Glaucoma Practice Questions

Q: Chronic simple glaucoma is a type of_____ glaucoma?

Primary open angle. **Explanation:** **Chronic Simple Glaucoma** is the synonymous clinical term for **Primary Open Angle Glaucoma (POAG)**. It is a chronic, progressive optic neuropathy characterized by a triad of: 1. **Open anterior chamber angles** (on gonioscopy). 2. **Characteristic optic disc changes** (cupping). 3. **Corresponding visual field defects** (e.g., arcuate scotoma). The condition is "Primary" because it occurs without an identifiable systemic or ocular cause, and "Open Angle" because the trabecular meshwork is visible, though its microscopic resistance to aqueous outflow is increased, leading to elevated Intraocular Pressure (IOP). **Analysis of Incorrect Options:** * **Option A (Primary Closed Angle):** This involves physical apposition between the iris and the cornea, blocking the drainage angle. It is usually acute or subacute and presents with a shallow anterior chamber. * **Options C & D (Secondary Glaucomas):** These occur due to identifiable pre-existing ocular conditions (e.g., pseudoexfoliation, pigment dispersion, uveitis, or trauma). Chronic simple glaucoma, by definition, lacks these secondary triggers. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Age (>40 years), Family history, Myopia, Diabetes Mellitus, and African race. * **Early Sign:** The earliest visual field defect is often a **Paracentral scotoma** or **Siedel’s sign**. * **Treatment:** Prostaglandin analogues (e.g., Latanoprost) are the first-line medical management. * **Gold Standard Diagnosis:** Goldmann Applanation Tonometry (for IOP) and Humphrey Visual Field analysis.

Q: Trabecular (conventional) outflow of aqueous humor accounts for what percentage?

90 percent. **Explanation:** The drainage of aqueous humor from the anterior chamber occurs via two primary pathways. The **Trabecular (Conventional) pathway** is the predominant route, accounting for approximately **90%** of total aqueous outflow. In this pathway, fluid flows through the trabecular meshwork, into the Canal of Schlemm, and eventually enters the episcleral veins. This route is pressure-dependent, meaning the rate of drainage increases as intraocular pressure (IOP) rises. **Analysis of Options:** * **Option A (90%):** Correct. Standard physiological data indicates that the vast majority of aqueous exits via the trabecular route. * **Options B, C, and D:** These are incorrect because they underestimate the contribution of the conventional pathway. The remaining **10%** of aqueous drainage occurs via the **Uveoscleral (Unconventional) pathway**, where fluid passes through the ciliary muscle into the suprachoroidal space. **High-Yield Clinical Pearls for NEET-PG:** 1. **Uveoscleral Pathway:** While it only accounts for 10% of drainage, it is the primary target for **Prostaglandin analogues** (e.g., Latanoprost), which increase outflow through this route. 2. **Resistance Site:** The maximum resistance to aqueous outflow in a normal eye is located at the **juxtacanalicular trabecular meshwork** (the portion closest to the Canal of Schlemm). 3. **Steroid-Induced Glaucoma:** Corticosteroids reduce the permeability of the trabecular meshwork, leading to decreased conventional outflow and increased IOP. 4. **Blood in Schlemm’s Canal:** Can be seen during gonioscopy if episcleral venous pressure exceeds IOP (e.g., in Sturge-Weber Syndrome).

Q: Which of the following is NOT a cause of hypotony maculopathy?

Suprachoroidal hemorrhage. **Explanation:** **Hypotony maculopathy** occurs when intraocular pressure (IOP) drops significantly (usually <6 mmHg), leading to structural collapse of the globe. This results in chorioretinal folds, vascular engorgement, and edema in the macular region, which can cause permanent vision loss. **Why Suprachoroidal Hemorrhage is the Correct Answer:** Suprachoroidal hemorrhage (SCH) involves the accumulation of blood in the suprachoroidal space. This is a **space-occupying lesion** that causes a sudden **increase** in intraocular pressure (acute glaucoma) and a shallowing of the anterior chamber. Because it is associated with high IOP (hypertony) rather than low IOP, it cannot cause hypotony maculopathy. **Analysis of Incorrect Options:** * **Perforating corneal ulcer:** Any full-thickness breach in the globe (trauma or ulcer) leads to the leakage of aqueous humor, causing profound hypotony. * **Overfiltering bleb:** A common complication of trabeculectomy where excessive drainage of aqueous into the subconjunctival space lowers IOP below physiological limits. * **Cyclodialysis:** This involves the separation of the ciliary body from the scleral spur, creating an abnormal drainage pathway for aqueous into the suprachoroidal space, leading to chronic hypotony. **NEET-PG High-Yield Pearls:** * **Definition of Hypotony:** IOP < 6 mmHg. * **Classic Sign:** "Stellate" or radial chorioretinal folds centered at the fovea. * **Common Causes:** Post-surgical leak (most common), cyclodialysis cleft, ciliary body detachment, and pharmacological inhibition of aqueous (e.g., Cidofovir). * **Management:** The primary goal is to identify and fix the source of the leak or over-filtration to restore normal IOP.

Q: Secondary glaucoma in the early stage of herpes zoster ophthalmicus occurs due to:

Trabeculitis. **Explanation:** The correct answer is **A. Trabeculitis.** In the **early stage** of Herpes Zoster Ophthalmicus (HZO), secondary glaucoma is primarily caused by an inflammatory process involving the trabecular meshwork, known as **trabeculitis**. The Varicella-Zoster Virus (VZV) causes direct viral infiltration and inflammation of the trabecular cells, leading to edema and reduced outflow facility of the aqueous humor. This results in a sudden, often significant, rise in intraocular pressure (IOP). **Analysis of Options:** * **B. Iridocyclitis:** While HZO frequently causes iridocyclitis (uveitis), the glaucoma associated with it is specifically due to the inflammation of the drainage channels (trabeculitis) rather than the inflammation of the iris/ciliary body itself. In late stages, uveitis can cause glaucoma via synechiae, but trabeculitis is the hallmark of the early phase. * **C. Hemorrhagic hypopyon:** This is a rare finding and not a standard mechanism for glaucoma in HZO. * **D. Hypersecretion of aqueous humor:** Glaucoma is almost always a result of decreased outflow, not increased production (hypersecretion) of aqueous humor. **High-Yield Clinical Pearls for NEET-PG:** * **Hutchinson’s Sign:** Vesicles on the tip or side of the nose (involving the nasociliary nerve) indicate a high risk of ocular involvement in HZO. * **Sectoral Iris Atrophy:** A classic late-stage complication of HZO-related uveitis due to ischemic vasculitis. * **Treatment:** Management involves topical steroids to control inflammation and aqueous suppressants (like Beta-blockers or Carbonic anhydrase inhibitors) to lower IOP. **Prostaglandin analogues** are generally avoided in active viral uveitis as they may exacerbate inflammation.

Q: Very high intraocular pressure, vertically oval mid-dilated pupil, and shallow anterior chamber are seen in which condition?

Acute primary angle closure glaucoma. ### Explanation **Correct Answer: B. Acute primary angle closure glaucoma (APACG)** The clinical triad described—**very high intraocular pressure (IOP)**, a **vertically oval mid-dilated pupil**, and a **shallow anterior chamber**—is the classic presentation of an acute attack of angle-closure glaucoma. * **Pathophysiology:** A sudden total blockage of the drainage angle leads to a rapid rise in IOP (often 40–70 mmHg). This high pressure causes **ischemia of the iris sphincter muscle**, resulting in a pupil that is non-reactive and fixed in a mid-dilated, vertically oval position. The shallow anterior chamber is the predisposing anatomical factor. **Why other options are incorrect:** * **A. Primary Open Angle Glaucoma (POAG):** This is a "silent" chronic condition. The IOP rises gradually, the anterior chamber depth is normal, and the pupil remains normal. * **C. Malignant Glaucoma (Ciliary Block):** While it presents with a shallow chamber and high IOP, it typically occurs **post-operatively** (e.g., after glaucoma surgery). The hallmark is the flattening of both the central and peripheral anterior chamber. * **D. Pupillary Block Glaucoma:** This is the *mechanism* behind most cases of angle closure, but "Acute Primary Angle Closure Glaucoma" is the specific clinical diagnosis that encompasses the full constellation of symptoms (pain, vomiting, and pupillary changes). **High-Yield Clinical Pearls for NEET-PG:** * **Symptoms:** Sudden ocular pain, headache, nausea, vomiting, and seeing **colored halos** around lights (due to corneal edema). * **Cornea:** Appears "steamy" or "cloudy" (ground-glass appearance). * **Immediate Management:** IV Mannitol, Acetazolamide, and topical Beta-blockers to lower IOP. * **Definitive Treatment:** **Laser Peripheral Iridotomy (LPI)** is the treatment of choice for both the affected eye and the fellow (prophylactic) eye.

Q: Primary open-angle glaucoma is associated with all of the following EXCEPT?

Pars planitis. **Explanation:** Primary Open-Angle Glaucoma (POAG) is a chronic, progressive optic neuropathy characterized by an open anterior chamber angle and typical optic disc changes. The question asks for the condition **not** associated with POAG. **Why Pars Planitis is the correct answer:** Pars planitis is a form of intermediate uveitis. While it can lead to increased intraocular pressure, it causes **Secondary Glaucoma** (due to inflammatory debris or steroid use), not Primary Open-Angle Glaucoma. POAG, by definition, occurs in the absence of an underlying ocular or systemic disease that physically obstructs the trabecular meshwork. **Analysis of incorrect options (Risk factors for POAG):** * **Diabetes Mellitus:** There is a strong clinical association between DM and POAG. Proposed mechanisms include microangiopathy of the optic nerve head and metabolic dysfunction of the trabecular meshwork. * **Myopia:** High myopia is a well-established risk factor. Myopic eyes often have structural changes in the lamina cribrosa that make the optic nerve more susceptible to pressure-induced damage. * **Hyperthyroidism:** Thyroid eye disease (Graves' ophthalmopathy) is associated with increased episcleral venous pressure and orbital congestion, which correlates with a higher prevalence of open-angle glaucoma. **High-Yield Clinical Pearls for NEET-PG:** * **Major Risk Factors for POAG:** Age (>40 years), Family history (Heredity), Race (African-Americans), Raised IOP, and Cardiovascular disease (Hypertension). * **Steroid-Induced Glaucoma:** This is a type of secondary open-angle glaucoma that must be differentiated from POAG. * **Genetic Link:** Mutations in the **MYOC** (Myocilin) gene are most commonly associated with POAG. * **Diagnosis:** Requires the triad of raised IOP (usually), characteristic optic disc cupping, and specific visual field defects (e.g., Bjerrum’s scotoma).

Q: What is the earliest symptom of congenital glaucoma?

Photophobia. **Explanation:** Congenital glaucoma (Buphthalmos) results from developmental anomalies of the angle of the anterior chamber, leading to increased intraocular pressure (IOP). **Why Photophobia is the correct answer:** Photophobia is considered the **earliest** and most common symptom. It occurs due to corneal edema caused by elevated IOP. When the cornea swells, it causes light to scatter, irritating the rich nerve endings of the corneal epithelium. This leads to the classic triad of symptoms: **Photophobia, Lacrimation, and Blepharospasm.** While all three often appear together, photophobia is clinically recognized as the initial sign that parents notice. **Analysis of Incorrect Options:** * **Lacrimation (A) and Blepharospasm (B):** These are part of the classic triad but are usually secondary responses to the irritation caused by corneal edema and photophobia. They occur almost simultaneously but are preceded by light sensitivity. * **Diminution of vision (D):** This is a late feature. In infants, vision loss occurs much later due to optic nerve damage (cupping), corneal scarring, or secondary amblyopia. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Photophobia + Lacrimation + Blepharospasm. * **Earliest Sign:** Corneal edema (hazy cornea). * **Haab’s Striae:** Horizontal or curvilinear breaks in Descemet’s membrane due to corneal stretching. * **Buphthalmos:** "Ox-eye" appearance; occurs because the infant's sclera is distensible and stretches when IOP is >21 mmHg (usually seen if glaucoma occurs before age 3). * **Treatment of Choice:** Surgery is the primary treatment. **Goniotomy** (if the cornea is clear) or **Trabeculotomy/Trabeculectomy** (if the cornea is hazy). Medical therapy is only a temporary measure.

Q: Which type of glaucoma is associated with cataract?

Phacomorphic glaucoma. **Explanation:** **Phacomorphic glaucoma** is a type of secondary angle-closure glaucoma caused directly by an advanced cataract. As the lens becomes **intumescent** (swollen and enlarged) during the cataractous process, it pushes the iris-lens diaphragm forward. This leads to pupillary block and subsequent narrowing or closure of the anterior chamber angle, resulting in a rapid rise in intraocular pressure (IOP). **Analysis of Incorrect Options:** * **Neovascular glaucoma:** This is a secondary glaucoma caused by the growth of new vessels (neovascularization) on the iris and angle, typically triggered by retinal ischemia (e.g., Diabetic Retinopathy or CRVO), not the lens itself. * **Phacoanaphylactic glaucoma:** This is an inflammatory (uveitic) glaucoma caused by a hypersensitivity reaction to lens proteins following trauma or surgery. While lens-related, it is primarily an **immunological** response rather than a direct mechanical effect of the cataractous mass. * **Buphthalmos:** This refers to the "ox-eye" appearance (enlarged eyeball) seen in **Congenital Glaucoma** due to the distensibility of the infant sclera under high IOP. It is not associated with adult cataract formation. **High-Yield Clinical Pearls for NEET-PG:** * **Phacolytic Glaucoma:** Occurs when a **hypermature** cataract leaks soluble lens proteins through an intact capsule, which then clog the trabecular meshwork (a form of open-angle glaucoma). * **Treatment of Phacomorphic Glaucoma:** Immediate medical management to lower IOP, followed by **cataract extraction** (definitive treatment). * **Key Distinction:** Phacomorphic = Swollen lens (Angle-closure); Phacolytic = Leaking proteins (Open-angle).

Question 1

Chronic simple glaucoma is a type of_____ glaucoma?

Accepted Answer

Primary open angle

Answer

Primary closed angle

Answer

Secondary open angle

Answer

Secondary closed angle

Question 2

Which statement regarding glaucoma is true?

Accepted Answer

None of the above.

Answer

If recognized early, the optic neuropathy of glaucoma is reversible.

Answer

Topical B-adrenergic antagonists have few if any side effects due to their systemic absorption.

Answer

The initial symptom of optic neuropathy due to glaucoma is loss of central vision.

Question 3

Trabecular (conventional) outflow of aqueous humor accounts for what percentage?

Accepted Answer

90 percent

Answer

80 percent

Answer

70 percent

Answer

60 percent

Question 4

Which of the following is NOT a cause of hypotony maculopathy?

Accepted Answer

Suprachoroidal hemorrhage

Answer

Perforating corneal ulcer

Answer

Overfiltering bleb

Answer

Cyclodialysis

Question 5

Secondary glaucoma in the early stage of herpes zoster ophthalmicus occurs due to:

Accepted Answer

Trabeculitis

Answer

Iridocyclitis

Answer

Hemorrhagic hypopyon

Answer

Hypersecretion of aqueous humor

Question 6

Which tonometer is characterized by a variation in its application surface?

Accepted Answer

Maklakov tonometer

Answer

Mackey-Marg tonometer

Answer

Rebound tonometer

Answer

Dreger's tonometer

Question 7

Very high intraocular pressure, vertically oval mid-dilated pupil, and shallow anterior chamber are seen in which condition?

Accepted Answer

Acute primary angle closure glaucoma

Answer

Primary open angle glaucoma

Answer

Malignant glaucoma

Answer

Pupillary block glaucoma

Question 8

Primary open-angle glaucoma is associated with all of the following EXCEPT?

Accepted Answer

Pars planitis

Answer

Diabetes mellitus

Answer

Myopia

Answer

Hyperthyroidism

Question 9

What is the earliest symptom of congenital glaucoma?

Accepted Answer

Photophobia

Answer

Lacrimation

Answer

Blepharospasm

Answer

Diminution of vision

Question 10

Which type of glaucoma is associated with cataract?

Accepted Answer

Phacomorphic glaucoma

Answer

Neovascular glaucoma

Answer

Phacoanaphylactic glaucoma

Answer

Buphthalmos

Glaucoma — MCQs

Glaucoma — MCQs

On this page

Practice by Chapter

Want unlimited practice?