Q: Complete answer this without photos A: III MBBS Ophthalmology Paper - Complete Text Answers Q1. Fill in the blanks a Keratometry is useful in measuring corneal curvature corneal power. b Treatment of choice in aphakia is posterior chamber intraocular lens IOL implantation. c Corneal transparency is mainly maintained by endothelial layer of cornea. d Tonometer is useful in measuring intraocular pressure IOP in eye. e Lens is derived from surface ectoderm layer during fetal period. f YAG laser is used to treat posterior capsular opacification after-cataract in pseudophakic eye. --- Q2. MCQs 1 Collection of blood in anterior chamber is called: a Hyphema 2 Drug causing macular toxicity: a Gentamicin 3 Should not be used in raised IOP associated with uveitis: b Pilocarpine 4 Not a refractive error: b Presbyopia --- Q3. Preterm baby case ROP Baby 28 weeks, 1150 g, oxygen therapy: suspected Retinopathy of Prematurity ROP. a Why retina check? Risk factors Because baby is high risk for ROP prematurity + low birth weight + oxygen exposure. Risk factors: - Gestational age ≤34 weeks especially 32 weeks - Birth weight ≤2000 g especially 1500 g - Prolonged/unregulated oxygen therapy - Sepsis - Apnea/bradycardia episodes - Respiratory distress/mechanical ventilation - Blood transfusions - Multiple pregnancy, poor postnatal weight gain b Staging of ROP - Stage 1: Demarcation line - Stage 2: Ridge - Stage 3: Extraretinal fibrovascular proliferation - Stage 4A: Partial retinal detachment not involving macula - Stage 4B: Partial retinal detachment involving macula - Stage 5: Total retinal detachment - Plus disease: Venous dilatation + arteriolar tortuosity posterior pole, indicates severe activity - Aggressive posterior ROP APROP: rapidly progressive severe posterior disease c Zones of ROP - Zone I: Circle centered on optic disc, radius = 2 × disc-fovea distance - Zone II: From edge of zone I to nasal ora serrata - Zone III: Residual temporal crescent retina d Management - Timely screening as per protocol - Observe mild disease many regress - Treat Type 1 ROP / threshold disease: - Laser photocoagulation to avascular retina gold standard - Intravitreal anti-VEGF bevacizumab/ranibizumab in selected cases zone I/APROP - Stage 4/5 with detachment: - Scleral buckle or vitrectomy lens-sparing vitrectomy in selected stage 4 - Long-term follow-up for refractive error, amblyopia, strabismus, late retinal complications e Complications/sequelae of untreated progressive ROP - Retinal folds and traction - Partial/total retinal detachment - Leukocoria - High myopia, anisometropia, astigmatism - Strabismus, amblyopia, nystagmus - Glaucoma - Cataract - Severe irreversible visual impairment/blindness --- Q4. Explain briefly any five - concise notes for all six a Astigmatism Refractive error where eye has unequal refractive power in different meridians. Types: - Regular: with-the-rule, against-the-rule, oblique - Irregular: scars, keratoconus Symptoms: blurred vision, eyestrain, headache. Diagnosis: retinoscopy, keratometry, autorefractometer, corneal topography. Treatment: cylindrical glasses, toric contact lens, refractive surgery LASIK/PRK, keratoplasty in severe irregular cases. b Eye banking Systematic collection, preservation and distribution of donor corneas. Steps: donor identification - consent - enucleation/in-situ corneoscleral rim retrieval - preservation MK medium/cold storage/organ culture - serology - grading - allocation for keratoplasty. Uses: optical, therapeutic, tectonic keratoplasty. Contraindications: HIV, active septicemia, rabies, viral hepatitis as per protocol, unknown cause of death in some settings. c CRAO Central retinal artery occlusion Acute painless severe monocular vision loss. Signs: RAPD, retinal whitening, cherry-red spot, box-carring. Risk factors: carotid atherosclerosis, emboli, HTN, diabetes, cardiac disease, GCA in elderly. Management immediate: ocular massage, IOP lowering acetazolamide/manitol, anterior chamber paracentesis, carbogen where available, stroke workup urgently. Prognosis: poor; retinal survival about 90-100 minutes. d VKC Vernal keratoconjunctivitis Chronic bilateral recurrent allergic inflammation in children/young males. Symptoms: intense itching, ropy discharge, photophobia, foreign body sensation. Signs: giant papillae tarsal, limbal gelatinous thickening, Horner-Trantas dots; shield ulcer may occur. Treatment: allergen avoidance, cold compresses, lubricants, topical antihistamines/mast cell stabilizers, short steroid pulses, tacrolimus/cyclosporine for steroid-sparing. e Tonometry Measurement of IOP. Methods: - Applanation Goldmann = gold standard - Non-contact air puff - Indentation Schiotz - Rebound tonometry Normal IOP: about 10-21 mmHg. Errors due to corneal thickness, astigmatism, corneal edema/scar. f AION Anterior ischemic optic neuropathy Ischemia of optic nerve head causing sudden painless vision loss with disc edema. Types: - Arteritic giant cell arteritis, emergency - Non-arteritic vascular risk factors Features: altitudinal field defect common, RAPD, swollen disc. Management: - Arteritic: immediate high-dose systemic steroids to save fellow eye - NAION: risk factor control DM, HTN, sleep apnea, smoking --- Q5. Short notes any three - all four given a Blunt trauma in eye Injuries: lid edema/ecchymosis, subconj hemorrhage, hyphema, iridodialysis, angle recession, lens subluxation/dislocation, traumatic cataract, vitreous hemorrhage, commotio retinae, choroidal rupture, retinal detachment, globe rupture. Evaluation: visual acuity, slit lamp, IOP if no rupture, dilated fundus, B-scan/CT orbit if needed. Management: shield, analgesia, cycloplegics, steroids/antiglaucoma as indicated, hyphema precautions, surgery for rupture/lens/retina as required. b Visual field defects in glaucoma - Early: paracentral scotoma, small Bjerrum scotoma, nasal step of Roenne, Seidel scotoma - Intermediate: arcuate scotoma, ring scotoma - Advanced: peripheral constriction, tubular vision, temporal island only, end-stage field loss Perimetry is essential for diagnosis/progression monitoring. c Anatomy of cornea - Transparent avascular tissue, 11.5-12 mm horizontal diameter - Refractive power 43 D - Thickness: central 520 µm, peripheral thicker - 5 layers: epithelium, Bowman, stroma, Descemet membrane, endothelium - Nutrition from tears, aqueous, limbal vessels - Sensory supply: ophthalmic division of trigeminal long ciliary nerves d Scleritis Severe painful inflammation of sclera, often associated with autoimmune disease RA, GPA etc. Types: anterior diffuse, nodular, necrotizing; posterior scleritis. Features: deep boring pain, violaceous congestion, tenderness, decreased vision in severe forms. Diagnosis: clinical, B-scan posterior, systemic workup. Treatment: NSAIDs - systemic steroids - immunosuppressants/biologics in severe disease. Differentiate from episcleritis milder, sectoral, less painful. --- Q6. 59-year-old female, progressive painless distance blur, better near vision, yellow lens a Most likely diagnosis + supporting factors Diagnosis: Nuclear senile cataract nuclear sclerosis. Supporting features: - Age 59 years - Slow progressive painless diminution of vision - Distance vision reduced, near temporarily better "second sight" due to myopic shift - Yellowish discoloration of lens nuclear brunescence - No major anterior segment inflammation signs b Types of cataract and systemic associations Morphological types senile: - Nuclear - Cortical - Posterior subcapsular - Mature/hypermature By etiology: - Congenital/developmental - Age-related - Traumatic - Complicated uveitis, high myopia, RP etc. - Metabolic diabetes, galactosemia, hypocalcemia - Drug-induced steroids - Radiation/electric Systemic associations: - Diabetes mellitus - Atopy - Myotonic dystrophy - Neurofibromatosis - Wilson disease - Hypoparathyroidism - Chronic steroid use c Management techniques Definitive treatment is surgery when visually significant. Surgical options: - Phacoemulsification + foldable PCIOL preferred - Small incision cataract surgery SICS + PCIOL - ECCE less common now - ICCE obsolete except special indications Pre-op: biometry, IOL power calculation, systemic control, informed consent. Post-op: topical antibiotic-steroid, NSAID drops, follow-up and refraction. d Complications during and after management Intraoperative: - Posterior capsular rupture ± vitreous loss - Zonular dialysis - Dropped nucleus - Descemet detachment, endothelial damage - Suprachoroidal hemorrhage Early postoperative: - Corneal edema, raised IOP - Anterior uveitis - Endophthalmitis - Wound leak, shallow AC - IOL decentration Late postoperative: - Posterior capsular opacification - Cystoid macular edema - Retinal detachment risk in predisposed eyes - Bullous keratopathy - Chronic uveitis, secondary glaucoma --- Q7. Explain why any five - all six answered a Bilateral disc edema requires neurology opinion Often indicates raised intracranial pressure/papilledema or intracranial pathology mass lesion, CVST, meningitis, IIH. Needs urgent neuroimaging and neuro-evaluation to prevent vision and life-threatening complications. b Sudden pain and diminution of vision in keratoconus Suggests acute corneal hydrops due to break in Descemet membrane with stromal edema causing sudden painful visual drop. c CRAO is an ocular emergency Retina tolerates ischemia only for a short time; delay causes irreversible blindness. Also a marker of systemic vascular event stroke risk, requiring urgent management. d Role of genetic counselling in retinoblastoma RB1 mutation can be heritable. Counselling helps risk estimation for siblings/future offspring, early screening, prenatal options, and surveillance for second primary tumors. e Urgent suturing of corneal tear Prevents expulsion of intraocular contents, infection/endophthalmitis, iris prolapse and permanent visual loss. Early globe closure restores integrity and improves prognosis. f Systemic workup in recurrent uveitis Recurrent uveitis commonly associated with systemic infectious/autoimmune disease TB, syphilis, HLA-B27 spondyloarthropathy, sarcoidosis, Behcet. Finding cause guides targeted therapy and reduces recurrence/complications. --- Q8. Short notes a Counselling of parents to prevent amblyopia in child with refractive error AETCOM - Explain amblyopia is preventable/treatable if detected early - Emphasize regular vision screening preschool and school age - Full-time use of prescribed spectacles - Adherence to follow-up refraction - If advised, patching/penalization of better eye exactly as prescribed - Watch for squint, head tilt, close viewing, poor school performance - Limit excess screen time, encourage visual tasks with correction - Reassure, motivate, and address stigma of glasses - Stress critical period of visual development early treatment best b Anatomy of anterior chamber angle and grading Angle structures anterior - posterior: - Schwalbe line - Trabecular meshwork non-pigmented then pigmented - Scleral spur - Ciliary body band - Iris root Grading systems: 1. Shaffer by angular width: Grade 4 35-45 degrees, wide open, Grade 3 25-35 degrees, Grade 2 20 degrees, possible closure, Grade 1 10 degrees, high risk, Grade 0 closed. 2. Spaeth: more detailed insertion, angle width, iris configuration. 3. Van Herick slit-lamp peripheral AC depth estimate: quick screening for narrow angle. c Preseptal vs orbital cellulitis Preseptal cellulitis: - Infection anterior to orbital septum - Lid edema/erythema - No proptosis - No painful/restricted eye movements - Vision usually normal - No RAPD - Usually mild systemic signs Orbital cellulitis: - Infection posterior to septum - Lid edema + proptosis - Painful/restricted EOM, diplopia - Reduced vision possible - RAPD may be present - Fever/toxicity common - Risk of abscess, cavernous sinus thrombosis, meningitis Needs urgent admission, IV antibiotics, imaging, possible surgical drainage. d Chemical injury of eye Common agents: alkali more severe and acids. Pathogenesis: alkali penetrates rapidly causing liquefactive necrosis and limbal stem cell damage. Emergency management immediate: 1. Copious irrigation immediately normal saline/Ringer/water till pH neutral 2. Remove particulate matter from fornices 3. Check pH repeatedly 4. Topical antibiotics, cycloplegics, lubricants 5. Topical steroids short course acute phase, antiglaucoma if needed 6. Oral vitamin C, doxycycline collagenase inhibition in suitable patients 7. Monitor for epithelial defects, melt, glaucoma Classification: Roper-Hall / Dua classification based on corneal haze and limbal ischemia. Late management: symblepharon release, AMT, limbal stem cell transplant, keratoplasty as indicated. --- If you want, I can now convert this into a clean “exam writing format” headings + pointwise + mark-wise length so you can reproduce it directly in answer sheets. Q: Explain 3 of question number 2 A: Q23: “Which should not be used in raised IOP associated with uveitis?” Correct answer: b Pilocarpine Why pilocarpine should not be used In uveitic glaucoma raised IOP with active inflammation, pilocarpine is avoided because it: - Causes miosis and ciliary muscle spasm, increasing pain - Can worsen blood-aqueous barrier breakdown, increasing inflammation - Promotes formation of posterior synechiae iris sticking to lens - May aggravate pupillary block tendency in inflamed eyes What is preferred instead - Control inflammation: topical corticosteroids - Keep pupil dilated: cycloplegic/mydriatic eg atropine/homatropine - Lower IOP with safer agents: - Beta-blocker timolol - Carbonic anhydrase inhibitor acetazolamide/dorzolamide - Alpha-agonist with caution as appropriate So, in short: Pilocarpine is contraindicated/avoided in raised IOP due to uveitis.
