Glaucoma Practice Questions

Q: Descemet membrane breach is seen in ?

Congenital glaucoma (Buphthalmos). ***Congenital glaucoma (Buphthalmos)*** - In **congenital glaucoma**, increased intraocular pressure (IOP) in infancy stretches the developing eye, leading to enlargement (buphthalmos) and **Descemet membrane breaches** or ruptures. - These ruptures appear as fine, parallel, or branching lines on the posterior corneal surface, known as **Haab's striae**, which are characteristic signs of this condition. *Angle closure glaucoma* - This condition involves a sudden rise in IOP due to physical obstruction of the **aqueous humor outflow** and does not typically cause Descemet membrane breaks. - Clinical signs include **corneal edema** due to endothelial dysfunction, but not membrane breaches. *Acute Iridocyclitis* - **Acute iridocyclitis** is an inflammatory condition of the iris and ciliary body, primarily causing cells and flare in the anterior chamber. - It does not directly lead to **Descemet membrane breaches** or structural damage like stretching of the cornea. *Subconjunctival hemorrhage* - This condition is characterized by **bleeding under the conjunctiva** and is typically due to ruptured conjunctival blood vessels. - It is a superficial condition that does not involve the cornea or the Descemet membrane.

Q: What are the characteristic features of Posner-Schlossman syndrome?

Unilateral glaucomatous changes with mild anterior uveitis. ***Unilateral glaucomatous changes with mild anterior uveitis*** - Posner-Schlossman syndrome, also known as **glaucomatocyclitic crisis**, is characterized by recurrent, acute attacks of **unilateral elevated intraocular pressure** (glaucomatous changes). - These attacks are accompanied by **mild anterior uveitis**, which typically presents with few or no precipitates and minimal redness. *Ipsilateral optic atrophy with contralateral papilloedema* - This constellation of symptoms, known as **Foster Kennedy syndrome**, is associated with intracranial masses, not Posner-Schlossman syndrome. - It involves **optic atrophy** in one eye due to direct pressure on the optic nerve and **papilledema** in the other eye due to increased intracranial pressure. *Granulomatous uveitis with iris heterochromia* - **Granulomatous uveitis** is characterized by large mutton-fat keratic precipitates and often seen in diseases like sarcoidosis or tuberculosis, which is not typical for Posner-Schlossman. - **Iris heterochromia** (different colored irises) is a characteristic feature of **Fuchs' heterochromic cyclitis**, another form of chronic anterior uveitis, but not Posner-Schlossman syndrome. *None of the options* - This option is incorrect as one of the provided choices accurately describes the characteristic features of Posner-Schlossman syndrome. - The other options describe different ophthalmological conditions.

Q: Drug of choice for open angle glaucoma:

Latanoprost. ***Latanoprost*** - **Prostaglandin F2α analogs** like latanoprost are generally considered **first-line therapy** for open-angle glaucoma due to their efficacy and once-daily dosing. - They work by **increasing uveoscleral outflow** of aqueous humor, thereby lowering intraocular pressure (IOP). *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** that reduces aqueous humor production. - It is typically used for **acute angle-closure glaucoma** or when initial treatments fail, often due to systemic side effects with long-term use. *Timolol* - **Timolol** is a **non-selective beta-blocker** that reduces aqueous humor production. - While effective, it is often a second-line agent or used in combination due to potential systemic side effects like **bronchospasm** and **bradycardia**. *Brimonidine* - **Brimonidine** is an **alpha-2 adrenergic agonist** that reduces aqueous humor production and increases uveoscleral outflow. - It is typically used as a second-line agent or in combination therapy due to potential side effects like **ocular pruritus** and **allergic conjunctivitis**.

Q: Which Goldmann type is considered the standard in perimetry?

Goldmann type III (commonly used stimulus size). ***Goldmann type III (commonly used stimulus size)*** - This stimulus size is the **international standard** for kinetic perimetry and ensures comparability of visual field charts worldwide. - It provides a balance between **sensitivity** and minimizing the effects of **pupil size** and other ocular factors. *Goldmann type I (small stimulus size)* - While very small, this stimulus type is **not the standard** for general perimetry. - It is sometimes used for detecting **subtle defects** or for patients with very good visual acuity, but its small size can make it harder to detect. *Goldmann type II (medium-small stimulus size)* - This stimulus size is **smaller than the standard** and is not universally adopted for perimetry. - It offers slightly more sensitivity than the standard but can be more affected by **refractive errors** or media opacities. *Goldmann type IV (large stimulus size)* - This stimulus is **much larger than the standard** and is typically used for detecting **gross defects** or in patients with severely impaired vision. - Its large size makes it **less sensitive** to smaller visual field abnormalities.

Q: What is the most common symptom associated with congenital glaucoma?

Excessive tearing. ***Excessive tearing*** - **Epiphora**, or excessive tearing, is one of the most common early symptoms of **congenital glaucoma** in infants. - This symptom occurs due to **corneal irritation** and **damage** resulting from elevated intraocular pressure. *Eye pain* - While glaucoma can cause eye pain, it is less commonly reported as the *initial* and *most frequent* symptom in **congenital glaucoma** in infants who cannot verbalize their discomfort. - **Irritability** or excessive crying might be indirect signs of pain, but tearing is a more direct and observable sign. *Sensitivity to light* - **Photophobia**, or sensitivity to light, is another common symptom of congenital glaucoma. - However, **excessive tearing** often precedes or co-occurs with photophobia as an initial presenting symptom in infants. *Itching of the eyes* - **Ocular itching** is typically associated with **allergic conjunctivitis** or other inflammatory conditions, not directly with congenital glaucoma. - Itching is not a primary or common symptom of elevated intraocular pressure in infants.

Q: What is the first-line treatment for acute angle closure glaucoma?

Acetazolamide. **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.

Q: Type of laser used for iridotomy?

Nd:YAG laser. ***Nd:YAG laser*** - The **Nd:YAG laser** is the most commonly used laser for performing a laser peripheral iridotomy due to its ability to create a small perforation in the iris. - Its **photodisruptive** mechanism allows for precise tissue disruption with minimal thermal damage to surrounding structures. *Excimer laser* - **Excimer lasers** operate in the **ultraviolet (UV) spectrum** and are primarily used in refractive surgery (e.g., LASIK) for corneal reshaping. - They are not suitable for iridotomy due to their limited penetrating ability and potential for corneal damage. *Krypton laser* - **Krypton lasers** produce red and yellow light, and were historically used for **photocoagulation** in retinal diseases. - They are not typically used for iridotomy as their primary mechanism is thermal coagulation rather than tissue disruption. *Diode laser* - **Diode lasers** are used in ophthalmology for various applications, including **photocoagulation** in the retina and transscleral cyclophotocoagulation for glaucoma. - While they can deliver energy to tissues, they are generally less effective and precise for creating a peripheral iridotomy compared to the Nd:YAG laser.

Q: Van Herick angle grade '3' of anterior chamber denotes

Moderately open angle. ***Moderately open angle*** - A **Von Herick angle grade 3** indicates that the width of the peripheral anterior chamber is approximately **one-quarter to one-half** the thickness of the peripheral cornea. - This assessment suggests a **moderately open anterior chamber angle**, indicating that while there is some risk of angle closure, it is not immediately narrow. *Wide open angle* - A **wide open angle** is typically represented by a **Von Herick grade 4**, where the anterior chamber angle is as wide or wider than the corneal thickness. - This grade signifies a **low risk of angle closure** and good aqueous outflow. *Narrow angle* - A **narrow angle** is generally associated with **Von Herick grades 1 or 2**, where the anterior chamber is significantly shallower. - Grade 1 indicates an angle width of **less than one-quarter** of peripheral corneal thickness, posing a higher risk of angle closure. *Closed angle* - A **closed angle** represents an extreme case where the **iris is in contact with the trabecular meshwork**, blocking aqueous outflow. - This condition is not typically graded in the Von Herick system as an existent angle, but rather as an absence of a visible angle (grade 0 or **"slit"**).

Q: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Posner-Schlossman syndrome. ***Posner-Schlossman syndrome*** - Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**. - The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma. - Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg). *Foster-Kennedy syndrome* - This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor. - It does not involve anterior uveitis or primary elevated intraocular tension. - This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition. *Vogt-Koyanagi-Harada syndrome* - An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms. - While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis. - IOP may be elevated but not the defining feature with dramatic episodic rises. *Fuchs heterochromic iridocyclitis* - A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia. - May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes. - Inflammation is typically **quiet and chronic** rather than acute and recurrent.

Q: Which of the following is not a risk factor for angle closure glaucoma?

Small lens. ***Correct Answer: Small lens*** - A smaller lens would lead to a **deeper anterior chamber**, reducing the likelihood of iridotrabecular contact and angle closure. - In contrast, a **large or thick lens** is a well-established risk factor for angle closure glaucoma as it pushes the iris forward, causing pupillary block. - Small lens size is **NOT a risk factor** for angle closure glaucoma. *Incorrect: Small eye* - A small eye (e.g., in **nanophthalmos**) is associated with a relatively large lens in proportion to the eye size, which can push the iris forward and narrow the angle. - This anatomical configuration makes individuals more prone to **pupillary block** and angle closure. *Incorrect: Hypermetropia* - **Hyperopic eyes** tend to be shorter with reduced axial length, which often results in a shallower anterior chamber and a relatively crowded anterior segment. - This shallow anterior chamber increases the risk of the iris occluding the **trabecular meshwork**, predisposing to angle closure. *Incorrect: Small cornea* - A small corneal diameter can be indicative of a generally smaller anterior segment, often correlating with a **shallow anterior chamber**. - A smaller cornea contributes to a more crowded anterior segment, predisposing to **angle closure glaucoma**.

Question 1

Descemet membrane breach is seen in ?

Accepted Answer

Congenital glaucoma (Buphthalmos)

Answer

Angle closure glaucoma

Answer

Acute Iridocyclitis

Answer

Subconjunctival hemorrhage

Question 2

What are the characteristic features of Posner-Schlossman syndrome?

Accepted Answer

Unilateral glaucomatous changes with mild anterior uveitis

Answer

Ipsilateral optic atrophy with contralateral papilloedema

Answer

Granulomatous uveitis with iris heterochromia

Answer

None of the options

Question 3

Drug of choice for open angle glaucoma:

Accepted Answer

Latanoprost

Answer

Acetazolamide

Answer

Brimonidine

Answer

Timolol

Question 4

Which Goldmann type is considered the standard in perimetry?

Accepted Answer

Goldmann type III (commonly used stimulus size)

Answer

Goldmann type I (small stimulus size)

Answer

Goldmann type II (medium-small stimulus size)

Answer

Goldmann type IV (large stimulus size)

Question 5

What is the most common symptom associated with congenital glaucoma?

Accepted Answer

Excessive tearing

Answer

Eye pain

Answer

Sensitivity to light

Answer

Itching of the eyes

Question 6

What is the first-line treatment for acute angle closure glaucoma?

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 7

Type of laser used for iridotomy?

Accepted Answer

Nd:YAG laser

Answer

Excimer laser

Answer

Krypton laser

Answer

Diode laser

Question 8

Van Herick angle grade '3' of anterior chamber denotes

Accepted Answer

Moderately open angle

Answer

Wide open angle

Answer

Closed angle

Answer

Narrow angle

Question 9

Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Accepted Answer

Posner-Schlossman syndrome

Answer

Foster-Kennedy syndrome

Answer

Vogt-Koyanagi-Harada syndrome

Answer

Fuchs heterochromic iridocyclitis

Question 10

Which of the following is not a risk factor for angle closure glaucoma?

Accepted Answer

Small lens

Answer

Small eye

Answer

Small cornea

Answer

Hypermetropia

Glaucoma — MCQs

Glaucoma — MCQs

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