OCULAR DISEASE – I

5 marks question & answer

2022-23

1. Dacryocystitis.

Ans : Infection of the lacrimal sac is usually secondary to obstruction f the nasolacrimal duct. It
may be acute or chronic and is most commonly staphylococcal or streptococcal.

Clinical features :

• Tearing: Excessive tearing, also known as epiphora, is a common symptom.

• Swelling: Patients may experience swelling and tenderness in the inner corner of the
affected eye.
• Discharge: Purulent discharge from the inner corner of the eye is often present.
• Redness: The area around the affected tear duct may appear red and inflamed.
• Pain: Some individuals may experience pain or discomfort around the affected eye.
• Eyelid Edema: Swelling of the eyelid may occur, especially if the infection spreads.

Treatment :

The infection is usually self- limiting but sometimes primary management required –

• Warm Compresses: Applying warm compresses to the affected eye several times a day
can help relieve symptoms and promote drainage.
• Antibiotics: Broad-spectrum antibiotics are typically prescribed to treat the underlying
bacterial infection.
• Nasolacrimal Duct Massage: Gentle massage over the lacrimal sac area can help
promote drainage of the blocked tear duct.
• Topical Steroids: In cases of significant inflammation, topical steroids may be prescribed
to reduce swelling and discomfort.
• Dacryocystorhinostomy : Dacryocystorhinostomy is commonly required after the acute
infection has been controlled and may reduce the risk of recurrent infection and can result
in closure of a fistula.

2. Discuss corneal dystrophies.

Ans : Corneal dystrophies are a group of genetic eye disorders characterized by abnormal
accumulation of material in the cornea, the clear outer layer of the eye. Here are some common
types:

I. Fuchs’ Endothelial Dystrophy: This dystrophy affects the endothelial cells, which are
responsible for maintaining the cornea’s clarity by pumping excess fluid out of the cornea.
In Fuchs’ dystrophy, these cells deteriorate, leading to corneal swelling and blurred vision,
particularly in the morning.
II. Granular Corneal Dystrophy: This type is characterized by the accumulation of grain-like
deposits in the cornea, leading to cloudy vision and discomfort. It typically starts in
childhood or adolescence and progresses slowly over time.

1|Page
 III. Lattice Corneal Dystrophy: Lattice dystrophy is named for the lattice-like pattern of
deposits that form in the cornea. These deposits can lead to vision problems such as
glare, blurry vision, and sometimes recurrent corneal erosions.
IV. Macular Corneal Dystrophy: This rare type affects the stromal layer of the cornea,
causing the buildup of abnormal material known as glycosaminoglycans. It leads to
corneal clouding, reduced vision, and photophobia (light sensitivity).
V. Map-Dot-Fingerprint Dystrophy (Epithelial Basement Membrane Dystrophy): This
condition is characterized by irregularities in the basement membrane of the corneal
epithelium, leading to recurrent corneal erosions. Patients may experience episodes of
pain, blurred vision, and sensitivity to light.
VI. Meesmann’s Corneal Dystrophy: Meesmann’s dystrophy is a rare disorder that affects
the corneal epithelium, causing tiny cysts to form within the outer layer of the cornea. It
can lead to symptoms such as irritation, foreign body sensation, and occasional blurry
vision.
VII. Reis-Bucklers Corneal Dystrophy: This type involves the abnormal deposition of material
in the Bowman’s layer of the cornea, leading to corneal opacities, decreased vision, and
recurrent corneal erosions.

Each type of corneal dystrophy has its own distinct characteristics and progression, but they all
share the common feature of causing visual impairment due to abnormal deposits or changes in
the corneal structure. Treatment options vary depending on the specific type and severity of the
dystrophy, ranging from medications and lubricating eye drops to surgical interventions such as
corneal transplantation.

3. Discuss scleritis in details.

Ans : Scleritis is a serious inflammatory condition affecting the sclera, the white outer layer of the
eye.

Etiology: Scleritis can be caused by various factors, including autoimmune diseases like
rheumatoid arthritis and granulomatosis with polyangiitis, infections, trauma, and sometimes
idiopathic causes.

Signs and Symptoms:

• Severe eye pain, often described as deep or boring

• Redness and inflammation in the affected area
• Sensitivity to light (photophobia)
• Blurred vision
• Tearing
• Headache

Types: There are different types of scleritis based on severity and location, including:

• Anterior scleritis: Affects the front portion of the sclera.

• Posterior scleritis: Involves the back portion of the sclera.
• Necrotizing scleritis: Associated with tissue death and is considered the most severe
form.
• Non-necrotizing scleritis: Inflammation without tissue death.

2|Page
 Treatment :

• Tab. Indomethacin—100 mg daily for 4 days, reducing to 75 mg daily until the inflammation
resolves.
• Oral prednisolone—60–80 mg daily, then the dose can be tapered accordingly, as the
inflammation subsides.
• Local corticosteroids are less effective, and subconjunctival injection is contra-indicated
for fear of perforation of the globe.
• Immunosuppressive alkylating agents, or oral azothioprim in severe and unresponsive
cases.
• Atropine (1%) eye ointment—2 times daily for associated uveitis.

4. Write a short note on : Vogt-Koyanagi-Harada syndrome.

Ans : Vogt-Koyanagi-Harada (VKH) syndrome is a rare autoimmune disorder that affects multiple
systems in the body, particularly the eyes, skin, and nervous system. Here are some key points
about VKH syndrome:

• Autoimmune Disorder: VKH syndrome is caused by an abnormal immune response

targeting melanocytes, which are cells that produce melanin. This leads to inflammation
and damage in various tissues where melanocytes are found.
• Ocular Symptoms: The hallmark feature of VKH syndrome is bilateral, granulomatous
uveitis, which is inflammation of the uvea (the middle layer of the eye). This can cause
symptoms such as blurred vision, eye pain, redness, and sensitivity to light. In severe
cases, it can lead to vision loss or blindness.
• Treatment: The mainstay of treatment for VKH syndrome involves suppressing the
abnormal immune response with corticosteroids, often in combination with
immunosuppressive medications such as azathioprine or methotrexate. Early intervention
is crucial to prevent permanent vision loss and other complications.
• Prognosis: With prompt and appropriate treatment, many individuals with VKH syndrome
experience improvement in their symptoms and may achieve remission. However, some
may have recurrent episodes or develop long-term complications such as cataracts,
glaucoma, or vision impairment.
• Management: Long-term management of VKH syndrome may involve regular monitoring
by an ophthalmologist and adjustments to medication dosages based on disease activity.
In some cases, surgical intervention may be necessary to address complications such as
cataracts or glaucoma.
• Supportive Care: Supportive measures such as wearing sunglasses to protect the eyes
from bright light and seeking prompt medical attention for any new or worsening
symptoms are important for managing VKH syndrome and preserving vision and overall
health.

5. Discuss about scleral thinning.

Ans : Scleral thinning refers to a condition where the sclera, the tough outer layer of the eye,
becomes thinner than normal. This condition can be caused by various factors and can have
significant implications for eye health. Here's a pointwise discussion about scleral thinning:

3|Page
 Causes of Scleral Thinning:

• Age: As individuals age, the sclera can naturally become thinner and weaker.
• Trauma: Direct trauma to the eye or repetitive mechanical stress can cause localized
thinning of the sclera.
• Inflammation: Conditions such as scleritis, which involve inflammation of the sclera, can
lead to thinning.
• Genetic Factors: Certain genetic disorders can predispose individuals to scleral thinning.
• Systemic Diseases: Conditions such as rheumatoid arthritis and systemic lupus
erythematosus (SLE) can also be associated with scleral thinning.

Symptoms:

• Scleral thinning may not always present with specific symptoms, especially in the early
stages.
• However, if thinning progresses significantly, it can lead to symptoms such as visual
disturbances, increased sensitivity to light, and in severe cases, protrusion of the eye
(exophthalmos).

Complications:

• One of the major concerns with scleral thinning is the increased risk of complications such
as globe rupture, where the integrity of the eye's outer layer is compromised.
• Scleral thinning can also predispose individuals to other eye conditions such as
keratoconus and myopia progression.

Diagnosis:

• Diagnosis of scleral thinning typically involves a comprehensive eye examination by an

ophthalmologist.
• Various imaging techniques such as optical coherence tomography (OCT) and ultrasound
may be used to assess the thickness and integrity of the sclera.

Treatment:

• Treatment options for scleral thinning depend on the underlying cause and severity of the
condition.
• In cases where thinning is due to inflammation, anti-inflammatory medications may be
prescribed.
• Surgical interventions such as scleral grafting or the use of scleral implants may be
considered in severe cases to reinforce the weakened scleral tissue.

2018-19

6. Congenital dacryocystitis.

Ans: Congenital dacryocystitis is a condition that affects infants and occurs due to the obstruction
or underdevelopment of the nasolacrimal duct, which is responsible for draining tears from the
eyes into the nasal cavity. Here's a pointwise discussion about congenital dacryocystitis:

• Definition: Congenital dacryocystitis refers to the inflammation or infection of the lacrimal

sac, which arises due to a blockage or obstruction in the nasolacrimal duct present since
birth.

4|Page
 • Causes: The primary cause of congenital dacryocystitis is a congenital obstruction in the
nasolacrimal duct, which may be caused by a membrane at the valve of Hasner, abnormal
anatomy of the nasolacrimal system, or incomplete canalization during fetal development.
• Symptoms: Infants with congenital dacryocystitis typically present with symptoms such
as excessive tearing (epiphora), discharge from the affected eye, redness and swelling
near the inner corner of the eye (medial canthus), and recurrent eye infections.
• Diagnosis: Diagnosis is often made based on clinical examination, where the pediatrician
or ophthalmologist may observe the characteristic symptoms and signs. A dye
disappearance test (Jones test) can also be performed to confirm the obstruction. Imaging
studies such as dacryocystography or ultrasonography may be used in some cases to
visualize the nasolacrimal duct and confirm the diagnosis.
• Management:
a. Conservative Management: In many cases, congenital dacryocystitis resolves
spontaneously within the first year of life as the nasolacrimal system matures. Initial
management may involve gentle massage of the lacrimal sac area to promote tear
drainage and the application of warm compresses to alleviate symptoms.
b. Medical Management: Antibiotic eye drops or ointments may be prescribed if there is
evidence of infection. Probing and irrigation of the nasolacrimal duct under anesthesia
may be considered if conservative measures fail.
c. Surgical Intervention: If the obstruction persists beyond the first year of life or if there are
recurrent infections, surgical intervention may be necessary. The most common surgical
procedure is dacryocystorhinostomy (DCR), which involves creating a new drainage
pathway for tears by connecting the lacrimal sac directly to the nasal cavity.

7. Entropion-classification and management.

Ans: Entropion is a medical condition where the eyelid, typically the lower eyelid, turns inward
towards the eye, leading to discomfort, irritation, and potential damage to the cornea. Entropion
can be classified based on its etiology, or the underlying cause. Here are the main classifications:

i. Involutional Entropion: This is the most common type and is associated with
aging. It occurs due to weakening of the muscles and tissues around the eye,
leading to a loss of support for the eyelid. Involutional entropion typically affects
older individuals.
ii. Cicatricial Entropion: Cicatricial entropion is caused by scarring of the eyelid or
surrounding tissues, which leads to the eyelid rolling inward. Scarring can result
from trauma, inflammation, infections, or certain skin conditions like ocular
pemphigoid or Stevens-Johnson syndrome.
iii. Spastic Entropion: This type of entropion is characterized by involuntary muscle
spasms or contractions of the eyelid, causing it to turn inward. Spastic entropion
can be associated with conditions such as blepharospasm or facial nerve
paralysis.
iv. Congenital Entropion: In rare cases, entropion can be present at birth or develop
shortly thereafter. Congenital entropion may occur due to abnormalities in eyelid
development or muscle function.

5|Page
 v. Mechanical Entropion: Mechanical entropion is caused by mechanical factors
such as tumors, swelling, or abnormalities in the anatomy of the eyelid or
surrounding structures, which force the eyelid to turn inward.

Classification based on etiology helps in understanding the underlying cause of entropion, which is
essential for determining the most appropriate treatment approach. Treatment options may include
lubricating eye drops, eyelid taping, botulinum toxin injections (for spastic entropion), surgical
correction to tighten or reposition the eyelid, or addressing the underlying condition causing entropion.

8. Clinical features of Keratoconus.

Ans : Keratoconus is a progressive eye disorder that affects the cornea, the transparent front part
of the eye. It's characterized by the cornea thinning and gradually bulging into a cone shape, which
leads to distorted vision. The clinical features of keratoconus can vary among individuals but
generally include the following:

i. Blurred or Distorted Vision: One of the most common symptoms is blurry or distorted
vision. As the cornea becomes irregularly shaped, it affects the way light enters the eye,
leading to difficulties in focusing. Patients often experience a sudden deterioration in
vision, particularly in their teens or twenties.
ii. Increased Sensitivity to Light (Photophobia): Individuals with keratoconus may become
more sensitive to light than usual. This sensitivity can cause discomfort in bright
environments, making it challenging to tolerate sunlight or bright indoor lighting.
iii. Frequent Changes in Eyeglass or Contact Lens Prescription: Due to the progressive
nature of keratoconus, individuals often require frequent changes in their eyeglass or
contact lens prescriptions to maintain clear vision. However, even with updated
prescriptions, achieving optimal vision can become increasingly difficult as the condition
progresses.
iv. Irregular Astigmatism: Keratoconus typically results in irregular astigmatism, which
occurs when the cornea is shaped more like a football than a basketball. This irregularity
causes light to focus unevenly on the retina, leading to distorted and blurry vision,
particularly at night.
v. Ghost Images or Multiple Images (Monocular Diplopia): Patients may experience seeing
ghost images or double vision in one eye (monocular diplopia). This symptom can
significantly impact daily activities such as reading, driving, or watching television.
vi. Corneal Scarring: In advanced stages of keratoconus, the cornea may develop scar tissue
due to the stretching and thinning of its layers. Corneal scarring further impairs vision and
can cause discomfort or irritation.
vii. Eye Rubbing: Many individuals with keratoconus report frequent eye rubbing, which can
exacerbate the condition by further weakening the corneal structure. Eye rubbing is often a
response to itching or discomfort caused by the irregular shape of the cornea.
viii. Corneal Hydrops: In rare cases, keratoconus can lead to corneal hydrops, a sudden
swelling of the cornea due to the influx of fluid into the weakened corneal tissue. Corneal
hydrops can cause sudden vision loss, pain, and increased sensitivity to light.

Early diagnosis and management of keratoconus are crucial to preserving vision and preventing
complications. Treatment options may include prescription eyeglasses or contact lenses, corneal
collagen cross-linking to strengthen the cornea, and in severe cases, corneal transplantation.

6|Page
 Regular eye examinations by an ophthalmologist or optometrist are essential for monitoring the
progression of the condition and adjusting treatment accordingly.

9. Clinical features and management of Blepharitis.

Ans: Blepharitis is a common and often chronic condition characterized by inflammation of the
eyelid margins. It can affect people of all ages and may lead to discomfort, irritation, and potential
complications if left untreated. Understanding its clinical features and appropriate management
strategies is crucial for effective treatment. Here's a discussion on these aspects:

Clinical Features:

• Redness and Swelling: Blepharitis typically presents with redness and swelling along the
margins of the eyelids.
• Eyelid Crustiness: Patients may experience crusting at the base of the eyelashes,
especially upon waking up in the morning.
• Itchiness and Irritation: Individuals with blepharitis often report itching and irritation in
and around the eyelids.
• Tearing: Excessive tearing or watering of the eyes can occur due to the irritation caused by
blepharitis.
• Sensitivity to Light: Some patients may experience sensitivity to light (photophobia).
• Foreign Body Sensation: A sensation of having something foreign in the eye is common
among blepharitis patients.
• Dry Eyes: Blepharitis can disrupt the normal functioning of the tear film, leading to
symptoms of dry eyes.
• Meibomian Gland Dysfunction (MGD): Many cases of blepharitis are associated with
dysfunction of the meibomian glands, which are responsible for producing the oily
component of tears. This can lead to meibomian gland blockage and subsequent
complications like chalazion or styes.

Management:

• Eyelid Hygiene: Regular eyelid hygiene is the cornerstone of blepharitis management. This
involves gently cleansing the eyelid margins and lashes with warm water and a mild
cleanser or using commercially available eyelid cleansing products.
• Warm Compresses: Applying warm compresses to the eyelids can help loosen crusts,
open blocked meibomian glands, and improve oil flow.
• Lid Scrubs: Lid scrubs with products containing diluted baby shampoo or specialized
eyelid cleansing solutions can effectively remove debris and bacteria from the eyelid
margins.
• Topical Antibiotics: In cases of blepharitis with significant bacterial involvement, topical
antibiotics such as erythromycin or azithromycin ointment may be prescribed to reduce
bacterial load and inflammation.
• Anti-inflammatory Medications: Corticosteroid eye drops or ointments may be used for
short-term management of severe inflammation, but prolonged use should be avoided due
to potential side effects.
• Artificial Tears: Lubricating eye drops or ointments can alleviate symptoms of dry eyes
associated with blepharitis.

7|Page
 • Treatment of Associated Conditions: Managing underlying conditions such as rosacea or
seborrheic dermatitis, which are often associated with blepharitis, can help improve
symptoms.
• Meibomian Gland Expression: In cases of meibomian gland dysfunction, manual
expression of the glands by a healthcare professional may be necessary to clear blockages
and improve gland function.
• Oral Medications: In some cases, oral antibiotics or oral anti-inflammatory medications
may be prescribed, especially if there is significant inflammation or infection.

10. Differences between Scleritis and Episcleritis.

Ans:

11. Differences between corneal degeneration & dystrophy.

Ans: Differences between corneal degeneration & dystrophy

8|Page
2017-18

12. Blepharitis.

Ans:

9|Page
 13. Differences between Granulomatous & non-granulomatous uveitis using a tabular from.

Ans : Differences between Granulomatous & non-granulomatous uveitis :

14. Clinical features & management of congenital or infantile glaucoma. (Bupthalmos)

Ans: It is a congenital or infantile glaucoma due to aqueous outflow obstruction, as a result of

failure of the development of tissue at the angle of the anterior chamber.

10 | P a g e
 Clinical features & management:

11 | P a g e
 15. Van Herrick System of grading the anterior chamber angle.

Ans: The Van Herick System is a method used to grade the depth of the anterior chamber angle in
ophthalmology. This system is named after Dr. Harry Van Herick, who introduced it in the 1960s.
It's a quick and simple technique used to assess the peripheral anterior chamber depth,
particularly in the context of glaucoma assessment.

Here's how the Van Herick System works:

1. Equipment: All that's required for this assessment is a slit lamp biomicroscope.

2. Procedure: The procedure involves shining a slit beam of light onto the cornea at a specific
angle and then observing the depth of the anterior chamber angle in relation to the cornea.

3. Grading: The depth of the anterior chamber angle is graded relative to the corneal thickness. The
grading system typically consists of four grades:

- Grade 4: The chamber depth is at least equal to half of the corneal thickness.
- Grade 3: The chamber depth is less than half of the corneal thickness.
- Grade 2: The chamber depth is equal to or less than one-fourth of the corneal
thickness.
- Grade 1: The chamber depth is less than one-fourth of the corneal thickness,
which indicates a shallow anterior chamber.

4. Interpretation: A higher grade indicates a deeper anterior chamber angle, which is generally
considered normal. Lower grades, especially Grade 1, indicate a shallower anterior chamber,
which could be associated with an increased risk of angle-closure glaucoma.

5. Clinical Utility: The Van Herick System is particularly useful in assessing patients for angle-
closure glaucoma or evaluating patients with conditions predisposing them to shallow anterior
chamber angles, such as hyperopia or a history of acute angle-closure attacks.

6. Limitations: While the Van Herick System provides a quick and easy assessment of the anterior
chamber angle, it's important to note that it's a subjective grading system and may not provide the
most accurate assessment compared to more sophisticated imaging techniques like gonioscopy
or anterior segment optical coherence tomography (AS-OCT). Therefore, it's often used as an initial
screening tool rather than a definitive diagnostic tool.

Van Herick System offers a simple and valuable method for assessing the depth of the anterior
chamber angle, aiding clinicians in the early detection and management of conditions such as
angle-closure glaucoma.

12 | P a g e
 16. Difference between Cortical & Nuclear Cataract.

Ans:

2016-17

17. Acute adult dacryocystitis – discuss clinical features & complications only.

Ans: Acute adult dacryocystitis is a condition characterized by inflammation and infection of the
lacrimal sac, typically caused by obstruction of the nasolacrimal duct. Here are the clinical
features and potential complications associated with this condition:

Clinical Features:

• Pain and Tenderness: Patients often experience pain and tenderness in the medial
canthal region (inner corner of the eye).
• Swelling: Swelling around the lacrimal sac area is common, which may extend to the
surrounding tissues.
• Redness: The affected area may appear red and inflamed due to the underlying infection.
• Epiphora: Excessive tearing or watering of the eye occurs due to the obstruction of the
nasolacrimal duct, leading to poor drainage of tears.
• Mucopurulent Discharge: Patients may present with discharge from the affected eye,
which can be thick and purulent.
• Fever: Systemic symptoms such as fever may be present, indicating an inflammatory
response to the infection.
• Tenderness on Pressing Over the Lacrimal Sac: Palpation of the lacrimal sac area often
reveals tenderness.

Complications:

• Periorbital Cellulitis: Untreated or severe cases of acute dacryocystitis can lead to the
spread of infection to the surrounding tissues, resulting in periorbital cellulitis. This is
characterized by erythema, edema, and warmth in the periorbital area, and it can
potentially progress to orbital cellulitis.
• Orbital Cellulitis: In severe cases, the infection may spread to the orbit (the bony cavity
containing the eye), causing orbital cellulitis. This is a serious condition that can lead to
visual impairment or even blindness if not promptly treated. Symptoms include proptosis
(bulging of the eye), restricted eye movement, decreased visual acuity, and severe pain.

13 | P a g e
 • Subperiosteal Abscess: Prolonged or untreated dacryocystitis may result in the formation
of a subperiosteal abscess, which is a collection of pus between the periosteum and the
bony orbit. This can lead to further complications such as compressive optic neuropathy
and cavernous sinus thrombosis.
• Septicemia: Although rare, severe infections can lead to bloodstream infection
(septicemia), which can be life-threatening if not promptly treated with systemic
antibiotics.

Prompt recognition and treatment of acute dacryocystitis are crucial to prevent complications.
Management typically involves systemic antibiotics to control the infection, along with lacrimal
sac massage, warm compresses, and referral for surgical intervention to relieve the obstruction in
the nasolacrimal duct. In severe cases or when complications arise, hospitalization and
intravenous antibiotics may be necessary, along with close monitoring for potential sequelae such
as orbital cellulitis or abscess formation.

18. Discuss the 4 stages in the healing of bacterial keratitis.

Ans: Bacterial keratitis is a serious infection of the cornea caused by bacteria. The healing process
of bacterial keratitis typically occurs in four stages:

i. Inflammatory Response and Destruction: When bacteria infect the cornea, the body's
immune system triggers an inflammatory response to fight off the infection. This stage
involves the recruitment of immune cells such as neutrophils and macrophages to the site
of infection. These immune cells release inflammatory mediators and enzymes to combat
the bacteria, leading to tissue damage and destruction of corneal cells.
ii. Repair and Regeneration: As the inflammatory response subsides, the healing process
enters the repair and regeneration stage. Corneal epithelial cells begin to proliferate and
migrate to cover the damaged areas of the cornea. This process is crucial for restoring the
integrity of the corneal surface and preventing further infection.
iii. Granulation Tissue Formation: Granulation tissue, composed of new blood vessels and
connective tissue, forms in the area of the cornea that was affected by the infection. This
stage is characterized by the formation of a pinkish-red tissue over the corneal ulcer.
Granulation tissue helps facilitate the delivery of oxygen and nutrients to the healing tissue
and promotes further repair and regeneration.
iv. Scar Formation and Remodeling: In the final stage of healing, the granulation tissue
matures and remodels into a scar. The scar tissue may not have the same transparency or
refractive properties as the original corneal tissue, leading to visual disturbances such as
blurred vision or astigmatism. However, the scar serves to strengthen the cornea and
restore its structural integrity. Over time, the scar may become less noticeable, but it may
still affect visual acuity depending on its location and size.

19. Discuss features of Herpes Zoster Ophthalmicus (only Stage -1 – Acute 0cular lesions
only)

Ans: Clinical features:

There are three stages:

• Stage I: Acute lesions—which develops within 3 weeks.

• Stage II: Chronic lesions—may persist for upto 10 years.

14 | P a g e
 • Stage III: Recurrent lesions—which may reappear after 10 years.

Stage I: Acute Ocular Lesions

• Lids: Redness, edema and vesicular eruptions.
• Conjunctiva: Acute mucopurulent conjunctivitis.
• Sclera: Episcleritis and scleritis.
• Cornea :
➢ Punctate epithelial keratitis.
➢ Microdendrites: Small, fine, multiple dendritic or stellate lesions
➢ Nummular keratitis : Multiple granular lesions, surrounded by a halo of stromal haze.
➢ Disciform keratitis.
➢ Sensation is diminished or absent.
• Iris: Acute iridocyclitis with hyphema (hyperacute iritis) and patches of iris atrophy.
• Intraocular pressure may be raised.
• Retina: Acute retinal necrosis.
• Neuro-ophthalmological: Optic neuritis and cranial nerve palsies—affecting the 3rd
(most common), 4th and 6th nerves.

2015-16

20. Explain “Aqueous flare” and “Aqueous cells”.

Ans: Aqueous flare and aqueous cells are two important clinical signs observed during ophthalmic
examinations, particularly in the context of inflammatory conditions affecting the eye. They are
indicative of underlying pathology and play a crucial role in diagnosing and monitoring various
ocular diseases.

Aqueous Flare:

• Aqueous flare refers to the presence of protein and other large molecules in the aqueous
humor, the clear fluid filling the front part of the eye between the lens and cornea.
• Normally, the aqueous humor is transparent and free from any particulate matter.
However, in inflammatory conditions such as uveitis, iritis, or endophthalmitis, the blood-
ocular barrier becomes compromised, allowing proteins and cells to leak into the anterior
chamber.
• When a slit lamp examination is performed, the presence of increased protein in the
aqueous humor causes a hazy appearance known as flare. This haze is caused by the
scattering of light by the proteins.
• Aqueous flare is often graded subjectively by the clinician based on the intensity of the
haze observed under slit lamp examination. It serves as an important indicator of the
severity of inflammation and response to treatment.

Aqueous Cells:

• Aqueous cells, also referred to as "aqueous flare cells" or simply "cells," are the
inflammatory cells that infiltrate the anterior chamber of the eye in response to ocular
inflammation.
• These cells can include various types of white blood cells, such as lymphocytes,
macrophages, and neutrophils, depending on the underlying etiology of the inflammation.

15 | P a g e
 • Like aqueous flare, the presence and quantity of aqueous cells are assessed through slit
lamp examination. The clinician observes the number and type of cells in the anterior
chamber and may grade them based on severity.
• Monitoring the presence and quantity of aqueous cells is crucial for diagnosing and
managing inflammatory conditions of the eye, as well as assessing the response to
treatment.

21. Write a short note on Rubella cataract.

Ans:

• Rubella infection during pregnancy may cause widespread ocular and systemic defects.
• Incidence of cataract is more, if the infection is contracted in the second month of
pregnancy; and sometimes in the third month.
• The cataract is originally nuclear and progresses to become total (pearly-white in color).
• It is associated with microphthalmos, nystagmus, strabismus, glaucoma, iris hypoplasia
and change to salt-and-pepper retinopathy.
• The systemic associations are congenital heart disease—patent ductus arteriosus (PDA)
microencephaly, mental retardation, deafness and dental anomalies.
• Pathologically, the nucleus is found to be necrotic and it may harbor the virus for up to 2
years following birth.
• Removal of such cataract frequently provokes an intense uveitis or endophthalmitis
(probably by liberation of retained virus) with disappointing visual result.
• However, in view of total bilateral cataract, complete aspiration, should usually be
attempted with a complete iridectomy (as the pupils dilate poorly) and high dose of
corticosteroids.
• All the congenital anomalies associated with maternal rubella in the first trimester can be
avoided by vaccination of the mother.
• The rubella-vaccine is itself toxic to the fetus, and it must therefore be administered at
least 3 months before the pregnancy.

22. Write a short note on IOL power calculation using SRK formula.

Ans: Intraocular lens (IOL) power calculation is a crucial step in cataract surgery and other
refractive surgeries. The goal is to select an IOL power that will provide the patient with optimal
visual outcomes post-surgery. There are various formulas used for IOL power calculation, and one
of the commonly used formulas is the SRK (Sanders, Retzlaff, and Kraff) formula.

The SRK formula is a theoretical formula that estimates the IOL power based on three key
variables: the axial length of the eye (AL), the corneal power (K), and the desired postoperative
refraction. The formula is as follows:

IOL Power=A−(2.5×AL)−(0.9×K)
Where:

A is the A-constant, which is a factor determined by the specific IOL manufacturer and model. It
incorporates the optic design and characteristics of the IOL.

16 | P a g e
 AL is the axial length of the eye, measured from the anterior surface of the cornea to the retinal
pigment epithelium.

K is the average corneal power, typically measured using techniques like keratometry or corneal
topography.

It's important to note that while the SRK formula is widely used, it may not be the most accurate
formula for all eyes, particularly in cases of extreme axial lengths, irregular corneas, or other ocular
anomalies. Therefore, surgeons often use different formulas or adjust the A-constant to improve
accuracy based on their clinical experience and patient outcomes.

2015

23. Treatment options of senile Ectropion.

Ans : Senile ectropion is corrected by reducing the horizontal lid laxity:

• Zeigler’s cautery to correct the medial lid laxity with punctal eversion.
• Medial conjunctivoplasty for mild cases of medial ectropion.
• Horizontal lid shortening to correct ectropion involving the whole lid.
• Bick’s procedure excision of a full-thickness triangular wedge of lid at the outer canthus
and then suture vertically.
• Byron-Smith modification of Kuhnt- Szymanowski procedure : Pentagonal wedge
resection of the lid margin, along with excision of a triangular skin flap laterally.

17 | P a g e
 24. Hypermature Cataract (morgagnian & sclerotic type)

Ans: Hypermature stage: If the process is allowed to go on without any intervention, the cortex
becomes disintegrated and then liquefied, or transformed into a pultaceous mass. It is of two
types:

a. Morgagnian cataract :

Here, the cortex liquefies and the nucleus may sink at the bottom within the lens capsule.

• The cortex appears milky-white and the nucleus appears as a brown mass, limited above
by a semicircular line, which may change its position.
• Anterior chamber may be shallow and may give rise to secondary angle-closure glaucoma.

b. Sclerotic cataract :

The lens becomes more and more inspissated, and shrunken in appearance, due to loss of fluid from
the lens.

• The lens is more flat and yellowish white in appearance.

• The anterior capsule becomes thickened due to proliferation of the anterior cuboidal cells, and
there may be calcium or cholesterol crystals on it.
• Owing to shrunken lens, the iris becomes tremulous with deep anterior chamber, and finally
the lens may be subluxated due to degeneration of the zonules.

A long-standing hypermature cataract may give rise to the following complications:

➢ Subluxation or dislocation of the lens.

➢ Lens-induced glaucoma.
➢ Lens-induced uveitis.
➢ Ultimately, there will be absolute glaucoma with ‘no PL’.

25. Herpes zoster ophthalmicus infection – clinical features & management.

Ans : Read Herpes Zoster Ophthalmicus totally part very well from [Essential of Ophthalmology –
SK Basak book] chapter -13 ( page-192 to 194)-7th edition.

26. Complications that can occur, after perforation of a corneal ulcer.

Ans: They vary according to the location and the size of the perforation.

➢ Anterior synechia: If the perforation is very small, the iris becomes gummed down the
opening, and the adhesion organizes.
➢ Iris prolapse: If the perforation is large and peripheral or paracentral.
➢ Adherent leucoma: Due to healing of the perforated ulcer with prolapsed iris.
➢ Anterior staphyloma : In case of large perforation → total prolapse of the iris → pseudocornea
formation → organization to form cicatrix in which the iris remains incarcerated → whole thing
bulge out due to high IOP.
➢ Phthisis bulbi: In case of large perforation → extrusion of the contents of the eyeball →
shrinkage of the globe with low IOP.

18 | P a g e
 2013

27. Episcleritis.

Ans: This is a benign inflammatory process affecting the deep subconjunctival connective tissue
(episclera), and sometimes, including the superficial scleral lamella.

Etiopathology:

• Autoimmune Factors: Episcleritis is often associated with autoimmune diseases such as

rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome. In these
cases, the immune system mistakenly attacks the body's own tissues, including the
episclera.
• Infections: While less common, episcleritis can sometimes be triggered by infections,
including viral, bacterial, or fungal agents.
• Environmental Factors: Irritants like smoke, dust, and pollen may also contribute to the
development of episcleritis, particularly in individuals with sensitive eyes.

Clinical types:

Two clinical types—simple and nodular.

i. Simple episcleritis: There is sectorial redness with mild tenderness.

ii. Nodular episcleritis: A small purple nodule with surrounding injection, is situated 2–3 mm
away from the limbus (usually on the temporal side). The nodule is immobile and tender.

Clinical Features:

• Redness: The most prominent clinical feature is redness, usually localized to one or both
eyes.
• Pain or Discomfort: Patients may experience mild to moderate discomfort, described as a
sensation of irritation or grittiness in the affected eye.
• Tearing: Excessive tearing or watery eyes can occur due to irritation of the ocular surface.
• Photophobia: Sensitivity to light may be present, making it uncomfortable to be in brightly
lit environments.
• Nodule Formation: In some cases, small nodules or raised areas may be visible on the
episclera.
• Bilateral Involvement: While episcleritis commonly affects only one eye, bilateral
involvement can occur, particularly in cases associated with systemic diseases.

Complications:

• Recurrence: Episcleritis may recur intermittently, especially in individuals with underlying

autoimmune conditions.
• Scleritis: Although rare, there is a risk of progression to scleritis, a more severe
inflammation involving the deeper layers of the sclera. Scleritis can be associated with
significant ocular pain and has the potential for vision-threatening complications.
• Corneal Involvement: Severe or chronic cases of episcleritis may lead to corneal
involvement, including corneal thinning or ulceration.

19 | P a g e
 • Secondary Glaucoma: In some instances, episcleritis can be associated with an increase
in intraocular pressure, leading to secondary glaucoma if left untreated.
• Systemic Complications: Episcleritis can be associated with underlying systemic
diseases, and addressing these conditions is essential to prevent systemic complications.

Treatment:

• Cold artificial tears – 4 times daily are helpful in many cases of simple episcleritis.
• Corticosteroids drops—4 times daily, and ointment at night.
• Oral anti-inflammatory agents, like ibuprofen, indomethacin or diclofenac.
• Non-steroidal anti-inflammatory drops, e.g. flurbiprofen or diclofenac drop, when steroids
are contraindicated.
• Tab. salicylate or indomethacin for a prolonged period to prevent recurrences, even when
no history of ‘rheumatism’ can be elicited.

28. “Hard stop” and “Soft stop” during syringing for patency of lacrimal passages.

Ans: During syringing for the patency of lacrimal passages, both "hard stop" and "soft stop" are
terms used to describe different sensations or findings encountered by the ophthalmologist
performing the procedure.

After insertion of a probe or cannula, an attempt is made to touch the medial wall of the lacrimal
sac and the lacrimal bone. The interpretation may be a hard stop or a soft stop.

➢ Hard stop: A firm to hard feeling caused by the probe–touching the medial wall of the sac
against the lacrimal bone. It indicates that the lacrimal passage is patent up to the lacrimal
sac and also indicates that the obstruction is below, i.e. at the NLD.
➢ Soft stop: A spongy (soft) feeling as the probe presses the common canaliculus (CC)
against the medial wall of the sac. It indicates either stenosis or obstruction of the
canalicular system. However, an iatrogenic kinking of canalicular system during probing
may also result in soft stop.

29. Secondary glaucoma due to lens disorders.

Ans : There are some common types of secondary glaucoma associated with lens disorder.

20 | P a g e
 Pseudoexfoliative Glaucoma

Secondary glaucoma with pseudoexfoliation syndrome.

• It is due to deposition of fibrillar basement membrane like material, and pigment granules
in the trabecular meshwork.
• Characteristic white exfoliative material is seen on the anterior lens capsule in three
distinct concentric zone.
• Treatment is same as POAG.

Phacomorphic Glaucoma

• A swollen intumescent cataract (immature or hypermature) may cause secondary angle-

closure glaucoma.
• Initial treatment is to reduce acute rise in IOP medically, followed by extraction of cataract
with or without IOL implantation.

Phacolytic Glaucoma

• A secondary open-angle glaucoma due to microleak of lens capsule in a hypermature or

rarely in a mature cataract.
• IOP-rise is due to obstruction of trabecular meshwork by macrophages which ingest the
lens protein.
• Treatment is initially by medical means, followed by cataract extraction.

Lens Particle Glaucoma

• It occurs typically following extracapsular cataract extraction, or after penetrating injury of

the lens.
• It is due to obstruction of the trabecular meshwork by the lens particles, with associated
inflammation.
• Residual lens material should be removed surgically either by irrigation or by vitrectomy (if
associated with rupture of the posterior capsule).

Phacoanaphylactic Glaucoma

• Always associated with a latent period, and during that period sensitization to lens protein
occurs.
• The typical finding is a chronic ‘granulomatous’ uveitis.
• Corticosteroids therapy along with antiglaucoma medication is required. When medical
treatment fails, the retained lens material should be surgically removed.

Associated with Ectopia Lentis

• Secondary glaucoma may develop in congenital ectopia lentis, traumatic or spontaneous

lens subluxation and dislocation.
• The mechanisms are pupillary block, phacolytic glaucoma or angle anomaly with
peripheral anterior synechiae.
• Treatment by iridectomy (in pupillary block), or lens extraction (in phacolytic type and
when the lens is cataractous).

21 | P a g e
 2012

30. Dry eye.

Ans: Read totally about dry eye part from Essential of ophthalmology – SK Basak [ Chapter-22,
Diseases of the lacrimal apparatus]

31. Macular function tests in a case of total cataract.

Ans: When dealing with a total cataract, which involves clouding of the lens of the eye, macular
function tests become crucial for assessing the health of the macula, the central part of the retina
responsible for detailed vision. Since a total cataract obscures the lens completely, traditional
visual acuity tests like Snellen chart readings may not be feasible. Instead, several other tests can
be employed to evaluate macular function:

i. Optical Coherence Tomography (OCT): This non-invasive imaging technique uses light
waves to produce high-resolution cross-sectional images of the retina. OCT can provide
detailed information about the structure and thickness of the macula, helping to assess
any abnormalities or damage.
ii. Electroretinography (ERG): ERG measures the electrical responses of various cell types
in the retina, including those in the macula, to flashes of light. It can help determine the
overall health and function of the macula, even when visual acuity is compromised.
iii. Fundus Autofluorescence (FAF): FAF imaging captures the natural fluorescence emitted
by certain molecules in the retina, which can indicate metabolic activity and the health of
retinal cells, including those in the macula. Changes in autofluorescence patterns can
reveal macular abnormalities.
iv. Microperimetry: This test combines visual field testing with fundus imaging to assess
macular function. It measures the sensitivity of the macula to light stimuli at different
locations, providing a detailed map of macular sensitivity and function.
v. Visual Evoked Potential (VEP): VEP measures the electrical signals generated by the
visual pathway in response to visual stimuli. While not specific to the macula, abnormal
VEP responses can indicate dysfunction along the visual pathway, which can indirectly
reflect macular health.

These tests can be valuable in assessing macular function in cases of total cataract, where direct
visualization of the macula may be obstructed. By evaluating the structure and function of the
macula through these tests, ophthalmologists can better understand the impact of the cataract on
visual function and plan appropriate management, including surgical intervention if necessary.

32. Gonioscopy.

Ans: It is a procedure by which we can see details of angle of anterior chamber. It is an OPD
procedure. It is done with an instrument called gonioscope.

Gonioscopy is a routine procedure that measures the angle between the iris and the cornea (the
iridocorneal angle), using a goniolens (also known as a gonioscope) together with a slit lamp or
operating microscope.

Different structures seen with a gonioscope. They are :

22 | P a g e
 a. Schwalbe’s line: It is the termination of descemet’s membrane. It appears as a solid,
glistening structure.
b. Trabecular meshwork: It gives soft, velvety appearance. It is easy to identify at 12 o’clock
position due to its pigmentation. It has two parts: Anterior one-third is non-pigmented and
posterior two-third parts is pigmented. Schlemn’s canal is visible only if it is filled with blood.
c. Scleral spur: It is a narrow, solid, whitish band, easily identified at 12 o’clock position where it
is least likely to be covered with pigments. It is half the width of TM.
d. Ciliary body band: It is as wide as the TM. In angle recession width of ciliary body band is
more than width of TM.

Clinical Application of Gonioscopy

It is done to assess depth of angle of anterior chamber. Depth of angle of AC can be divided
into five grades:
Grade-0 : Iris is in contact with the corneal endothelium. No structure of angle can be seen.
It is seen in acute angle closure attack. Immediate treatment is required to save vision.
Grade-1 : Only Schwalbe’s line is visible. There are high chances of angle getting closed
hence immediate preventive measures need to be taken like YAG iridotomy.
Grade-2 : Schwalbe’s line and TM is visible. There are less chances of angle getting closed.
Grade-3 : Schwalbe’s line with TM and scleral spur are visible. It is an open angle and there
are no chances of angle closure.
Grade-4 : Schwalbe’s line, TM, Scleral spur and ciliary body band are visible. It is a wide open
angle and there are no chances of angle closure.
• Angle recession can be diagnosed only by doing gonioscopy.
• Gonioscopy is a must for diagnosis and treatment of congenital glaucoma.

Technique of Gonioscopy

• Make the patient sit against slit lamp. Explain him the procedure properly. Put one drop of 2%
xylocaine eye drop. Take the gonio lens, put some coupling fluid like 2% HPMC and insert it over
cornea. Using slit-lamp beam different angle structures can be seen. Examination of 360° angle
can be done by rotating the gonio lens 360° gradually. While using Goldman three-mirror
gonioscope dome-shaped mirror is used for gonioscopy. Structures can be seen more easily if
during the procedure patient is asked to look towards the mirror of the gonio lens.

2011

33. Entropion.

Ans: Entropion is a condition where the eyelid (usually the lower lid) turns inward, causing the
eyelashes and skin to rub against the cornea and conjunctiva, leading to irritation, redness, and
potential damage to the surface of the eye. This condition can be uncomfortable and can even
affect vision if left untreated. Here's a breakdown of its types, clinical features, and treatment
options:

23 | P a g e
 Types of Entropion:

• Involutional Entropion: This is the most common type and typically occurs due to aging-
related changes in the eyelid tissues, leading to laxity and inward rotation of the eyelid margin.
• Cicatricial Entropion: Scar tissue formation in the eyelid, often due to trauma, inflammation, or
previous surgeries, causes the eyelid to turn inward.
• Spastic Entropion: This type usually arises from ocular surface irritation or inflammation,
causing the eyelid to contract abnormally and turn inward.
• Congenital Entropion: Rarely, some individuals may be born with entropion due to abnormal
eyelid development.

Clinical Features:

• Eye Irritation: Patients may experience irritation, tearing, and foreign body sensation due to the
constant rubbing of eyelashes against the cornea.
• Redness and Swelling: The affected eye may appear red and swollen due to chronic irritation.
• Corneal Abrasion or Ulceration: Prolonged entropion can lead to corneal abrasions or even
ulcers, which may cause pain, blurred vision, and increased sensitivity to light.
• Mucous Discharge: Excessive tearing and irritation can lead to the production of mucous
discharge from the affected eye.

Treatment Options:

• Conservative Management: In mild cases, lubricating eye drops or ointments may help
alleviate symptoms by reducing friction between the eyelid and the cornea.
• Eyelid Taping or Taping Techniques: This temporary measure can help to hold the eyelid in the
correct position, preventing it from turning inward.
• Botulinum Toxin Injection: In cases of spastic entropion, injecting botulinum toxin into the
affected eyelid muscles can help relax them, reducing the inward turning of the eyelid.
• Surgical Correction: Definitive treatment usually involves surgical correction, where the eyelid
is surgically tightened or repositioned to prevent it from turning inward. The specific technique
used depends on the type and severity of entropion.
• Involutional Entropion: Surgical procedures such as eyelid tightening (e.g., lateral tarsal strip
procedure) or eyelid retractor reinsertion may be performed.
• Cicatricial Entropion: Treatment focuses on releasing scar tissue and reconstructing the
eyelid, often requiring more complex surgical techniques.
• Congenital Entropion: Surgery may be necessary to correct the abnormal eyelid anatomy.
• Adjunctive Treatments: In some cases, additional treatments such as cryotherapy (freezing) or
cautery (heat therapy) may be used to address underlying contributing factors, such as
trichiasis (misdirected eyelashes) or conjunctival scarring.

Entropion should be evaluated and treated by an ophthalmologist to prevent potential

complications and preserve vision and eye health. The choice of treatment depends on the
underlying cause, severity of symptoms, and individual patient factors. Regular follow-up care is
essential to monitor for recurrence and ensure optimal outcomes.

24 | P a g e
 34. Bupthalmos.

Ans: Buphthalmos, also known as congenital glaucoma or infantile glaucoma, is a rare condition
characterized by increased intraocular pressure (IOP) within the eye. This elevated pressure
typically develops due to a malformation of the eye's drainage structures, leading to impaired fluid
outflow and subsequent accumulation of aqueous humor.

• Etiology: Buphthalmos can result from various factors, including genetic mutations,
developmental abnormalities, or a combination of both. In many cases, it's believed to be
inherited, with a genetic predisposition contributing to the abnormal development of the
eye's drainage system.
• Symptoms: Infants born with buphthalmos may present with a range of symptoms,
including photophobia (sensitivity to light), excessive tearing, enlarged or cloudy corneas,
and in some cases, enlargement of the eyeball itself. These symptoms often become
apparent within the first few months of life.
• Pathophysiology: Buphthalmos occurs when there is a blockage or abnormality in the
trabecular meshwork, which is responsible for draining aqueous humor from the eye. This
obstruction leads to a buildup of fluid, causing an increase in intraocular pressure.
Elevated pressure within the eye can damage the optic nerve and result in vision loss if left
untreated.
• Diagnosis: Diagnosis of buphthalmos typically involves a comprehensive eye
examination, including measurement of intraocular pressure, assessment of the optic
nerve, and examination of the anterior chamber angle using specialized instruments.
Imaging studies such as ultrasound or optical coherence tomography (OCT) may also be
used to evaluate the structure of the eye.
• Treatment: The primary goal of treatment for buphthalmos is to lower intraocular pressure
and preserve vision. This often involves a combination of medical therapy, such as topical
or oral medications to reduce fluid production or increase drainage, and surgical
intervention to improve aqueous outflow. Surgical options may include trabeculotomy,
trabeculectomy, or implantation of drainage devices.
• Prognosis: With early diagnosis and appropriate treatment, the prognosis for individuals
with buphthalmos can be favorable. However, delayed diagnosis or inadequate
management can lead to irreversible damage to the optic nerve and permanent vision loss.
Long-term monitoring and follow-up care are essential to detect and address any
complications or changes in intraocular pressure.
• Management Challenges: Managing buphthalmos in infants and young children can be
challenging due to their small size and the need for specialized equipment and expertise.
Additionally, compliance with treatment regimens, particularly with medications or post-
operative care, can be difficult in this population. Close collaboration between
ophthalmologists, pediatricians, and other healthcare providers is often necessary to
optimize outcomes for affected individuals.

35. Phyctenular kerato-conjunctivitis.

Ans: Phlyctenular keratoconjunctivitis, also known as phlyctenulosis or phlyctenular keratitis, is an

inflammatory condition primarily affecting the cornea and conjunctiva of the eye.

25 | P a g e
 Etiology:

Phlyctenular keratoconjunctivitis is commonly associated with a hypersensitivity reaction,

typically to microbial antigens. It can be triggered by bacterial infections, especially
Staphylococcus aureus, or by other allergens or irritants. Additionally, it can be linked to conditions
such as tuberculosis, acne rosacea, or other chronic inflammatory disorders.

Symptoms:

• Redness and irritation of the eye

• Foreign body sensation
• Photophobia (sensitivity to light)
• Excessive tearing
• Blurred vision
• Itching

Signs:

• Small, elevated lesions (phlyctenules) on the conjunctiva or cornea

• These lesions can appear yellowish-white and are often surrounded by a zone of
hyperemia (increased blood flow)
• Conjunctival injection (redness)
• Corneal involvement may lead to superficial corneal opacities or ulcers in severe cases

Complications:

• Corneal scarring: Prolonged inflammation and recurrent episodes can lead to corneal
scarring, potentially affecting vision.
• Secondary bacterial infection: Phlyctenular keratoconjunctivitis can predispose the eye
to bacterial infections, which may exacerbate inflammation and prolong healing.

Investigations:

• Slit-lamp examination: This is crucial for visualizing the characteristic lesions on the
conjunctiva and cornea.
• Microbiological culture: If there's suspicion of bacterial involvement, a culture of ocular
secretions can help identify the causative organism.
• Allergy testing: In cases where allergies are suspected triggers, allergy testing may be
performed to identify specific allergens.
• Tuberculin skin test or interferon-gamma release assay (IGRA): Particularly in regions
where tuberculosis is prevalent, these tests may be conducted to assess for tuberculosis
infection.

Treatment:

Treatment typically involves addressing the underlying cause and managing inflammation:

• Topical corticosteroids: These are often prescribed to reduce inflammation and promote
healing. However, their use should be carefully monitored due to the risk of complications
such as increased intraocular pressure and cataract formation.
• Topical antibiotics: If bacterial infection is present or suspected, topical antibiotics may
be prescribed.

26 | P a g e
 • When cornea is involved—atropine (1%) eye ointment, or homatropine eye drop 2–3
times daily.
• Cool compresses: These can help alleviate discomfort and reduce inflammation.
• Avoidance of allergens or irritants: Identifying and avoiding triggers can help prevent
recurrent episodes.

36. Differences between mature and immature cataract in tabular from.

Ans:

37. Pterygium.

Ans: Read from Basak – chapter 12 (disease of the conjunctiva) Page-165 (7th edition)

38. Chronic Dacryocystitis.

Ans: Chronic dacryocystitis is a condition characterized by inflammation and infection of the

lacrimal sac, which is the portion of the tear drainage system located in the inner corner of the eye.

Definition: Chronic dacryocystitis refers to the long-standing inflammation and infection of the
lacrimal sac, typically caused by obstruction of the nasolacrimal duct, which prevents tears from
draining properly.

Symptoms:

• Persistent tearing or watering of the affected eye.

• Mucoid or purulent discharge from the inner corner of the eye.
• Swelling and tenderness around the nasal side of the lower eyelid.
• Recurrent eye infections, such as conjunctivitis or cellulitis.
• Crusting of the eyelashes, particularly upon waking.

Causes:

• Obstruction of the nasolacrimal duct: This is the most common cause, often due to
narrowing or blockage of the duct, which can occur as a result of aging, trauma, infection,
or congenital abnormalities.

27 | P a g e
 • Chronic infections: Bacterial or fungal infections can lead to persistent inflammation of
the lacrimal sac, contributing to chronic dacryocystitis.
• Anatomical abnormalities: Structural defects in the tear drainage system can predispose
individuals to chronic dacryocystitis.

Diagnosis:

• Clinical examination: An ophthalmologist may perform a thorough examination of the

eyes and eyelids, looking for signs of inflammation, discharge, and swelling around the
lacrimal sac.
• Lacrimal syringing: This procedure involves flushing saline through the tear drainage
system to assess for blockages or obstructions.
• Imaging studies: X-rays, CT scans, or MRI may be ordered to evaluate the anatomy of the
tear drainage system and identify any structural abnormalities.

Treatment:

• Antibiotic therapy: Oral or topical antibiotics may be prescribed to treat active infections
and reduce inflammation.
• Lacrimal sac irrigation: Flushing the lacrimal sac with saline solution can help clear
blockages and improve tear drainage.
• Dacryocystorhinostomy (DCR): In cases where conservative measures fail, surgical
intervention may be necessary to create a new drainage pathway for tears, bypassing the
obstructed nasolacrimal duct.
• Nasolacrimal duct intubation: This procedure involves inserting a silicone tube into the
nasolacrimal duct to keep it open and promote drainage.

Complications:

• Recurrent infections: Untreated chronic dacryocystitis can lead to recurrent bouts of

bacterial or fungal conjunctivitis and cellulitis.
• Abscess formation: Severe inflammation of the lacrimal sac can result in the formation of
an abscess, requiring surgical drainage.
• Vision loss: Although rare, chronic inflammation and infection can potentially lead to
damage to the surrounding ocular structures, resulting in vision impairment.

39. Trichiasis.

Ans: Trichiasis is the inward misdirection of the eyelash(es) which irritate the cornea and/or the
conjunctiva.

Etiology

• Congenital—known as distichiasis.
• Acquired—due to diseases those cause scarring of the eyelid margin, e.g. stye, ulcerative
blepharitis, membranous conjunctivitis, trachoma and post-traumatic.

Symptoms

• Foreign body sensation

• Lacrimation and pain.

28 | P a g e
 Fig : Trichiasis

Signs

• Conjunctival congestion
• Reflex blepharospasm
• Ciliary congestion
• Recurrent erosions of the cornea
• Superficial corneal opacities
• Vascularization of the cornea.

Treatment

• Epilation: Removal of the offending eyelashes with cilia forceps. This must be repeated
every 6–8 weeks.
• Soft bandage contact lens: To protect the cornea temporarily.
• Permanent procedures: By destroying the hair roots.
➢ Electrolysis (under local anesthesia): A fine needle (negative pole) is introduced into the
hair follicle, and a current of 2 mAmp is passed. End point is judged by the appearance of
foam, and the eyelash with bulbus root can be easily lifted out.
➢ Electrodiathermy: A current of 30 mAmp is used for 10 seconds.
➢ Cryotherapy: Very effective for a row of ingrowing eyelashes. Under local anesthesia, the
cryoprobe is applied to lid margin and then freeze at –20°C → prolonged thawing → re-
freeze. Depigmentation of the skin is a problem.
➢ Irradiation is effective in severe cases, but it produces conjunctival keratinization.
➢ Argon laser cilia ablation is also effective.
➢ Plastic repair: If many cilia are misdirected, operative procedure as entropion is most
effective.

40. Phacomorphic glaucoma.

Ans: Phacomorphic glaucoma is a type of glaucoma that occurs due to a sudden increase in
intraocular pressure (IOP) caused by a swollen lens in the eye.

Definition: Phacomorphic glaucoma is a type of secondary angle-closure glaucoma. It results

from an acute increase in intraocular pressure due to a swollen and enlarged lens, typically in
patients with mature or hypermature cataracts.

29 | P a g e
 Pathophysiology:

• It primarily occurs when a mature or hypermature cataract leads to intumescent (swollen)

lens, causing a forward displacement of the iris-lens diaphragm.
• This forward displacement can cause obstruction of the trabecular meshwork, leading to
impaired outflow of aqueous humor and subsequent elevation of intraocular pressure.

Symptoms:

• Patients may experience sudden onset of severe eye pain.

• Blurred vision or vision loss.
• Halos around lights.
• Redness of the eye.
• Nausea or vomiting.

Risk Factors:

• Advanced age.
• Presence of mature or hypermature cataracts.
• History of angle-closure glaucoma in the fellow eye.
• Predisposing anatomical factors such as shallow anterior chamber depth.

Diagnosis:

• Diagnosis is based on clinical examination findings including elevated intraocular pressure,

corneal edema, shallow anterior chamber, and a swollen lens visible on slit-lamp
examination.
• Gonioscopy may reveal a closed or narrow angle.

Treatment:

• Immediate treatment is aimed at lowering intraocular pressure to prevent optic nerve

damage and preserve vision.
• This often involves the use of topical and/or oral medications to lower IOP, such as topical
beta-blockers, alpha agonists, and carbonic anhydrase inhibitors.
• In some cases, laser peripheral iridotomy or surgical intervention may be necessary to
relieve pupillary block and restore aqueous outflow.

41. K.P.s (Keratitic precipitates)

Ans: Keratic precipitates, often abbreviated as KP, are a clinical finding in ophthalmology referring
to inflammatory cells or debris adhering to the corneal endothelium. These precipitates are
typically observed as small, white or grayish deposits on the inner surface of the cornea,
particularly in conditions involving intraocular inflammation, such as uveitis or iritis.

The appearance, distribution, and characteristics of keratic precipitates can provide valuable
diagnostic clues about the underlying cause of inflammation within the eye. They may vary in size,
shape, and density, and their presence can help differentiate between various types of uveitis or
distinguish infectious from non-infectious causes.

30 | P a g e
 Management of keratic precipitates involves treating the underlying inflammatory condition that is
causing them. This often requires a multidisciplinary approach involving ophthalmologists and
sometimes rheumatologists or infectious disease specialists, depending on the underlying cause.
Topical or systemic anti-inflammatory medications may be prescribed to reduce inflammation and
prevent further damage to the eye.

Regular monitoring and follow-up are essential to assess the response to treatment and prevent
potential complications associated with chronic inflammation, such as vision loss or secondary
glaucoma. In some cases, surgical intervention may be necessary to address complications or
restore visual function.

42. Vernal conjunctivitis.

Ans: Vernal conjunctivitis, also known as spring catarrh, is a type of allergic conjunctivitis that
primarily affects children and young adults, typically in the spring and summer months. It's
characterized by inflammation of the conjunctiva, the mucous membrane that covers the front of
the eye and lines the inside of the eyelids. Here's a breakdown of its key aspects:

Etiological Factors:

• Allergic reactions: Vernal conjunctivitis is triggered by allergic reactions to environmental

factors such as pollen, dust mites, animal dander, and certain chemicals.
• Genetic predisposition: There may be a genetic component involved, as it tends to run in
families.
• Environmental factors: Dry, dusty, or windy environments can exacerbate symptoms.

Symptoms:

• Intense itching
• Redness (hyperemia) of the conjunctiva
• Watery discharge
• Photophobia (sensitivity to light)
• Foreign body sensation (feeling like there's something in the eye)
• Blurred vision
• Swelling of the eyelids

Fig: Vernal conjunctivitis

Signs:

• Papillae formation: These are small, elevated bumps on the conjunctiva that contain
blood vessels and are characteristic of vernal conjunctivitis.

31 | P a g e
 • Trantas dots: These are collections of white blood cells (eosinophils) and epithelial cells
that appear as white or yellowish deposits in the limbal region of the conjunctiva.

Histopathology:

Histological examination of tissue samples from the conjunctiva typically reveals:

• Eosinophilic infiltration: Eosinophils are a type of white blood cell involved in allergic
reactions and inflammation.
• Mast cell activation: Mast cells release histamine and other inflammatory mediators in
response to allergens.
• Hyperplasia of conjunctival epithelium: The conjunctival tissue may show thickening
due to increased cell proliferation.

Complications:

• Corneal involvement: Prolonged inflammation can lead to corneal complications such as

ulceration, scarring, and neovascularization (growth of new blood vessels).
• Giant papillary conjunctivitis (GPC): In some cases, vernal conjunctivitis can progress to
GPC, which is characterized by larger papillae forming on the conjunctiva, typically
associated with contact lens wear.
• Visual impairment: Severe cases of vernal conjunctivitis can impair vision due to corneal
involvement or persistent inflammation.

Treatment :

• Cold compress which is soothing.

• Topical steroids, like dexamethasone or betamethasone, 4–8 times daily depending
upon the severity. Steroid-antibiotic mixture is not preferred.
• Long-term use of topical steroids has problems like cataract and glaucoma. Dilute
steroid preparations (1:10) can be used rather safely.
• Disodium chromoglycate (2–4%)—four times daily as drops. It can be used safely for a
prolonged period. It mainly, prevents the fresh attack, as it is a mast-cell stabilizer.
• Topical antihistaminics like azelastine, epinastine, olopatadine, are helpful to give
relief from severe itching.
• Topical nonsteroidal anti-inflammatory drugs—like ketorolac, flurbiprofen, or
diclofenac may be useful.
• For giant papillae—cryoapplication, β-irradiation or excision may be done.
• Acetylcysteine (10–20%) drop—to prevent excessive mucus production.
• Protection from external allergens.

43. Phacolytic glaucoma.

Ans: Phacolytic glaucoma is a type of secondary glaucoma caused by the leakage of lens proteins
into the anterior chamber of the eye due to a hypermature or Morgagnian cataract. This condition
occurs when the lens capsule becomes compromised, allowing lens proteins to leak out and
trigger an inflammatory response.

32 | P a g e
 Cause: Phacolytic glaucoma typically occurs in older individuals with advanced cataracts. The
cataract becomes so mature that the lens capsule weakens and ruptures, releasing lens proteins
into the anterior chamber.

Inflammatory Response: The leaked lens proteins provoke an inflammatory reaction within the
eye, leading to trabecular meshwork blockage. This blockage impairs the normal outflow of
aqueous humor from the eye, causing an increase in intraocular pressure (IOP).

Symptoms: Patients with phacolytic glaucoma often experience symptoms typical of glaucoma,
such as decreased vision, eye pain, redness, halos around lights, and sometimes nausea and
vomiting.

Diagnosis: Diagnosis involves a comprehensive eye examination, including measurement of

intraocular pressure, evaluation of the optic nerve, and assessment of visual field defects. Slit-
lamp examination may reveal a hypermature cataract with leakage of lens material into the
anterior chamber.

Treatment: The primary treatment for phacolytic glaucoma is typically surgical removal of the
cataract. This procedure, known as phacoemulsification, involves breaking up the cataract and
removing it from the eye. Additionally, medications may be prescribed to reduce intraocular
pressure and inflammation before and after surgery.

44. LASIK.

Ans: LASIK, which stands for Laser-Assisted In Situ Keratomileusis, is a popular surgical procedure
aimed at correcting vision problems, particularly nearsightedness, farsightedness, and
astigmatism.

Procedure: LASIK involves reshaping the cornea, the clear front part of the eye, using an excimer
laser. The surgeon creates a thin flap in the cornea, either with a microkeratome blade or a
femtosecond laser. This flap is then lifted, and the underlying corneal tissue is reshaped with the
excimer laser to correct the refractive error. Finally, the flap is repositioned, acting as a natural
bandage.

Refractive Error Corrected: LASIK can effectively correct various refractive errors:

• Nearsightedness (myopia): Difficulty in seeing distant objects clearly.

• Farsightedness (hyperopia): Difficulty in seeing nearby objects clearly.
• Astigmatism: Blurred or distorted vision caused by irregularly shaped cornea or lens.

Advantages:

• Quick Results: Most patients experience improved vision immediately or within a day or
two after the procedure.
• Minimal Discomfort: LASIK is usually painless, and discomfort during recovery is typically
mild and short-lived.
• Reduced Dependence on Corrective Eyewear: Many patients achieve 20/20 vision or
better, reducing or eliminating the need for glasses or contact lenses.
• Fast Recovery: Most patients can resume normal activities, including work and driving,
within a few days after surgery.

33 | P a g e
 Risks and Complications:

• Dry Eyes: Some patients experience temporary or chronic dry eyes after LASIK, which can
usually be managed with eye drops.
• Undercorrection or Overcorrection: In some cases, the desired vision correction may not
be fully achieved or may be excessive, requiring further treatment or enhancement.
• Flap Complications: Issues with the corneal flap, such as dislocation or irregular healing,
can occur, but they are rare with modern LASIK techniques.
• Halos, Glare, or Starbursts: Some patients may experience visual disturbances,
especially at night, which typically improve over time but can persist in some cases.

Preparation and Aftercare:

• Before the procedure, patients undergo a thorough eye examination to determine their
suitability for LASIK and to plan the surgery.
• After LASIK, patients are typically prescribed medicated eye drops to prevent infection and
promote healing. They are also advised to avoid rubbing their eyes and to follow any
additional instructions provided by their surgeon.
• Follow-up appointments are scheduled to monitor healing and assess vision correction.

45. nd YAG laser capsulotomy.

Ans: Nd:YAG laser capsulotomy is a common procedure used to treat posterior capsule
opacification (PCO) after cataract surgery. When cataract surgery is performed, the natural lens of
the eye is removed and an artificial lens, called an intraocular lens (IOL), is implanted to restore
vision. However, over time, the capsule behind the IOL can become cloudy, causing vision to
become hazy or blurred. This cloudiness is known as posterior capsule opacification.

Nd:YAG laser capsulotomy involves using a laser, specifically a neodymium-doped yttrium

aluminum garnet (Nd:YAG) laser, to create an opening in the cloudy posterior capsule. This opening
allows light to pass through unimpeded, restoring clear vision.

The procedure is typically quick and performed on an outpatient basis. The patient's eyes are
numbed with eye drops, and a special contact lens is placed on the eye to help focus the laser. The
laser is then used to create a small opening in the center of the cloudy capsule. This opening clears
the visual axis, allowing light to pass through and improving vision.

Nd:YAG laser capsulotomy is considered safe and effective, with high success rates in restoring
clear vision. Complications are rare but can include increased eye pressure, retinal detachment, or
damage to the cornea or lens. However, these risks are minimal when the procedure is performed
by a skilled ophthalmologist.

After the procedure, patients may experience some mild discomfort or glare, but these symptoms
typically resolve quickly. Vision improvement is often immediate, and patients can usually resume
normal activities shortly after the procedure.

Notes prepared by – Akash Ghosh

Contact No : +916289712492
34 | P a g e