10.Ophthalmology.pdf

Index Lens - Page 1 Previous Year Questions (Diseases of Lens) - Page 37 Glaucoma - Page 54 Previous Year Questions (Glaucoma) - Page 92 Cornea - Page 109 Previous Year Questions (Cornea) - Page 135 Sclera - Page 171 Uvea - Page 181 Previous Year Questions (Uveitis) - Page 207 Neuro Ophthalmology - Page 217 Previous Year Questions (Neuro Ophthalmology) - Page 241 Conjunctiva - Page 263 Previous Year Questions (Conjunctiva) - Page 293 Lacrimal Drainage System - Page 315 Previous Year Questions (Lacrimal Drainage System) - Page 325 Orbit - Page 330 Previous Year Questions (Orbit) - Page 353 Ocular Injuries - Page 368 Previous Year Questions (Ocular Injuries) - Page 372 Eyelids - Page 378 Previous Year Questions (Ocular Adnexa) - Page 394 Optics - Page 403 Previous Year Questions (Optics) - Page 439 Squint - Page 460 Previous Year Questions (Squint, Strabismus) - Page 479 Retina - Page 490 Previous Year Questions (Retina) - Page 532 Community Ophthalmology - Page 569 Previous Year Questions (Community Ophthalmology) - Page 577 Vitreous - Page 581 Embryology - Page 584 Lasers - Page 590 Lens 1. Which of the given statements about the anatomy of the lens is true? 1. The refractive index of the lens is maximum at the centre of the lens 2. The sutures in the lens fibers look like a straight ‘U’ from the anterior surface 3. The strong adhesion between the posterior-most part of the lens and the hyaloid membrane is called as the suspensory ligament 4. The refractive power of the lens is 16-17 D A. 1 and 2 are true B. 1 and 3 are true C. 1 and 4 are true D. 2 and 4 are true ---------------------------------------- 2. A 70-year-old woman presents with complaints of gradually worsening vision over the past several years. On slit lamp examination, the ophthalmologist observes a yellow hue and opacification of the central region of the eye's crystalline lens, with clear peripheral vision. Which type of water-insoluble protein is primarily associated with the patient's condition? (or) Which type of water-insoluble protein is primarily associated with nuclear cataract formation? A. High-molecular weight protein (HMW) 1 B. High-molecular weight protein (HMW) 2 C. Crystallin gamma D. High-molecular weight protein (HMW) 4 ---------------------------------------- 3. What is the likely cause of the cataract shown in the image? (or) A 45-year-old male patient presents with complaints of progressive vision impairment in both eyes. Upon examination, an ophthalmologist observes a distinct cataract with a unique pattern as depicted in the image. Which of the following diseases is associated with this particular cataract? A. Diabetes Mellitus B. Myotonic Dystrophy C. Cataract in galactosemia 1 D. Morgagnian cataract ---------------------------------------- 4. A 5-year-old boy is brought to the ophthalmology clinic with complaints of vision problems. Examination reveals bilateral congenital cataracts, glaucoma, and developmental delay. Further evaluation reveals hypotonia, intellectual disability, and renal abnormalities. Which of the following conditions is most likely responsible for this patient's presentation? (or) Which syndrome presents with bilateral congenital cataracts, glaucoma, developmental delay and renal abnormalities? A. Lowe syndrome B. Retinoblastoma C. Congenital rubella syndrome D. Marfan syndrome ---------------------------------------- 5. Which type of cataract is shown in the image? (or) A 60-year-old patient presents with a complaint of progressive blurring of vision in both eyes. On examination, slit-lamp evaluation reveals dense cortical lens opacities with a characteristic pattern, as shown in the image. What type of cataract is being shown in the image? A. Toxic cataract B. Traumatic cataract C. Sunflower cataract D. Radiational cataract ---------------------------------------- 6. A 35-year-old patient complains of bilateral decreased vision. Upon examination, shield-like dense anterior subcapsular plaque that wrinkles the anterior capsule is observed. Which systemic disease is commonly associated with this type of cataract? (or) Which systemic disease is commonly associated with shield cataracts? A. Myotonic dystrophy Page 2 2 B. Atopic dermatitis C. Diabetes mellitus D. Neurofibromatosis type 2 (NF2) ---------------------------------------- 7. A 65-year-old patient with significant visual impairment due to cataracts is scheduled for extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation. Which of the following steps is NOT involved in the procedure? A. Making an incision on the limbus B. Hydro dissection C. Removal of the entire lens including the capsular bag D. Cleaning the capsular bag with irrigation aspiration (I/A) ---------------------------------------- 8. A 65-year-old female with progressive vision loss due to cataracts is scheduled for cataract surgery. Which cataract surgery utilizes neodymium glass laser? A. SICS (Small Incision Cataract Surgery) B. MICS (Minimal Incision Cataract Surgery) C. Phacoemulsification D. FLACS (Femto Laser Assisted Cataract Extraction) ---------------------------------------- 9. Which modality of anesthesia involves administration into intraconal space? (or) A 70-year-old patient is scheduled for elective cataract surgery. Which modality of anesthesia involves injecting anesthetics in the intraconal space in close proximity to the nerves responsible for regulating both ocular motility and sensory perception? A. Topical anaesthesia B. Peribulbar injection C. Retrobulbar injection D. Supraorbital nerve block ---------------------------------------- 10. A 65-year-old patient who recently underwent cataract surgery presents with symptoms of recurrent episodes of increased intraocular pressure. Upon examination, the ophthalmologist suspects UGH syndrome. Which type of IOL is most likely associated with this syndrome? (or) Which type of IOL is most likely associated with UGH syndrome? A. ACIOL B. PCIOL C. Toric IOL D. Multifocal IOL Page 3 3 ---------------------------------------- 11. Which of the following is the treatment of choice for endophthalmitis in a patient with the ability to perceive hand movements after 7 months of cataract surgery? (or) A patient presents to the ophthalmology clinic with complaints of worsening vision, redness, pain, light sensitivity, and discharge from his right eye. He reports undergoing a cataract operation in the same eye 7 months ago. Upon examination, the patient demonstrates the ability to perceive hand movements, along with lid swelling, chemosis, corneal edema, and hypopyon. Vitritis is observed along with the presence of inflammatory cells and exudates in the vitreous. Which of the following is the treatment of choice for this condition? A. Pars plana vitrectomy B. Intravitreal antibiotic injections C. Systemic antibiotics D. Cycloplegics and topical steroids ---------------------------------------- 12. A patient presents with complaints of experiencing annoying visual phenomena like flashes of light and dark shadows after cataract surgery and monofocal IOL implantation 2 years ago. What is the term used to describe these symptoms? A. Endophthalmitis B. Dysphotopsia C. Refractive surprise D. Anterior capsular contraction and fibrosis ---------------------------------------- 13. Which of the following is not a chronic postoperative complication of the cataract surgery? A. CME B. Refractive Surprise C. Displacement of IOL D. Shallow anterior chamber ---------------------------------------- 14. A 7-year-old child is brought to the ophthalmologist. On examination, peripheral cortical opacities are noted in both lenses. What type of congenital cataract do these opacities represent? A. Blue dot cataract B. Cataracta pulverulenta C. Lamellar/zonular cataract D. Coronary cataract ---------------------------------------- 15. A 2-year-old child is brought to the ophthalmology clinic due to visual abnormalities, heart defects, and deafness. On examination, the child is found to have a nuclear cataract. Which of the following is the most common ocular feature associated with this condition? Page 4 4 (or) Which of these features will be a found in a child with Congenital Rubella Syndrome ? A. Pearly white lens opacity B. Microphthalmos C. Rubella keratitis D. Salt and pepper fundus ---------------------------------------- 16. A 20-year-old patient is noted to have subluxation of the lens, manifesting as inferonasal ectopia lentis. Which of the following systemic diseases is most likely associated with the observed ocular findings in this patient? A. Marfan's syndrome B. Ehlers-Danlos syndrome C. Stickler syndrome D. Homocystinuria ---------------------------------------- 17. A 60-year-old patient presented with complaints of difficulty reading in bright light. Evaluation reveals the presence of posterior subcapsular cataracts. Which cells are responsible for the development of posterior subcapsular cataracts? A. Bowman's layer B. Wedl cells C. Muller cells D. Schlemm's canal ---------------------------------------- 18. Why are posterior subcapsular cataracts often lead to maximum diminution of vision? A. They affect the eye's accommodation reflex. B. They result in significant myopia. C. They cause significant glare and halos around lights. D. They are formed near the nodal point of the eye. ---------------------------------------- 19. A 70-year-old patient presents with pain, redness, and a sudden decrease in vision in the right eye, two days after undergoing cataract surgery. Examination reveals increased intraocular pressure in the right eye and evidence of anterior chamber inflammation. The patient does not have a past diagnosis of glaucoma. Which of the following terms best describes this condition? (or) What is the likely diagnosis in this case of raised intraocular pressure and anterior chamber inflammation after cataract surgery? A. Acute angle-closure glaucoma B. Phacoanaphylactic glaucoma Page 5 5 C. Pseudoexfoliation glaucoma D. Normal-tension glaucoma ---------------------------------------- 20. A 45-year-old patient complains of difficulty reading small print and seeing objects up close. This problem has gradually worsened over the past few years. Which of the following mechanisms best explains his diagnosis? (or) What is the likely mechanism in a middle-aged patient with gradual worsening of close vision? A. Corneal shape changes and retinal degeneration B. Atrophy of ciliary muscles and decreased elasticity of the lens C. Lens hardening and vitreous humor opacities D. Retinal degeneration and vitreous humor opacities ---------------------------------------- 21. A 60-year-old patient presents with complaints of blurry vision and difficulty seeing clearly, particularly in bright sunlight. The ophthalmologist suspects age-related changes in the lens and the formation of cataracts. Which of the following substances could have potentially delayed the development of cataracts? (or) Which substance can delay cataract development? A. Vitamin D B. Vitamin K C. Vitamin C D. Vitamin A ---------------------------------------- 22. A 45-year-old diabetic patient presents with complaints of cloudy vision, which is worse in bright light. The ophthalmologist observes opacities in the patient's lens shown in the image below. What is the mechanism underlying the formation of the particular cataract shown in the image? (or) What is the mechanism underlying the formation of the opacities in the image below? A. Accumulation of lipids in the lens Page 6 6 B. Oxidative stress on lens proteins C. NADPH-dependent Aldose Reductase activity D. Age-related thickening of the lens capsule ---------------------------------------- 23. A 1-month-old infant was brought with complaints of poor feeding and yellow discoloration. Physical examination reveals hepatomegaly, jaundice, bilateral cataract as shown in the image and laboratory tests show elevated levels of galactose-1-phosphate in the blood. What is the cataract and most likely underlying cause of this cataract? (or) What is the likely diagnosis and underlying cause of bilateral cataracts as shown in the image in a infant with hepatomegaly, jaundice, and elevated levels of galactose-1-phosphate? A. Oil Droplet Cataract due to Galactose Phosphate Uridyl Transferase deficiency B. Cortical cataract due to Glutathione Peroxidase-4 deficiency C. Posterior subcapsular cataract due to Hexokinase deficiency D. Posterior subcapsular cataract due to Lens Dehydration ---------------------------------------- 24. A 40-year-old patient with a history of liver disease presents with complaints of incoordination, slurred speech, and hand tremors. On examination, the ophthalmologist observes a characteristic brownish-golden ring at the periphery of the cornea. Which of the following statements is not true regarding the disease the patient is suffering from? (or) Which statement is not true regarding the disease in a patient with liver disease, incoordination, slurred speech, hand tremors, and a characteristic brownish-golden ring at the corneal periphery? A. The ring starts superiorly and inferiorly first. B. Ring is formed due to deposition of the copper. C. All cases with hepatic involvement will present with the ring. D. Most cases with Neurological involvement will present with the ring. ---------------------------------------- 25. A 15-year-old male presents to an ophthalmologist with complaints of blurred vision. On slit lamp examination, the ophthalmologist observes an unusual finding in the anterior portion of the lens as shown in the image given below. What is not true regarding the condition this male is suffering from? Page 7 7 (or) What is not true regarding the unusual anterior lens finding shown in the image? A. Seen in patients suffering from Familial Hemorrhagic Nephritis. B. More common in Males. C. Image is showing Oil Globule Reflex. D. Seen in patients suffering from Lowe’s Syndrome. ---------------------------------------- 26. A 40-year-old male with a known history of chronic anterior uveitis now presents with diminished vision.Which of the following images shows the pathognomonic feature of the disease this patient is suffering from? (or) Which image demonstrates polychromatic lusture with bread crumb appearance? A. B. C. D. ---------------------------------------- 27. A 45-year-old woman with a history of systemic lupus erythematosus has been taking long-term high-dose glucocorticoid therapy for many years. She now presents with complaints of visual disturbances, particularly glare and reduced night vision. Her best-corrected visual acuity is reduced, and slit-lamp examination reveals the presence of bilateral posterior subcapsular cataracts. Which of the following statements is not true about the usage of steroids? (or) Which statement regarding the usage of steroids, is not true? A. Topical steroid usage most commonly causes OAG. B. Systemic steroids most commonly causes OAG. C. Systemic steroids most commonly cause PSC D. Steroids disturb the osmotic balance of the lens, causing toxic cataracts ---------------------------------------- Page 8 8 28. A 25-year-old patient presents to the emergency department after sustaining blunt trauma to the left eye during a sporting event. Which of the following ocular features will not be seen in the patient? A. B. C. D. ---------------------------------------- 29. Which of the following features as shown in the image is observed by an Ophthalmologist in a 36-year-old male who presented to the OPD and sustained a blunt injury to right eye? A. Hyphema B. Iridodialysis C. Corneal abrasion D. Retinal detachment ---------------------------------------- 30. A 48-year-old male came to the OPD with complaints of progressive visual loss over the past 1 year. He works at a glass factory. On examination the ophthalmologist finds a specific cataract. What is the cataract this patient is suffering from and what is the cause? (or) What type of cataract is likely affecting a male working at a glass factory, and what is the cause of this cataract? A. Glass-Worker’s Cataract caused by ultraviolet radiation exposure. B. Glass-Blower’s Cataract caused by infrared radiation. C. Welder's Cataract caused by exposure to bright visible light. D. Nuclear Cataract caused by age-related changes. ---------------------------------------- 31. A 6-year-old child presents to an ophthalmology clinic with a dense cataract in the right eye, causing significant visual impairment. The ophthalmologist recommends surgery. Which of the following complications is of particular concern and contributes to the contraindication of Intracapsular Cataract Extraction (ICCE)? (or) Page 9 9 What is the primary complication associated with Intracapsular Cataract Extraction (ICCE) in pediatric patients with dense cataracts? A. Delayed visual rehabilitation B. Increased intraocular pressure C. Risk of retinal detachment D. Development of corneal opacity ---------------------------------------- 32. A 60-year-old patient presents to the ophthalmology clinic with a mature cataract in the right eye, causing significant vision impairment. The ophthalmologist recommends cataract surgery. The surgeon explains that a circular opening is created in the anterior lens capsule, resembling the movement of a can opener. This technique is commonly used in which of the following cataract extraction methods? (or) In which cataract extraction method is the 'can opener' technique used, involving the creation of a circular opening in the anterior lens capsule? A. Phacoemulsification B. Intracapsular Cataract Extraction (ICCE) C. Extracapsular Cataract Extraction (ECCE) D. Laser-assisted Cataract Surgery ---------------------------------------- 33. What is the name of the curved, self-sealing sutureless incision made during Small Incision Cataract Surgery (SICS)? A. Linear incision B. Radial incision C. Sclerocorneal tunnel incision D. Clear corneal incision ---------------------------------------- 34. A 60-year-old patient with a cataract is scheduled for cataract surgery. The ophthalmologist plans to perform phacoemulsification. Which of the following best describes the typical size of the incision and frequency of Phaco probe used in phacoemulsification? (or) What is the typical size of the incision made and frequency of Phaco probe used in phacoemulsification for cataract surgery? A. A small-sized incision of 5-6 millimetres and 50 kHz B. A small-sized incision of 2.75-3.2 millimetres and 40 kHz. C. A small, self-sealing incision of less than 1 millimetres and 60 kHz. D. No incision is made in phacoemulsification and 70 kHz. ---------------------------------------- 35. A 70-year-old patient is scheduled for cataract surgery. However, during the surgery, the ophthalmologist encounters difficulty in visualizing the lens capsule due to mature cataract. Which of Page 10 10 the following dyes is commonly used to enhance visibility in such cases? (or) Which dye is commonly used to enhance the visibility of the lens capsule during mature cataract surgery? A. Flourescein B. Rose Bengal C. Trypan Blue D. Methylene Blue ---------------------------------------- 36. What is the ideal solution used for irrigation and aspiration, to maintain a clear visual field, and achieve optimal surgical conditions? A. Balanced Salt Solution B. Lactated Ringer's solution C. Balanced Salt Solution Plus (BSS Plus) D. Hydroxypropyl methylcellulose (HPMC) ---------------------------------------- 37. A 60-year-old patient with a history of complicated cataract surgery and inadequate capsular support requires an intraocular lens (IOL) that can be securely implanted in the absence of intact capsular structures. Which type of IOL shown below, is implanted into the sclera? (or) Which of the following IOL is called as Scleral Fixated IOL’s? A. B. C. D. ---------------------------------------- 38. Which artery is most commonly associated with supra-choroidal hemorrhage during cataract surgery? A. Central retinal artery B. Long posterior ciliary artery C. Short posterior ciliary artery D. Anterior ciliary artery ---------------------------------------- 39. A 65-year-old woman, three years post-cataract surgery in her right eye, presents with gradually worsening vision. Slit-lamp examination reveals opacification of the posterior lens capsule. Which of the following images is not related to the condition this patient is suffering from? (or) Which of the following images does not represent the type of Secondary cataract? Page 11 11 A. B. C. D. ---------------------------------------- 40. A 60-year-old patient presents with decreased vision several months after undergoing cataract surgery. On examination, the ophthalmologist confirms the presence of posterior capsular opacification. What is the treatment of choice for this condition? (or) What is the treatment of choice for posterior capsular opacification after cataract surgery? A. Repeat cataract surgery B. Topical antibiotic drops C. Nd YAG Laser posterior capsulotomy D. Oral corticosteroids ---------------------------------------- 41. A newborn infant is brought to the pediatrician's office due to the presence of bilateral congenital cataracts. Several family members also had congenital cataracts. Which of the following genes is most likely not responsible for the development of congenital cataracts? (or) Which gene is most likely not responsible for the development of congenital cataracts in a patient with a family history of the condition? A. CRY-G gene B. Cx gene C. MIP gene D. EGFR gene ---------------------------------------- 42. A 6-month-old infant is brought to the pediatrician due to concerns about poor vision. On examination, markedly diminished vision with bilateral cataracts is noted. Which of the following cataracts is the most common congenital cataract associated with this presentation? (or) Which of the following cataracts is the most common congenital cataract causing marked diminution of vision? A. B. C. D. ---------------------------------------- Correct Answers Page 12 12 Question Correct Answer Question 1 3 Question 2 4 Question 3 2 Question 4 1 Question 5 3 Question 6 2 Question 7 3 Question 8 4 Question 9 3 Question 10 1 Question 11 2 Question 12 2 Question 13 4 Question 14 4 Question 15 4 Question 16 4 Question 17 2 Question 18 4 Question 19 2 Question 20 2 Question 21 3 Question 22 3 Question 23 1 Question 24 3 Question 25 4 Question 26 1 Question 27 2 Question 28 3 Question 29 2 Question 30 2 Question 31 3 Question 32 3 Question 33 3 Page 13 13 Question 34 2 Question 35 3 Question 36 3 Question 37 3 Question 38 3 Question 39 3 Question 40 3 Question 41 4 Question 42 2 Solution for Question 1: Correct Option C -1 and 4 are true: Explanation of all 4 statements: Therefore, Option C is correct, marking statement 1 and 4 as correct. Incorrect Options: Options A, B, and D are incorrect. Refer to Option C for an explanation. Solution for Question 2: Correct Option D - High-Molecular weight protein (HMW) 4: The most likely explanation for the patient's symptoms, including progressive blurred vision with a yellow hue and opacification in the central region of the crystalline lens, is a nuclear cataract. They are primarily associated with changes in water-insoluble lens proteins. High-Molecular weight protein (HMW) 4 is the specific water-insoluble protein that is responsible for nuclear cataract formation. Incorrect Options: Option A - High-molecular weight protein (HMW) 1: High-molecular weight protein 1 is a water-soluble protein and is not responsible for cataract formation. Option B - High-molecular weight protein (HMW) 2: High-molecular weight protein 2 is also a water-soluble protein and is not responsible for cataract formation. Option C - Crystallin gamma: Crystallin gamma is also a water-soluble protein responsible for congenital cataract formation. Solution for Question 3: Correct Option B - Myotonic dystrophy: Page 14 14 The image given in the question is of a Christmas tree cataract. Christmas tree cataract is indeed associated with Myotonic dystrophy, a genetic neuromuscular disorder. The distinctive appearance of the cataract is a result of specific crystalline deposits in the lens and is one of the ocular manifestations seen in individuals with Myotonic dystrophy. Incorrect Options: Option A - Diabetes Mellitus: Diabetes mellitus can lead to the development of snowstorm cataracts. Option C - Galactosemia cataract: Galactosemia can lead to the development of Lamellar cataracts or Oil droplet cataracts Option D - Morgagnian cataract: Morgagnian cataracts are characterized by liquefaction and disintegra tion of the lens cortex, leading to the sinking of the nucleus. Solution for Question 4: Correct Option A - Lowe syndrome: The clinical scenario described is consistent with Lowe syndrome, also known as oculocerebrorenal syndrome, an X-linked recessive disorder characterized by a triad of ophthalmic, neurologic, and renal abnormalities. Ophthalmic findings in Lowe syndrome include congenital cataracts, which are typically bilateral and present at birth or shortly thereafter. Glaucoma, characterized by increased intraocular pressure, may also be observed. These ocular manifestations often lead to vision impairment or blindness in affected individuals. Incorrect Options: Option B – Retinoblastoma: Retinoblastoma is a malignant tumor of the retina, typically seen in childre n. It can present with leukocoria (white pupillary reflex) or strabismus. Option C - Congenital rubella syndrome: Congenital rubella syndrome is caused by intrauterine infectio n with the rubella virus during pregnancy. Ocular manifestations can include cataracts, retinopathy, and microphthalmia. Option D - Marfan syndrome: Marfan syndrome is a connective tissue disorder characterized by variou s systemic manifestations, including cardiovascular, skeletal, and ocular abnormalities. Ocular findings in Marfan syndrome commonly include lens dislocation, myopia, and retinal detachment. Solution for Question 5: Correct Option C - Sunflower cataract: The image given in the question is of a Sunflower cataract caused by copper deposition. This is typically due to Wilson's disease or a copper-containing foreign body (also called chalcosis) and the pattern observed is of sunflower, hence the name sunflower cataract. Incorrect Options: Option A - Toxic cataract: Toxic cataract refers to the development of cataracts due to certain medicati ons like steroids, phenothiazines, amiodarone, and busulfan. Page 15 15 Option B - Traumatic cataract: Traumatic cataract occurs as a result of direct trauma or injury to the ey e. While trauma can cause lens opacities, the sunflower-like pattern described in the scenario is not ch aracteristic of traumatic cataracts. Option D - Radiational cataract: Radiational cataract refers to the development of cataracts due to exp osure to ionizing radiation, such as in cases of radiation therapy. Solution for Question 6: Correct Option B - Atopic dermatitis: Shield-like dense anterior subcapsular plaque that wrinkles the anterior capsule is characteristic of shield cataracts, commonly associated with atopic dermatitis. Atopic dermatitis is a chronic inflammatory skin condition characterised by redness, thickening and hardening of the skin. Shield cataracts are a specific type of cataract characterized by an anterior subcapsular opacity that covers the entire pupillary area. Incorrect Options: Option A - Myotonic dystrophy: Myotonic dystrophy is associated with presenile cataracts, specifically Christmas tree cataracts. Option C - Diabetes mellitus: While diabetes mellitus can lead to the development of cataracts, it typica lly causes posterior subcapsular cataracts (snowflake cataracts) or cortical cataracts. Option D - Neurofibromatosis type 2 (NF2): Neurofibromatosis type 2 is associated with various ocular manifestations, including posterior subcapsular cataracts. Shield cataracts are not typically associated with NF2. Solution for Question 7: Correct Option C - Removal of the entire lens including the capsular bag: Page 16 16 This statement is not true for the procedure of ECCE with PCIOL implantation. In ECCE, the anterior portion of the lens capsule is opened, and the nucleus of the lens is removed, leaving the posterior capsule (the capsular bag) intact. This allows for the implantation of a posterior chamber intraocular lens (PCIOL) into the capsular bag to restore vision. Incorrect Options: Option A - Making an incision on the limbus: This step is commonly involved in ECCE with PCIOL impl antation. The limbal incision provides access to the anterior chamber of the eye for cataract removal an d lens implantation. Option B - Hydro dissection: Hydro dissection is a technique used during cataract surgery, including E CCE with PCIOL implantation. It involves injecting a balanced salt solution into the space between the l ens and the lens capsule to separate the lens nucleus from the surrounding capsule, making it easier t o remove the lens. Options D - Cleaning the capsular bag with irrigation aspiration (I/A): After removing the lens nucleus, t he posterior chamber of the eye (the capsular bag) is indeed cleaned using an irrigation-aspiration (I/A) device. This device helps to remove any remaining lens material or cortical material that might be left i n the capsular bag after the nucleus removal. Solution for Question 8: Correct Option D - FLACS (Femto Laser Assisted Cataract Extraction): FLACS, or Femto Laser Assisted Cataract Extraction, is a cataract surgery technique that utilizes a Neodymium glass laser. The laser is used for various steps in the procedure, including making the incision, creating a continuous curvilinear capsulorhexis (CCC), and fragmenting the lens. The Femto laser's precise and controlled energy allows for a more automated and precise surgical approach. Incorrect Options: Option A - SICS (Small Incision Cataract Surgery): SICS (Small Incision Cataract Surgery) involves sm all incisions and a scleral tunnel formation with the help of a crescent knife. Option B - MICS (Minimal Incision Cataract Surgery): MICS (Minimal Incision Cataract Surgery) is simil ar to phacoemulsification but with a smaller incision size and emulsifying the lens using ultrasound energy. Option C - Phacoemulsification: Phacoemulsification is a widely used cataract surgery technique that u ses ultrasound energy to emulsify and remove the cataract. Solution for Question 9: Correct Option C - Retrobulbar injection: Retrobulbar injection involves anesthetic administration in the intraconal space. This technique ensures effective anaesthesia by targeting the nerves in close proximity to the eyeball responsible for ocular movement and sensory perception. Incorrect Options: Option A - Topical anaesthesia: Topical anaesthesia involves applying anaesthetic agents directly to th e surface of the eye. While it can provide localized numbing effects, but no akinesia. Page 17 17 Option B - Peribulbar injection: Peribulbar injection is administered in the extraconal space. Option D - Supraorbital nerve block: A supraorbital nerve block is a technique used to provide anaesth esia to the forehead and scalp above the eye. While it can numb the sensory branches of the supraorbi tal nerve, it does not target the nerves responsible for ocular motility and sensation. Solution for Question 10: Correct Option A - ACIOL: UGH syndrome (Uveitis, Glaucoma, Hyphema) can occur as a complication of ACIOL (Anterior Chamber Intraocular Lens). The ACIOL can block the angle, leading to increased intraocular pressure, glaucoma, and bleeding into the anterior chamber (hyphema), along with uveitis, resulting in UGH syndrome. Incorrect Options: Option B - PCIOL (Posterior Chamber Intraocular Lens): PCIOLs are positioned in the posterior chamb er of the eye, away from the angle and iris. They are less likely to cause angle blockage and subseque nt glaucoma or hyphema. Option C - Toric IOL: Toric IOLs are specialized lenses used to correct astigmatism. They are not direc tly associated with UGH syndrome. Option D - Multifocal IOL: Multifocal IOLs are designed to provide vision correction at multiple distance s, and they are typically placed in the posterior chamber. Solution for Question 11: Correct Option B - Intravitreal antibiotic injections: The clinical scenario described is suggestive of endophthalmitis, an acute postoperative complication of cataract surgery, which is a purulent inflammation of intraocular fluids usually due to infection. The hallmark feature of endophthalmitis is progressive vitritis, along with other signs and symptoms such as worsening vision, redness, pain, photophobia, blepharospasm, and discharge. On examination, findings such as lid swelling, chemosis, corneal edema, hypopyon, and vitritis further support the diagnosis. The treatment of choice for endophthalmitis with the ability to perceive hand movements is intravitreal antibiotic injections, typically including ceftazidime and vancomycin. These antibiotics are effective in targeting the infection within the eye. Systemic antibiotics, such as quinolones, may be given for their higher ocular penetration. Pars plana vitrectomy is indicated when there is no hand movement vision. Incorrect Options: Option A - Pars plana vitrectomy: Pars plana vitrectomy is not the treatment of choice for endophthalmi tis. It is indicated only when there is no hand movement vision, and the patient described in the scenari o has worsening vision but still retains hand movement or better vision. Option C - Systemic antibiotics: Systemic antibiotics, such as quinolones, may be given in cases of end ophthalmitis to provide additional coverage. However, they are not the primary treatment of choice for t his condition. Intravitreal antibiotic injections are preferred for targeted delivery and higher efficacy. Page 18 18 Option D - Cycloplegics and topical steroids: Cycloplegics and topical steroids are used in the manage ment of associated uveitis, which can occur in conjunction with endophthalmitis. However, they are not the primary treatment for endophthalmitis itself. Solution for Question 12: Correct Option B – Dysphotopsia: These symptoms are characteristic of dysphotopsia, which is the perception of abnormal visual sensations or disturbances after intraocular lens (IOL) implantation. Dysphotopsia can manifest as various visual phenomena, including flashes of light (positive dysphotopsia) or dark shadows (negative dysphotopsia). It is commonly associated with certain types of IOLs, particularly monofocal IOLs. The design and material of the IOL can affect the incidence of dysphotopsia. Incorrect Options: Option A - Endophthalmitis: Endophthalmitis is an infection of the vitreous humor, typically presenting with symptoms such as pain, redness, and vision loss. Option C - Refractive surprise: Refractive surprise refers to a significant residual refractive error after cataract surgery. It is characterized by a discrepancy between the intended and achieved refractive outcome. Option D - Anterior capsular contraction and fibrosis: Anterior capsular contraction and fibrosis can occ ur after cataract surgery, leading to visual disturbances due to capsular phimosis or anterior capsule op acification. Solution for Question 13: Correct Option D - Shallow anterior chamber: Shallow anterior chamber is an acute postoperative complication of cataract surgery. Shallow anterior chamber can occur due to various reasons such as aqueous leakage, pupillary block glaucoma, or ciliary block glaucoma. It is characterized by a reduced depth of the anterior chamber, which can lead to increased intraocular pressure and other associated symptoms. Incorrect Options: Option A - CME (Cystoid Macular Edema): CME is a chronic postoperative complication of cataract sur gery. It is characterized by the accumulation of fluid in cyst-like spaces within the macula, leading to bl urred or distorted vision. Option B - Refractive Surprise: Refractive surprise refers to a significant residual refractive error following cataract surgery. It is considered a chronic postoperative complication. Option C - Displacement of IOL: Displacement of IOL can occur after cataract surgery and is considered a chroni c postoperative complication. The lens may get displaced in various directions, such as lateral, downw ards (sunset syndrome), or upwards (sunrise syndrome). Page 19 19 Solution for Question 14: Correct Option D - Coronary cataract: Coronary cataract is the type of congenital cataract that is characterized by peripheral cortical opacities in both lenses. Coronary cataracts are so named because they consist of a group of club-shaped cortical opacities that are arranged around the equator of the lens like a crown or corona. They usually do not affect visual acuity. Coronary cataracts are often inherited in an autosomal dominant pattern. Incorrect Options: Option A - Blue dot cataract: A blue dot cataract is characterized by bluish dots on the lens. It is comm only seen in Down syndrome and affects both the nucleus and cortex of the lens. It typically does not a ffect the visual acuity. Option B - Cataracta pulverulenta: Cataracta pulverulenta refers to a powdery or dusty appearance of t he lens due to fine opacities distributed throughout the lens. It involves both the nucleus and cortex of t he lens. Option C - Lamellar/zonular cataract: Lamellar or zonular cataract is characterized by opacification of o ne layer of the lens, while the adjacent areas remain clear. It primarily involves the fetal nucleus of the l ens and can cause a marked diminution of vision. Solution for Question 15: Correct Option D - Salt and pepper fundus: The triad of visual abnormalities (cataract), heart defects, and deafness is suggestive of congenital rubella syndrome. A salt and pepper fundus refers to a speckled appearance of the retina, resembling the seasoning on food. This appearance is caused by the presence of diffuse chorioretinitis, which is the most common ocular manifestation of Congenital Rubella Syndrome. The rubella virus affects the retina, leading to disturbed growth of the pigmentary layer. Page 20 20 Incorrect Options: Option A - Pearly white lens opacity: Although pearly white lens opacity (nuclear pearly cataract) is ano ther ocular feature of Congenital Rubella Syndrome, it is the second most common ocular feature asso ciated with Congenital Rubella Syndrome. Option B - Microphthalmos: Microphthalmos, or small-sized eyes, can be associated with Congenital R ubella Syndrome. However, it is not the most specific feature in this case. Option C - Rubella keratitis: Rubella keratitis refers to inflammation of the cornea due to rubella infectio n. While it can occur in Congenital Rubella Syndrome, it is not the most common ocular feature. Solution for Question 16: Correct Option D – Homocystinuria: Inferonasal ectopia lentis is commonly associated with Homocystinuria, a genetic disorder caused by an abnormal metabolism of the amino acid methionine. Patients with Homocystinuria may have inferonasal subluxation. Other clinical features of Homocystinuria include intellectual disability, skeletal abnormalities, and thromboembolic events. Incorrect Options: Option A - Marfan's syndrome: Marfan's syndrome is associated with superotemporal ectopia lentis. Option B - Ehlers-Danlos: Ehlers-Danlos syndrome is associated with subluxation of the lens can be in various directions and features a thin sclera and hyperelastic skin. Option C - Stickler syndrome: Stickler syndrome is a disorder of collagen production, manifesting most commonly with retinal detachment, progressive myopia, and occasionally ectopia lentis. Solution for Question 17: Page 21 21 Correct Option B - Wedl cells: Wedl cells refer to a specific type of lens epithelial cells that are primarily responsible for the development of posterior subcapsular cataracts (PSC). These cells undergo changes(dysplasia) and migrate to the posterior subcapsular region of the lens, where they contribute to the formation of opacities. PSC cataracts are characterized by clouding or opacities in the posterior lens, just beneath the capsule. Incorrect Options: Option A - Bowman's layer: Bowman's layer is a part of the cornea, not the lens. Bowman's layer contains acellular collagen and plays a role in maintaining the cornea's structural integrity. It is not related to cataract development. Option C - Muller cells: Muller cells are specialized glial cells found in the retina. They help in maintaini ng structural integrity, but they are not directly related to the development of cataracts. Option D - Schlemm's canal: Schlemm's canal is a structure in the eye's anterior chamber that plays a r ole in the drainage of aqueous humor. It is involved in the regulation of intraocular pressure and is not r elated to cataract formation. Solution for Question 18: Correct Option D - They are formed near the nodal point of the eye: The nodal point is an essential concept in optics, representing the point where light rays converge or appear to diverge after passing through the eye's optical system. Nodal point of eye is also the first focal point present just behind the lens. When a cataract develops near this nodal point, it significantly disrupts the passage of light through the eye, causing a more pronounced and severe impact on vision, particularly in low-light conditions and when reading. This disruption of light rays at or near the nodal point leads to significant diminution of vision. Incorrect Options: Page 22 22 Option A - They affect the eye's accommodation reflex: Posterior subcapsular cataracts can indeed aff ect the eye's ability to focus and accommodate, but this doesn't specifically relate to "maximum diminut ion of vision." Rather, it's related to issues with focusing and near vision. ption B - They result in significant myopia: While cataracts can change the refractive properties of the e ye and lead to refractive errors like myopia, it's not seen in posterior subcapsular cataracts, itsa feature of nuclear cataracts. Option C - They cause significant glare and halos around lights: Glare and halos around lights can be a ssociated with cataracts, but this is not the cause of maximum dimunition of vision. Solution for Question 19: Correct Option B - Phacoanaphylactic glaucoma: Phacoanaphylactic glaucoma is a rare but serious complication that can occur as a result of an immune response (type 3 hypersensitivity) to lens proteins released during cataract surgery. These proteins are typically sequestered within the lens and are not normally in contact with the body's immune system. However, during surgery, they can be exposed, leading to an immune response, where macrophage comes and engulfs the lens proteins and blocks the trabecular meshwork, leading to open-angle glaucoma known as Phacoanaphylactic Glaucoma. Incorrect Options: Option A - Acute angle-closure glaucoma: Acute angle-closure glaucoma is characterized by a sudden increase in intraocular pressure due to the blockage of the drainage angle of the eye. It presents sever e eye pain, headache, nausea, and vomiting, but the presentation in the question is more indicative of a reaction to cataract surgery. Option C - Pseudoexfoliation glaucoma: Pseudoexfoliation glaucoma is a type of glaucoma caused by t he accumulation of dandruff-like grey fibrillary material in the eye, often seen in the anterior segment. While it can lead to glaucoma, the presentation described in the question is more indicative of a reaction to cataract surgery. Option D - Normal-tension glaucoma: Normal-tension glaucoma is a type of glaucoma in which optic ne rve damage and vision loss occur despite intraocular pressure being within the normal range. It is asso ciated with a more chronic history. Solution for Question 20: Correct Option B - Atrophy of ciliary muscles and decreased elasticity of the lens: The patient is suffering from presbyopia characterized by a progressive decrease in near vision after the age of 40 years. This option represents the primary mechanism of presbyopia. It involves both weakening and atrophy of the ciliary muscles, along with a decrease in the flexibility of the eye's natural lens leading to error of accommodation, leading to difficulty in focusing on near objects as people age. Incorrect Options: Option A - Corneal shape changes and retinal degeneration: Changes in the cornea's shape can result in frequent changes in glasses of young, astigmatism, and unilateral diplopia, whereas retinal degener ation can result in decreased central vision. Page 23 23 Option C - Lens hardening and vitreous humor opacities: This option includes lens hardening, which is a more a ccurate representation of the changes occurring in presbyopia. However, vitreous humor opacities are more commonly associated with conditions such as floaters. Option D - Retinal degeneration and vitreous humor opacities: Retinal degeneration can lead to reduce d central vision slowly and vitreous humor opacities can lead to conditions like floaters. Solution for Question 21: Correct Option C - Vitamin C: Vitamin C acts as a free radical scavenger in the lens, helping to protect against oxidative damage and potentially delaying the development of cataracts. Free radicals can cause oxidative damage to the lens proteins and lipids, leading to changes in the lens's transparency and the development of cataracts. Antioxidants act as protective agents by donating electrons to free radicals, stabilizing them, and preventing them from causing damage. Incorrect Options: Option A - Vitamin D: Vitamin D is more closely associated with calcium absorption and bone health. Option B - Vitamin K: Vitamin K plays a vital role in blood clotting and bone health but is not typically associated with being a free radical scavenger in the lens. Option D - Vitamin A: Vitamin A is important for vision, it is essential for the functioning of photoreceptor cells in the retina but is not a primary antioxidant in the lens. Solution for Question 22: Correct Option C - NADPH-dependent Aldose Reductase activity: The image shows a Snowflake Cataract. It is a specific type of cataract characterized by opacities in the lens of the eye that resemble snowflakes. These opacities are associated in conditions such as diabetes, where high level of glucose can lead to increases activity of NADPH-dependent aldose reductase, an enzyme involved in the sorbitol pathway, resulting in the accumulation of sorbitol in the lens, sorbitol is a hyperosmotic molecule and any hydration will form opacities. Incorrect Options: Options A, B, and D are incorrect. Refer to Option C for an explanation. Solution for Question 23: Correct Option A - Oil Droplet Cataract due to Galactose Phosphate Uridyl Transferase deficiency: Page 24 24 The specific type of cataract shown in the image in a 1-month-old infant's eyes is an Oil Droplet cataract, seen in galactosemia, an inborn error of galactose metabolism due to the deficiency of the enzyme galactose phosphate uridyl transferase resulting in the accumulation of galactose-1-phosphate, causing damage to the lens Incorrect Options: Options B, C, and D are incorrect. Refer to Option A for an explanation. Solution for Question 24: Correct Option C - All cases with hepatic involvement will present with the ring: The patient is suffering from Wilson disease, and the brownish-golden ring is a Kayser-Fleischer (KF) ring. Kayser-Fleischer (KF) ring is a characteristic sign of Wilson's disease, a genetic disorder that results in the accumulation of copper in various organs, including the liver, brain, and eye. While KF rings are commonly associated with Wilson's disease, not all cases with hepatic involvement will necessarily present with these rings; only 65% of cases will show KF rings. The presence of KF rings is often seen in patients with neurological (95% cases) involvement rather than hepatic involvement. Incorrect Options: Option A - The ring starts superiorly and inferiorly first: This statement is true. In Wilson's disease, Kay ser-Fleischer (KF) rings typically start to appear at the superior and inferior portions of the cornea due t o the deposition of copper. Over time, the ring becomes more complete. Option B - Ring is formed due to the deposition of copper: This statement is true. KF rings are indeed f ormed due to the deposition of copper in Descemet's cornea membrane. Option D - Most cases with Neurological involvement will present with the ring: This statement is true. KF rings are often associated with neurological involvement in Wilson's disease. While not all patients with Wilson's disease will have neurological symptoms, when neurological symptoms are present, KF ri Page 25 25 ngs are more likely to be observed as well. Solution for Question 25: Correct Option D - Seen in patients suffering from Lowe’s Syndrome: The Image given in the question is Oil Globule Reflex, a finding seen in the anterior lenticonus characterized by a conical or spherical protrusion in the anterior portion of the lens in patients suffering from Alport's syndrome (familial hemorrhagic nephritis), most commonly an X-linked disease affecting males predominantly. Lowe's Syndrome is a separate and distinct genetic disorder characterized by kidney dysfunction and not typically associated with the anterior lenticonus or the "Oil Globule Reflex", it is more associated with the Posterior Lenticonus. Incorrect Options: Options A, B, and C are incorrect. Refer to Option D for an explanation. Solution for Question 26: Correct Option - A: : Page 26 26 The patient is already a known case of chronic anterior uveitis, which suggests the patient likely has complicated cataract, which is a complication of chronic anterior uveitis. Pathognomonic feature of complicated cataracts is polychromatic lustre and bread crumb appearance is seen in option A, thus marking it as the correct option. Incorrect Options: Option B - The given image shows the Rosette-shaped cataract, which is a cortical cataract that starts from the posterior cortex caused by blunt trauma. Option C - The given image shows sunflower cataract which is due to Wilson’s Disease or any copper- containing foreign body. Option D - The given image shows a Snowflake/Snowstorm cataract caused by the accumulation of so rbitol in the lens due to excessive blood glucose level. Solution for Question 27: Correct Option B - Systemic Steroids causes OAG most commonly: Systemic steroids are associated with the development of cataracts, most commonly posterior subcapsular cataracts (PSCs). PSC can lead to visual disturbances, such as glare around lights and reduced night vision. Incorrect Options: Option A - Topical steroid usage causes OAG most commonly: Topical steroids, when applied to the e ye, can cause open-angle glaucoma (OAG) more commonly than cataracts due to the deposition of Mucopolysaccharides. Option C - Systemic steroids cause PSC: PSC formation is the most common complication of systemic steroid use. Option D - Steroids disturb the osmotic balance of the lens, causing toxic cataracts: Steroids can disru pt the normal functioning of lens fibers and lead to the accumulation of water within the lens, causing o pacities (toxic cataracts). Page 27 27 Solution for Question 28: Correct Option - C: : The Cataract Shown in the image is a Stellate Anterior subcapsular cataract. This is typically seen after electric shocks, like lightning damage. Hence it is not seen in the patient eye with blunt trauma. Incorrect Options: Option A - The image shows a Rosette-shaped Cataract, a cortical cataract that starts from the posterior cortex after a patient sustains a blunt trauma to the eye. Option B - Image shows a Cherry red spot at retina, which is due to edema at the macula of the retina after sustaining a blunt trauma to eye known as Berlin’s Edema also known as commotiae retinae. Option D - Image shows a ring on the anterior capsule of lens known as Vossius ring, formed because of pigment deposition of iris on the anterior capsule of lens after a blunt injury. Solution for Question 29: Correct Option B - Iridodialysis An iridodialysis is characteristic of blunt injury to the eye. Iridodialysis is the disinsertion of the iris from the scleral spur. Incorrect Options: Option A - Hyphema: Hyphema is a condition where there is blood in the anterior chamber of the eye. It can occur as a result of blunt traum a to the eye. Hyphema can cause decreased vision, eye pain, due to increased intraocular pressure an d can also lead to corneal staining. Page 28 28 Option C - Corneal abrasion: A corneal abrasion is an injury to the corneal epithelium. Corneal abrasio ns typically cause pain, tearing, and foreign body sensation. Option D - Retinal detachment: It is a seperation of retinal pigment epithelium from neurosensory retina. Symptoms of retinal detachment may include flashes of light, floaters, and a curtain or shadow over the field of vision. An ophthalmologist would need to perform a dilated retinal examination to confirm retinal detachment. Solution for Question 30: Correct Option B - Glass-Blower’s Cataract caused by infrared radiation: This patient likely developed a Glass-Blower's Cataract due to chronic exposure to infrared radiation, a known risk in occupations like working in a glass factory where individuals are exposed to the high temperatures and infrared radiation generated during glassblowing processes. Incorrect Options: Option A - Glass-Worker’s Cataract and caused by ultraviolet radiation exposure: While UV radiation c an be harmful to the eyes and can lead to conditions like photokeratitis or UV-induced cataracts, but gl ass-blower cataract is caused due to infrared radiation and high temperature. Option C - Welder's Cataract caused by exposure to bright visible light: Prolonged exposure to intense visible light, such as that experienced by welders, can be harmful to the eyes and may lead to conditio ns like welder's flash or photic retinopathy. Option D - Nuclear Cataract caused by age-related changes: Nuclear cataract is a type of age-related cataract caused by the natural aging process, diabetes and smoking. The lens is hard and inelastic, re sulting in decreased ability to accommodate and obstructs the light resulting in glare, difficulty reading i n bright light conditions. Solution for Question 31: Correct Option C - Risk of retinal detachment: Intracapsular Cataract Extraction (ICCE) is a surgical technique for cataract removal in which the entire lens capsule, including the cataract, is removed from the eye. In paediatric patients there is a strong adhesion between the posterior capsule of lens and anterior hyaloid membrane by Weigert ligament. So, when the capsule is pulled, there is a risk of the vitreous humor being pulled, causing retinal detachment. Incorrect Options: Options A, B, and D are incorrect. Refer to Option C for an explanation. Solution for Question 32: Correct Option C - Extracapsular Cataract Extraction (ECCE): Page 29 29 The "can opener" technique, as described in the question, is commonly used in Extracapsular Cataract Extraction (ECCE). In ECCE, the surgical procedure involves creating a circular opening in the anterior (front) lens capsule, which resembles the movement of a can opener. This circular opening in the lens capsule allows the surgeon to access and remove the cataract while leaving the posterior part of the capsule intact. After cataract removal, an intraocular lens (IOL) can be inserted into the eye to replace the natural lens and restore vision. Incorrect Options: Option A - Phacoemulsification: Phacoemulsification is a modern cataract surgery technique. It involve s the use of ultrasound energy to break up the cataract within the lens, and the fragmented pieces are t hen aspirated out of the eye. Unlike ECCE, which involves a larger incision and removal of the entire cataract, phacoemulsification typically uses a smaller incision. Option B - Intracapsular Cataract Extraction (ICCE): Intracapsular Cataract Extraction (ICCE) is an old er cataract surgery technique where the entire lens, including the lens capsule, is removed. Option D - Laser-assisted Cataract Surgery: Laser-assisted Cataract Surgery is a modern cataract surgery technique that involves the use of a femtosecond laser to perform certain step s of the procedure, such as creating corneal incisions and softening the cataract. Solution for Question 33: Correct Option C - Sclerocorneal tunnel incision: The "Sclerocorneal tunnel incision" in Small Incision Cataract Surgery (SICS) is a curved, self-sealing incision in the eye's tough outer layer (sclera) that allows cataract removal with reduced risk of complications and better wound stability. It consists of the following steps: External scleral incision: A scleral groove, one-third to half thickness, is created approximately 1.5mm to 2mm behind the limbus and varies in length from 5.5mm to 7.5mm based on the hardness of the nucleus. Sclerocorneal tunnel: It is made with the help of a crescent knife. It usually extends l - 1.5 mm into the clear cornea. Internal corneal incision: It is made with the help of a sharp 3.2 mm angled keratome. External scleral incision: A scleral groove, one-third to half thickness, is created approximately 1.5mm to 2mm behind the limbus and varies in length from 5.5mm to 7.5mm based on the hardness of the nucleus. Sclerocorneal tunnel: It is made with the help of a crescent knife. It usually extends l - 1.5 mm into the clear cornea. Internal corneal incision: It is made with the help of a sharp 3.2 mm angled keratome. External scleral incision: A scleral groove, one-third to half thickness, is created approximately 1.5mm to 2mm behind the limbus and varies in length from 5.5mm to 7.5mm based on the hardness of the nucleus. Sclerocorneal tunnel: It is made with the help of a crescent knife. It usually extends l - 1.5 mm into the clear cornea. Internal corneal incision: It is made with the help of a sharp 3.2 mm angled keratome. Page 30 30 Incorrect Options: Option A - Linear incision: A linear incision typically refers to a straight-line cut, and it is not the type of incision used in Small Incision Cataract Surgery (SICS). Option B - Radial incision: A radial incision would involve cuts extending outward from a central point, and it is not a common incision type in cataract surgery, especially in SICS. Option D - Clear corneal incision: A clear corneal incision is a different type of incision used in some ca taract surgery techniques, such as phacoemulsification. It involves a small, clear corneal cut, rather than a scleral incision. Clear corneal incisions are made on the cornea, not the sclera, and are associated with specific surgical methods. Solution for Question 34: Correct Option B - A small-sized incision of 2.75-3.2 millimetres and 40 kHz: In phacoemulsification, the typical incision size is in the range of about 2.75 to 3.2 millimetres, and the typical frequency of the Phaco probe is around 40 kHz to break and emulsify the cataract. Incorrect Options: Options A, C, and D are incorrect. Refer to Option B for an explanation. Solution for Question 35: Correct Option C - Trypan Blue: Trypan Blue helps enhance visibility and facilitates the surgical process by staining the anterior lens capsule, allowing for improved visualization and precise capsulorrhexis. Incorrect Options: Page 31 31 Option A - Flourescein: Flourescein is a contrast agent that is used in procedures like fundus angiogra phy to visualize blood vessels in the retina. Option B - Rose Bengal: Rose Bengal is a stain used in ophthalmology to assess the health of the ocul ar surface, particularly in conditions like dry eye and corneal abrasions. Option D - Methylene Blue: Methylene Blue is a dye used in various medical and laboratory application s, such as in tissue staining and microbiological diagnostics. Solution for Question 36: Correct Option C - Balanced Salt Solution Plus (BSS Plus): Balanced Salt Solution Plus (BSS Plus) is the ideal solution for irrigation and aspiration during cataract surgery because it is closest to the composition of aqueous humor, helps maintain stable intraocular pressure, provides a balanced environment (ph), ensures a clear surgical field, maintains corneal endothelium functioning, and glutathione maintains the blood-aqueous barrier which protects the cells from oxidative stress reducing the inflammation and supports surgical procedures effectively. Incorrect Options: Option A - Balanced Salt Solution: While Balanced Salt Solution (BSS) is used in ophthalmic surgery, e specially during cataract surgery, it does not have glutathione, and prolonged exposure is less protectiv e to the corneal endothelium. Option B - Lactated Ringer's solution: Lactated Ringer's solution is also used in ophthalmic surgery, pr olonged perfusion causes endothelial cell break down and corneal swelling. Option D - Hydroxypropyl methylcellulose (HPMC): Hydroxypropyl methylcellulose (HPMC) is a viscoelastic substance used in ocular surgeries. Solution for Question 37: Correct Option - C: : Page 32 32 Scleral fixated IOLs are designed to be fixated to the sclera rather than being placed in the capsular bag or attached to the iris. The Scleral fixated IOL’s has hole in the haptic to pass the suture through the sclera as shown in the image. This type of IOL is often used in cases where there is a lack of capsular support, and it is sutured to the sclera in the posterior chamber to ensure stability and visual improvement. Incorrect Options: Option A - PCIOL: PCIOL stands for Posterior Chamber Intraocular Lens, and is typically placed in the posterior chamber of the eye, behind the iris and in front of the natural lens (if present) or the capsular bag. It is identified by two holes on the lens known as Dialing holes for proper adjustment of lens durin g insertion of the IOL. Option B - Iris claw lenses: Iris claw lenses are a type of IOL that are fixated to the iris, not the sclera. T hey are held in place by small claw-like haptics that attach to the iris, providing stability. They are used when an appropriate posterior capsular support is lacking. Option D - Toric IOL: Toric IOLs are designed to correct astigmatism. They can be placed in the capsul ar bag or in the posterior chamber of the eye, depending on the surgeon's preference and the patient's needs. The three dots on the lens are used to define at which axis the lens should be put. Solution for Question 38: Correct Option C - Short posterior ciliary artery: Supra-choroidal hemorrhage during intraocular surgery is the most commonly associated with the disruption of the short posterior ciliary artery. Supra-choroidal hemorrhage is the accumulation of blood in the potential space between the choroid and the sclera. Puncturing of the artery while giving anesthesia or due to sudden changes in the intraocular pressure can lead to the forceful expulsion of blood and intraocular contents, posing a significant risk to the procedure and the patient's vision. Incorrect Options: Page 33 33 Option A - Central retinal artery: The central retinal artery is responsible for supplying blood to the inner layers of the retina. While occlusion or damage to the central retinal artery can lead to sudden onset vi sion loss. Option B - Long posterior ciliary artery: The long posterior ciliary arteries supply blood to the posterior s egment of the eye, including the choroid and the ciliary body. While damage to the long posterior ciliary arteries can lead to bleeding and complications during eye surgery, they are not the most common art eries associated with expulsive hemorrhage. Option D - Anterior ciliary artery: The anterior ciliary arteries supply blood to the anterior segment of th e eye, including the extraocular muscles. While damage to the anterior ciliary arteries can result in blee ding, it is not primarily linked to expulsive hemorrhage during intraocular surgery. Solution for Question 39: Correct Option C: : The diagnosis is likely a secondary cataract. This option does not show any type of after-cataract. The image given is a “Blue dot cataract” also known as cerulean cataracts, are developmental cataracts characterized by blue and white opacifications scattered in the nucleus and cortex of the lens associated with Down’s syndrome. The diagnosis is likely a secondary cataract. This option does not show any type of after-cataract. The image given is a “Blue d ot cataract” also known as cerulean cataracts, are developmental cataracts characterized by blue and white opacifications scattered in the nucleus and cortex of the lens associated with Down’s syndrome. Incorrect Options: Option A: This image shows a diffuse type of after cataract, formed due to fibrous metaplasia of the epithelial cells. Option B: This image shows circular opacities, also known as Elschnig pearls. These are formed by mi grated epithelial cells. Page 34 34 Option D: This image shows a fibrotic ring at the periphery due to the proliferation of the residual cells also known as the Soemmerring ring. Solution for Question 40: Correct Option C - Nd YAG Laser posterior capsulotomy: Nd YAG laser posterior capsulotomy is a non-invasive procedure used to treat posterior capsular opacification (PCO) following cataract surgery. This technique involves using a laser to create a small, precise opening in the cloudy posterior capsule of the eye. This allows light to pass through the previously obstructed capsule, addressing visual disturbances and glare sensitivity. It is a minimally invasive outpatient procedure and is highly effective in restoring clear vision for patients experiencing PCO. Incorrect Options: Option A - Repeat cataract surgery: We have already removed the cataract, so this is not an option. Option B - Topical antibiotic drops: Topical antibiotic drops are used to prevent or treat eye infections, particularly after eye surgery. They are not a primary treatment for posterior capsular opacification (PCO). Option D - Oral corticosteroids: Oral corticosteroids are medications that can be used for various medic al conditions, including reducing inflammation and suppressing the immune system. Solution for Question 41: Correct Option D - EGFR gene: The EGFR (Epidermal Growth Factor Receptor) gene is not typically associated with congenital cataracts. Congenital cataracts are often caused by mutations in specific lens-related genes such as crystallin genes (CRY-G), connexin genes (Cx), and major intrinsic protein gene (MIP), which play essential roles in lens development and transparency. Incorrect Options: Option A - CRY-G gene: CRY-G gene is one of the crystallin genes, and mutations in crystallin genes c an lead to congenital cataracts. Crystallins are proteins that are essential for maintaining the transpare ncy and refractive properties of the eye's lens. Mutations in crystallin genes can disrupt the normal stru cture and function of the lens, resulting in the development of congenital cataracts. Option B - Cx gene: Cx (Connexin) genes code for proteins that are involved in gap junctions, which ar e essential for maintaining lens transparency. Mutations in connexin genes can disrupt the communicat ion between lens cells, leading to opacities in the lens and the development of congenital cataracts. Option C - MIP gene: The MIP (Major Intrinsic Protein) gene codes for a protein called aquaporin-0, wh ich is crucial for lens fiber cell physiology. Mutations in the MIP gene can result in impaired water trans port and the accumulation of intracellular water in lens fibers, leading to lens opacities and congenital c ataracts. Page 35 35 Solution for Question 42: Correct Option B: The image given shows a lamellar cataract, also known as zonular or fusiform cataracts, which are the most common type of congenital cataract associated with marked vision impairment. These cataracts typically affect the central or infantile nucleus of the lens due to vitamin D deficiency, leading to a cloudy or opacified area that can significantly impact vision. Incorrect Options: Option A - The image shows Blue dot cataract: Blue dot cataracts are typically small, round, and white opacities found on the anterior lens capsule. While they can be present at birth, they are generally not associated with marked diminution of vision and are considered relatively minor congenital cataracts. Option C - The image shows Posterior Polar Cataract: Posterior polar cataracts are characterized by o pacities at the back of the lens, associated with remnants of hyaloid tissues (mittendorf dots). While the y can affect vision, they are not as common as lamellar cataracts and do not result in marked diminutio n of vision. Option D - The image shows Anterior polar cataract: Anterior polar cataracts involve opacities in the fro nt of the lens, associated with persistent pupillary membranes. These cataracts are typically less comm on and do not result in marked diminution of vision compared to lamellar cataracts. Page 36 36 Previous Year Questions 1. What kind of laser can be utilized to treat posterior capsular opacification, which is observed during an examination of a patient who has reported decreased visual acuity following cataract surgery? A. Femto laser B. Nd YAG laser C. Argon fluoride D. Argon ---------------------------------------- 2. What substance is responsible for the development of a diabetic cataract in a 68-year-old female patient, which has been present for 3 months? A. Glucose B. Fructose C. Lactose + Glucose D. Sorbitol + Fructose ---------------------------------------- 3. What is the probable medical condition for a 70-year-old individual who has relied on presbyopia glasses but can now comfortably read the newspaper without them? A. Index myopia B. Index hypermetropia C. Regression of presbyopia D. None of the above ---------------------------------------- 4. A child has elevated Liver enzyme levels. A ring-like structure noted on ocular examination has shown in the image below. Which of the following is the cause for this? A. Copper B. Zinc C. Selenium D. Iron 37 ---------------------------------------- 5. Please identify the surgical procedure depicted in the provided image. A. Capsulorrhexis B. Hydrodissection C. Intraocular lens implantation D. Lens aspiration ---------------------------------------- 6. Can you determine the observation indicated by the arrow in the image provided? A. Vossius ring B. Weiss ring C. Fleischer’s ring D. Kayser Fleischer ring ---------------------------------------- 7. What is the primary risk factor associated with the diagnosis of a 37-year-old man with hypertension and diabetes, who is experiencing symptoms of blurred vision, photophobia, and increasing pain in his right eye? He has been wearing contact lenses for the past two years and mentions swimming in a local pond with his cousins two weeks ago. Page 2 38 A. Diabetes B. Hypertension C. Previous respiratory infection D. Contact lenses ---------------------------------------- 8. Riya was found to have a height of more than 95 percentile for her age and an arm-span to height ratio of more that 1.05. on further examination, she had flat feet, mild scoliosis, and long slender fingers. An image of her showing characteristic signs is provided below. What is the most common ocular complication expected in this child? A. Hypertensive retinopathy B. Rosette cataract C. Retinitis pigmentosa D. Subluxation of lens ---------------------------------------- 9. What is the term used to describe the type of cataract shown in the slit lamp examination findings of a patient who has been taking corticosteroids for a long time? A. Morgagnian hypermature cataract B. Posterior subcapsular cataract C. Sunflower cataract D. Snowflake cataract Page 3 39 ---------------------------------------- 10. What is the appropriate approach to treating a patient who presents with pain and visual disturbance 36 hours after undergoing cataract surgery, with an image of their eye provided below? A. Intravenous steroids B. Intravenous antibiotics C. Bandage and padding of the eye D. Intravitreal antibiotics ---------------------------------------- 11. The following image depicts a particular type of cataract. what is the most common cause of this cataract? A. Penetrating trauma B. Steroid use C. Diabetes D. Blunt trauma ---------------------------------------- 12. What could be the likely diagnosis for a 55-year-old male patient who visited the OPD with complaints of experiencing glare while driving at night, despite having cataract surgery a year ago? The patient's best corrected visual acuity is 6/12 in the right eye and 6/9 in the left eye, with no improvement observed when using a pinhole. A. Cystoid macular edema B. Psudophakic bullous keratopathy Page 4 40 C. ARMD D. Posterior capsular opacification ---------------------------------------- 13. Rosette cataract is seen after? A. Blunt trauma to eye B. Copper foreign body in eye C. Penetrating injury to eye D. Infection ---------------------------------------- 14. What is the formula utilized to calculate the power of the lens during cataract surgery for a patient who has previously undergone LASIK for myopia? A. SRK 1 B. SRK 3 C. Hoffer Q D. Haigis L ---------------------------------------- 15. Ectopia lentis is seen in? A. Homocystinuria B. Refsum's disease C. Wilson's disease D. Sarcoidosis ---------------------------------------- 16. Which muscle is paralyzed in a patient who has left-sided head tilt resulting in right hypotropia that worsens with right head tilt and dextroversion? A. Right superior oblique B. Right superior rectus C. Right inferior oblique D. Left inferior oblique ---------------------------------------- 17. After the uneventful placement of an intraocular lens in a young patient during cataract surgery, what further steps should be taken? A. IOL replaced every 10 years B. Never replaced C. Relaced when secondary cataract develops Replaced when presbyopia develops D. Replaced when presbyopia develops ---------------------------------------- Page 5 41 18. A 65-year-old diabetic woman presents with painless loss of vision. The ocular findings are shown in the image below. What is the likely diagnosis and management for this patient? A. Zonular cataract and lensectomy B. Rosette cataract and sugar control C. Sunflower cataract and lesion extraction D. Immature senile cataract and phacoemulsification with IOL ---------------------------------------- Correct Answers Question Correct Answer Question 1 2 Question 2 4 Question 3 1 Question 4 1 Question 5 1 Question 6 1 Question 7 4 Question 8 4 Question 9 2 Question 10 4 Question 11 4 Question 12 4 Question 13 1 Question 14 3 Question 15 1 Question 16 2 Question 17 2 Page 6 42 Question 18 4 Solution for Question 1: In the clinical scenario mentioned above decreased visual acuity after the cataract surgery with the presence of posterior capsular opacification is suggestive of After cataract. Nd YAG laser is used in the treatment of the patient with posterior capsular opacification. Symptoms which usually occur after the cataract surgery: Slowly blurring may worsen. Reduction in visual acuity. Treatment Posterior capsulotomy using the Nd-YAG laser. Incorrect Choices: Option a. Femto laser: FLACS - Femtosecond laser-assisted cataract surgery. The laser used is a neodymium glass (Nd: glass) laser with a wavelength of 1053 nanometers. Each laser duration is 10- 15 seconds. Similar to phacoemulsification, some of the steps are done by laser. Steps performed by laser are continuous curvilinear capsulorhexis and nuclear fragmentation. Option c. Argon fluoride: It is a deep ultraviolet laser with a wavelength of 193 nanometers. It is an excimer laser that consists of a mixture of noble gas such as xenon, krypton, or argon and a halogen gas. ArF is sometimes called an exciplex laser. The mechanism of action is photoablation which is the flattening of the cornea. Option d. Argon: Argon lasers are Ion lasers that produce a visible blue-green beam with wavelengths of 488 nm and 514 nm, which are absorbed selectively by hemoglobin, melanin, and other pigments that lie under the retina. Solution for Question 2: The accumulation of sorbitol and fructose is responsible for developing a diabetic cataract. In diabetes, excess glucose in the blood can enter the eye’s lens and be converted to sorbitol by the enzyme aldose reductase. Sorbitol is an alcohol that can accumulate in the lens and cause osmotic stress, leading to oxidative damage and impaired lens function. Over time, this can result in the formation of a diabetic cataract, which is a clouding of the lens that can cause vision loss. Osmotic stress causes overhydration, and apoptosis of lens epithelial cells and hydropic lens fibers. Secondary osmotic overhydration causes snowflake cataracts. Incorrect Choices: Option a. Glucose is not directly involved in developing a diabetic cataract. Option b. Fructose alone is not involved in developing a diabetic cataract. Page 7 43 Option c. Lactose and Glucose can contribute to hyperglycemia in individuals with diabetes, which can, in turn, lead to the formation of sorbitol and the development of diabetic complications like cataracts. H owever, they are not directly involved. Solution for Question 3: Index myopia is a term used in the context of contact lenses and eyeglasses prescription. It refers to a situation where the eye's lens prescription (in diopters) is greater than the contact lens or eyeglass prescription. When someone has index myopia, it means that their eye's natural lens, which changes shape to focus on objects at various distances (accommodation), is overcorrecting or causing their vision to be more myopic (nearsighted) than what is indicated by the prescription in their eyeglasses or contact lenses. For example, if a person has a prescription for -2.00 D (diopters) in their eyeglasses but experiences blur when looking through those glasses, it may be due to index myopia. This means that their eye's natural lens is contributing an additional myopic correction, making the total correction too strong. Index myopia is attributed to variation in the index of refraction of one or more of the ocular media. Cataracts may lead to index myopia. This is called a second-sight phenomenon if a person is hyperopic and starts developing pre-cataracts and changes vision by temporarily going through a phase where either near or distant vision improves. Index myopia is a term used in the context of contact lenses and eyeglasses prescription. It refers to a situation where the eye's lens prescription (in diopters) is greater than the contact lens or eyeglass pre scription. When someone has index myopia, it means that their eye's natural lens, which changes shape to focus on objects at various distances (accommodation), is overcorrecting or causing their vision to be more myopic (nearsighted) than what is indicated by the prescription in their eyeglasses or contact lenses. For example, if a person has a prescription for -2.00 D (diopters) in their eyeglasses but experiences bl ur when looking through those glasses, it may be due to index myopia. This means that their eye's nat ural lens is contributing an additional myopic correction, making the total correction too strong. Incorrect Choices: Option b. Index hypermetropia: It is due to the change in the refractive index of the crystalline lens, which occurs in old age or diabetics. The refractive index gradually increases from the center to the periphery. Option c. Presbyopia: It is defined as difficulty in seeing near objects. Loss of a ccommodation with age and corrected with convex lenses. Solution for Question 4: This is a case of sunflower cataracts. The ring-like structure noted in the periphery on ocular examination is the Kayser-Fleischer ring, and the deposits are the copper deposits in Descemet’s membrane. This is pathognomonic of Wilson's disease Incorrect Choices: Option b. Kayser-Fleischer ring does not occur due to zinc. Option c. Kayser-Fleischer ring does not occur due to selenium. Page 8 44 Option d. Iron: Fleischer ring seen in epithelium iron deposition in keratoconus. Solution for Question 5: Correct Choice: a Capsulorhexis is actually a term describing a surgical technique used in cataract surgery rather than a pathological condition. Specifically, it refers to the creation of a circular tear in the anterior capsule of th e lens. This procedure allows the surgeon to remove the cloudy lens (the cataract) and insert an artifici al lens. In a successful capsulorhexis, the tear is continuous and circular, providing a clear opening through which the lens material can be removed. This is ideally achieved using a special instrument or a fine needle under high magnification, and is considered an important and delica te step in cataract surgery. Following cataract surgery, we can detect the signs of capsulorhexis by examining the eye under a slit lamp microscope.If the capsulorhexis has been successful, we can see a well-defined, circular ope ning in the anterior capsule of the lens, through which the intraocular lens can be seen. The other conditions associated with capsulorhexis are not 'detected', but rather are complications that can occur during or after cataract surgery, if the capsulorhexis procedure was not executed properly. T hese can include a radial tear or a 'run-out' where the tear extends to the periphery of the lens, which may complicate the remaining steps of cataract surgery and postoperative recovery. Incorrect Choices: Option b. Hydrodissection: This is a surgical technique commonly used during cataract surgery, where balanced salt solution is injected between the lens capsule and the cataractous lens to separate them, thereby facilitating lens removal. Option c. Intraocular Lens Implantation: This procedure involves the surgical placement of an artificial l ens, typically following cataract removal, to restore vision by replicating the focusing power of the eye's natural lens. Option d. Lens Aspiration: This surgical method involves the removal of the eye's natural lens, typically due to a cataract or other lens pathology, using a small incision and a specialized aspiration device. Solution for Question 6: Correct Choice: a A Vossius ring is a condition that is typically detected during an ophthalmological examination following a trauma to the eye. It is often associated with blunt trauma to the eye, especially in events that lead to hyphema of iris sphincter tears. The Vossius ring itself is identified by the presence of pigment dispersion in a circular shape on the anterior surface of the lens. This dispersion or imprint of pigmented cells from the posterior surface of the iris occurs during the incident of trauma when the iris is pushed against the lens. The resulting ring is usually complete and prominent and is often centrally located on the lens. It can persist long after the initial injury, sometimes for years, and can serve as a historical indicator of the trauma. Page 9 45 Using the slit-lamp, the clinician would be able to visualize the circular deposition of pigment on the lens, indicating the presence of a Vossius ring. Incorrect Choices: Option b. Weiss Ring: This is an opacified ring-shaped structure that can be seen floating within the vitr eous humor of the eye, often signifying a posterior vitreous detachment, a condition in which the vitreous gel separates from the retina. Option c. Fleischer's Ring: This refers to a pigmented, circular line found at the edge of the cornea in k eratoconus patients. It's composed of iron deposits and signifies corneal thinning and protrusion. Option d. Kayser-Fleischer Ring: This is a copper-colored ring found at the periphery of the cornea, mo st commonly seen in patients with Wilson's disease, a rare genetic disorder leading to excessive copper deposition in the body. Solution for Question 7: Correct Option: D The most important risk factor for the patient's diagnosis in this case is "Contact lenses." Explanation of the options: Option A: Diabetes: While diabetes is a significant risk factor for various eye conditions such as diabeti c retinopathy, it is not the most important risk factor in this particular case. The patient's symptoms and history suggest a different condition related to contact lens use. Option B: Hypertension: Hypertension, or high blood pressure, is not directly related to the patient's dia gnosis. It may have implications for overall health, including eye health, but it is not the primary risk fact or in this case. Option C: Previous respiratory infection: Although a previous respiratory infection may weaken the immune system and make a person more susceptible to certain infections, it is not the most important risk factor in this case. The patient's symptoms and histo ry point to a different cause related to contact lens use. Option D: Contact lenses: The patient's use of contact lenses is the most important risk factor in this ca se. Contact lenses, especially if not properly cleaned, disinfected, or used according to guidelines, can lead to various eye conditions and infections. In this case, the patient's symptoms, including blurred visi on, photophobia, and increasing pain, raise concerns about a potential eye infection associated with contact lens use, such as microbial keratitis. Given the patient's recent history of swimming in a pond, there is an increased risk of exposure to micr oorganisms present in the water, which can adhere to contact lenses and potentially lead to an eye infe ction. Therefore, the correct answer is "Contact lenses," as they are the most important risk factor for the pati ent's diagnosis based on the symptoms and history provided. Page 10 46 Solution for Question 8: Correct Option: D Based on the given description and the characteristic signs shown in the image of the hand, the most c ommon ocular complication expected in this child is Subluxation of lens. Explanation of the options: Option A: Hypertensive retinopathy: Hypertensive retinopathy is a condition characterized by changes i n the blood vessels of the retina due to high blood pressure. It typically does not present with the descri bed features of tall stature, arm-span to height ratio, flat feet, scoliosis, and long slender fingers. Option B: Rosette cataract: Rosette cataract refers to a specific pattern of opacification in the lens of th e eye. It is not typically associated with the described features and findings in this child. Option C: Retinitis pigmentosa: Retinitis pigmentosa is an inherited degenerative disorder of the retina that leads to progressive vision loss. Although it can present with characteristic signs in the retina, it is not commonly associated with the described features of tall stature, arm-span to height ratio, flat feet, s coliosis, and long slender fingers. Option D: Subluxation of lens: Subluxation of the lens, also known as lens subluxation or ectopia lentis, is a condition where the lens of the eye is partially dislocated from its normal position. It is commonly a ssociated with a connective tissue disorder called Marfan syndrome, which is characterized by tall stat ure, arm-span to height ratio, flat feet, scoliosis, and long slender fingers. The characteristic signs sho wn in the image of the hand, specifically the thumb sign and the wrist sign, are indicative of Marfan syn drome. Subluxation of the lens is a common ocular complication in individuals with Marfan syndrome. Therefore, based on the given information and characteristic signs, the most common ocular complicati on expected in this child is subluxation of the lens. Solution for Question 9: Correct choice: B In the above given case, the patient has a history of long standing use of steroids. The given image of slit lamp examination shows granular appearance in the lens which indicates that it is a case of posterior subcapsular cataract. Chronic steroid use is one of the commonest causes of posterior subcapsular cataract. Incorrect Choices: Option A: In Morgagnian hypermature cataract, the whole cortex liquifies and the lens is converted into a bag of milky fluid. Option C: Sunflower cataract is associated with Wilson’s disease, copper deposition and penetrating tr auma. Option D: Snowflake cataract is seen in diabetes mellitus and in Down’s syndrome. Solution for Question 10: Page 11 47 Correct Option D: Intravitreal antibiotics Given image of eye shows inflammation, congestion and hypopyon and diagnosis is endophthalmitis The correct management option for endophthalmitis, Endophthalmitis refers to an infection within the eye, which is a serious complication that can occur after cataract surgery. Prompt treatment is necessary to prevent further damage and preserve vision. Intravitreal antibiotics are the mainstay of treatment for endophthalmitis. They involve injecting antibiotics directly into the vitreous cavity of the eye, which allows for high concentrations of the medication to reach the site of infection and combat the causative organisms. Incorrect Options: Option A: Intravenous steroids- The use of intravenous steroids is not the primary approach for the ma nagement of endophthalmitis. Steroids are given intravitreally and topically, Option B: Intravenous antibiotics- Intravitreal antibiotics provide a more direct and targeted approach to deliver high concentrations of antibiotics to the site of infection. Option C: Bandage and padding of the eye- Bandaging and padding the eye may provide comfort and protection in certain eye conditions, but they do not address the underlying infection in endophthalmitis. Prompt administration of antibiotics directly into the eye is necessary to combat the infection. Solution for Question 11: Correct Option: D Option D: Blunt Trauma: Blunt trauma refers to injuries caused by a direct blow or impact to the eye without penetration. Blunt trauma can result in damage to the lens, leading to the development of cataracts, including r

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