Ocular Manifestations of Systemic Disorders Practice Questions

Q: All of the following are false about eye lid signs in GRAVES DISEASE except?

Stellwag's sign: Incomplete and infrequent blinking. **⚠️ QUESTION ISSUE: All four options are TRUE statements about Graves' disease, making this question technically flawed.** ***Stellwag's sign: Incomplete and infrequent blinking*** ✓ - **Stellwag's sign** is correctly defined as **incomplete and infrequent blinking**, causing a characteristic staring appearance. - This is a **TRUE** sign of **Graves' ophthalmopathy** due to sympathetic overactivity. - **Marked as correct answer**, but all options are actually true. *Mobius sign: convergence insufficiency* ✓ - **Moebius sign** is correctly defined as **convergence insufficiency** (inability to converge eyes for near vision). - This is a **TRUE** sign of **Graves' disease**. - Statement is medically accurate. *Dalrymple sign: lid retraction* ✓ - **Dalrymple's sign** is correctly defined as **lid retraction** (upper eyelid retraction exposing sclera above iris). - This is a **TRUE** and classic sign of **Graves' ophthalmopathy**. - Statement is medically accurate. *Von Graefe's sign: lid lag on downgaze* ✓ - **Von Graefe's sign** is correctly defined as **lid lag on downgaze** (upper eyelid lags behind eyeball during downward gaze). - This is a **TRUE** sign of **Graves' disease**. - Statement is medically accurate. **Educational Note:** This FMGE-2017 question is problematic because all four eyelid sign descriptions are medically accurate. In the actual exam, Stellwag's sign was likely considered the "best" answer, possibly because it's the most specific or commonly tested.

Q: Sarcoidosis is associated with

Anterior uveitis. ***Anterior uveitis*** - **Anterior uveitis**, particularly chronic granulomatous anterior uveitis, is the most common ocular manifestation of **sarcoidosis**. - It results from **non-caseating granulomas** affecting the iris and ciliary body. - Sarcoidosis can also cause intermediate uveitis, posterior uveitis, and panuveitis, but anterior uveitis is most frequently seen. - Characteristic findings include mutton-fat keratic precipitates and iris nodules (Koeppe and Busacca nodules). *Keratitis* - **Keratitis** (inflammation of the cornea) is less commonly associated with sarcoidosis compared to uveitis. - While ocular sarcoidosis can rarely cause interstitial keratitis or band keratopathy, direct corneal inflammation is not a hallmark feature. *Cataract* - **Cataracts** are not directly caused by sarcoidosis itself, but can be a complication of chronic uveitis or prolonged corticosteroid treatment. - The disease process of sarcoidosis does not primarily involve cataract formation. *Ectopia lentis* - **Ectopia lentis** (lens dislocation) is a rare condition usually associated with genetic disorders like **Marfan syndrome** or homocystinuria. - It is not a recognized ocular manifestation of sarcoidosis.

Q: All are manifestation of dengue virus infection in eye except?

Cataract. ***Cataract*** - **Cataracts** are primarily associated with aging, congenital factors, trauma, or long-term steroid use, not directly with acute dengue virus infection. - While dengue can cause various ocular manifestations, the formation of cataracts is a **chronic process** that does not fit the typical acute or subacute presentation of dengue-related eye complications. *Vitreous hemorrhage* - **Vitreous hemorrhage** can occur in dengue due to associated **thrombocytopenia** and coagulation abnormalities, leading to bleeding in the eye. - Severe dengue can induce systemic vasculopathy and bleeding tendencies, which may manifest as intraocular hemorrhage. *Maculopathy* - **Dengue maculopathy** is a recognized complication, often presenting as macular edema, hemorrhage, or foveolitis, leading to visual impairment. - This is thought to be due to direct viral effects, immune-mediated responses, or vasculitis affecting the retinal microvasculature. *Optic neuritis* - **Optic neuritis** following dengue infection has been reported, characterized by inflammation of the optic nerve, causing acute vision loss. - This is considered to be an **immune-mediated post-infectious complication** rather than a direct viral cytopathic effect on the nerve.

Q: Which type of uveitis is most commonly associated with systemic autoimmune diseases such as ankylosing spondylitis and reactive arthritis?

Anterior uveitis. ***Anterior uveitis*** - **Anterior uveitis**, particularly acute anterior uveitis, is the type most frequently associated with **HLA-B27 positive spondyloarthropathies**, such as **ankylosing spondylitis** and **reactive arthritis**. - It often presents with sudden onset of **redness**, **pain**, and **photophobia** in one or both eyes. *Intermediate uveitis* - This type of uveitis primarily affects the **vitreous** and **pars plana**, often presenting with **floaters** and **blurred vision**. - It is typically associated with conditions like **multiple sclerosis** or is idiopathic, rather than spondyloarthropathies. *Posterior uveitis* - **Posterior uveitis** involves the **retina** and **choroid**, leading to symptoms like **decreased vision** and **scotomas**. - It is more commonly linked to infectious causes (e.g., **toxoplasmosis**, **tuberculosis**) or systemic diseases like **sarcoidosis**, not spondyloarthropathies. *Panuveitis* - **Panuveitis** involves inflammation of all parts of the uvea: **iris**, **ciliary body**, and **choroid**. - While it can occur in severe cases, it is not the initial or most common presentation of uveitis associated with spondyloarthropathies; **anterior uveitis** is the characteristic form.

Q: Which of the following ocular findings is not associated with diabetes?

Blepharophimosis. ***Blepharophimosis*** - This is a **congenital disorder** characterized by small palpebral fissures, ptosis, and epicanthus inversus, which is **not associated with diabetes**. - It is a **developmental anomaly** of the eyelids, with no known link to metabolic conditions like diabetes. *Retinopathy* - **Diabetic retinopathy** is a common and serious complication of diabetes, caused by damage to the blood vessels in the retina. - It can lead to vision loss if not managed, and is directly linked to **poor glycemic control**. *Early senile cataract* - Diabetes is a significant risk factor for the **earlier development and progression of cataracts**, including senile cataracts. - High blood sugar levels can cause changes in the lens, leading to **opacification** and impaired vision. *Neovascular glaucoma* - This severe form of **secondary glaucoma** is often a complication of advanced **diabetic retinopathy**. - Ischemia in the retina triggers the growth of **new blood vessels** on the iris and in the angle of the eye, obstructing aqueous outflow and raising intraocular pressure.

Q: What is the most common eye lesion in HIV?

Cotton wool spots. ***Cotton wool spots*** - These are the most common ocular manifestation in HIV-positive individuals, resulting from **ischemic retinal nerve fiber layer damage**. - While not vision-threatening themselves, their presence indicates **microvascular damage** and can be a sign of systemic disease progression. *Kaposi Sarcoma of Lid* - While Kaposi sarcoma can affect the eyelids in HIV patients, it is **not the most common ocular lesion**. - It presents as a **reddish-purple nodule** or plaque and is an indicator of advanced immunosuppression. *CMV Retinitis* - Cytomegalovirus (CMV) retinitis is a significant and **vision-threatening opportunistic infection** in advanced HIV. - However, it occurs in patients with **severe immunosuppression** (low CD4 counts) and is less common overall than cotton wool spots. *Choroiditis* - Choroiditis, an inflammation of the choroid, can occur in HIV patients due to various opportunistic infections or directly from the virus. - It is **less prevalent** than cotton wool spots and typically requires specific etiologies beyond HIV itself.

Q: Which of the following is a specific sign of albinism?

Iris transillumination. ***Iris transillumination*** - This is a highly **specific sign** of albinism, resulting from the severe reduction or absence of pigment in the iris. - When light shines through the pupil, it passes through the unpigmented iris, creating a visible red reflex, indicating the lack of pigment that normally blocks the light. *Sensitivity to light (photophobia)* - While common in albinism due to the lack of pigment in the iris and retina allowing more light to enter the eye, **photophobia is not specific** to albinism. - It can be a symptom of various other ocular conditions like uveitis, corneal abrasions, or migraines. *Involuntary eye movements (nystagmus)* - **Nystagmus is frequently associated with albinism** due to foveal hypoplasia and impaired visual development but is **not specific**. - It can also be caused by neurological disorders, inner ear problems, or other ocular conditions. *Decreased visual acuity* - **Reduced vision is a characteristic feature of albinism** resulting from foveal hypoplasia and abnormal optic nerve pathways, but it is **not specific** to the condition. - Numerous eye conditions, such as refractive errors, cataracts, and retinal diseases, can lead to decreased visual acuity.

Q: What condition is characterized by a salt and pepper fundus appearance in the retina?

Congenital syphilis. ***Congenital syphilis*** - The **"salt and pepper" fundus** appearance is a classic ophthalmologic finding in congenital syphilis, resulting from diffuse pigmentary retinopathy. - This condition is caused by widespread pigmentary changes in the retina, affecting both the retinal pigment epithelium and neurosensory retina. - It represents chronic, bilateral, and symmetric chorioretinitis that is pathognomonic for congenital syphilis. *Congenital toxoplasmosis* - While it can cause chorioretinitis, congenital toxoplasmosis typically presents with **focal, destructive lesions** rather than diffuse "salt and pepper" pigmentary changes. - Classic ocular lesions are often described as a **"headlight in the fog"** or inactive, pigmented chorioretinal scars. *Congenital histoplasmosis* - Ocular histoplasmosis syndrome (OHS) is usually acquired, not congenital, and causes **discrete chorioretinal scars** ("histo spots") often in the macula or peripapillary region. - It does not result in a diffuse **"salt and pepper" fundus** appearance. *Congenital rubella* - Congenital rubella syndrome can cause pigmentary retinopathy, but the pattern is typically **patchy or mottled** rather than the classic "salt and pepper" appearance. - Other ocular findings include cataract, microphthalmos, and glaucoma.

Q: Patient with acute pancreatitis developed sudden loss of vision; the most likely cause is:

Purtscher's retinopathy. ***Purtscher's retinopathy*** - **Purtscher's retinopathy** is a rare but classic complication of acute pancreatitis, presenting with **sudden vision loss** due to retinal ischemia. - It is characterized by **Purtscher flecken**, which are multifocal areas of retinal whitening with clear zones separating them from the retinal vessels, and often bilateral. *Hyperglycemia* - While complications of diabetes can affect vision, severe hyperglycemia itself typically causes **gradual vision changes** due to osmotic shifts in the lens, not sudden loss. - Acute vision loss due to hyperglycemia would more likely relate to **diabetic retinopathy exacerbation** or **vitreous hemorrhage**, which are not directly implied by acute pancreatitis alone. *Hypoxia* - **Severe systemic hypoxia** can lead to retinal ischemia and vision changes, but sudden, dramatic vision loss specifically from hypoxia is less common than from Purtscher's in the context of acute pancreatitis. - Although pancreatitis can lead to respiratory distress and hypoxia, Purtscher's retinopathy is a more specific and direct ocular complication. *Central Retinal Vein Occlusion (CRVO)* - **CRVO** causes sudden, painless vision loss usually in **one eye** due to a blockage in the central retinal vein. - While pancreatitis increases the risk of hypercoagulability, CRVO is not the most common or specific cause of sudden vision loss associated with acute pancreatitis.

Q: The most common ophthalmic affection of diphtheria is –

Isolated ocular palsies. ***Isolated ocular palsies*** - Diphtheria exotoxin can lead to localized neuropathies, and **ocular muscle palsies** are common, often affecting individual extraocular muscles rather than generalized paralysis. - Involvement typically presents as problems with **accommodation** or specific ocular movements due to cranial nerve involvement. *Ptosis* - While ptosis can occur due to **oculomotor nerve dysfunction**, it is less common as an isolated, primary ophthalmic manifestation of diphtheria compared to other ocular palsies. - It usually indicates more widespread **Cranial Nerve III involvement**, which is not the most frequent initial or isolated ocular finding. *Total ophthalmoplegia* - This involves paralysis of **all extraocular muscles**, which is a severe and less common manifestation of diphtheria. - Diphtheria typically causes more **localized and incomplete palsies** rather than affecting all eye movements universally. *Ophthalmoplegia externa* - This involves paralysis of the **extraocular muscles** but spares the **intrinsic eye muscles** (pupil and accommodation). - While diphtheria *can* cause external ophthalmoplegia, **isolated ocular palsies** (which include external ophthalmoplegia) more accurately describe the common presentation of affecting specific muscles or nerves.

Question 1

All of the following are false about eye lid signs in GRAVES DISEASE except?

Accepted Answer

Stellwag's sign: Incomplete and infrequent blinking

Answer

Mobius sign: convergence insufficiency

Answer

Dalrymple sign: lid retraction

Answer

Von Graefe's sign: lid lag on downgaze

Question 2

Sarcoidosis is associated with

Accepted Answer

Anterior uveitis

Answer

Keratitis

Answer

Cataract

Answer

Ectopia lentis

Question 3

All are manifestation of dengue virus infection in eye except?

Accepted Answer

Cataract

Answer

Vitreous hemorrhage

Answer

Maculopathy

Answer

Optic neuritis

Question 4

Which type of uveitis is most commonly associated with systemic autoimmune diseases such as ankylosing spondylitis and reactive arthritis?

Accepted Answer

Anterior uveitis

Answer

Intermediate uveitis

Answer

Posterior uveitis

Answer

Panuveitis

Question 5

Which of the following ocular findings is not associated with diabetes?

Accepted Answer

Blepharophimosis

Answer

Retinopathy

Answer

Early senile cataract

Answer

Neovascular glaucoma

Question 6

What is the most common eye lesion in HIV?

Accepted Answer

Cotton wool spots

Answer

Kaposi Sarcoma of Lid

Answer

CMV Retinitis

Answer

Choroiditis

Question 7

Which of the following is a specific sign of albinism?

Accepted Answer

Iris transillumination

Answer

Sensitivity to light (photophobia)

Answer

Involuntary eye movements (nystagmus)

Answer

Decreased visual acuity

Question 8

What condition is characterized by a salt and pepper fundus appearance in the retina?

Accepted Answer

Congenital syphilis

Answer

Congenital rubella

Answer

Congenital toxoplasmosis

Answer

Congenital histoplasmosis

Question 9

Patient with acute pancreatitis developed sudden loss of vision; the most likely cause is:

Accepted Answer

Purtscher's retinopathy

Answer

Hypoxia

Answer

Central Retinal Vein Occlusion (CRVO)

Answer

Hyperglycemia

Question 10

The most common ophthalmic affection of diphtheria is –

Accepted Answer

Isolated ocular palsies

Answer

Ptosis

Answer

Total ophthalmoplegia

Answer

Ophthalmoplegia externa

Ocular Manifestations of Systemic Disorders — MCQs

Ocular Manifestations of Systemic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?