Glaucoma MCQs

CRVO is not an emergency in eye The ocular emergencies are Ischemic optic neuropathy: rule out giant-cell arteritis (GCA) Central retina artery occlusion: rule out GCA and causes of emboli/thrombus Mac-on rhegmatogenous retinal detachmen Acute third nerve palsy: rule out intracranial aneurysm Open globe: rule out intraocular foreign body Acute angle closure glaucoma Endophthalmitis Alkali injury: requires urgent and copious irrigation Orbital cellulitis Reference: kanski 9/e chapter 22 pg. 892-916

The use of cycloplegic agents for cycloplegic refraction is an important part in the evaluation of patients with complaints pertaining to binocular vision and ocular motility. Adverse reactions to cycloplegic agents(anticholinergics) include allergic or hypersensitive reaction with conjunctivitis, eyelid edema and dermatitis. Psychological effects have been observed in children receiving the drug. Adverse reactions occur more frequently with atropine compared to other agents. Systemic intoxication from atropine manifests as dry mouth, fever, flushing of the face, rapid pulse, nausea, dizziness, delirium and erythema. Patients with previous adverse side effects are at risk for adverse reactions to further use of the offending cycloplegic agents. In none of the other conditions are cycloplegic drops contraindicated. Reference: Kanski, 6th edition, Pg no. 756.

Ans. D. Small lens Predisposing factors for PACG :- i) Shallow anterior chamber,ii) Short eye (short axiallensth),i1i) Smaller corneal diameter, iv) Anterior location of iris-lens diaphragm, v) Hlpermetropic eye, vi) Large lens (older cataractous).

Morgagnian cataract can lead to phacolytic glaucoma and phacoanaphylactic uveitis. Hypermature cataract has two varieties. Sclerotic cataract : The lens becomes shrunken and small with calcification on the anterior capsule. There is wrinkling of the lens capsule. It predisposes to subluxation of lens. Morgagnian cataract : There is total liquefaction of the cortex as a result of which the nucleus sinks inferiorly. The liquefied cortex leaks through the intact capsule and blocks the trabecular meshwork. This leads to phacolytic glaucoma or lens protein glaucoma. It also causes phacoanaphylactic uveitis . Reference: Yanoff and Duker 4th edition 415-416

This describes a case of HMSC morgagnian cataract with lens proteins blocking the TM and hence increase the IOP. It is a type of secondary open angle glaucoma. Reference: parson 21st edition pg 288

Trisomy 13 Patau Syndrome Microphthalmos Colobomas Retinal dysplasia Cataract Corneal opacities Optic nerve hypoplasia Cyclopia Intra-ocular cartilage Trisomy 18 Edwards syndrome Blepharophimosis Ptosis Epicanthal fold Hypertelorism Microphthalmos Uveal coloboma Congenital glaucoma Corneal opacities Cataract and hypoplasia of optic nerves in both eyes, retinal dysplasia and Bergmeister's papilla Trisomy 21 G Trisomy or Down's syndrome Upward slanting palpebral fissure(Mongoloid slant) Almond-shaped palpebral fissure Epicanthus Telecanthus Narrowed interpupillary distance Esotropia High refractive errors Cataract Iris hypoplasia Keratoconus Reference: A. K. Khurana, 5th edition, Page no. 439/440.