38 - Hirschberg test

Positive Hirschberg sign: the light falls on the centre of the right pupil, but is medial to the centre of the left pupil; therefore, the person in the picture has an exotropia.

In the fields of optometry and ophthalmology, the Hirschberg test, also Hirschberg corneal reflex test, is a screening test that can be used to assess whether a person has strabismus (ocular misalignment).

A photographic version of the Hirschberg is used to quantify strabismus.

It is performed by shining a light in the person's eyes and observing where the light reflects off the corneas. In a person with normal ocular alignment the light lands on the centre of both corneas. For an abnormal result, based on where the light lands on the cornea, the examiner can detect if there is an exotropia (abnormal eye is turned out), esotropia (abnormal eye is turned in), hypertropia (abnormal eye higher than the normal one) or hypotropia (abnormal eye is lower than the normal one).

In exotropia the light lands on the medial aspect of the cornea. In esotropia the light lands on the lateral aspect of the cornea. In hypertropia the light lands on the inferior aspect of the cornea. In hypotropia the light lands on the superior aspect of the cornea. A cover test can tell you the extent of the eso/exotropia.

Individuals can suffer from several tropias at once. In Graves ophthalmopathy, it is not uncommon to see an esotropia (due to pathology of the medial rectus muscle) co-morbid with a hypotropia (due to pathology of the inferior rectus muscle).

The technique was developed by German ophthalmologist Julius Hirschberg who in 1886 used a candle to observe the light reflex in an eye with strabismus.

37 - Persistent Hyperplastic Primary Vitreous (PHPV)

* It is persistence of the primary vitreous and hyaloid arterial system.

* Almost always unilateral (~90%)

*It is associated with Patau syndrome (Trisomy 13) .

* Presents as white pupillary reflex in the newborn (congenital leukocoria)

*It is usually associated with cataract, glaucoma , long and extended ciliary processes because of pull from contracted retrolental tissue, micropthalmos, intraocular hemorrhage and tractional retinal detachment.

* Investigations : USG and CT scan

* Differential diagnosis with retinoblastoma is done on the basis of micropthalmos and elongated ciliary processes.

* If diagnosed early, treatment is aspiration of lens, excision of retrolental membrane and vitrectomy.

* Visual prognosis is poor.

36 - Muscae Volitantes (Eye Floaters)

Muscae volitantes or floaters are moving vitreous opacities perceived when they cast a shadow on the retina. So they are more noticeable against a bright background.

They may be perceived by the patient as black dots, rings, strands or spider webs and keep on moving even when the head is still. Vitreous is normally transparent but when some processes cause degeneration and liquefaction of the vitreous it produces floaters.

The various causes of floaters are :

35 - Vitreous Mcqs with answers and explanations

1. Hyaluronic acid is found in ?
a. Vitreous humor
b. Synovial fluid
c. Cartilage
d. Cornea

answer a.Vitreous humor

2. Floaters can be seen in all of the following except ?
a. Vitreous hemorrhage
b. Retinal detachment
c. Uveitis
d. Acute congestive glaucoma

answer d. Acute congestive glaucoma.

3. The most common cause of vitreous hemorrhage in adults is ?
a. Retinal hole
b. Trauma
c. Hypertension
d. Diabetes

answer d. Diabetes. Trauma is the most common cause of vitreous hemorrhage among young individuals.

4. Black floaters in a diabetic patient indicate ?
a. Vitreous hemorrhage
b. Maculopathy
c. Vitreous infarction
d. Post vitreous detachment

answer a. Vitreous hemorrhage.

5. A 25 year old male gives history of sudden painless loss of vision in one eye for the past 2 weeks. There is no history of trauma. On examination the anterior segment is normal but there is no fundal glow. Which one of the following is the most likely cause ?
a. Vitreous hemorrhage
b. Optic atrophy
c. Developmental cataract
d. Acute attack of angle closure glaucoma

answer a.vitreous hemorrhage .

6. "Snow ball" opacity in vitreous is seen in ?
a. Pars planitis
b. sarcoidosis
c. Juvenile RA
d. Toxoplasmosis
e. Fuch's lesion

answer a and b. Pars planitis and Sarcoidosis. Other causes are amyloidosis,candidiasis and lyme disease.

7. Which one of the following statements concerning persistent hyperplastic primary vitreous (PHPV) is not true ?
a. It is generally unilateral
b. Visual prognosis is usually good
c. It may calcify
d. It is most easily differentiated from retinoblastoma by the presence of exopthalmos or cataract

answer b is a wrong statement because the prognosis of PHPV is usually poor.

8. PHPV is associated with which of the following ?
a. Patau syndrome
b. Down syndrome
c. Tuberous sclerosis
d. Sturge weber syndrome

answer a. Patau syndrome. Trisomy 13.

9. A vitreous aspirate has been collected in an emergency at 9 pm. What advice would you like to give to the staff on duty regarding the overnight storage of the sample ?
a. The sample should be kept at 4 degree centigrade
b. The sample should be incubated at 37 degree centigrade
c. The sample should be refrigerated in deep freezer
d. The sample should be refrigerated for the initial 3 hours and then incubated at 37 degree centigrade

answer a. The sample should be kept at 4 degree centigrade.

34 - Macular Function tests

Try this stupid mnemonic to remember this :

Photo Card's Entoptic view Indirectly stressed that Amsler's Flying Potential was Inferior 2 Maddox.

33 - Gerontoxon and Pseudogerontoxon

 

Arcus senilis (Gerontoxon) 
A common finding in the elderly but of no pathological significance. It is formed by lipid deposition at the periphery of the cornes. This condition is also found in familial hypercholesterol-anemias.

Pseudogerontoxon is a lesion that resembles a small segment of arcus senilis or gerontoxon and is seen in many individuals with limbal vernal or atopic keratoconjunctivitis. It is an important clinical finding because pseudogerontoxon is often times the only clinical evidence of previous allergic eye disease.

It is a characteristic feature of VERNAL KERATOCONJUNCTIVITIS, also called SPRING CATARRH.

32 - Vossius ring

The first figure shows Vossius ring due to Retro illumination and the second figure shows Vossius ring due to Direct illumination.

When blunt trauma occurs to the eye and the iris pigment epithelial cells are compressed against the anterior lens capsule with great force, a ring of cells may be left on the anterior capsule of lens, which is referred to as Vossius'' ring.

31 - Retinoscopy illustration video

 This is one of the best illustrated videos i have ever seen in my entire medical life. The guy very beautifully explains the whole concept of red reflex and using the red reflex to diagnose the condition and provide treatment . Have patience and watch the whole video , U will love it . I will soon post some theory regarding retinoscopy. Bye.

30 - Various types of cataract ( cataract eponyms )

      1. Christmas tree cataract = Myotonia Dystrophica 

      2. Snow flake / Snow storm cataract = Diabetes Mellitus

      3. Sunflower cataract = Wilson's disease

      4. Oil drop cataract = Galactosemia 

      5. Bread crumb appearance and polychromatic lustre 
                            =        Complicated cataract .

29 - AIIMS MAY 2008 mcqs with answers

1q: Retinitis Pigmentosa is not associated with ?

a. usher syndrome
b. kornzewig syndrome
c. kearns-sayre syndrome
d. marfan syndrome

answer d. marfan syndrome

2q: choroidal neovascularisation is seen in all except ?

a. hypermetropia
b. myopia
c. angioid streaks
d. trauma

answer a. hypermetropia

3q: Pterygium is  ?

a. an inflammatory response
b. a connective tissue degeneration
c. an infection
d. associated with vitamin A deficiency

answer b. connective tissue degeneration

4q: which of the following does not handle free radicals in lens ?

a. vitamin A
b. vitamin C
c. vitamin E
d. catalase

answer a. vitamin A

5q: A mass present in  muscle cone, encapsulated , presentation in the 3rd-4th decade with gradually increasing proptosis . what is the probable diagnosis ?

a. capillary hemangioma
b. cavernous hemangioma
c. dermoid
d. none

answer b. cavernous hemangioma

6q: a 12 year old boy comes into room with left sided head tilt , on correcting that he has right sided hypertropia, which increases on left gaze and tilting the head towards right. which muscle is affected ?

a. right superior oblique
b. left superior oblique
c. right superior rectus
d. left superior rectus

answer a. right superior oblique

7q: diabetic macular edema is due to all except ?

a. disruption of retinal pigment epithelium
b. oxidative stress
c. increased VEGF
d. increased expression of protein kinase 3

answer a. disruption of retinal pigment epithelium

8q: which of the following is true about telecanthus ?

a. increase in intercanthal distance with normal interpupillary distance
b. widely separated medial wall of orbits
c. decrease in the intercanthal distance with normal interpupillary distance
d. none

answer a. increase in intercanthal distance with normal interpupillary distance

9q: which of the following is true about chalazion ?

a. chronic non-specific inflammation
b. lipogranulomatous inflammation
c. dermoid
d. none

answer b. lipogranulomatous inflammation

10q: iridocorneal endothelial syndrome is associated with ?

a. progressive atrophy of iris stroma
b. bilateral symmetrical stromal edema of iris and cornea
c. deposition of collagen in descemet's membrane
d. deposition of glycosaminoglycan in descemet's membrane

answer a. progressive atrophy of iris stroma

11q: equal and opposite innervation is explained by which law ?

a. hering law
b. sherrington law
c. sherring
d. donder

answer b. sherrington law

28 - AIIMS MAY 2007 mcqs with answers

1q: Which of the following is autosomal dominant disorder ?

a. gyrate atrophy
b. best disease
c. lawrence moon biedl syndrome
d. bassen kornweig's disease

answer b. Best disease

2q: Most common causes of blindness in children, in india are all except ?

a. malnutrition
b. opthalmia neonatorum
c. glaucoma
d. congenital dacrocystitis

answer d. congenital dacrocystitis

3q: Hyaluronic acid is found in ?

a. vitreous humor
b. synovial fluid
c. cartilage
d. cornea

answer a. vitreous humor

4q: which of this does not handle the free radicals in lens ?

a. Vitamin A
b. Vitamin C
c. Vitamin E
d. Catalase

answer a. Vitamin A

5q: which of the following are not included in Vision 2020 ?

a. cataract
b. trachoma
c. onchoceriasis
d. epidemic conjunctivitis

answer d. Epidemic conjunctivitis

27 - AIIMS November 2007 mcqs with answers

1q: dangerous area of the eyeball is ?

a. ciliary body
b. sclera
c. optic nerve
d. retina

answer a. ciliary body.

2q: corneal transparency is maintained by all except ?

a. hydration
b. widely spaced collagen fibrils
c. increased mitotic figures in centre of cornea
d. unmyelinated nerve fibers

answer c. increased mitotic figures in the centre of cornea

3q: SAFE strategy is for ?

a. trachoma
b. diabetic retinopathy
c. onchoceriasis
d. glaucoma

answer a. trachoma

4q: Ionic pump in corneal endothelium maintains hydration by cellular metabolism. it can be blocked by ?

a. inhibition of anaerobic glycolysis
b. activation of anaerobic glycolysis
c. inhibition of electron transport chain
d. C-AMP mediated phosphodiesterase inhibition

answer a. inhibition of anaerobic glycolysis.

26 - Risk factors for cataract

1. Increasing age - oxidative damage to membranes and proteins


2. sunlight ( especially the UV-A, UV-B components ) - hydration


3. severe diarrhoeal dehydration - denaturation of proteins


4. vitamins A, C, E deficiency - opacification of lens fibres with fibrous metaplasia


5. diabetes - opacification of lens epithelium


6. smoking - accumulation of pigmented molecules
                    ( 3-hydroxykynurenine and chromophores which lead to yellowing )


7. corticosteroids - disturbance in osmotic balance


8. genetic - failure of ion pumps ( increased intralenticular calcium and sodium with decrease in potassium )

25 - Sherrington law of reciprocal innervation

During the initiation of an eye movement, increased innervation to an extraocular muscle is accompanied by simultaneous inhibition ( a reciprocal decrease in innervation ) of the direct antagonist of the contracting muscle of the same eye.

                             

If the left medial rectus muscle receives innervational flow to initiate adduction of the left eye, there is simultaneous decreased and inhibitory flow to the left lateral rectus muscle to make it relax and enable the eyeball to move medially.

24 - Embryological derivatives of Eye and its parts

1. Derivatives of Neural ectoderm : smooth muscle of the iris, optic vesicle and cup, iris epithelium, ciliary epithelium, part of the vitreous, retina, retinal pigment epithelium, fibres of the optic nerve.

2. Derivatives of surface ectoderm :  conjunctival epithelium, corneal epithelium, lacrimal glands, tarsal glands, lens.

3. Derivatives of mesoderm : extraocular muscles, corneal stroma, sclera, iris, vascular endothelium of eye and orbit, choroid and part of the vitreous .

4. Derivatives of neural crest* : corneal stroma, keratocytes and endothelium, sclera, trabecular meshwork endothelium, iris stroma, ciliary muscles, choroidal stroma, part of the vitreous, uveal and conjunctival melanocytes, meningeal sheaths of the optic nerve, ciliary ganglion, schwann cells of the ciliary nerves, orbital bones, orbital connective tissue, connective tissue sheath and muscular layer of the ocular and orbital blood vessels . 

( *during the folding of the neural tube, a ridge of cells comprising the neural crest develops from the tips of the converging edges and migrates to the dorsolateral aspect of the tube. neural crest cells from this region subsequently migrate and give rise to various structures within the eye and the orbit )  
 

26 - AIIMS november 2002 opthalmology mcqs with answers part 3

11q: a 60 year old man presented with watering from his left eye since 1 year . syringing revealed a patient drainage system . rest of the ocular examination was normal . a provisional diagnosis of lacrimal pump failure was made. Confirmations of the diagnosis would be by ?

a. dacryoscintigraphy
b. dacryocystography
c. pressure syringing
d. canaliculus irrigation test

answer a . dacryoscintigraphy

12q: a one year old child having leucocoria was detected to be having a unilateral large retinoblastoma filling half the globe . current therapy would involve ?

a. enucleation
b. chemotherapy followed by local dyes
c. direct laser ablation using photodynamic cryotherapy
d. scleral radiotherapy followed by chemotherapy

answer a . enucleation

13q: the standard sutureless cataract surgery done with phaco-emulsification and foldable IOL has an incision of ?

a. 1mm – 1.5 mm
b. 2 mm – 2.5 mm
c. 3 mm – 3.5 mm
d. 3.5 mm – 4.5 mm

answer c . 3 mm – 3.5 mm

14q: in a patient with AIDS chorioretinitis is typically caused by ?

a. cytomegalovirus
b. toxoplasma gondii
c. Cryptococcus neoformans
d. Histoplasma capsulatum

answer a . cytomegalovirus

15q: which is the commonest cause of ocular morbidity in the community ?

a. cataract
b. refractive error
c. ocular injury
d. vitamin A deficiency

answer b . refractive error                   Go to part 1 

25 - AIIMS november 2002 opthalmology mcqs with answers part 2

6q: in the grading of trachoma, trachomatous inflammation – follicular is defined as the presence of ?

a. 5 or more follicles in the lower tarsal conjunctiva
b. 3 or more follicles in the lower tarsal conjunctiva
c. 5 or more follicles in the upper tarsal conjunctiva
d. 3 or more follicles in the upper tarsal conjunctiva

answer c . 5 or more follicles in the upper tarsal conjunctiva

7q: a 8 year old boy presented with swelling in the left eye of 3 months duration, examination revealed proptosis of left eye with preserved vision. Right eye is normal. CT scan revealed intraorbital extraconal mass lesion. Biopsy revealed embryonal rhabdomyosarcoma . metastatic work up was normal. The standard line of treatment is ?

a. chemotherapy only
b. wide local excision
c. enucleation
d. chemotherapy and radiation therapy

answer d . chemotherapy and radiation therapy

8q: a 17 year old girl with keratitis and severe pain in the eye came to the hospital and acanthamoeba keratitis was suspected. The patient gave the history of following 4 points . out of these which is not a risk factor for acanthamoeba keratitis ?

a. extended wear contact lens
b. exposure to dirty water
c. corneal trauma
d. squamous blepharitis

answer d . squamous blepharitis

9q: significant loss of vision in a patient with hypertension occur due to all of the following except ?

a. occipital infarct
b. anterior ischemic optic neuropathy
c. papilloedema
d. retinal hemorrhage

answer c . papilloedema

10q: a 30 year old male presents with a history of injury to the eye with a leaf 5 days ago and pain, photophobia and redness of the eye for 2 days. What would be the most likely pathology ?

a. anterior uveitis
b. conjunctivitis
c. fungal cornal ulcer
d. corneal laceration

answer c . fungal corneal ulcer                            Go to part 3 

24 - AIIMS november 2002 opthalmology mcqs with answers part 1

1q: which morphological type of cataract is most visually handicapping ?

a. cortical
b. nuclear
c. posterior subcapsular
d. zonular

answer c . posterior subcapsular cataract

2q: a 2 year old child presented with leucocoria in the right eye since 2 months. On examination a total retinal detachment was present in the same eye. Ultrasound B scan revealed a heterogenous subretinal mass with calcification . the most likely clinical diagnosis is ?

a. coats disease
b. retinoblastoma
c. toxocariasis
d. retinal tuberculoma

answer b . retinoblastoma

3q: while working in a neonatal ICU your team delivers a premature infant at 27 weeks of gestation and weighing 1500 gm. How soon will you request fundus examination by an ophthalmologist ?

a. immediately
b. 3-4 weeks after delivery
c. At 34 weeks gestational age
d. At 40 weeks gestational age

answer c . 34 weeks of gestational age the first examination should be performed between 4 and 6 weeks of chronological ( postnatal ) age or between 31st and 33rd weeks of post conceptional age which ever is later

4q: a friend of yours has a spectacle correction of – 6.0 and – 8.0 . he telephones you one morning and tells that he has started seeing some opacities floating infront of his eye and that his vision has decreased slightly over the last few days. As an intern in the ophthalmology section, what would you do ?

a. reassure
b. refraction and prescribe a new spectacle
c. direct opthalmoscopy
d. indirect opthalmoscopy

answer d . indirect opthalmoscopy

5q: according to the national programme for control of blindness ( NPCB ) survey ( 1986 – 1989 ) the highest prevalence of blindness in India is in ?

a. jammu and Kashmir
b. Orissa
c. Bihar
d. Uttar Pradesh

answer a . jammu and Kashmir                         Go to part 2 

23 - phacoemulsification cataract surgery videos

I found these great videos on youtube which show the whole surgical procedure of the phacoemulsification cataract surgery . there are two parts . the first one is part 1 and includes the removal of anterior capsule and emulsification of the lens. the second one shows the introduction of the Intraocular lens 

( IOL ) . watch, know , learn and enjoy. They are beautiful .

22 - AIIMS MAY 2001 opthalmology mcqs

1q: the most common complication of hypermature sclerotic cataract is ?

a. dislocation of the lens
b. phacomorphic glaucoma
c. uveitis
d. neovascularisation of retina

answer a. dislocation of lens

2q: a 14 year old boy complains of pain during reading. On examination, his both eyes are normal and vision with snellen’s reading is 6/5 . he stills complains of pain on occluding one eye . the diagnosis is ?

a. myopia
b. pseudomyopia
c. hyperopia
d. emmetropia

answer b. pseudomyopia

3q: a 16 year old boy complains of pain in the right eye. After refractometry, he was prescribed a +3.5 D sphere lens. The cover test is normal. There is no heterophoria. The diagnosis is ?

a. organic amblyopia
b. anisometric amblyopia
c. hemitropic amblyopia
d. toxic amblyopia

answer b. anisometric amblyopia

4q: a patient complains of pain in both eyes with congestion. Blurring of vision, photophobia and mucopurulent discharge since one day. Many cases have been reported from the same community. The causative agent is probably ?

a. adenovirus
b. enterovirus 70
c. herpes simplex
d. echo virus

answer b. enterovirus

5q: a male patient with a history of hypermature cataract presents with a two day history of ciliary congestion, photophobia, blurring of vision and on examination has a deep anterior chamber in the right eye . the left eye is normal . the diagnosis is ?

a. phacomorphic glaucoma
b. phacolytic glaucoma
c. phacotoxic glaucoma
d. phacoanaphylactic uveitis

answer d. phacoanaphylactic uveitis

6q: a 60 year old male patient operated for cataract 6 months back now complains of floaters and sudden loss of vision . the diagnosis is ?

a. vitreous hemorrhage
b. retinal detachment
c. central retinal artery occlusion
d. cystiod macular edema

answer b. retinal detachment

7q: a 12 year old boy presents with recurrent attacks of conjunctivitis for the last 2 years with intense itching and ropy discharge . the diagnosis is ?

a. vernal conjunctivitis
b. phlyctenular conjunctivitis
c. trachoma
d. viral conjunctivitis

answer a. vernal conjunctivitis

8q: a 25 year old lady presents with severe sudden onset of pain, corneal congestion, photophobia and deep anterior chamber in the right eye. The left eye is normal . X ray pelvis shows sacroileitis . the diagnosis is ?

a. anterior uveitis
b. posterior uveitis
c. intermediate uveitis
d. scleritis

answer a. anterior uveitis

9q: a neonate, 30 days old, presents with excessive lacrimation and photophobia. He has a large and hazy cornea. His both lacrimal duct systems are normal .the diagnosis is ?

a. megalocornea
b. keratoconus
c. congenital glaucoma
d. hunter’s syndrome

answer c. congenital glaucoma

10q: a patient has normal anterior chamber and hazy cornea in one eye and shallow anterior chamber and myotic pupil in the fellow eye. The diagnosis is ?

a. endopthalmitis
b. acute congestive glaucoma
c. chronic simple glaucoma
d. acute anterior uveitis

answer d. acute anterior uveitis