Ocular Manifestations of Systemic Disorders Practice Questions

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

Ciliary muscle spasm. **Explanation:** In **Anterior Uveitis** (Iridocyclitis), the inflammation of the iris and ciliary body leads to a classic triad of symptoms: pain, photophobia, and blurred vision. **1. Why Ciliary Muscle Spasm is correct:** The hallmark of pain and sudden visual disturbance in acute anterior uveitis is the **spasm of the ciliary muscle and the iris sphincter**. The inflammation irritates these smooth muscles, causing them to contract uncontrollably. This spasm results in: * **Pain:** A deep, throbbing ache (ciliary neuralgia). * **Diminution of vision:** The spasm induces "accommodative spasm," shifting the refractive state toward myopia (pseudomyopia), which causes blurring of distance vision. **2. Analysis of Incorrect Options:** * **A. Blood in Anterior chamber (Hyphema):** While blood can cause sudden vision loss, it is not a standard feature of primary anterior uveitis unless it is traumatic or associated with specific syndromes like Fuchs' Heterochromic Iridocyclitis (Amsler sign). * **B. Cells in Anterior chamber:** While "cells and flare" are the diagnostic signs of uveitis, they typically cause a gradual "mistiness" or "haze" rather than sudden painful diminution. * **C. Edema of Cornea:** This occurs in late stages or if there is secondary glaucoma (due to high IOP). While it causes blurred vision, it is a secondary complication rather than the primary cause of the initial painful spasm. **Clinical Pearls for NEET-PG:** * **Treatment Gold Standard:** Cycloplegics (e.g., **Atropine or Homatropine**) are used specifically to paralyze the ciliary muscle, thereby relieving the spasm and the associated pain. * **Miosis:** The iris sphincter spasm leads to a small, sluggishly reacting pupil, which helps differentiate uveitis from Acute Congestive Glaucoma (where the pupil is mid-dilated). * **Ciliary Flush:** The characteristic redness in uveitis is due to the engorgement of anterior ciliary vessels.

Q: Vogt Koyanagi–Harada (VKH) syndrome is characterized by which of the following types of uveitis?

Chronic granulomatous uveitis. **Explanation:** Vogt-Koyanagi-Harada (VKH) syndrome is a multisystem autoimmune disorder characterized by T-cell mediated destruction of melanocytes. It typically presents as a **bilateral, chronic granulomatous panuveitis** associated with extraocular manifestations involving the integumentary (poliosis, vitiligo, alopecia) and central nervous systems (meningismus, tinnitus, hearing loss). * **Why Option A is correct:** The hallmark of VKH is granulomatous inflammation. Histologically, this is characterized by "Dalen-Fuchs nodules" (clusters of epithelioid cells and macrophages between the RPE and Bruch’s membrane) and diffuse thickening of the uveal tract with non-necrotizing granulomas. * **Why Option B is incorrect:** Non-granulomatous uveitis is typically associated with HLA-B27 related conditions (like Ankylosing Spondylitis) or idiopathic acute anterior uveitis. VKH involves the formation of granulomas, which is a specific type of chronic inflammatory response. * **Why Option C is incorrect:** Purulent uveitis (Endophthalmitis) is caused by pyogenic organisms (bacteria/fungi) and is characterized by pus formation and intense neutrophilic infiltration, which is not the mechanism in VKH. **High-Yield Clinical Pearls for NEET-PG:** * **Target Antigen:** Tyrosinase-related proteins (found in melanocytes). * **Four Stages:** Prodromal (flu-like), Uveitic (exudative retinal detachment), Convalescent ("Sunset Glow Fundus"), and Chronic Recurrent. * **Sunset Glow Fundus:** An orange-red discoloration of the fundus due to depigmentation of the RPE, seen in the convalescent stage. * **Sugiura’s Sign:** Perilimbal vitiligo (highly specific for VKH). * **Treatment:** High-dose systemic corticosteroids and immunosuppressants.

Q: What is the most common cause of endophthalmitis in patients with AIDS?

Candida. **Explanation:** **1. Why Candida is Correct:** In patients with AIDS or other immunocompromised states, **Candida albicans** is the most common cause of endogenous endophthalmitis. It typically occurs via hematogenous spread, often associated with intravenous drug use, long-term indwelling catheters, or prolonged antibiotic therapy. Clinically, it presents as characteristic "fluffy white cotton-ball" chorioretinal exudates that can extend into the vitreous (vitritis), often described as a "string of pearls" appearance. **2. Why the Other Options are Incorrect:** * **Rhizopus (A):** This is the causative agent of Mucormycosis. While it is a devastating fungal infection in immunocompromised patients (especially those with diabetic ketoacidosis), it typically causes **Rhino-orbital-cerebral mucormycosis** (orbital cellulitis and necrosis) rather than primary endophthalmitis. * **Aspergillus (B):** This is the second most common fungal cause of endogenous endophthalmitis. It is more aggressive than Candida, often leading to rapid vision loss and macular infarction, but it is statistically less frequent. * **Cryptococcus (C):** While *Cryptococcus neoformans* is a common cause of fungal meningitis in AIDS patients, its ocular involvement usually manifests as **papilledema** (due to increased intracranial pressure) or optic neuropathy rather than endophthalmitis. **3. Clinical Pearls for NEET-PG:** * **Most common overall ocular opportunistic infection in AIDS:** CMV Retinitis (presents with "Pizza-pie" or "Cottage cheese and ketchup" appearance). * **Most common fungal endophthalmitis:** Candida albicans. * **Drug of Choice:** Systemic Fluconazole or Voriconazole; Intravitreal Amphotericin B is used for severe vitritis. * **Key differentiator:** If the question asks for the most common *viral* cause, it is CMV; if it asks for *fungal*, it is Candida.

Q: Granulomatous uveitis is seen in all of the following conditions except?

Uveitis associated with ankylosing spondylitis. **Explanation:** Uveitis is pathologically classified into two types: **Granulomatous** and **Nongranulomatous**. The differentiation is crucial for diagnosing systemic associations. **1. Why Ankylosing Spondylitis (AS) is the correct answer:** Uveitis associated with **Ankylosing Spondylitis** is the classic prototype of **Nongranulomatous uveitis**. It typically presents as an acute, unilateral, recurrent anterior uveitis. It is strongly associated with the **HLA-B27** marker. Pathologically, it lacks the organized collection of macrophages (granulomas) and presents with fine, small keratic precipitates (KPs) on the corneal endothelium. **2. Why the other options are incorrect (Granulomatous causes):** * **Sympathetic Ophthalmitis:** A bilateral granulomatous panuveitis following penetrating ocular trauma. It is characterized by **Dalen-Fuchs nodules** (granulomas between the RPE and Bruch’s membrane). * **Tubercular Uveitis:** Tuberculosis is a chronic infectious granulomatous disease. Ocular involvement typically shows "mutton-fat" KPs and iris nodules (Koeppe and Busacca nodules). * **Sarcoidosis:** A multisystem idiopathic disease characterized by non-caseating granulomas. It frequently causes granulomatous uveitis with a "string of pearls" appearance in the vitreous. **Clinical Pearls for NEET-PG:** * **Mutton-fat KPs:** Large, greasy-looking clusters of epithelioid cells and macrophages; a hallmark of **Granulomatous uveitis**. * **HLA-B27 Triad:** Ankylosing spondylitis, Reiter’s syndrome (Reactive arthritis), and Psoriatic arthritis all cause **Nongranulomatous** uveitis. * **Vogt-Koyanagi-Harada (VKH) syndrome:** Another high-yield cause of bilateral granulomatous panuveitis associated with poliosis and vitiligo.

Question 1

Sudden painful diminition of vision in Anterior Uveitis is due to?

Accepted Answer

Ciliary muscle spasm

Answer

Blood in Anterior chamber

Answer

Cells in Anterior chamber

Answer

Edema of Cornea

Question 2

Which of the following can cause uveitis?

Accepted Answer

Staphylococcus

Answer

Tuberculosis

Answer

Streptococcus

Answer

Klebsiella

Question 3

Vogt Koyanagi–Harada (VKH) syndrome is characterized by which of the following types of uveitis?

Accepted Answer

Chronic granulomatous uveitis

Answer

Chronic non-granulomatous uveitis

Answer

Acute purulent uveitis

Answer

None of the above

Question 4

What is the most common cause of endophthalmitis in patients with AIDS?

Accepted Answer

Candida

Answer

Rhizopus

Answer

Aspergillus

Answer

Cryptococcus

Question 5

Granulomatous uveitis is seen in all of the following conditions except?

Accepted Answer

Uveitis associated with ankylosing spondylitis

Answer

Sympathetic ophthalmitis

Answer

Tubercular uveitis

Answer

Uveitis associated with sarcoidosis

Ocular Manifestations of Systemic Disorders — MCQs

Ocular Manifestations of Systemic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?