Ophthalmology

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[9.2] A 59-year-old man is admitted to the intensive care unit for a myocar- dial infarction. He is given a ẞ-adrenergic antagonist and instructed to avoid emotional turmoil to decrease sympathetic stimulation of the heart. From a cellular perspective, sympathetic stimulation of the heart does which of the following?

A previously healthy, 27-year-old agricultural worker develops nausea, vomiting, abdominal cramps, cough with wheezing and dyspnoea, salivation, and lacrimation 1 hour after leaving work in a field. On examination, he is afebrile with a heart rate of 50/min and blood pressure of 90/55 mm Hg. Laboratory studies show plasma cholinesterase activity less than 50% of normal. Atropine is given intravenously, and his condition improves. He was most likely exposed to which of the following substances?

A Aflatoxin
B Cyclodiene
C Dioxin
D Ergot alkaloid
E Organophosphate

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Correct Answer - D
All of the above REF: Khurana 4
th ed p. 110
MOOREN'S ULCER:
Severe inflammatory peripheral ulcerative keratitis , chronic
serpigenous or rodent ulcer
Treatment:
1. Topical corticosteroids
2. Immunosuppressives with systemic steroids , e.g. cyclosporine
3. Soft contact lens
4. Lamellar or full thickness corneal grafting

Correct Answer - D
Ans. is 'd i.e., All of the above
Causes of cherry red spot
GM2 gangliosidoses (Tay sachs & sandhoff)
Hurler's syndrome
GM1 gangliosidoses
Cryoglobulinemia
Niemann - Pick's disease
Laber's congenital amaurosis
Sialidosis (galactosialidosis)
Metachromatic leukodystrophy
Mucopolysacharidosis VII
Central retinal artery occlusion (CRAO)
Multiple sulfatase deficiency
Trauma (Berlin's edema / commotio retinae)
Poisoning :- Carbon mono-oxide, methanol
Quinine and Dapsone
Shprintzen-Goldberg syndrome


Not seen in.(kGF)

krabbe's disease
Gauchers disease
Fabry disease


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Correct Answer - C
Ans. is 'c' i.e., Across ora serrata

Attachement of vitreous

Vitreous is attached anteriorly to the lens (Hyloid capsular ligament
of Wieger) and ciliary epithelium in front of the ora serrata.

The part of vitreous about 4 mm across the ora serrata is known as
the "base of vitreous" where the attachement is strongest
Posteriorly vitreous is attached to the edge of the optic disc and
macula lutea (foveal region) forming ring-shaped structure around them

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Correct Answer - C
Ans. is 'c' i.e., Vitreous
The eyeball is divided into two segments : ?

Anterior segment
1. Part of eyeball anterior to posterior border of lens is called anterior segment.
2. It consists of lens, and structures anterior to it, i.e., cornea, iris and two aqueous humor-filled spaces, i.e., anterior and posterior
chambers.
3. Anterior chambers : - It is bounded anteriorly by back of cornea and posteriorly by the iris & part of ciliary body. It contains aqueous humor.
4. Posterior chamber : - This triangular chamber is bounded anteriorly by the posterior surface of the iris & ciliary body and posteriorly by the lens and it zonules. It also contains aqueous humor.
5. Thus, both anterior and posterior chambers are part of anterior
segment and both contain aqueous humor.

Posterior segment
1. Part of eye ball posterior to lens is called posterior segment.
2. It consists of vitreous humor, retina, choroid and optic disc.

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Correct Answer - B
Ans. is `b' i.e., Homocysteinuria

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Correct Answer - A
A i.e Keratoconjunctivitis sicca

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Correct Answer - B
B i.e. Concussion injury

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Correct Answer - B
B i.e. Central Retinal Artery Occlusion

Central retinal artery occlusion characteristically presents with
sudden painless loss of vision, cherry red spot & cattle-truck
appearanceQ (of retinal veins usually).

Source of emboli from carotid artery & heart disease, and thrombus from arteriosclerosis along with hypertension & arteritis are predisposing factors.


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Correct Answer - D
Ans. is 'd' i.e., All the above

Fuch's heterochromic iridocyclitis (Fuch's uveitis syndrome)

It is a form of anterior and intermediate uveitis.

The condition is usually unilateral and chronic in nature and is
characterized by a chronic non-granulomatous uveitis and eventually results in iris heterochromia (a change in the colour of iris).


The disease has following characteristic features :
i) Heterochromia of iris
ii) Diffuse stromal iris atrophy
iii) Fine KPs at back of cornea
iv) Faint aqueous flare
v) Absence of posterior synechiae
vi) A fairly common rubeosis iridis, sometimes associated with
neovascularisation of the angle of anterior chamber.
vii) Comparatively early development of complicated cataract and secondary glaucoma (usually open angle type). Glaucoma has been reported in 10-59% of cases.


Treatment
Fuch's heterchromic uveitis responds variable to steroids and
cycloplegics.

The complications of long term use of these drugs may at times outweigh their potential benefits.

Therefore, treatment withtopical steroids is given to iritis which is sufficiently active to require
the treatment, otherwise the patient is routinely followed without
giving any treatment.

Cataract responds well to most forms of intraocular surgeries,
including the standard IOL implantation.

Hyphemia may occur
because of rubeosis iridis (neovascularization of iris).

Glaucoma control may be somewhat more problematic, with surgical options indicated for later forms of disease

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Correct Answer - D
Ans. D: Anterior dislocation of the lens

Factors responsible for hypermetropia:

Short axial length of the eyeball

Curvature hypermetropia commonly occurs as a factor in astigmatism (corneal plana)

Index hypermetropia accounts for the hypermetropia of old age due
to increased refractive index of the cortex of the lens relative to the
nucleus so that overall refractive power of the lens decreases.

It may be associated with diabetes, tumors, microphthalmia (a growth dysfunction during fetus development) and fovea hypoplasia, a condition that affects the blood vessels in the retina.
While these conditions may result in hypermetropia, one of the most
commonly cited causes of farsightedness is considered to be aging.

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