10

58 Ophthalmology

Cataract Questions  157. a. b. c. d.

Rosette cataract Rosette cataract in seen seen due due to (MAHE 2001) T r au m a Cu-foreign body Diabetes Hyperparathyroidism

158. a. b. c. d.

Cataract Catara ct is is seen seen with with:: (PGI (PGI 88) 88) G a l a c t os e m i a C on g e n i t a l R u be l l a To x o p l a s m o s i s All of the above

159. a. b. c. d.

The lens lens derive derives s its nutri nutrition tion from: from:-- (AI 88) Aq ue ou s Scl era V i t r eo u s None

160. a. b. c. d.

Dislocation of lens Dislocation lens is seen seen in all except except (PGI (PGI 95) 95) Retinoblastoma M e du l l o bl a s to m a Neuroblas toma None of the above

161. a. b. c. d.

The latest latest techniqu technique e in cataract cataract surgery surgery is is using (KERALA (KERALA 91) 91) Microscope L a s er UV light IR rays

162. a. b. c. d.

Oil drop drop catar cataract act is is seen seen in : (KERALA (KERALA 90) 90) Hunters syndrome G a l a c t os e m i a Steroid therapy Rubel la

58

Cataract 163. a. b. c. d.

All are are indicat indications ions of ICCE ICCE except except (PGI 97) Immature cataract S u b l u x a te d l e n s Matu Ma ture re ca cata tara ract ct in ag age e gro group up 30 30-4 -40y 0yrs rs Matu Ma ture re ca cata tara ract ct in 45 45-5 -50y 0yrs rs

164. a. b. c. d.

Most commo common n cause cause of blindne blindness ss in India India is : (AIIMS 87) Vit A deficiency Tra c ho ma Cataract Syph il is

165. a. b. c. d.

Rider’s Rider’ s catara cataract ct is seen seen in in : (AI 91) 91) Blue - Dot cataract Zonular ca cataract Anterior Ca Capsular ca cataract Coronary cataract

166. a. b. c. d.

Supra-temporal Supra-tem poral lenta lentall subluxatio subluxation n is seen seen in : (AI (AI 89) Weis iss s- Mar March ches esa ani sy syn ndr drom ome e Marfans Hu n te r s Ho m o c y s t i n u r i a

167. a. b. c. d.

Polychromatic Polychrom atic luste lusterr is seen in : (AIIM (AIIMS S 96) Post Po ster erio iorr su subc bcap apsu sula larr ca cata tara ract ct Zonular ca cataract Cortical cataract Nuclear ca cataract

168. a. b. c. d.

Anterior lenti Anterior lenticonus conus is seen seen in in : (AI 96) 96) Marfans Weis iss s - Ma Marche hes sani sy synd ndrrom ome e Al p or t ’ s Ho m o c y s t i n u r i a

169. a. b. c. d.

Cataract is Cataract is found found in in all all except except (AIIMS (AIIMS 89) Pri rima mary ry pu pulm lmon onar ary y hyp hyper erte tens nsio ion n Hy p o p a r a t h y r o i d i s m I.D.D.M Myotonic dystrophy

59

60 Ophthalmology 170. In complicated complicated catara cataract, ct, the followin following g part of the the lens is involved involved (AP 98) a. Anterior part of lens b. L ens nu nucleu s c. Post Po ster erio iorr par partt of of len lens s cap capsu sule le d. All of the above 171. a. b. c. d.

Treatment Treatme nt of conge congenit nital al cataract cataract::- (PGI (PGI 97) Needling & Aspiration Extracapsular ext extraction Int ntrracapsula larr ext xtrractio ion n Cryotherapy

172. a. b. c. d.

Atopic catar cataract act is is that that which which follows follows:: (KAR (KAR 98) Exposure to syphilis Injury Poi so nin g Sk i n d i se as e s

173.. Which morpholo 173 morphological gical type of of cataract cataract is most most usually usually handicappin handicapping g (AIIMS 2002) a. Cortical b. Nu cl e ar c. Post erior su su b c a p s u l a r d. Zonul ar 174. a. b. c. d.

Parentera Parent erall steroid steroids s cause cause (AIIMS (AIIMS 86) Cataract G l a u c o ma Corneal opacity Papi lloe dema

175. Nuclear Nuclear cataract cataract is associat associated ed with followi following ng type type of refractiv refractive e error : (AP 98) a. Myopia b. Hypermetropi a c. Presby opia d. Astigmatis m 176. a. b. c. d.

The commone commonest st type type of catarac cataractt in childre children n is : (PGI (PGI 84) 84) Snow flake cataract Lamellar cataract Morgagnian cataract Sunflower cataract

Cataract 177. a. b. c. d.

Sun flow flower er catara cataract ct is seen seen in : (AIIMS (AIIMS 86) 86) Tr a u m a Ch al c o s i s Di a b e t e s Hyperthyroidism

178. a. b. c. d.

Which is not a featu feature re of compli complicated cated catara cataract ct (AIIMS (AIIMS 91) Sutural involvement Axial spread Polychromatic lustre Orig Or igin inat ates es fr from om po post ster erio iorr co cort rtex ex

179. a. b. c. d.

Uniocular polyop Uniocular polyopia ia is seen seen in which stage: - (AP 97) In tu mes c ent Mature cataract Hypermature cataract Incipient ca cataract

180. a. b. c. d.

Modern criteria Modern criteria for for cataract cataract opera operation tion is is : (JIPMER (JIPMER 95) 95) Maturation of cataract Loss of vision Co m p l i c a t i o n s All of above

181. a. b. c. d.

Cataract Catara ct is associ associate ated d with:with:- (PGI (PGI 88) Pse seud udo o-m -mus uscu cula larr hyp hyper ertr tro oph phy y Myotonia co congenita Myotonic dy dystrophy SL E

182. a. b. c. d.

Ideal site for for IOL IOL implantat implantation ion is : (AIIMS (AIIMS 87) 87) Anterior to pupil Behind the cornea In the lens capsule Behind th the le lens ca capsule

183. a. b. c. d.

Most comm common on complic complicatio ation n of ECCE ECCE is : - (PGI (PGI 95) 95) Re t i n a l d e t a c h m e n t Opac Op acif ific icat atio ion n of po post ster erio iorr ca caps psul ule e Vitreous Ha Haemorrhage No n e

184. a. b. c. d.

Lens capsu capsule le is is thinnes thinnestt at: at: - (AIIMS 87) Centre Anteriorly Laterally Superior pole Posteriorly

61

62 Ophthalmology 185. a. b. c. d.

Treatment Treatme nt of unilate unilateral ral hypermat hypermature ure cataract cataract includ includes: es: - (AP 94) Aphakic glas ses Contact gl asses Removal of lens Remo Re mova vall of of le lens + IOL IOL im impl plan anta tati tion on

186. a. b. c. d.

Cataract Catara ct is seen seen in in all exce except pt : (AI (AI 90) Dystrophia myotonica Atopic Eczema Di abet es mel li tus Toxemia of of pr pregnancy

187. a. b. c. d.

Lens disloc dislocatio ation n occurs occurs in all except except::- (KERALA (KERALA 94) 94) Marfan’s syndrome Hom ocy s tin uri a G l a u c o ma Batten - Ma Mayou di disease

188. a. b. c. d.

Lens deve develop lop fro from: m: - (KERA (KERALA LA 94) 94) Coel omi c ep ith eli um Endoderm Surface ectoderm M e s o d er m

189. a. b. c. d.

Vision is diminishe Vision diminished d in day light light in which which type of catarac cataractt (PGI 88) 88) Pe rip her al Centra l Hypermature Co n c us s i on

190. a. b. c. d.

IOL is is contrai contraindica ndicated ted in : (JIP (JIPMER MER 90) Young diabetics One eyed Corneal dystrophy All of the above

191. In which type type of the the following following type type of IOL implant implant in in ECCE used used : (AIIMS 89) a. Iris support b. ACIOL c. PCIOL d. Angle support

Cataract 192. a. b. c. d.

All are cause causes s of early early onset onset cataract cataract except:except:- (DELH (DELHII 96) Di a b e t e s m e l l i t u s Sm o k i n g Heredity Rec ecur urre rent nt ep epis isod odes es of di diar arrh rhoe oea a

193. a. b. c. d.

Developmental Development al cataract cataract is seen seen in :- (PGI (PGI 87) 87) Ru b e l l a G a l ac t o s e mi a Cr e t i n i s m All

194. a. b. c. d.

Advantage of Advantage of IOL over over glasses glasses are all all except except : (PGI (PGI 97) Better field of vi vision Better Ac Accommodation Better underwater vision No chromatic aberration

63

195.. Which of the following type of senile cataracts is the most notorious 195 notorious to produce glaucoma: - (AIIMS 2000) a. Incipient ca cataract b. Lamellar cataract c. Hypermature cataract d. Intumescent cataract 196. a. b. c. d.

Voss ossius ius rin ring g is: is: - (AP (AP 97) 97) Circ Ci rcul ular ar pi pigm gmen entt rim rim on on the the ant anter erio iorr caps capsul ule e of of lens lens Degeneration of retina Depigmentation of iris Pigmentation of of co cornea

197. a. b. c. d.

Snow flake Snow flake catarac cataractt is seen in:in:- (PGI (PGI 83) 83) Di a b e t e s G a l ac t o s e mi a Tr a u m a Ru b e l l a

198. a. b. c. d.

YAG laser laser is used in t/t of : (AIIMS (AIIMS 92) Retinal Detachment Diabetic Re Retinopathy Open Angle gl glaucoma After cataract

64 Ophthalmology 199. Which of of the followin following g is wrong wrong regarding regarding congeni congenital tal cataract cataract : (AP 98) a. Usually bilateral b. Progressive in in na nature c. Rapi Ra pid d det deter erio iora rati tio on of of vis visio ion n d. Early surgery required 200. a. b. c. d.

Bilateral dislocat Bilateral dislocation ion of lens lens is seen seen in all except except : (AI (AI 2000) Marfans sy syndrome Rubel la Marchesani syndrome Alkaptonuria

201. a. b. c. d.

The commone commonest st type type of cataract cataract in adults adults is: is: (PGI 85) Nuclear cataract Cortical cataract Morgagnian cataract Intumescent cataract

202. a. b. c. d.

Most common common type type of cataract cataract followi following ng irradiat irradiation ion is : - (PGI (PGI 83) Post erior s ub ubcapsul ar Anterior subcapsular Tear dr drop ca cataract Di ff u se

203. a. b. c. d.

Second sigh Second sightt is seen seen in: in: - (MAHE (MAHE 2000) 2000) Senile nuclear cataract Zonular cataract Traumatic ca cataract Post Po ster erio iorr ca caps psul ular ar ca cata tara ract ct

204. a. b. c. d.

Commonestt indicati Commones indication on of IOL IOL implant implant is: is: (DELHI (DELHI 93) Diabetic cataract Unilateral cataract Complicated cataract Dislocation of lens

205. a. b. c. d.

Immature catara Immature cataract ct can be diagnos diagnosed ed by : - (TN (TN 99) Retinosc opy Direct ophthalmoscopy Dist Di stan antt di dire rect ct op opht htha halm lmos osco copy py Indi In dirrect oph phth thal almo mosc scop opy y

Cataract

65

206. a. b. c. d.

Cataract Catara ct in a new new born born is : - (KERAL (KERALA A 95) Zonular Nuc l ea r S n o wf l a k e Co r t i c a l

207. a. b. c. d.

Method followed to decrease decrease post-op post-op infection infection in cataract cataract surgery surgery Pre-op. an a n ti b i o t i c s Intra-op. an antibiotics Post Po st-o -op. p. su sub b co conj njun unct ctiv ival al in inje ject ctio ion n Post-op. IV antibiotics

208. a. b. c. d.

Which is not not associat associated ed with with zonula zonularr catarac cataractt : (PGI 93) Di a b e t e s IUGR Ric k et s Dent al ab abnormal iti es

66 Ophthalmology

Cataract Answers  1 57 57. (a) Trauma (Ref: K -373) Traumatic cataract is due to: (i) Im Imbib bibiti ition on of aqueou aqueous s (ii) Direc Directt mechanical mechanical effects effects of injury on lens fibres fibres It could be:(i) Discr Discrete ete subep subepitheli ithelial al opacit opacities ies (ii) Early Rosette cataract : feathery lines of opacity along star shaped suture lines usually in posterior cortex (iii)) Late Rosette cataract: It develops in posterior cortex 1-2 yrs after (iii injury. 158.. (d) 158 (d) Al Alll of of the the ab abov ove e (Ref: K -187) Causes of cataract : (1)) He (1 Here redi dity ty : eg eg.. Catar Catarac acta ta Pulv Pulver eran anta ta,, Coro Corona nary ry cata catara ract ct (2)) Ma (2 Mate tern rnal al : In Infe fect ctio ions ns eg eg.. Rub Rubel ella la,, Tox Toxop opla lasm smos osis is Drug ingestion : Corticosteroids Radiation (3)) Foe (3 oeta tall : Metab abo olic diso sorrders : Ga Gallac acttose sem mi a galactose kinase deficiency Deficient oxygenation (4) Idi Idiopa opathi thic c 159. 15 9. (a) (a) Aqueous (Ref: K -184) Crystalline lens being an avascular structure is dependent on aqueous humour for its nutrition. The metabolic activity is largely confined to the cortex. 80% of Glucose is metabolised anaerobically by glycolytic pathway, 15% by hexose monophosphate shunt & small proportion via oxidative kreb’s citric acid cycle.Sorbitol pathway is important for Diabetic & galactosemic patients. 160.. (d) 160 (d) No None ne of th the e abo above ve (Ref: K -210) In dislocated lens, all the zonules are severed form the lens. Intraocular tumours gives rise to dislocation by mechanical stretching of the lens fibres and their ultimate rupture. Clinical Features:Deep Anterior chamber Aphakia 66

Cataract

67

Iridodonesis Complications :Uveitis Secondary Glaucoma 161 . (b) Laser (Ref: K -203) In laser phacoemulsification, the lens nucleus is emulsified using laser energy. The advantage of this technique is that laser energy used to emulsify cataractous lens is not exposed to other intra ocular structures. 162. 16 2. (b) (b) Ga Gala lact ctos osem emia ia (Ref: K -194) Galactosemia occurs in two forms:(i) Cla Classi ssical cal Galacto Galactosem semia ia  Deficiency of Galactose - 1- PO 4 Uridyl-Transferase (ii) Defic Deficiency iency of of Galactokin Galactokinase. ase. It is frequently accompanied with Bilateral cataract. The lens changes may be reversible & occurence of cataract may be prevented if milk & milk products are eliminated from diet when diagnosed at early stage. 163. (c) Mat Mature ure cat catara aract ct in in age age group group 3030-40y 40yrs rs (Ref: K -198) In ICCE, the entire cataractous lens along with the intact capsule is removed. Therefore weak and degenerated zonules are a prerequisite for this method. Because of this reason, this technique is not employed in young where the zonules are strong. Other indications of ICCE:(a) eye camp camps s (b) facili facilities ties for microsurgery microsurgery not available (c) surgeo surgeon n not trained trained in ICCE 164. 16 4. (c) Cataract (Ref: K -425) Leading causes of blindness in India:(i)) Ca (i Cata tara ract ct (ii) Ref Refrac ractiv tive e err errors ors (iii) Aphakic blindness (iv) (i v) Glaucoma (v)) Cor (v Cornea neall opacity opacity (vi) (v i) Trachoma (vii)Others 165. 16 5. (b) (b) Zo Zonu nula larr cata catara ract ct (Ref: K -187) Cataract occurs in the zone of foetal nucleus surrounding the embryonic nuclear occasionally, two such rings of opacity are present. The main mass of lens internal & external to the zone of cataract is

68 Ophthalmology clear, except for small linear opacities like spokes of wheel (riders) which may be seen towards the equator. 166. 16 6. (b) Marfans (Ref: K -210) It is autosomal dominant mesodermal dysplasia Other anomalies accompanying are:(i) Ar Arac achn hnod odac acty tyly ly (ii) Long extr extremit emities ies (iii) Hyper Hyperextens extensibilit ibility y of joints (iv)) High arched (iv arched palate (v)) Diss (v Dissectin ecting g Aneurysm Aneurysm 167. (a) Pos Postr tr.. subsub-cap capsul sular ar cat catara aract ct (Ref: K -195) The opacity is irregular in outline and variable in density. Slit lamp examination shows bread crumb appearance. Characteristic sign is appearance of iridescent colored particles, the so called ‘polychromatic lustre’ of reds, greens & blues. A diffuse yellow haze is seen in adjoining cortex. Slowly the opacity spreads & finally the entire lens becomes opaque giving chalky white appearance. 168. 16 8. (c) (c) Alport’s (Ref: K -212) It is a cone-shaped elevation of anterior pole. On distant direct ophthalmoscopy, both present as oil globule lying in the centre of red reflex. Slit lamp examination confirms the diagnosis. 169. (a) Pr Prima imary ry pul pulmon monary ary hyp hypert ertens ension ion (Ref: K-187 FOR ‘d’ ; K-194  ‘b’ & ‘c’) (a) Hypop Hypoparath arathyroid yroidism ism  hypocalcemic cataract (Discrete white flecks of opacities) (b) I.D I.D.D. .D.B. B.  snow flake cataract (c) Myoto Myotonic nic dystr dystrophy ophy  Cataract is part of this congenital anomaly 170. (c) Pos Poster terior ior par partt of of lens lens cap capsul sule e (Ref: K -195) When posterior part of lens capsule is affected following changes occur:(i) ‘Br ‘Bread ead-cr -crumb umb’’ opacities opacities (ii) Pol Polychr ychromat omatic ic lustre (iii) Chalk Chalky y white opacity opacity of lens 171. (a) Ne Need edli ling ng & Asp Aspir irat atio ion n (Ref: K -189) Needling & Aspiration is obsolete now In this technique, a cruciate incision is made in the anterior capsule with a ziegler’s knife and lens matter was stirred up and left as such for self absorption.

Cataract

69

High post-op complications were: Uveitis, Glaucoma & after cataract. 172. 17 2. (d) (d) Sk Skin in di dise seas ases es (Ref: K -196) Atropic cataracts are bilateral & occur at young age Disease leading to atopic cataract are: ♦ Atopic Dermatitis ♦ Poikiloderma ♦ Vasculare atrophica ♦ Scleroderma ♦ Keratitis folliculare 173. 17 3. (d) Zonular (Ref: K -191) Zonular cataract is a congenital cataract that occurs in the zone of foetal nucleus. The ‘spokes of a wheel’ opacity gives riders appearance. Cause : Genetic Autosomal dominant Environmental Vit. D deficiency It is bilateral & causes severe visual defect. 174. 17 4. (a) Cataract (Essential of Medical Pharmacology -K.D. Tripathi 5/e, 264) Corticosteroids induce posterior subcapsular cataract Children are more susceptible than adults Therefore regular examination of all patients requiring prolonged corticosteroids therapy should be done by an ophthalmologist. 175. (a ) Myopia (Ref: K -192) In patients with nuclear cataract, distant vision deteriorates due to progressive Index myopia. Such patients may be able to read without presbyopic glasses. This improvement in near vision is referred to as ‘second sight’. 176. 17 6. (b) (b) La Lame mell llar ar cata catara ract ct (Ref: K -187) In lamellar or zonular cataract the development of lens is interfered at later stage. Etiology: (a) Hered Heredity ity of dominant dominant type type (b) Associ Associated ated with with Vit D deficiency deficiency 177. 17 7. (b) Ch Chal alco cosi sis s (Ref: K -378) Chalcosis refers to the specific changes produced by the alloy of copper in the eye. Sunflower cataract is produced by deposition of copper under the posterior capsule of the lens. It is brilliant golden green in colour & arranged like the petals of a sunflower. Other changes of chalcosis: (a) K-F ring ring of of cornea cornea (b) Golden plaques at postr. pole of Retina.

70 Ophthalmology 178. (a) Su Sutu tura rall in invo volv lvem emen entt (Ref: K -195) Complicated cataract refers to the opacification of lens secondary to intraocular disease. Etiology:(a) Inflam Inflammatory matory : Iridocyclitis, Iridocyclitis, endophthalmitis endophthalmitis (b) Degene Degenerative rative : Retinitis Retinitis Pigmentosa Pigmentosa (c) Reti Retinal nal Detachm Detachment ent (d)) Gla (d Glauco ucoma ma (c) Intra - ocular tumors, tumors, Eg. Retinoblast Retinoblastoma. oma. 179. (d) (d) In Inci cipi pien entt ca cata tara ract ct (Ref: K -192) Uniocular Polyopia doubling, trebling of objects. It occurs due to irregular refraction by the lens owing to variable refractive index as a result of cataractous process. Other symptoms of cataract :(i) Glare (ii) Col Colore ored d haloes haloes (iii) Black spots spots in front of eyes (iv) Image blurring, distortion of image image (v)) Los (v Loss s of visio vision. n. 180.. (b) 180 (b) Lo Loss ss of vi visi sion on (Ref: K -196) An individual is operated for cataract when the visual handicap becomes a significant deterrent to the maintenance of his or her usual lifestyle. Patients with usual activity of less than 6/36 may be advised surgical management. 181. (c) My Myot oton onic ic Dy Dyst stro roph phy y (Ref: K -187) Foetal factors affecting the lens & causing cataract are: (1) Deficient oxygenation owing to placental haemorrhage (2) Metabolic disorders like galactosemia, galactokinase deficiency (3) Cat Catara aracts cts lowe’s syndrome, myotonic dystrophica, congenital icthyosis (4) Maln Malnutri utrition tion (5) Bir Birth th Trauma Trauma 182.. (c) 182 (c) In th the e len lens s cap capsu sule le PCIOLS are commonly placed behind the iris. They are supported by ciliary sulcus or the capsular bag. In-the-bag-fixation is commonest today. Typ ype es of of IOL : (a) ACIO ACIOL L - Eg. Kelman Kelman multiflex multiflex (b) Iris supported supported - eg. singh singh & worst’s (c) PCIOL - Modifie Modified d J-loop or C-loop C-loop

Cataract

71

183. (b) (b) Op Opaci acific ficati ation on of of postr postr.. caps capsule ule (Ref: K -199) The types of ‘After Cataract’ are:(i) Thin membr membranous anous after catar cataract act (ii) Dense membrano membranous us after after cataract cataract (iii) Soemer Soemerrings rings Ring (iv) (i v) Elsching’s pearls Cause: Residual opaque lens matter may persist when it is imprisoned between remains of antr. & postr. capsule 184. 18 4. (d) Po Post ster erio iorrly (Ref: K -183) Lens capsule is a thin, transparent, hyaline membrane surrounding the lens which is thicker over anterior than the posterior surface. The lens capsule is thickest at pre-equator region (14µ ) & thinnest at the postr. pole (3µ ). In ECCE, major portion of antr. capsule with epithelium, nucleus & cortex are removed, leaving behind intact postr. capsule. 185. (d) (d) Rem Remova ovall of len lens s + IOL IOL impl implant antati ation on Hypermature cataract has a visual acuity of PL +ve It occurs in two forms: (i)) Mo (i Morg rgag agni nian an : Who hole le cor corte tex x liqu liquef efie ies s & len lens s is co conv nver erte ted d int into o a bag of milky fluid. The small brownish nucleus settles at the bottom altering its position with change in position of head. (ii) Sclerotic : T h e co co r t e x be be c o m e s di di si n t e g r a t e d & l e n s becomes shrunken due to leakage of water. The antr. capsule is wrinkled & thickened due to proliferation of antr. cells & a dense white capsule cataract is formed. 186. (d) (d) Tox oxem emia ia of of Pre Pregn gnan ancy cy (Ref: K -194, 17) Cataract 

Congenital 

Developmental 

Eg. Dystrophica Myotonica Acquired Dermatogeni c Eg.Atopic Eczema

Senile Traum Traumatic atic Comp Complicate licated d Metabolic Metabolic Eg. Diabetes Mellitus

72 Ophthalmology 187. (d) (d) Ba Batt tten en - May Mayou ou di dise seas ase e (Ref: K -210) Dislocation of lens with systemic anomalies :(i)) Mar (i arfa fan’ n’s s syn syndr drom ome e : Auto Au toso soma mall domi domina nant nt inh inher erit itan ance ce Supra-temporal displacement (i i) Homo cy sti nur ia : Autosomal recessive Infra-nasal displacement (iii)) We (iii Weil il - Ma Marc rche hesa sani ni syn syndr drom ome e : Aut Autoso osomal mal recess recessive ive Forward subluxation of lens (iv) (i v) Eh Ehle lers rs-D -Dan anlo los s sy synd ndro rome me : Subl Su blux uxat atio ion n wi with th bl blue ue sc scle lera ra 188.. (c) 188 (c) Su Surf rfac ace e ecto ectode derm rm (Ref: K -8) Other structures from surface ectoderm:(i) Cor Cornea neall epi epithe thelium lium (ii) Conj Conjuncti unctival val epithelium epithelium (iii) Lacrim Lacrimal al gland (iv)) Epithe (iv Epithelium lium of eyelids (v)) Epitheliu (v Epithelium m of lacrimal apparatus (vi) Conjunctival & tarsal glands 189. 18 9. (b) Central (Ref: K -192) Light in the day causes constriction of the pupil The opacity of lens at the centre is right infront of the constricted pupil. During the dim light in the evening, pupil dilates & the person can see better. Hence vision is markedly diminished in the day. 190.. (d) 190 (d) Al Alll of of the the ab abov ove e (Ref: Nema 379) Other contraindications are:(i) Proli Proliferat ferative ive Diabetic Diabetic Retinopat Retinopathy hy / Rubeosis Rubeosis Iridis (ii) Uveit Uveitis is (Active (Active or Chron Chronic) ic) (iii)) Glaucoma with advanced field loss (iii (iv)) Retinal detachment (iv detachment 1 91. (c) PCIOL(Ref: K -205) Advantages of PCIOL:(i) Norm Normal al physiolog physiological ical place place of of natural natural lens lens (ii) Least magnif magnificatio ication n (iii) Decreased incidence of endopthalmodonesis (iv) Least chance of corneal damage (v)) Post-o (v Post-op p complicat complication ion of (a) vitreous herniation in AC (b) pupillary block (c) vitreous Touch syndrome are low

Cataract

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192. 19 2. (b) Smoking (Ref: K -190, 194) Factors affecting age of onset & maturation of cataract include: (i)) He (i Here redi dity ty (ii) UV irradi irradiatio ations ns (iii) Dieta Dietary ry factors Anomalous diet as regards certain proteins, amino-acids, Vitamins (Riboflavin, Vit.E, Vit.C) (iv) Dehydrational crisis Eg. Diarrhoea, Cholera (v) Di Diab abet etes es osmotic overhydration of lens 193 . (d) All (Ref: Nema 221 & K - 187) Developmental cataract may occur from infancy to adolescence:Therefore opacities may involve infantile or adult nucleus, deeper parts of cortex or capsule. Developmental cataract typically affects the particular zone which is being formed when this process is disturbed. The fibres laid down previously & subsequently are often normally formed & remain clear. 194. (b) (b) Be Bett tter er Ac Acco comm mmod odat atio ion n (Ref: P - 295 & 297) Disadvantages of IOL are:(a) Cos Costly tly (b) Increased post-op complications:- Corne Corneal al dystrop dystrophy hy - Impla Implant nt dislocation dislocation - Pupil block glaucoma - Cysto Cystoid id Macular Macular edema edema - Post-op iridocyclit iridocyclitis is - Post-op astigmatism 195. (d) (d) In Intu tume mesc scen entt cat catar arac actt (Ref: K -191) Intumescent cataract is a type of immature senile cataract. In this stage, lens may become swollen due to continued hydration. Due to the swollen lens, the AC becomes shallow. The swollen lens blocks the trabecular meshwork & the aqueous outflow is blocked. This causes increased intra-ocular tension resulting in glaucoma. 196. (a) Circu Circular lar pigme pigment nt rim rim on on the the anterio anteriorr capsule capsule of lens lens (Ref: K -  373) Vossius ring occurs in contusion injury. It is a circular ring of brown pigment seen on anterior capsule. It occurs due to striking of contracted pupillary margin against the crystalline lens. Other effects of trauma on lens:(i) Con Concus cussio sion n catara cataract ct (ii) Trauma Traumatic tic absorptio absorption n of lens

74 Ophthalmology (iii) Subluxat Subluxated ed lens lens (iv)) Dislocat (iv Dislocation ion of lens 197. 19 7. (a) (a) Diabetes (Ref: K -194) True Diabetic cataract usually occurs in young adults due to osmotic overhydration of lens. Initially a large number of fluid vacuoles appear underneath the antr. & postr. capsule which is soon followed by appearance of bilateral snow flake opacities in the cortex. 198.. (d) 198 (d) Af Afte terr ca cata tara ract ct (Ref: Nema - 235) Types of ‘after-cataract’ & their treatment (a) Thi n me mbra no us : YAG laser capsulotomy (b) Thic k membran ous : Me m b r a n e c t om y (c) Soem merri ng s ri ng : No treatment ( d ) E l s c h i n g s Pe a r l s : YAG laser capsulotomy 199. (c) Rap Rapid id de deter terior iorati ation on of vi visio sion n Egs. of congenital & developmental cataract (i) Cat Catara aracta cta centralis centralis pulveru pulverulent lenta a (ii) Zon Zonula ularr cataract cataract (iii) Sutur Sutural al cataract cataract (iv) Antr. polar cataract (v)) Postr (v Postr.. polar catar cataract act (vi)) Coro (vi Coronary nary cataract (vii)Punctate cataract (viii)Total congenital cataract 200. 20 0. (b) Rubella (Ref: K -210) In Rubella, the child is born with a dense white nuclear cataract congenital Rubella cataract may be alone or as a part of congenital Rubella Syndrome which consists of:(i) Ocular defects defects (Cong. (Cong. cataract, cataract, salt & pepper Retinopat Retinopathy hy,, microphthalmos) (ii) Ear defects defects (Deafness (Deafness due to destruction destruction of organ of corti) (iii)) Heart defects (Patent ductus Atreiosus, Pulmonary stenosis) (iii 201. (b) (b) Co Cort rtic ical al ca cata tara ract ct (Ref: K -190) Cortical cataract exists in two forms: (i) Cu Cupu puli lifo form rm - 5% 5% (ii) Cun Cuneif eiform orm - 70% Nuclear cataract is responsible for remaining 25% cataracts. Cuneiform cataract which is most common is characterised by wedge shaped opacities with clear areas in between. Cupuliform cataract forms a part of postr. cortex (Postr. sub capsular cataract)

Cataract

75

202.. (a) Po 202 Post strr. su subc bcap apsu sula larr (Ref: K -195) Radiational energy is known to produce cataract by damaging the lens epithelium. The types seen are:(a) Infra red cataract cataract = (Postr. (Postr. subcapsular cataract) Also called Glass-worker’s cataract (b) Irrad Irradiation iation cataract cataract (X-ray, (X-ray, γ  rays) (c) UV radiatio radiation n cataract cataract 203.. (a) Se 203 Seni nile le nu nucl clea earr cat catar arac actt (Ref: K -192) In patients with nuclear sclerosis, distant vision deteriorates due to progressive ‘index’ myopia. Such patients may be able to read without presbyopic glasses. This improvement in near vision is called ‘second sight’. As opacification progresses vision steadily diminishes. 204. (b) (b) Un Unil ilat ater eral al ca cata tara ract ct (Ref: Nema - 379) Specific indications for IOL are:(i) Macu Macular lar Deg Degener eneratio ation n (ii) Sev Severe ere Arthrit Arthritis is (iii) Menta Mentall retar retardation dation (iv) (i v) Parkinsonism (v)) Professional (v Professionals s wanting wanting good vision (a) Doct Doctors ors (b)) Pil (b Pilots ots (c) Arm Armed ed forces forces 205. (c) Dis Dista tant nt dir direct ect oph ophtha thalmo lmosco scopy py (Ref: K -193 Table 8.1) In D.D.O, Immature senile cataract shows multiple dark areas against red fundal glow. Other examinations to be done in cataract: (i) Vi Visu sual al ac acui uity ty (ii) Iri Iris s sha shadow dow  present in immature cataract (iii) Oblique illumination for color of lens Greyish white in ISC (iv)) Slit lamp (iv lamp  Areas of normal with cataractous cortex. 206. 20 6. (a) Zonular (Ref: K -187) Zonular cataract is a congenital cataract occurring in the zone of foetal nucleus: Etiology: Vit. D deficiency Hereditary Senile cataract occurs in two forms: (i)) Co (i Cort rtic ical al (ii)) Nu (ii Nucle clear ar Diabetes in young as well as adults leads to snowflake cataract

76 Ophthalmology 207. (c) Po Post st-o -op p sub. sub.con conj. j. inje inject ction ion.. Panophthalmitis may follow cataract surgery It is a serious disease and should be treated at earliest. Perforation of globe following improper surgery must be repaired immediately & gentamycin injected subconjunctivally (6 hrly) in addition to systemic antibiotics. Post-op sepsis can also be controlled by intra-vitreal injections of gentamycin. Other measures : Vitrectomy Evisceration 208. 20 8. (a) (a) Diabetes (Ref: Nema 224) Etiology of Zonular cataracts: Heredity  Autosomal dominant trait Congenital nuclear & sutural opacities Mate Ma tern rnal al me meta tabo boli lic c dis distu turb rban ance ces s - Hypo Hypoth thyr yroi oidi dism sm (I (IU UGR GR)) Disturbanc Distu rbances es of Calci Calcium um metab metabolism olism - Hypov Hypovitami itaminosis nosis D (Rickets) - Def Defect ective ive dev develo elopme pment nt of enamel of permanent teeth.