcoma, Wilm's tumor, and leukemias are the more common metastatic orbital lesions afflicting children.> Most common Malignant Orbital tumors in Adults are lymphomas. Often they are initially confined to the orbit without any systemic manifestations. Direct invasion of the orbit from the surrounding skin and sinus cavities can occur from squamous and basal cell cancers. Other malignancies that arise from tissues within the orbit are less common (Hemangiopericytoma, Chondrosarcoma, Malignant neurofibroma). Metastatic orbital tumors most frequently arise from breast & prostate.


Question: Rapid change of presbyopic glass is a feature of

D i.e. Open angle glaucoma Conditions associated with altered refraction Feature Found in Frequent change of presbyopic glasses Open angle glaucoma Q Second sight/ Myopic Shift/Improvement in near vision Senile immature nuclear cataract Fluctuation of refractory error Diabetic cataract Frequent change of glasses Coical or nuclear cataract Primary Open Angle Glaucoma/ Chronic Simple Glaucoma It is chronic, slowly progressive, bilateral disease characterized by - adult onset, 10P > 21 mmHg at some point in the course of disease, an open angle, glaucomatous optic nerve head damage and visual field loss. It presents with painless progressive loss of vision Q, frequent change in presbyopic glasses Q and difficulty in near work owing to accommodative failure.


Question: Earliest sign of Acute Anterior Uveitis is

Earliest sign of Acute Anterior Uveitis is Aqueous flare.


Question: NOT a feature of Fuch's Heterochromic Uveitis among the following is

Posterior Synichae is always absent in Fuch's Heterochromic Uveitis.


Question: In maturity onset diabetes mellitus, ophthalmoscopy should be done at

Ans. is 'a' i.e immediately Ophthalmological examination is done inType II diabetese mellitus - at the time of diagnosis and reexamined at least annually*Type I DM - Within 3 yrs after diagnosis and reexamined on at least on annual basis*Diabetic women who becomes pregnant - should be examined in the 1st trimester and at least every 3 months thereafter until parturition. *Explanation :Diabetic retinopathy depends on the length of time the patient has had diabetes, even though his sugar level may be well controlled.Both in Type I and Type II DM, retinopathy occurs at least 3 to 5 years after the onset of diseaseBut type I DM can be diagnosed at the time of onset because of specific symptoms, such as polyuria, nocturnal enuresis, polydipsia, polyphagia.Type II DM is usually diagnosed many years after the onset of disease. Type II remains occult for many yrs and usually presents as a neurological or cardiological complication or may be diagnosed accidently during routine laboratory studies.


Question: The temporal field of vision is

A normal visual field is an island of vision measuring 90 degrees temporally to central Fixation, 50 degrees superiorly and nasally, and 60 degrees inferiorly. Visual acuity increases from movement discrimination in the extreme peripheral vision to better than 20/20 in the center of vision. Reference: AK khurana 7th edi

Anatomy, Development and clinical examination


Question: Treatment of choice for fellow eye in acute angle closure glaucoma is


Question: Sclera buckling is used in the treatment for

Retinal detachment: It is the separation of neurosensory retina proper from the pigment epithelium Scleral buckling i.e., inward indentation of the sclera to provide external tamponade is still widely used to maintain chorioretinal apposition for at least a couple of weeks in simple cases of Rhegmatogenous or primary retinal detachment. Scleral buckling is achieved by inseing an explant (silicone sponge or solid silicone band). Radially oriented explant is most effective in sealing an isolated hole, and circumferential explant (encirclage) is indicated in breaks involving three or more quadrants The other surgical options include pneumatic retinopexy or vitreoretinal surgery Scleral buckling is a surgical procedure used to repair a retinal detachment. In this surgery, a surgeon attaches a piece of silicone or a sponge onto the white of the eye at the spot of a retinal tear. The buckle is designed to repair retinal detachment by pushing the sclera toward the retinal tear or break. Ref: Khurana; 4th ed; Pg 276


Question: The earliest sign of papilledema is

Early (incipient) papilloedema:_ Symptoms are usually absent and visual acuity is normal._ Pupillary reactions are normal.Ophthalmoscopic features of early papilloedema are: (i) Obscuration of the disc margins (nasal margins are involved first followed by the superior, inferior and temporal) (ii) Blurring of peripapillary nerve fiber layer. (iii) The absence of spontaneous venous pulsation at the disc(appreciated in 80% of the normal individuals).(iv) Mild hyperemia of the disc. (v) Splinter hemorrhages in the peripapillary region may be present._ Visual fields are fairly normal.Ref: Khurana; 4th edition; Pg.No. 299


Question: Esotropia is associated with

Esotropia - hypermetropia.
Exotropia - myopia.


Question: Optic radiations arise from

Answer- A. Lateral Geniculate bodyThe optic radiations (geniculocalcarine pathway) extend from the lateral geniculate body to the visual coex. Inferior fibres of optic radiations ,subserve upper visual fields and superior fibres subserve inferior visual fields.The visual pathway staing from retina consists of optic nerve, optic chiasma, optic tracts, lateral geniculate bodies, optic radiations, visual coex.


Question: Secondary detion of the eye is an example of the following law

Secondary detion: It is detion of the normal eye seen under cover, when the patient is made to fix with the squinting eye. It is greater than the primary detion. This is due to the fact that the strong impulse of innervation required to enable the eye with paralysed muscle to fix is also transmitted to the yoke muscle of the sound eye resulting in a greater amount of detion. This is based on Hering's law of equal innervation of yoke muscles. Ref:- A K KHURANA; pg num:-331


Question: A patient presents with Right homonymous hemianopia. Most likely site of lesion is

Ans. (a) Left optic radiationRef: Khurana 6/e, p. 314Just remember - Homonymous is always Contralateral and all in lesions below optic chiasma.


Question: Slit lamp examination helps in the examination of

Structures examined in Slit lamp: *Eyelids *Conjunctiva *Cornea *Anterior chamber *Iris and Pupil *Lens - Anterior and Posterior surface *Retina ( with +78D or +90D lens ) Choroid can be examined with Indirect Ophthalmoscopy only. Reference : Khurana's Theory and Practice of Optics and Refraction; 2nd Ed; Pg. 350-360

Anatomy, Development and clinical examination


Question: Most common site for retinal break is

Upper temporal region is most common site for retinal break The mechanism most commonly involves a break in the retina that then allows the fluid in the eye to get behind the retina. A break in the retina can occur from a posterior vitreous detachment, injury to the eye, or inflammation of the eye. Other risk factors include being sho sighted and previous cataract surgery Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 371


Question: Koeppe's and Busaca's nodules are characteristic of

Presentation of anterior uveitis : - Iris nodules : a) Koeppe's nodules - present on pupillary margin b) Busacca's nodules - present on surface of iris Both are seen in granulomatous uveitis


Question: Onion ring Appearance is seen in

Onion ring/whorled Appearance  seen in Posterior polar Cataract.


Question: Longest pa of the optic nerve is

The optic nerve is about 47- 50 mm in length and can be divided into 4 pas : intraocular (1mm), intraorbital (30mm), intracanalicular (6-9mm) and intracranial (10mm). Refer comprehensive ophthalmology 6th edition , A K Khurana , page no. 310.


Question: Anterior vitreous cells are least likely to be found in

Anterior vitreous cells are least likely to be found in Retinitis pigmentosa.


Question: The cause of a coloured &;Halo&; in narrow angle glaucoma is

Clinical Features of Glaucoma - Cupping of disc. - Raised intraocular pressure with coloured halos due to corneal oedema Ref khurana 6th edition pg 1234 - Visual field defect.


Question: 40 years male with spherophakia is at risk for developing

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 248) Phacomorphic glaucoma is an acute secondary angle-closure glaucoma caused by:Intumescent lens i.e., swollen cataractous lens due to rapid maturation of cataract or sometimes following traumatic rupture of the capsule is the main cause of phacomorphic glaucomaAnterior subluxation or dislocation of the lensSpherophakia (congenital small spherical lens) Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence. The increase in lens thickness from an advanced cataract, a rapidly intumescent lens, or a traumatic cataract can lead to pupillary block and angle closure.


Question: A dendritic ulcer is caused by

B i.e. Herpes simplex Dendritic & geographical corneal ulcers Q are seen in herpes simplex ocular disease. Dendritic ulcers (branching ulcer with knobbed ends), resembles no other condition, and is pathognomic of herpes simplex ocular infectionQ. The use of steroids in dendritic ulcer hastens the formation of geographical ulcer so it is contraindicatedQ. Early lesions of acanthameba keratitis appears like dendritic ulcers (which is usually a characteristic feature of herpes simplex keratitis), hence it is called pseudo-dendritic keratitis


Question: Most common metastatic orbital tumour in children

Metastatic orbital tumours in children neuroblastoma, nephroblastoma, Ewing's, testicular embryonal sarcoma and Ovarian sarcoma.


Question: Van herick&;s angle grade 3 of anterior chamber denotes

Van herick&;s method:*To evaluate the chamber depth of the right eye, turn the lamp so that the light is coming at the temporal limbus at an angle of 60 degrees. Change the slit to its most narrow setting, and direct the beam onto the cornea, just barely to the right of the limbus. *You should see three things: the beam of light sharply focused on the cornea in a thin slit, the light falling on the iris(unfocused), and a dark interval in between.* The dark interval is the area of interest, as it represents the chamber's depth. *If this shadow is one-quaer to one-half the width of the illuminated corneal section, the angle is open. If the dark section is less than one-quaer the width of the corneal beam, the chamber is narrow. If there is no dark interval (ie, the corneal and iris beams meet), the angle is extremely narrow or closed. The chamber is graded from 1 to 4 or labeled as closed, open, shallow, or moderate.FeaturesGradeClosed angle0Angle extremely narrow, probable closure1+Angle moderately narrow, possible closure2+Angle moderately open, closure not possible3+Angle wide open, closure not possible4+Ref: The slit lamp primer; 2nd edition; Pg. 41


Question: The most common cause of glaucoma with elevated IOP and optic nerve damage present in only ONE eye is

A secondary glaucoma may complicate perforating as well as blunt injuries. Mechanisms. Traumatic glaucoma may develop by one or more of the following mechanisms: Inflammatory glaucoma due to iridocyclitis, Glaucoma due to intraocular haemorrhage, Lens-induced glaucoma due to ruptured, swollen or dislocated lens, Angle-closure due to peripheral anterior synechiae formation following perforating corneal injury producing adherant leucoma. Epithelial or fibrous in growth, may involve trabeculum. Angle recession (cleavage) glaucoma. Axenfeld rieger syndrome and Sturge weber syndrome are not as common as trauma. Pseudoexfoliation syndrome -can cause both u/l as well as b/l glaucoma, most common secondary open-angle glaucoma worldwide


Question: Attachement of Vitreous is Srongest at

Ans. is 'c' i.e., Across ora serrata Attachement of vitreous Vitreous is attached anteriorly to the lens (Hyloid capsular ligament of Wieger) and ciliary epithelium in front of the ora serrata. The pa of vitreous about 4 mm across the ora serrata is known as the "base of vitreous" where the attachement is strongest Posteriorly vitreous is attached to the edge of the optic disc and macula lutea (foveal region) forming ring-shaped structure around them


Question: Most Common infection in Contact Lens user is

Most Common infection in Contact Lens user is Pseudomonas


Question: Blow out fracture of orbit commonly produces

(D) Fracture of floor of orbit # Blow out fracture of orbit; Intraorbital haemorrhages, proptosis, paralysis of extrinsic muscles and fracture of the floor of the orbit are not infrequent following a blunt injury to the orbital region> Proptosis develops due to reactive oedema and intra-orbital haemorrhage.> Partial or complete ophthalmoplegia occurs as a result of injury to the muscles or due to profuse orbital oedema.> In the fracture of the floor of orbit, the eyeball is depressed into the maxillary antrum & the inferior rectus and inferior oblique muscles are entrapped causing diplopia.> There occurs limitation of upward gaze, and downward gaze may also be reduced because of the pinched inferior rectus muscle in between the chips of the broken bone> A positive forced duction test, downwards and inwards displacement of the globe and radiological evidence virtually confirm the diagnosis of blowout fracture with incarcerated orbital tissue.> The fracture of the base of skull implicates optic foramen and may cause optic atrophy or pulsating exophthalmos.> The fracture of the optic canal is characterised by a wound at the lateral part of the eyebrow, loss of direct homolateral pupillary reaction and hemianopic field defects.> The patient may suffer from epistaxis and varying periods of unconsciousness.> The pallor of the optic disc may be noticed 2-3 weeks after the injury. Serial radiological tomograms taken at one minute intervals may confirm the diagnosis.


Question: Transpo of Ascorbic acid to lenses done by

Lens has a special carrier system for the Ascorbic acid which is a major oxidant in the lens This carrier system is mediated by myoinositol Refer: AK Khurana 6th edition


Question: Drug of choice for Spring Catarrah is

Drug of choice for Spring Catarrah is Olopatiadine.


Question: Gene responsible for Anterior segment morphogenesis

GENETICS IN CORNEA * PAX 6 gene a/w- Ectodermal Ectodactyly dysplasia & eye morphogenesis *PITX2 gene- Axenfeld Riger Syndrome Corneal Dystrophy & Anomalies *Lattice & Granular Corneal Dystrophy- TGF B1, 5q31, AD *Macular - AR, 16q22 *Fuch's endothelial dystrophy: AD, COL8A2 *Megalocornea: XLR, mostly males are involved Extra edge: - Faulty migration of NCC causes anterior segment dysgenesis.


Question: Macula lies from disc at a distance of..... from temporal margin of disc.


Question: Earliest symptom of sympathetic ophthalmia is


Question: Oldest cells of Lens are in

Lens contains oldest cells in its Nucleus.


Question: Blood retinal barrier is formed by

Ans. (d) Outer Plexiform layerRef: Retina by Ryan 6/e, p. 657; Khuranas Anatomy 2/e, p. 151Blood retinal barrier at 2 levels* Inner - Non-fenestrated capillaries of the retinal vessels (superficial capillary network in NFL and deep capillary network between INL and OPL)* Outer - tight junctions of RPE


Question: Diagnose the ocular pathology.

Ans. (c) PapilledemaOption a - should be a pale - white disc.Option b - POAG should present with loss of nasal neuro- retinal rim and Cupping (large cup, c/d ratio >0.5) along with vascular changes.Option d - CRAO - no occlusion can be seen, all arteries (thinner cross-section, red colour) and veins (thicker cross section, darker red color) are seen to be patientOption c - Papilledema - earliest sign is blurring of the disc margins, which is visible in the image.


Question: Total number of refractive surfaces in the Eye is

There are 4 refractive surfaces in the Eye

Anterior surface of Cornea
Posterior surface of Cornea
Anterior surface of Lens
Posterior surface of Lens


Question:
The type of corral ulcer seen in Vernal
keratoconjunctivitis is

Superficial punctate keratitis seen in Vernal Keratoconjunctivitis is characterised by Shied ulcer.


Question: Laser iridotomy is useful in

Ans. (a) Angle closure glaucomaRef.: A.K. Khurana 6th ed. 1247


Question: Crocodile tears are ssen in

Crocodile tear syndrome The mechanism appears to be a misdirection of regenerating gustatory fibers destined for the salivary glands, so that they become secretory fibers to the lacrimal gland and cause homolateral tearing while the patient is eating. A simple procedure, involving subtotal resection of the palpebral lobe of the involved lacrimal gland, proved to be an effective corrective measure in these cases.


Question: Most common cause of posterior staphyloma

POSTERIOR STAPHYLOMA It effects the posterior pole of the eye and is lined by the choroid. Degenerative high axial myopia is the most common cause. Indirect ophthalmoscopy shows a posterior outward curvature of the globe detected as a crescentric shadow in the macular region. The retinal vessels are seen to change direction, dipping down into the region. The staphylomatous region may appear pale due to degenerative changes in the retina, retinal pigment epithelium and choroid. Ref:- Parsons diseases of eye; pg num:-230


Question: IOP is most accurately measured by

Answer: b) Applanation tonometer (BASAK 4th ED, P-262)Measurement of IOP:1. Contact Tonometer* Indentation tonometer> When placed on a eye, the plunger together with a present weight, indents the cornea.> The amount of indentation is measured on a scale and the IOP can be calculated> Not accurate since IOP measured is influenced by scleral rigidity> Types# Schiotz (manual)# MacKay-Marg (electronic)* Applanation tonometer> Based on the principle of Imbert-Fick's law> Applanation tonometer measures the IOP by flattening the cornea over a specific area (3.06mm)> More accurate since the pressure values are not influenced by scleral rigidity> Types# Goldmann (slit-lamp mounted)# Parkins' (hand-held)2. Non-Contact tonometer3. Digital tonometry: IOP is roughly assessed by digital palpation, fluctuating the down-turned eye between two index fingers through the upper lid


Question: Steroid induced cataract

Drug induced cataract Coricosteroid-induced cataract Posterior subcapsular opacities are associated with the use of topical as well as systemic steroids. Prolonged use of steroids in high doses may result in cataract formation. Children are more susceptible than adults. Reference: A.K.Khurana; 6th edition; Page no:195


Question: Lipogranuomatous inflammation is seen in.


Question: Corneal curvature is measured by

The 'Keratometry' or 'ophthalmometry' is an objective method of estimating by measuring the curvature of the central cornea Gonioscopy- Biomicroscopic examination of the angle of the anterior chamber Perimetry-Procedure of estimating the extent of visual fields Tonography- a Non-invasive technique for determining the facility of aqueous outflow (C- value) Reference : AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 575

Anatomy, Development and clinical examination


Question: Berlin's edema is seen due to

Ocular Trauma o Blunt traums o Perforation Manifestations a. Corneal edema b. Hyphaema c. Iridodialysis d. Angle recession e. TM tear f. Hyphaema g. Subluxation/Dislocation of lens h. Rosette cataract i. Retinal dialysis j. Choroidal detachment k. Berlin's edema l. Optic nerve avulsion m. Nasolacrimal duct damage n. Blow out 7 RINGS OF BLUNT TRAUMA 1. Central iris: Sphincter tear 2. Peripheral iris: Iridodialysis 3. Anterior ciliary body: Angle recession 4. Separation of ciliary body from scleral spur: Cyclodialysis 5. Trabecular meshwork: Trabecular meshwork tear 6. Zonules/lens: Zonular tear with possible lens subluxation 7. Seperation of the retina from the ora serrata: Retinal dialysis Vitreous based detachment, that is, Retinal Dialysis is sign of blunt trauma.


Question: Heerfordt's syndrome does not include

Heerfordt's syndrome ( Uveoparotid fever) includes facial nerve palsy, not 6th Cranial nerve palsy.


Question: Vestibular Evoked Myogenic Potential (VEMP) has been used in assessment of

Ans. c. Inferior vestibular nerve function VEMPs are believed to be a good indicator of saccular and inferior vestibular nerve function in clinical evaluations." - Julie A. Honaker and Ravi N. Samy, Current Opinion in Otolaryngology and Head and Neck Surger Vestibular Evoked Myogenic Potential (VEMP) Assesses inferior vestibular nerve function. VEMP testing is a relatively noninvasive method to assess patients with vestibular disorders. The VEMPs are sho latency electromyograms (EMGs) evoked by high-acoustic stimuli at the ipsilateral ear and recorded surface electrodes over a tonically contracted sternocleidomastoid muscle. VEMP is a vestibule-collie reflex whose afferent limb arises from acoustically insensitive cells in the saccule, with signals conducted the inferior vestibular nerve.


Question: Global rupture due to blunt trauma is indicated by

C i.e. Contusion + Haemorrhage + Low intraocular pressure Complications of Blunt Trauma Voissius ring (on anterior surface of lens) Q Rossette shaped cataract Q Angle recession with secondary glaucoma Q Global rupture indicated by contusion, haemorrhage & low intraocular pressure Q Hyphaema with elevated lop

Contusion + haemorrhage + low intraocular pressure

Proptosis and decreased mobility of muscle


Question: Sudden Painless loss of vision is seen in

(A) Vitreous hemorrhage # Clinical features of vitreous haemorrhage:> Sudden development of floaters occurs when the vitreous haemorrhage is small.> In massive vitreous haemorrhage patient develops sudden painless loss of vision.> Fate of vitreous haemorrhage> Complete absorption> Organization> Complications like vitreous liquefaction, degeneration and khakhi cell glaucoma (in aphakia) may occur.> Retinitis proliferans> Treatment: Conservative treatment Treatment of the cause Vitrectomy> Sudden loss of vision: Central retinal artery occlusion Retinal detachment Central retinal vein occlusion Retrobulbar neuritis> Transient loss of vision: Carotid artery disease Migraine Papilloedema, Severe hypertension


Question: In posterior capsular cataract, treatment is

B i.e. Nd-YAG laser Nd. YAG (Neodymium-Yttrium-Aluminium-Garnet) laser is used for posterior capsulotomy in after cataract.Q After cataract/ Secondary cataract/ Posterior Capsular Opacification (PCO) - It is the opacity which persists or develops after ECCE - It may present as thickened posterior capsule or dense membranous after cataract or Soemmering's ringQ (thick ring of after cataract formed behind the iris, enclosed between the two layers of capsule) or Elschnig's pearlsQ (vacuolated subcapsular epithelial cells are clustered like soap bubbles along the posterior capsule) - It is treated by Nd-YAG-laser posterior capsulotomyQ (Neodymium-Yttrium-Aluminium-Garnet laser) or surgical membranectomy Laser Wavelength (nm) Clinical Application of LASERS in Ophthalmology Nd: YAG 1064Q Posterior capsulotomy Q, iridotomy, vitreolysis. Femtosecond laser 1053 Refractory surgery, lamellar corneal surgery. Diode laser 800 Retinal photocoagulation* Krypton laser 714 Retinal photocoagulation* Frequency doubled Nd: YAG 532 Retinal photocoagulation*, cyclophoto-coagulation Argon green 514 Retinal photocoagulation*, trabeculoplasty, iridoplasty, pupillo-mydriasis Excimer (Argon-fluoride) 193 Photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), LASIK, LASEK Retinal photocoagulation includes treatment for diabetic retinopathy, other causes of retinal neovascularization or oedema, retinal breaks, central serous retinochoroidopathy, subretinal neovascular membranes, small retinal tumors, angiomas. Argon green laser is m.c. used for this.


Question: Objective assessment of the refractive state of the eye is termed


Question: Most common tumour of eyelid is

(A) (Basal cell carcinoma) (430-Nema 5th) (457- Parson 21st)* Basal cell carcinoma is the most common maligment tumour of the eyelids and constitutes 85%-90% of the all malignant epithelial eyelid tumours.* Squamous papilloma is the most common benign tumour of the eyelid.Common malignant tumours of the eyelidTypeCommon locationClinical featuresSpreadTherapyBasal cell carcinomaMedial canthus, lower lidNodule, central ulceration with pearly surface telangiectasiaLocalResection RadiationSquamous cell carcinomaLower lid. From previous actinic keratosisUlcer with thickened margins, keratosis papillomatousLocal, lymph nodesResection,RadiationCryotherapySebacious cell carcinomaUpper lidNodular resembling, chalazion multifocal F > M recurrence commonLocal intraepith elial lymph nodesResectionCryotheropyExenterationMalignant melanomaPrevious nevi> 6mm size pigmented lesion. Vascularization inflammationLocal vascular lymph nodesResectionExenterationThe moct common benign orbital tumour is adults Cavernous HemangiomaMost common malignant orbital tumour in adults is LymphomaMost common benign orbital tumour in children is Dermoid cystMost common malignant orbital tumour in children is RhabdomyosarcomaBASAL CELL CARCINOMA* Also k/a "Rodent ulcer"* It is more common in Caucasians (99%)* Age is 40-79 years* Ultravoilet light exposure is one of the most important risk factors* It is locally malignant* It involves most commonly lower eyelid (50-60) >medial canthus (25-30%) >upper eyelid (15-20%) > lateral canthus* Basal cell nevus syndrome (Gorlin- Goltz syndrome) is a rare syndrome occurring in <l%of patients with basal cell carcinoma* Surgery is the treatment of choice - there are two- techniques(i) Moh's micrographic surgery(ii) Excisional biopsy with frozen section control


Question: Ciliary staphyloma affects ciliary zone upto mm behind the limbus

Answer- C. 8Staphyloma is an abnormal protrusion of uveal tissue through a weak and thin poion of cornea or sclera. So, a staphyloma is lined internally by weal tissue and ennally by weak cornea or sclera.Ciliary staphyloma : - This afects the ciliary zone that includes the region upto I mm behind the limbls. The ciliary body is incarcerated in the region of scleral ectasia. Causes are Developmental glaucoma, Primary or secondary glaucoma end stage, scleritis, trauma to ciliary region.


Question: Secondary deviation of eye is based on

Increased flow of energy to contracting muscles is accompanied by relaxation of C/L antagonists - sherrington's law.


Question: In the grading of trachoma,trachomatous inflammations follicular is defined as the presence of

The pneumonic is FIST-O Refer: Khurana 6th edition page number 65

5 or more follicles in the lower tarsal conjunctiva

Three or more molecules in the lower tarsal conjunctiva

Five or more follicles in upper tarsal conjunctiva

Three or more follicles in upper tarsal conjunctiva


Question: Preauricular lymphadenopathy not seen in

Ans. is 'c' i.e., Atopic conjunctivitiso Preauricular lymphadenopathy is seen in -Bacteral conjunctivitis (staphylococcal, gonococcal, pneumococcal).Viral conjunctivitis (Herpes simplex, epidemic keratoconjunctivitis).Chlamydial conjunctivitiso It is not seen in allergic (atopic) conjunctivitis.

Inflammations of Conjunctiva - Infective


Question: Vossius ring is seen in

B. i.e. (Blunt trauma) (367 - Parson 20th- 405 -Khurana 4th)Vossius- Ring - is a circular ring of brown pigment seen on the anterior capsule** of the lens* It occurs due to striking of the contracted pupillary margin against the crystalline lens. It is always smaller than the size of the pupil* It is always smaller than the size of the pupil produced by the force of the blow driving the cornea and iris backwards* Rosette - shaped cataract following blunt trauma


Question: Treatment of choice for phlyctenular conjunctivitis is


Question: Peripheral retinal degeneration is most common in case of

A i.e. Myopia Ophthalmoscopic findings of pathological myopia are - - Myopic crescents (on temporal edge of optic disc), - Foster fuch's spot - (dark red patch at macula due to retinal neovascularization & choroidal haemorrhage), Cystoid degeneration, - Peripheral retinal degeneration (lattice & snail track degenerations)Q - Posterior staphyloma.


Question: Most common congenital tumour of conjunctiva is

Commonest congenital tumour of the conjunctiva - Epibulbar dermoid


Question: Pterygium is

Pterygium is subconjuctival fibrobasvular growth encroaching on the cornea REF:Refer Khurana 6th edition page number 87


Question: Epidemic keratoconjunctivitis is caused by

Ans. d (Adenovirus). (Ref. Textbook of Microbiology by Anantanarayan, 6th/451)INFECTION BY ADENOVIRUS SyndromesPrinciple serotypes1Respiratory disease in children1, 2, 5, 62Sore-throat, febrile cold, pneumonia3, 4, 7, 14, 213ARDS in military recruits4, 7, 214Follicular (swimming pool) conjunctivitis3,75Epidemic kerato conjunctivitis sicca8, 19, 37Q6Diarrhoea40, 417Soft tissue sarcoma and bladder carcinoma18,198Gene therapy2,59AIDS43, 47


Question: Because of circle of least diffusion, the distant vision is comparatively good in

At point D, the divergence of veical rays is exactly equal to the convergence of the horizontal rays from the axis. So here the section is a circle, which is called the circle of least diffusion. Mixed astigmatism: refers to a condition where in the light rays in one meridian are focused in front and in other meridian behind the retina. Thus in one meridian eye is myopic and in another hypermetropic. Such patients have comparatively less symptoms as &;circle of least diffusion&; is formed on the retina. Reference :- A K KHURANA; page:-25,26,37


Question: Acquired nasolacrimal duct obstruction is caused by


Question: Nerve tested in pupillary reflex is

Afferent - 2nd nerve.
Efferent - 3rd nerve.


Question: Antigaucomatous drug causing spasm of accommodation

Ans. is 'b' i.e., Pilocarpine Ocular side effects of topical agents for POAG 13-blocker: Allergic blepheroconjunctivitis, corneal hyposthesia, blurred vision, dry eye, superficial punctate keratitis. Cholinomietics (pilocarpine): Blurred vision, miosis, accommodative spasm, browache. Sympathomimetics Non-selective (Dipivefrine): Follicular conjunctivities, rebound congestion, macular edema in aphakic Apraclonidine: Allergies, lid retraction, follicular conjunctivitis, fluctuation in visual acuity Brimonidine: Ocular allergy, conjuntival blanching. Carbonic anhydrase inhibitors (Dorzolamide, brinaolamide): Punctate keratitis, ocular allergies. Prostaglandin analogues (Latanoprost): Punctate keratitis, iris pigmentation.


Question: Scleral Expansion Bands are used in the management of

Schachar introduced scleral expansion bands for surgical reversal of presbyopia. Originally, the implant was designed as a continuous ring that was placed into the sclera. The modified and improved design of this prototype consists of four polymethylmethacrylate (PMMA) bands that are placed in four scleral tunnels at depths of 350 to 400 mm in order to create more space between the lens and the sclera. This follows the theory of accommodation described by Schachar.


Question: Treatment of chronic dacrocystitis  a) Dacrocystorhinostomy     b) Antibiotics    c) Probing    d) Massage


Question: Glaucoma capsulare is caused by

Occurrence of glaucoma in eye with pseudoexfoliation is called glaucoma capsulareReference: Aravind FAQS in Ophthalmology; First Edition; Page no: 232


Question: Excessive O2 concentration in Neonates causing

(Retrolental fibroplasia) (264-KH)Retinopathy of prematurity term coined for the disease "retrolental fibroplasia"* It is a bilateral proliferative retinopathy, occurring in premature infants (weighting less than 1300 gm) exposed to high concentration of oxygen during the first 10 days of life.* Premature infants should not be placed in incubator with an O2 concentration of more than 30% and efforts should be made to avoid infection and attacks of apnoea.


Question: Secondary action of Inferior oblique

Inferior oblique
1o - Extortion
2o - Elevation
3o - Abduction.


Question: Ophthalmoplegic migraine means

B i.e. When the headache is followed by paial paralysis of 3rd nerve without any scotoma Ophthalmoplegic migrane is characterized by recurrent episodes of migraine like headache accompanied mostly by recurrent, ipsilateral and transient paresis of 3rd (most common), 6th (rare) and/ or 4th (rarest) cranial nervesQ. It is more common in childhood & typically stas before the age of 10 years.

When headache is followed by complete paralysis of the IlIrd and VIth nerve on the same side as the hemicrania

When the headache is followed by paial paralysis of the IIIrd nerve on the same side as the hemicrania without any scotoma

Headache is associated with IIIrd, IVth and VIth nerve paralysis


Question: Drug of choice for Acute Anterior Uveitis

Atropine Is the Drug of choice for Acute Anterior Uveitis, due to

Relieves of Ciliary spasm
Preventing posterior synichae
Reduce candatis and reduces the signs


Question: Modified Kastenbaum surgery is done for

Modified Kastenbaum Surgery *Recession resection of all four horizontal recti is done according to the type and amount of nystagmus


Question: Increased intraocular tension can be diagnosed by

The intraocular pressure (IOP) is measured with the help of an instrument called tonometer. Two basic types of tonometers available are: indentation and applanation. Indentation (impression) tonometry is based on the fundamental fact that a plunger will indent a soft eye more than a hard eye. The concept of applanation tonometry was introduced by Goldmann is 1954. It is based on Imbe- Fick law which states that the pressure inside a sphere (P) is equal to the force (W) required to flatten its surface divided by the area of flattening (A); i.e., P = W/A. Reference: AK khurana 7th edition

Anatomy, Development and clinical examination


Question: Lesion in left optic tract manifest as

(D) Right homonymous hemianopia # Lesions of optic tract: These are characterized by incongrous homonymous hemianopia associated with contralateral hemianopic pupillary reaction (Wernicke's reaction).> These lesions usually lead to partial descending opitic atrophy and may be associated with contralateral third nerve paralysis and ipsilateral hemiplegia.> Common causes of optic tract lesions are syphilitic meningitis or gumma, tuberculosis and tumours of optic thalamus and aneurysms of superior cerebellar or posterior cerebral arteries.


Question: While performing duochrome test, If the patient repos that he sees red letters more clear than green, it indicates that he is slightly

Duochrome test: It is based on the principle of chromatic aberration. In this, the patient is asked to read the red and green letters. In an emmetropic eye the green rays are focused slightly anterior and red rays slightly posterior to the retina. Therefore, to an emmetropic patient letters of both colours look equally sharp. When the patient tells that he or she sees red letters more clearly than the green, it indicates that he or she is slightly myopic. Technique One eye is occluded Subject is asked to note whether the letters on the cha are equally visible or prominent on both backgrounds or more visible or prominent against one of the backgrounds Vision is slightly fogged by adding plus(+) sphere monocularly in 0.25DS steps until red background letters become more prominent This should occur in only one / two increments of plus power unless the eye has been over corrected The plus powered sphere before the eye is reduced until both background letters appear equally distinct. This represents optimum correction Next reduction causes green to be more prominent Reference :- A K KHURANA; page:-556


Question: Fluoroscein dye study is done to detect

Ans. is 'b' i.e., Retinal vascular pathology Angiography for fundus examination Angiography is used for dynamic flow study of Iris, Retina or choroid. Following types of angiographies are used. Fluorescein Angiography :- Sodium fluorescein dye is used by injecting it into antecubital vein. It is primarily used for retinal vasculature, but iris & choroid can also be examined. Indocyanine green Angiography :- It is used primarily for choroidal vasculature, especially in choroidal neovascular membranes (CNVM). Therefore, it is used in - i) The identification and delineation ofpoorly defined or occult choroidal neovascularization, (ii) Retinal pigmented epithelium (RPE) detachments.


Question: Most characteristic eye lesion in diabetes is

Most characteristic - Capillary aneurysm.


Question: Most common nerve involved in herpes zoster ophthalmicus is

HZO is an acute infection of Gasserian ganglion of the fifth cranial nerve by the varicella-zoster virus (VZV). VZV is a DNA virus and produces acidophilic intranuclear inclusion bodies. It is neurotropic in nature. In HZO , frontal nerve is more frequently affected than the lacrimal and nasociliary nerves. Ref: khurana 6 th edition page no.104


Question: Select the wrong pair of Yolk muscles

RMR & LLR & Not LMR are yolk muscle Yoke Muscles: *Synergist muscle: Involved in Same Version movement (So one muscle would be of left eye, other would be of right eye.) *Ex- Right eye dextroversion by RLR and LMR is involved.. these two are YOKE muscles. \


Question: Most common cause of hyphema due to Blunt trauma

Most common cause of hyphema due to Blunt trauma is Major arterial circle.


Question: Percentage disability ceificate that can be given for a patient with 1/60 in one eye & 6/60 vision in other eye would be

According to the vision of the patient the amount of visual disability ceificate would be 75 percent Category Better eye Worse eye % age Category 0 6/9-6/18 6/24- 6/36 20 Category 1 6/18-6/36 6/60 to Nil 45 Category 2 6/36- 4/60 or field of vision 10-20 Deg 3/60 to Nil 75 Category 3 3/60 to 1/60 or field of vision 10 Deg FC at 1 feet, to Nil 100 Category 4 FC at 1ft to Nil or field of vision 10 Deg FC at 1 feet to nil 100 One eyed Persons 6/6 FC at 1ft to Nil or field of vision 10 Deg 30


Question: Wernicke's hemianopic pupil is seen in the lesion of

Wernickes hemianopic pupil is seen in the lesion of optic tracts - characterized by contralateral homonymous hemanopia with a characteristic pupillary response. Narrow beam of light when shown into the non-seeing pa of the retina, pupil fails to react while when shown into the seeing pa of the retina, pupillary constriction occurs. Make your concept - Homonymous means same side (i.e. right or left) - Heteronymous means opposite side (i.e. nasal or temporal) - Congruous means same shape or symmetric on both sides - Incongruous means different shape or asymmetric on both sides - Hemianopia means half side is involved - Generally Anterior lesions cause heteronymous, incongruous defects and posterior lesions cause more homonymous and congruous defects Impoant Points on Visual Pathway Lesions 1. Optic nerve lesion - I/l direct and c/ L consensual gone Causes - optic atrophy/ optic neuritis - avulsion optic nerve 2. Proximal pa of optic nerve - I/L blindness C/L hemianopia 1. Saggital chiasma lesion - Bitemporal hemianopia - Paial descending optic atrophy Causes - suprasellar aneurysm - tumors of pitutory craniopharyngioma - suprasellar meningioma 2. Lateral chiasma - Binasal hemianopia of pupillary reflex Causes - Distention of 3rd ventricle Since some fibres of other side there is crossover Binasal Hemianopia 3. Optic tract Lesion- - Contralateral homonymous hemianopia with incongruity - Bow tie pattern of optic atropy 5.Temporal lobe lesion - contralateral homonymous superior quadrantanopia (pie in the sky defect) 6. Parietal Lobe lesion- Pie in the floor. Contralateral homonymous inferior quadrantanopia Homonymous hemianopsia, also referred to as homonymous hemianopia is the loss of half of the field of view on the same side in both eyes. Left superior homonymous quadrantanopia Left inferior homonymous quadrantanopia 7.Keyhole visual field defects: Vascular lesion of Lateral Geniculate body 8. Occipital lobe lesion Congruous homonymous hemianopia with sparing of macula Cause: Occlusion of posterior cerebral aery Congruous Homonymous macular defect Cause: Bullet injury/ head injury Bilateral homonymous macular defect Cause: Bilateral occipital defect


Question: Earliest symptom of Congenital Glaucoma

Earliest but nonspecific symptom of Congenital Glaucoma is photophobia


Question: Treatment for First degree angle closure glaucoma is

C i.e. Laser Irodotomy Laser Irodotomy is the treatment of choice for PACG, but is successful only if less than 180deg (50% )of the angle is closed. So it is effective in first degree angle closure glaucoma. But it may be difficult until the corneal thickening & iris congestion have settled (usually 48 hours). The Shaffer grading system The system of angle grading which is used almost universally today records the angle in degrees of arc subtended by the inner surface ofthe trabecular meshwork and anterior surface of the iris about one-third of the distance from its periphery. Grade Angle Description Grade 4 (35-45deg) The widest angle characteristic of myopia and aphakia in which the ciliary body can be visualized with ease; it is incapable of closure. Grade 3 (25-35deg) Open angle in which at least the scleral spur can be identified; it is also incapable of closure Grade 2 (20deg) Moderately narrow angle in which only the trabeculum can be identified; angle closure is possible but unlikely Grade 1 (10deg) Very narrow angle in which only Schwalbe line, and perhaps also the top of the trabeculum, can be identified; angle closure is not inevitable but the risk is high Slit angle One in which there is no obvious irido-corneal contact but no angle structures can be identified; this angle has the greatest danger of imminent closure Grade 0 (0deg) Closed angle due to iridocorneal contact and is recognized by the inability to identify the apex of the corneal wedge


Question: Parasitic subconjunctival cysts are caused by

Parasitic cysts such as subconjunctival cysticercus, hydatid cyst, and filarial cyst are not infrequent in developing countries. cyst with hooklets on the optic disc has been repoed who also had sub-cutaneous and cerebral involvement. The differential diagnosis of orbital cysticercosis includes idiopathic myositis, tumours or metastasis, muscle abscess or haematoma, and other parasitic infections like hydatid cyst Conjunctival cysts need a careful surgical excision. The excised cyst should always be subjected to histopathological examination. Ref: Khurana; 4th ed; Pg 86


Question: Red keratic precipitates are seen in

Keratic precipitates (KPs) are proteinaceous cellular deposits occurring at the back of the cornea. Mostly, these are arranged in a triangular fashion occupying the center and inferior pa of the cornea due to convection currents in the aqueous humor. The composition and morphology of KPs vary with the severity, duration, and type of uveitis.Following types of KPs may be seen:i. Mutton fat KPs: These typically occur in granulomatous iridocyclitis and are composed of epithelioid cells and macrophages. They are large, thick, fluffy, lardaceous KPs, having a greasy or waxy appearance. Mutton fat KPs are usually a few (10 to 15) in number.ii. Small and medium KPs (granular KPs). These are pathognomic of non-granulomatous uveitis and are composed of lymphocytes. These small, discrete, diy white KPs are arranged irregularly at the back of the cornea. Small KPs may be hundreds in number and form the so-called endothelial dusting.iii. Red KPs: These are formed when in addition to inflammatory cells, RBCs also take pa in the composition. They may be seen in hemorrhagic uveitis.iv. Old KPs: These are a sign of healed uveitis. Either of the above described KPs with healing process shrink, fade, become pigmented and irregular in shape (crenated margins). Old mutton fat KPs usually have a ground glass appearance due to hyalinization.Ref.UG Khurana 4th edition Pg.No142


Question: Von herick's angle grade 3 of anterior chamber denotes

Von Herick's technique compares the depth of peripheral anterior chamber with the corneal thickness. The method involves a narrow slit of light from a slit lamp being projected on to the peripheral cornea at an angle of 60deg as near as possible to the limbus. Ratio Angle closure Angle grade 1:1 open angle VH grade 4 1:1/2 Moderately open angle VH grade 3 1: 1/4 Moderately narrow angle VH grade 2 1: <1/4 angle closure likely VH grade 1


Question: In ophthalmology, muscle resection leads to

Ans. (b) Strengthening of muscleRef Kanski 8/e, p. 769Weakening procedures on recti muscleStrengthening proceduresRecessionResection[?]Retro equatorial myopexy (FADEN)AdvancementMarginal myotomyDouble breasting or tuckingMyectomyCinchingFree tenotomy or disinsertionTransposition


Question: Type 4 hypersenstivity to mycobacterium tuberculosis antigen may manifest as

Most common ocular manifestation of TB is Phlyctenular keratoconjunctivitis Refer: Khurana 6th edition page number 83


Question: Two tumours commonly associated with Masquerade syndrome are

Masquerade syndrome:Intraocular tumour necrosis may present as sterile endophthalmitis. These include a group of diseases which mimic anterior or posterior uveitis in their clinical features but the aetiopathogenesis is entirely different, being usually neoplastic or occasionally ischaemic. Acute leukaemia, iris melanoma, juvenile xanthogranuloma, small round cell malignancies, anterior segment ischaemia, reticulum cell sarcoma or large cell lymphoma are some of the conditions which can present in this manner. Eyelid sebaceous carcinoma and intraocular lymphoma are often associated with masquerade syndromes.

Conjunctival lymphoma, choroidal melanoma

Conjunctival lymphoma, intraocular lymphoma

Eyelid sebaceous ca, intraocular lymphoma


Question: Berlin's edema is due to

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 431)Berlin's edema (commotio retinae) is a common condition caused by blunt injury to the eye. It is characterized by a decreased vision in the injured eye a few hours after the injury. Under examination, the retina appears opaque and white in color in the periphery but the blood vessels are normally seen. Cherry-red' spot in the foveal region may be seen


Question: Vitrectomy is done in case of vitreous hemorrhage if not absorbed within

Vitrectomy is indicated if vitreous haemorrhage does not absorb in 3 months.


Question: Topical antifungal used in corneal fungal infection

C i.e. Natamycin Fungal corneal ulcer is treated by antifungal agents - topical & systemic (required in severe keratitis & endopthalmitis) and cycloplegics (e.g. atropine ointment or scopolamine)Q as an adjuvant therapy. Steroids are contraindicated Q


Question: β blocker of choice used in Glaucoma with hyperlipidaemia

β blocker of choice used in Glaucoma with hyperlipidaemia is Carteolol.
β blocker of choice used in Glaucoma with cardiopulmonary disease is Betaxolol and Carteolol.


Question: Posterior lenticonus is seen in

Lenticonus: It refers to the cone-shaped elevation of the anterior pole (lenticonus anterior) or posterior pole (lenticonus posterior) of the lens. Lenticonus anterior may occur in Alpo syndrome and lenticonus posterior in Lowe syndrome. On distant direct ophthalmoscopy, both present as an oil globule lying in the center of the red reflex. Slit-lamp examination confirms the diagnosis. Lowe syndrome is a condition that primarily affects the eyes, brain, and kidneys. This disorder occurs almost exclusively in males. Infants with Lowe syndrome are born with thick clouding of the lenses in both eyes (congenital cataracts), often with other eye abnormalities that can impair vision. Ref: Khurana; 4th edition; Pg. 204


Question: Disscociated vertical deviation seen in

Diplopia—seeing double—is a symptom with many potential causes, both neurological and .
This group of patients may also describe palinopsia—multiple images .
However, other causes of an apparent superior oblique palsy such as .
The optokinetic system cannot be properly assessed at bedside because the OKN


Question: Deapth of anterior chamber in normal person is

Deapth of anterior chamber is 2.4 to 2 5 Refer khurana 6/e p 3

Diseases of orbit, Lids and lacrimal apparatus


Question: BSGT stands for

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 334 - 358)Bagolini striated glasses test, or BSGT, is a subjective clinical test to detect the presence or extent of binocular functions and is generally performed by an ohoptist. It is mainly used in strabismus clinics


Question: The most commonly seen primary orbital tumour in children is

Rhabdomyosarcoma It is a highly malignant tumour of the orbit arising from the extraocular muscles. It is the most common primary orbital tumour among children, usually occurring below the age of 15 years (90%). Clinical features: It classically presents as rapidly progressive proptosis of sudden onset in a child of 7-8 years. Massive proptosis due to rhabdomyosarcoma located in the superonasal quadrant (mimmicking acute inflammatory process). The clinical presentation mimics an inflammatory process. The tumour commonly involves the superionasal quadrant; but may invade any pa of the orbit. Ref:- A K KHURANA; pg num:-394


Question: Posterior staphyloma is associated with

Posterior staphyloma is a condition that can be present in highly myopic individuals with long axial lengths. It is caused by elongation of the globe due to thinning and bulging of the sclera and results in an irregular configuration of the retina at the posterior pole. ref img

Diseases of orbit, Lids and lacrimal apparatus


Question: A woman complains of coloured haloes around lights in the evening, with nausea and vomiting, IOP is normal; Diagnosis is

B i.e. Prodromal stage of closed angle glaucoma In Prodromal (Latent) stage of angle closure glaucoma there occurs an attack of transient rise in IOP (40-60 mmHg) lasting for few seconds only Q. Such attacks are intermittent and are usually precipitated by overwork, anxiety, fatigue or due to dilation of pupil (as reading in dim illumination, or watching cinema in a darkened cinema hall) Q. During this phase patient experiences transient blurring of vision, coloured halos around the light due to corneal oedema and mild headache Q. On examination eye is white and not congested. Anterior chamber is narrow and gonioscopy reveals narrow angle.


Question: Minus cylinder lenses are prescribed because of

Aniseikonia is defined as a condition wherein, images projected to visual coex from the two retinae are abnormally unequal in size and/or shape. Up to 5% aniseikonia is well tolerated. Meridional aniseikonia - refractive differences only occur in one meridian In a plus cylinder the lens is ground on the anterior surface of spectacle and thus there is more scattering and distoion of image as compared to a minus cylinder which is ground on posterior surface. Thus a minus cylinder is more comfoable to the patient and hence all prescriptions are written with a minus cylinder. Extra edge: - In pt with monocular aphakia wearing contact lens, % of aniseikonia is approximately 8% - In aphakia, Aniseikonia is decreased with contact lens than glasses. Hence, IOL implantation is preferred management NOTE- Aneisokonia with IOL- (1-3%)


Question: Retinitis pigmentosa is not associated with

Associations of retinitis pigmentosaI. Ocular associations. These include myopia, primary open angle glaucoma, microphthalmos, conical cornea and posterior subcapsular cataract.II. Systemic associations. These are in the form of following syndromes:1. Laurence-Moon-Biedl syndrome: It is characterized by retinitis pigmentosa, obesity, hypogenitalism, polydactyly and mental deficiency.2. Cockayne's syndrome: It comprises retinitis pigmentosa, progressive infantile deafness, dwarfism, mental retardation, nystagmus and ataxia.3. Refsum's syndrome. It is characterized by retinitis pigmentosa, peripheral neuropathy, and cerebellar ataxia. 4. Usher's syndrome. It includes retinitis pigmentosa and labyrinthine deafness. 5. Hallgren's syndrome. It comprises retinitis pigmentosa, vestibulo-cerebellar ataxia, congenital deafness and mental deficiency. Ref: Khurana; Comprehensive Ophthalmology; 4th edition; Page no: 269


Question: Iris bombe occurs with

C i.e. Ring synechiae Annular posterior synechia/ Ring synechia are 360deg adhesion of pupillary margin to anterior capsuldial lens. Thus preventing circulation of aquous humor from posterior chamber to anterior chamber (seclusio pupillae)Q. So the aqueus collects behind the iris & pushes it anteriory like a sail lit Iris bombeQ formation. Due to this the anterior chamber becomes funnel shaped i.e. deeper in centre & shallower at periphery. And ant. surface of iris comes in contact with posterior surface of cornea at periphery, where eventually firm adhesions form (Peripheral anterior synechiae). Both ring & peripheral anterior synechaia lit secondary glaucoma. Yag laser iridotomy is treatment of choice to prevent secondary glaucoma. Complications of Anterior Uveitis - Seclusio occlusio pupillae Secondary glaucoma (most common)Q - Cyclitic membrane Complicated cataractQ Pseudoglioma due to vitreous exudation - Cystoid macular oedemaQ is common cause of visual impairment - Pthisis & atrophic bulbi - Tractional retinal detachment - Band shaped keratopathy: more common in children with JRA - Features of anterior uveitis (acute) include pain, redness /ciliary flush or congestion / perilimbal injection, tenderness, photophobia, blurred vision, keratic precipitates, aqueous flare and cellsQ. Smaller KPs are seen in nongranulomatous, whereas larger (mutton fat) KPs are characteristic of granulomatous uveitis. The normal convection currents of aqueous humor & gravitation result in KPs being typically concentrated over a triangular area (Arlt triangle) in the lower pa of cornea. A diffuse pattern of KPs is frequently seen in Fuch's hetrochromic iridocyclitis or herpetic Keratouveitis. New KPs are white and become shrunken (crenated) or more pigmented as they age. Cornea may show epithelial dendrites, geographic ulcers or stromal scarring in herpetic Keratouveitis. Conjunctiva demonstrate nodules in sarcoidosis. - Clinical features of intermediate uveitis include floaters, deterioration of vision (d/t opacities in anterior vitreous), minimal AF with occasional KPs (k/a spill over anterior uveitis), anterior vitritis, white snowball like exudates near ora serrata, coalescent exudates (snow bank appearance), mild peripheral periphlebitis. - Typical features of posterior uveitis include often painless floater with or without diminution of vision0, vitritis (detectable inflammatory cells & opacities in vitreous), retinitis- choroiditis (exudates, infiltration, odema or atrophy) and sheathing of vessels (perivascular exudates). - Other less frequent features of posterior segment involvement (i.e. complications) include macular edema, disc edema (papillitis), retrolental cyclitic membrane, vitreous haemorrhage; serous, tractional or rhegmatogenous RD; retinochoroidal neovascularization & atrophy.


Question: Ring of Sommerring is seen in


Question: Not a Cause of Salt & Pepper retinopathy

Salt and pepper retinopathy: Fundoscopic examination reveals granular, pigmentary mottling in the macula and periphery, with punctuate hypopigmentation & hyperpigmentation Causes of Salt & Pepper retinopathy * Congenital Syphilllis * Rubella * Thioridazine *Birdshot chorioretinopathy * Stargardt (rarely)


Question: A child with amblyopia is to be operated by

Amblyopia, also known as "lazy eye," occurs when the brain ors one eye and develops pathways to only one eye. The condition typically begins in infancy or early childhood. This may be corrected before the age of 5 years,through surgery.


Question: Corneal sensation is lost in

A i.e. Herpes simplex Decreased corneal sensations, dendritic and geographical ulcers are characteristic features of Herpes simplex ocular disease Q Sensory supply of cornea is through trigeminal nerve Q. Neurotrophic keratopathy occurs due to paralysis of sensory supply of cornea. Causes of neurotrophic keratopathy or anaesthetic cornea are:


Question: Axenfeld anomaly is seen in glaucoma associated with

a) Microdontia; b.Slit pupil and iris atrophy; c.Corectopia with iris atrophy; d,e.Posterior embryotoxon; f.Broad peripheral anterior synechiae. Axenfeld anomaly is seen in glaucoma associated with iridocorneal dysgenesis. It is a posterior embryotoxon characterised by prominent Schwalbe's ring. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p214.


Question: Macula lies from disc at a distance of ..... from temporal margin of disc.


Question: Amsler's grid is used to evaluate

The Amsler grid is a tool that eye doctors use to detect vision problems resulting from damage to the macula (the central pa of the retina) or the optic nerve. The damage may be caused by macular degeneration or other eye diseases, so the Amsler grid is useful in detecting these problems. Reference: AK khurana 7th edition

Anatomy, Development and clinical examination


Question: Arlts line is seen in

Arlts line is a linear scarring on the upper palpebral conjunctiva in patients of trachoma REF:Refer Khurana 6th edition page number 69


Question: Absence of Lamina cribrosa occurs in


Question: Snow blindness is caused due to

Snow blindness is a painful, temporary loss of vision due to overexposure to the sun's UV rays.


Question: Typical appearance of diabetic cataract is


Question: A 40 year old diabetic male present with vitrous haemorrhage. Most impoant cause for it is


Question: First eye muscle affected in thyroid disease

Thyroid related ophthalmopathy 5 times more common in female Extra ocular muscles involvement: I - Inferior rectus Am - Medial rectus So - Superior rectus Lucky - Lateral rectus


Question: Cattle track appearance is seen in

Central retinal aery occlusion (CRAO): It occurs due to obstruction at the level of lamina cribrosa.Symptoms: Patient complains of sudden painless loss of vision.Signs: Direct pupillary light reflex is absent. On ophthalmoscopic examination, retinal aeries are markedly narrowed but retinal veins look almost normal. Retina becomes milky white due to edema. The central pa of the macular area shows cherry-red spot due to vascular choroid shining through the thin retina of this region. In eyes with a cilioretinal aery, pa of the macular will remain normal. Blood column within the retinal veins is segmented (cattle trucking).After a few weeks, the edema subsides, and atrophic changes occur which include grossly attenuated thread-like aeries and consecutive optic atrophy.Ref: Khurana; 4th edition; Pg.No. 255


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

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


Question: Methanol attacks

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no.63 - 65) Methyl alcohol is metabolized very slowly and thus stays for a longer period in the bodyIt is oxidized into formic acid and formaldehyde in the tissues. These toxic agents cause edema followed by degeneration of the ganglion cells of the retina, resulting in complete blindness due to optic atrophy Methanol intoxication leads to oxidative stress and mitochondrial dysfunction, which in turn results in ganglion cell and optic nerve necrosis. Antioxidant therapy that inhibits the oxidative stress reaction is now being used as an alternative method of preventing methanol intoxication


Question: Satellite lesions in eye is caused by


Question: Paralysis of 3rd, 4th, 6th nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion

A i.e. Cavernous sinus Abrupt (sudden/ very rapid) onset of marked systemic features (high grade fever) with proptosis, chemosis especially with prostration, sequential ophthalmoplegia (i.e. initial lateal gaze involvement), bilateral involvement and mastoid edemaQ strongly suggest the diagnosis of cavernous sinus thrombosis. - In cavernous sinus, the ophthmic division of trigeminal (Vi)nerve picks up sympathetic fibers from cavernous plexus. These are for dilator papillae muscle. Vi divides just posterior to superior orbital fissure into 3 branches (lacrimal nerve, frontal nerve, nasociliary nerve), which pass through superior orbital fissureQ - Lesions of cavernous sinus e.g. thrombosis, rupture of aneurysm of internal carotid aery at may lead to paralysis of 3rd 4th, 5th and 6th nerve Q Feature Cavernous Sinus Thrombosis Orbital Cellultis Orbital Apex Syndrome Arise from - Most septic CST arise from - Exension of inflammation - < 1% of orbital cellulitis result in sphenoid or ethmoid sinuses >> from neighbouring tissues esp OAS; howeve, >50% of these dental, facial & ear infection by gram positive bacteria sinuses (mc ethmoid); eyelid, eyeball, face etc or occur in patient with diabetes meltitus and most frequently - Aseptic thrombosis (rare) is penetrating injuries & d/t rhinocerebral caused by conditions that 1/t surgeries mucormycosis. venous thrombosis eg - Bacterial OC is more common - Ketoacidosis is most impoant polycythemia, sickle cell anemia, in children whereas, fungal risk factor b/o lack of inhibitory (vasculidities), trauma, neurosurgery, pregnancy & oral condraceptive use. (mucor or Aspergillus) affect diabetic (ketoacidosis) & immune compromised activity against Rhizopus in serum. Involve Cavernous sinus i.e. - All orbital contents may be - Superior orbital fissure - 6th CN & carotid plexus of involved and may evolve into transmitting 3rd,4th, 6th and Vi sympathetic nerves run through the substance orbital abscess cranial nerves - Optic canal transmitting optic - 3rd,4th,ophthalmic (Vi) and maxillary (V2) division of 5th (2nd) cranial nerve CN and trigeminal ganglion lie in lateral wall Onset & progression Abrupt / violent /Very RapidQ Slower (relatively) Slower (relatively) Systemic Features MarkedQ (fever, headache, nausea, vomiting) Mild (less prominent) Mild (less prominent) Mastoid edema DiagnosticQ (Present) Absent Absent Laterality Bilateral (in >50%), although initially unilateral Unilateral Unilateral Proptosis & Chemosis Marked (with eye pain) Marked (with severe eye pain) Mild to moderate (do not always complain of pain) Vision Not affected in early stagesQ May lost early if retrobulbar Lost in early stages d/t optic (2" CN) optic neuritis or compression develop nerve involvement (RAPD) present Ophthalmoplegia Sequential (beginning with 6th Concurrent & complete Concurrent & complete external (3,4,6 CN) nerve) and completeQ. Initial external ophthalmoplegia ophthalmoplegia involving 3rd,4th lateral rectus (gaze) palsyQ is d/ t early involvement of 6th nerve in substance of CS. involving 3rd,4th & 6th nerve & 6th nerve Irigeminal (V) nerve Opthalmic (V1) and maxillary - Opthalmic (V1) division involved (5 CN) (V2) division involved (= decreased corneal sensation) Clinical Features Abrupt onset marked periorbital Signs of anterior eye Visual loss (2" CN) and edema, orbital congestion (chemosis), proptosis, adnexal involvement (chemosis, edema) are usually out of ophthalmoplegia are out of propoion and often precede edema, eye pain, ptosis and ophthalmoplegia (involving 3rd, 4th, 6th cm CN) with involvement of VI & Vz. propoion to ophthalmoplegia at least initially signs of anterior eye involvement, such as proptosis periorbital (adnexel) edema, and orbital congestion


Question: MC ocular manifestation of mumps is

A i.e. Dacroadenitis Mumps Most common manifestation of mumps (in all age groups) is parotitis Q 2nd most common manifestation of mumps in postpubeal males is orchitis Q Aseptic meningitis is common manifestation of mumps in both children & adults. Most common ocular manifestation of mumps is dacryoadenitis Q


Question: Subluxation of lens occurs in

(Marfan's syndrome): (214- Khurana 5th, 68- Nema 6th/e)SUBLUXATED LENS -The lens is kept in its position by the suspensory ligaments if the ligaments are weak or improperly developed the lens get subluxedClinico-ctiological typesI. Congenital displacement(a) Simple ectopia lentis(b) Ectopia lentis et papillae(c) Ectopia lentis with systemic anomalies1. Marfan's syndrome**2. Homocystinuria3. Weil Marchesani syndrome4. Ehler s Danlos syndrome5. Hyperlysinaemia6. Stickler syndrome7. Sulphite oxidase deficiencyII. Traumatic displacement of the lens* Usually associated with concussion injuries* Couching is an iatrogenic posterior dislocation of lens performed as a treatment of cataract in olden days* Posterior dislocation of lens- Deep AC- Tremulousness of the iris- Floating lens in the vitreousIII Consecutive or Spontaneous displacementCommon conditions -* Hypermature cataract* Buphthalmos* High myopia* Staphyloma* Intraocular tumours* Uveitis


Question: A patient of closed angle Glaucoma the treatment of choice in other eye is


Question: Fixation reflex of eyes develop at

Fixation reflex of eyes develop at 2 - 4 months.


Question: The earliest clinical manifestation of siderosis bulbi is

Siderosis bulbi It refers to the degenerative changes produced by an iron foreign body. Sidesosis bulbi usually occurs after 2 months to 2 years of the injury. However, earliest changes have been repoed after 9 days of trauma. Clinical manifestations : 1. The anterior epithelium and capsule of the lens are involved first of all. Here, the rusty deposits are arranged radially in a ring. Eventually, the lens becomes cataractous. 2. Iris. It is first stained greenish and later on turns reddish brown. 3. Retina develops pigmentary degeneration which resembles retinitis pigmentosa. 4. Secondary open angle type of glaucoma occurs due to degenerative changes in the trabecular meshwork. Ref:- A K KHURANA; pg num:-409,410

Deposits in Descemet's membrane of cornea

Rusty deposits in the anterior subcapsular cells of the lens


Question: The only intact eye movement in one and a half syndrome is

One-and-a-half syndrome is due to a lesion of MLF combined with PPRF of same side. Loss of all horizontal movements except contralateral abduction, which shows abduction nystagmus. One and One half syndrome (right sided lesion) Eight and half syndrome consists of one and half syndrome with 7th nerve palsy.


Question: Most common cause of fracture of roof of orbit

"Orbital roof fracture should be suspected in any child presenting with blunt injury to the brow or forehead with subsequent development of a hematoma of the upper lid in the hours following injury ". — Pediatric ophthalmology


Question: Retinal neovacularization is seen in A/E


Question: Not a manifestation of non proliferative diabetic retinopathy

Drusens are pathognomic of dry ARMD and not diabetic retinopathy Manifestations OF non proliferative diabetic retinopathy - a. Microaneurysm: Saccular outpouchings of the vessel wall due to loss of pericytes b. Dot blot haemorrhage: Due to break of wall of microaneurysm in the deep layers c. Superficial haemorrhage: haemorrhage in superficial layers d. Hard exudates: Lipofuschin deposits in inner layer e. Cotton wool spots: NFL Infarction f. Intraretinal microvascular anomalies: abnormal communicating vessels between aeries and the veins g. Venous bleeding


Question: Corneal ulcer is defined as

Answer- C. Erosion of epithelium + underlying inflammationCorneal ulcer refers to discontinuation in normal epithelial surface of cornea associated with necrosis of the surrounding corneal tissue

Loss of endothelium with loss of corneal sensation


Question: Satellite nodules are seen in


Question: The gene known to be associated with Cataract

The gene known to be associated with Cataract is CRYA4.


Question: Commotio retinae is seen in

BLUNT TRAUMA Retina 1. Commotio retinae (Berlin's oedema): It is of common occurrence following a blow on the eye. It manifests as milky white cloudiness involving a considerable area of the posterior pole with a cherry-red spot' in the foveal region. 2. Retinal haemorrhages: These are quite common following concussion trauma. Multiple haemorrhages including flame-shaped and pre retinal (subhyaloid) D-shaped haemorrhage may be associated with traumatic retinopathy. 3. Retinal tears: These may follow a contusion, paicularly in the peripheral region, especially in eyes already suffering from myopia or senile degenerations. 4. Traumatic proliferative retinopathy (Retinitis proliferans): It may occur secondary to vitreous haemorrhage, forming tractional bands. 5. Retinal detachment: It may follow retinal tears or vitreo-retinal tractional bands. 6. Concussion changes at macula. Traumatic macular oedema is usually followed by pigmentary degeneration. Sometimes, a macular cyst is formed, which on rupture may be conveed into a lamellar or full thickness macular hole. Ref:- A K KHURANA; pg num:-406


Question: Specific for albinism

Ans. is 'a' i.e., Red reflex All the given options are seen in albinism. But, red reflex is specific. Ocular features in albinism - a Red reflex Pink or blue iris Dazzling glare Photophobia Decreased vision Nystagmus Clear retinal and choroidal vessels, separated by glistening white space Strabismus (mild to moderate)


Question: Earliest visual field change in open angle glaucoma is


Question: Retinoblastoma arises from

Arises from immature retinal neural cells.


Question: Most common primary intracranial tumour producing neuro ophthalmological feature

Chromophobe adenoma - M/c primary intracranial tumour producing neuroophthal features.


Question: Amsler grid is used in


Question: Chalazion of lid is aEUR'

Chronic lipogranulomatous inflammation Chalazion: Also known as tarsal or meilmmian cyst It is not a cyst. It results from obstruction of a sebaceous gland either meibomian or Zeis. Extravasated lipid material produces a surrounding chronic lipogranulomatous inflammation (Yanoff & Duker Ophthalmology) Acute lesions are treated with hot compresses while chronic chalazia are treated using intralesional coicosteroid (e.g. Triamcinolone acetonide) or by surgical drainage (incision & curettage)


Question: Volume of anterior chamber is

Volume of anterior chamber is 0.25 ml.
Volume of posterior chamber is 0.06 ml.


Question: Comment on the diagnosis of this patient with hypokalemic periodic paralysis.

Ans. (c) Grave's disease.* Thyrotoxicosis is sometimes associated with a form of hypokalemic periodic paralysis; this disorder is particularly common in Asian males with thyrotoxicosis.* Lid retraction, causing a staring appearance, can occur in any form of thyrotoxicosis and is the result of sympathetic overactivity.* However, Graves' disease is associated with specific eye signs that comprise Graves' ophthalmopathy* Many scoring systems have been used to gauge the extent and activity of the orbital changes in Graves' disease. The "NO SPECS" scheme is an acronym derived from the following eye changes:0 = No signs or symptoms1 = Only signs (lid retraction or lag), no symptoms2 = Soft-tissue involvement (periorbital edema)3 = Proptosis (>22 mm)4 = Extraocular-muscle involvement (diplopia)5 = Corneal involvement6 = Sight loss

Adverse Ocular Effects of Systemic Drugs


Question: Not seen in keratoconus


Question: Most common complication of Acute Anterior Uveitis is

Most common complication of Acute Anterior Uveitis is Cataract.


Question: Bacteria causing acute hemorrhagic conjunctivitis is

Pneumococcus is the only bacteria causing acute hemorrhagic conjunctivitis.


Question: Distichiasis is

Answer- B. Growth of eyelashes from Meibomian OrificesDistichiasis is a rare disorder defined as the abnormal grorvth of lashes from the orifces of the meibomian glands on the posterior lamella of the tarsal plate.

Increased number of lashes in the lower eyelid


Question: Not a feature of Ocular Mucous Membrane Pemphigoid

It is type 2 hypersensitivity and not type 1 Ocular Mucous Membrane Pemphigoid * Type II hypersensitivity * Age> 60 * MC in females * Chronic inflammatory subepithelial blistering disease with subsequent cicatrization C/F * Inflammatory signs * Cicatrization- Loss of fornices ,symblepharon, loss of limbal stem cells * Lid: Trichaiasis& Entropion * Cornea: Superficial punctate keratitis, corneal neovascularization & even perforation * Mucus of oral cavity, anus, vagina and urethra may be involved * Cutaneous vesicles & bullae may be formed * Involvement of trachea and esophagus Rx * Lubricants * Dapsone * Immunosuppressants * Treatment of severe dry eye


Question: Initial screening test for the auditory function in neonates

Ans. b. Otoacoustic Emissions The screening investigation of high-risk neonates in ICU for suspected hearing loss is otoacoustic emissions. Uses of OAE Screening test of hearing in neonatesQ Help to differentiate between cochlear and retrocochlear lesionsQ Used to diagnose retrocochlear pathologies especially auditory neuropathyQ


Question: Primary objective of use of atropine in anterior uveitis

A i.e. Rest to the ciliary muscle In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae - Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.


Question: The ocular symptom of Von Recklinghausen disease is

NF-1 is the most common phakomatosis, affecting 1:4000 individuals, and presents in childhood. The gene locus is on 17q11. For NF- 1, the diagnostic criteria are met if two or more of the following features listed are present: 1. Six or more cafe au lait (CAL) macules greater than 5 mm in prepubeal patients and greater than 15 mm in postpubeal patients 2. Two or more neurofibromas of any type, or one plexiform neurofibroma 3. Axillary or inguinal freckling 4. Optic nerve glioma 5. Two or more Lisch nodules (iris hamaomas) 6. A distinctive osseus lesion such as sphenoid wing dysplasia or coical thinning of long bones, with or without pseudoahrosis 7. A first degree relative with NF- 1 based on the preceding criteria The ocular features are as follows: Orbital involvement: Optic nerve glioma Other neural tumors Spheno-orbital encephalocele Eyelid neurofibromas Iris lesions: Lisch nodules Congenital ectropion uveae Mammillations Prominent corneal nerves Glaucoma--Congenital and infantile glaucomas are common Fundus lesions: Choroidal naevi (not hemangioma) Retinal astrocytomas Anterior chamber angle malformations

Deformed anterior chamber with reduced angle of AC


Question: First investigation to be done in Hyphema is

First investigation to be done in Hyphema is Tonometry to detect raised Intraocular pressure.


Question: Yolk muscle pair is

Yoke muscles (contralateral synergists)refers to the pair of muscles (one from each eye) which contract simultaneously during version movements. For example, right lateral rectus and left medial rectus act as yoke muscles for dextroversion movements. Other pairs of yoke muscles are: right MR and left LR, right LR and left MR, right SR and left IO, right and left SO, right SO and left IR, and right IO and Left SRRefer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 339

Right medial rectus & Right lateral rectus

Right medial rectus & Left lateral rectus

Right superior oblique & Left inferior oblque

Right superior rectus & Left superior rectus


Question: Deposition and degeneration of retina occurs in


Question: The magnification obtained by direct ophthalmoscope is

TECHNIQUE MAGNIFICATION FIELD OF VIEW CHARACTERISTICS Direct ophthalmoscopy 15X 5* Erect and viual Indirect ophthalmoscopy with +20D 3X 45* Inveed reversed and real Indirect ophthalmoscopy with +30D 2X 50* Inveed reversed and real Biomicroscopic examination with +78D 10X 30* Inveed reversed and real Biomicroscopic examination with +90D 7.5X 40* Inveed reversed and real Fundus camera 2.5X 30* Erect, viual, photo documentation Ref. : Khurana's Theory and Practice of Optics and Refraction; 2nd Ed; Pg. 386


Question: Treatment of choice for Aniseikonia

Treatment 1. Optical aniseikonia may be corrected by aniseikonic glasses, contact lenses or intraocular lenses depending upon the situation. 2. For retinal aniseikonia treat the cause. 3. Coical aniseikonia is very difficult to treat. Image : Aniseikonia Reference : A K KHURANA OPHTALMOLOGY,Edition 4,Page-39


Question: Secondary glaucoma in early stage of herpes zoster ophthalmlcus occurs due to

HERPES ZOSTER OPHTHALMICUS Ocular lesions: Ocular complications usually appear at the subsidence of skin eruptions and may present as a combination of two or more of the following lesions: 1. Conjunctivitis: It is one of the most common complication of herpes zoster. It may occur as mucopurulent conjunctivitis with petechial haemorrhages or acute follicular conjunctivitis with regional lymphadenopathy. Sometimes, severe necrotizing membranous inflammation may be seen. 2. Zoster keratitis: May precede the neuralgia or skin lesions. 3. Episcleritis and scleritis: These usually appear at the onset of the rash but are frequently concealed by the overlying conjunctivitis. 4. Iridocyclitis: It is of a frequent occurrence and may or may not be associated with keratitis. There may be associated hypopyon and hyphaema (acute haemorrhagic uveitis). 5. Acute retinal necrosis: 6. Anterior segment necrosis and phthisis bulbi. 7. Secondary glaucoma: It may occur due to trabeculitis in early stages and synechial angle closure in late stages. Ref:- A K KHURANA; pg num:-104,105


Question: Cherry red spot on retina is seen in A/E


Question: Megalocornea is not seen in

Megalocornea is a feature of

Marfan Syndrome
Alport syndrome
Down's syndrome
Ehler-Danlos Syndrome


Question: Amsler grid test is for

Amsler grid test is for testing Macular function. The Amsler grid is a tool that eye doctors use to detect vision problems resulting from damage to the macula (the central pa of the retina) or the optic nerve. The damage may be caused by macular degeneration or other eye diseases, so the Amsler grid is useful in detecting these problems. Reference: AK khurana 7th edition

Anatomy, Development and clinical examination


Question: The laser used in LASIK is

Answer- C. Excimer laserKrypton red Excimer ( argon fluoride)- Photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), LASIK, LASEK


Question: Herpetic keratitis is treated by

D i.e. Idoxuridine Drug of choice for herpetic keratitis is Acyclovir Q (topical) Other antiviral drugs used are - Idoxuridine - Trifluorothyrnidine - Vidarabine


Question: Treatment of CMV retinitis in AIDS patient is

Answer- D. ValganciclovirValganciclovir- pro-drug of ganciclovir that is taken orally and is as effective for both induction.


Question: Headache with bitemporal hemianopia with 6/6 vision is seen in

Ans. (c) Chiasmal lesionRef: Parson's, 22/e, p. 507-509May be seen in chaismal lesions caused by 3rd ventricular glioma leading to raised ICP.


Question: "Fleischer ring" is a distinct feature of

A condition in which the clear tissue on the front of the eye (cornea) bulges outward. Visual: astigmatism, blurred vision, distoed vision, double vision, inability to see in dim light, nearsightedness, sensitivity to light, or vision loss Also common: a rim of discolouration around the front of the eye (fleischer ring) Picture show Keratoconus, a non circular, non-centered oval caused by a bulging cornea. Very common in Keratoconus, it is best viewed under cobalt blue light, that's why the sclera looks blue. Reference: Ganong&;s review of medical physiology 25edition page 132

Anatomy, Development and clinical examination


Question: Normal conjunctival flora is

Answer- C. Coagulase negative staphylococciResident flora-Coagulase negative staphylococci (most common)MicrococciHaemphillusCorneybacterium xerosis


Question: Earliest feature of xerophthalmia is


Question: The termination of Descemet&;s membrane is

Descement's membrane The Descement's membrane is a strong homogeneous basement membrane of the corneal endothelium It consists of collagen and glycoproteins. Unlike Bowman's membrane it can regenerate. In the periphery it appears to end at the anterior limit of trabecular meshwork as Schwalbe's line (ring) Reference: A.K.Khurana; 6th edition; Page no:96

Anatomy, Development and clinical examination


Question: Sunset sign is seen in

Answer- B. HydrocephalusSun set sign: The scleraa revisible between theupper eyelid and their is, Sun setting sign is seen usually in hydrocephalus due to loss of upward conjugate gaze caused by raised intracranial pressure (ICP).


Question: Amaurosis Fugax is

Ans. a (Transient ischemic attack of retina). (Ref. Basak, Ophthalmology, 2nd ed., 222)AMAUROSIS FUGAX (Transient ischemic attack of the retina)# Because neural tissue has a high rate of metabolism, interruption of blood flow to the retina for more than a few seconds results in transient monocular blindness, a term used interchangeably with amaurosis fugax.# C/f: Patients describe a rapid fading of vision like a curtain descending, sometimes affecting only a portion of the visual field.# Amaurosis fugax usually occurs from an embolus that becomes stuck within a retinal arteriole.# Ophthalmoscopy:- reveals zones of whitened, edematous retina following the distribution of branched retinal arterioles.- Complete occlusion of the central retinal artery produces arrest of blood flow and a milky retina with a cherry-red fovea.- Emboli are composed of either cholesterol (Hollenhorst plaque), calcium, or platelet-fibrin debris.# The most common source is an atherosclerotic plaque in the carotid artery or aorta, although emboli can also arise from the heart-in patients with diseased valves, atrial fibrillation, or wall motion abnormalities.# Impending branch or central retinal vein occlusion can produce prolonged visual obscurations that resemble those described by patients with amaurosis fugax. The veins appear engorged and phlebitic, with numerous retinal hemorrhages. In some patients, venous blood flow recovers spontaneously, while others evolve a frank obstruction with extensive retinal bleeding ("blood and thunder" appearance), infarctionAura of migraine# In a typical attack, a small central disturbance in the field of vision marches toward the periphery, leaving a transient scotoma in its wake. Patients can confuse aura of migraine with amaurosis fugax.# The expanding border of migraine scotoma has a scintillating, dancing, or zig-zag edge, resembling the bastions of a fortified city, hence the term fortification spectra (Teichopsia).Educational points:D/D of "cherry red" spot on fundus# CRAO,# Blunt injury (Berlin's edema of macula),# Tay-Sach's disease,# Niemann-Pick disease,# Sandhoff's disease & quinine anblyopia.# "Cattle-track" appearance is other important feature of CRVO, apart from Hollenhorst plauge.

Retinal detachment in diabetic retinopathy


Question: The most common second malignant in survival of retinoblastoma

Osteogenic sarcoma is the most common ocular malignancy in retinoblastoma. IT occurs in hereditary cases Refer khurana 6/e p 421

Diseases of orbit, Lids and lacrimal apparatus


Question: Vitreous attachment to the retina is strongest at

(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 264) Vitreous is attached anteriorly to the lens (Hyaloid capsular ligament of Wieger) and ciliary epithelium in front of the ora serrata. The pa of vitreous about 4mm across the ora serrata is known as the "base of vitreous" where the attachment is strongest. Posteriorly vitreous is attached to the edge of the optic disc and macula lutea (foveal region) forming a ring-shaped structure around them


Question: Fincham test is used to diagnose

Ans. (b) CataractRef: Khurana 4/e, p. 146If the halos break it is due to cataract and if not it is due to angle closure glaucoma.Thus, the test is positive in diagnosing cataract. Glaucoma is not being diagnosed by this test. It is a diagnosis by exclusion.


Question: The earliest symptom to occur in corneal ulcer is


Question: Cobblestone appearance is seen in

Cobblestone appearance is severe papillary hyperplasia in upper palpebral conjunctiva Refer: Khurana 6th edition page number 73


Question: In aphakia, Purkinje fibres absent are

Purkinje images test. This test does not have much significance and thus is not frequently employed in clinical practice. Normally, when a strong beam of light is shown to the eye, fpur images(Purkinje images) are formed from the four different reflecting surfaces viz. anterior and posterior surfaces of cornea and anterior and posterior surface of lens. In patients with mature cataract, fouh image (formed by posterior surface of the lens) is absent i.e., three Purkinje images are formed. In aphakia, third and fouh Purkinje images ( formed by anterior and posterior surface of lens) are absent, i.e., only two images are formed. Ref;A.K.Khurana; 6th edition; Page no: 506


Question: Safe strategy is for

Ans is 'a' i.e. Trachoma 'SAFE' strategy is a WHO recommended strategy to fight trachoma.'SAFE' strategy for Trachoma It includesSurgery - first component of the strategy for correction of trichiasis and entropionAntibiotics - Zithromax (azithromycin) single dose oral medication is used (Zithromax is donated by Pfizer Inc.) Tetracycline eye ointment was used before Pfizer donated Zithromax.Face washing -breaks the cycle of reinfection and prevents transmission of disease.Environmental Improvement - Poverty and poor living conditions contribute to high rates of blinding trachoma. Environmental improvement includesavailability of improved water suppliesimproved household sanitation, particularly safe disposal of faeces.


Question: Cause of asymmetrical enlargement of orbit

Asymmetrical enlargement of orbit

Rhabdomyosarcoma
Dermoidcyst
Lacrimal gland tumour.


Question: Retina is derived from

BASIC ANATOMY * Retina is the light sensitive tissue of the eye * Derived from neural ectoderm. * Extends from optic disc to ora serrata * Embryologically derived into two pas * Outer Pigmented Layer: Forms RPE (6th week) Inner neural layer: Neurosensory retina(40th week) 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: Agent used for dilatation of pupil in children is


Question: Persistant pupillary membrane originates from

Persistant pupillary membrane

Developmental abnormality of iris.
Starts at iris collarette (thickest part of iris).


Question: Bilateral ptosis is not seen in

A i.e. Marfan's Syndrome Marfan's Syndrome does not present with ptosis. It has bilateral subluxation of lens, retinal detachment, hypoplasia of dilator pupilae, flat cornea, axial myopia & angle anomaly etc.


Question: Amsler grid test is used for diagnosis of

Ans. b (Age related macular degeneration) (Ref. Clinical ophthalmology by By Jack J. Kanski Ip. 383)THE AMSLER GRID# used to test the macula, the very central part of the retina (the presence of central field defects or metamorphopsia). The test is simply a grid made of evenly spaced horizontal and vertical lines. A small dot is located in the center of the grid for fixation.# The Amsler grid is a grid of lines used to test for Age-Related Macular Degeneration (ARMD). Each eye is tested individually, with any perceived distortion of the grid considered to be a positive test.# Using Amsler grid is the simplest way for people with ARMD and Stargardt's to monitor their progress.# It contains 7 charts and 400 squares.GroupDefinitionNo AMDLess than 5 small drusen {<63 mm) within 3000 mm from foreal center in the study eyeMild AMDMore than 5 small srusen and /or less than 5 intermediate drusen (<63 mm but <125 mm) within 3000 mm from foveal center in the study eyeIntermediate AMDMore than 5 intermediate drusen and any large drusen (>125 mm) within 3000 mm from foveal center in the study eyeNeovascular AMDActive CNV with less than 50% fibrotic component and visual acuity >20/160Educational Points:# Ishihara chart is used to detect congenital color defects.# Amsler sign: noted in patients with Fuchs' heterochromic cyclitis (bleeding from neovascularized vessels following AC paracentesis).


Question: Polychromatic lusture is seen in

Polychromatic luster is a pathognomic feature of complicated cataract which is most commonly posterior subcapsular Refer: Khurana 6th edition page number 187