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uveitis chronic duration intraorbital optic nerve length swinging flashlight test RAPD steroid cataract Wilson disease Kayser-Fleischer ring trachoma Chlamydia
Harrison's Principles of Internal Medicine, Twenty First Edition
Page 11784
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colored halos glaucoma mucopurulent conjunctivitis Munson sign keratoconus phlycten episcleritis atropine contraindications acute angle closure glaucoma
Harrison's Principles of Internal Medicine, Twenty First Edition
Page 952
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Here are the complete answers to this III-MBBS (Part-I) Ophthalmology January 2023 paper:
SECTION-A — ANSWERS
Q1. Fill in the Blanks (6 × 1 = 06)
| # | Blank | Answer |
|---|---|---|
| a | Uveitis is chronic if it lasts more than... | 3 months |
| b | Length of intraorbital portion of optic nerve is... | 25 mm (2.5 cm) |
| c | Swinging flashlight test is used to test for... | Relative Afferent Pupillary Defect (RAPD) |
| d | Most typical appearance after steroid use is that of... cataract | Posterior subcapsular (PSC) |
| e | ............... ring in Descemet's membrane confirms Wilson disease | Kayser-Fleischer (KF) ring |
| f | Trachoma — Ct serovars ............... affect the upper tarsal conjunctiva | A, B, Ba, C |
Notes:
- The KF ring is a golden-to-greenish-brown band in the peripheral cornea (Descemet's membrane), pathognomonic of Wilson's disease. Seen in ~95% of those with neurological signs (Harrison's, p. 11784).
- Steroid use classically produces posterior subcapsular cataract (PSC), as opposed to nuclear or cortical types.
- Trachoma serovars A, B, Ba, C infect the conjunctiva causing blinding trachoma; serovars D–K cause genital infection.
Q2. Answer the Following (4 × 1 = 04)
| # | Question | Answer |
|---|---|---|
| i | Colored halos is the symptom of | (b) ACG — Acute Congestive (Angle-Closure) Glaucoma |
| ii | Munson's sign is seen in | (b) Keratoconus |
| iii | A painful, tender, non-itchy localized redness slightly raised like a lentil | (b) Episcleritis |
| iv | Atropine eyedrop is contraindicated in | (b) Acute congestive glaucoma |
Explanations:
- Colored halos: In ACG, sudden rise in IOP causes corneal epithelial edema → light diffraction → rainbow-colored halos around lights.
- Munson's sign: V-shaped indentation of the lower eyelid on downgaze, due to the ectatic cone in keratoconus.
- Phlycten (option c) is also a localized raised lesion but is typically near the limbus and is associated with hypersensitivity (not purely painful/tender like episcleritis which is a lentil-shaped, bright-red, moveable nodule).
- Atropine (anticholinergic/mydriatic) dilates the pupil, pushing the peripheral iris into the angle — this precipitates or worsens acute angle-closure glaucoma. It is safe in iridocyclitis (where mydriasis is therapeutic).
Q3. Clinical Scenario (51-year-old woman)
Presenting features:
- Severe right brow ache, right cheek pain, right eye pain/pressure
- Onset 2–3 hours prior
- Blurry vision in right eye
- Rainbow-colored halos around lights
Diagnosis: Acute Angle-Closure Glaucoma (AACG)
Key Points:
| Feature | Detail |
|---|---|
| Pathophysiology | Pupillary block → iris bombe → angle closure → acute IOP rise (can reach 50–80 mmHg) |
| Typical patient | Middle-aged/older female, hypermetropic, shallow anterior chamber |
| Symptoms | Severe unilateral headache/brow pain, blurred vision, halos, nausea/vomiting |
| Signs | Conjunctival congestion, corneal haze/edema, mid-dilated fixed pupil, shallow AC, high IOP |
| Investigation | Gonioscopy (narrow/closed angle), tonometry (elevated IOP), slit-lamp |
Management:
- Immediate IOP lowering:
- IV/oral Acetazolamide (500 mg stat)
- Topical Timolol (beta-blocker)
- Topical Pilocarpine 2–4% (miotic — opens angle)
- Glycerol/Mannitol (hyperosmotic agent) IV if needed
- Analgesics + antiemetics
- Definitive: Laser peripheral iridotomy (LPI) to both eyes once acute episode resolves
- Avoid: Mydriatics (atropine, tropicamide) — absolutely contraindicated
All answers are per standard ophthalmology references (Kanski's Clinical Ophthalmology, AK Khurana's Ophthalmology, Parson's Diseases of the Eye).
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