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uveitis chronic duration intraorbital optic nerve length swinging flashlight test RAPD steroid cataract Wilson disease Kayser-Fleischer ring trachoma Chlamydia

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colored halos glaucoma mucopurulent conjunctivitis Munson sign keratoconus phlycten episcleritis atropine contraindications acute angle closure glaucoma

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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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