Professional Documents
Culture Documents
The most
appropriate treatment is
a. Artificial tears
b. Topical Acyclovir
c. Systemic and topical erythromycin
d. Systemic ceftriaxone
e. Topical natamycin
2. A 54 year old woman complains of discomfort and foreign body sensation in her
right eye over the past few months. Slit lamp shows papillary hypertrophy of the
upper palpebral conjunctiva with prominent vessels and hyperemia of the upper
bulbar conjunctiva with punctate staining with rose bengal. Corneal changes
reveal micropannus and fine filaments at the superior periphery. The most likely
diagnosis is
a. Terrien’s degeneration
b. Mooren’s ulcer
c. Superior limbic keratoconjunctivitis
d. Trachoma
e. Rheumatoid arthritis with ocular involvement
4. On following, which would be the best initial medical agent for a patient with
severe asthma?
a. Carteolol
b. Betaxolol
c. Timolol
d. Dorzolamide
e. metipranolol
5. These statement about tear film is true except
a. pH at about 7,2
b. Osmolarity af 302mOsm per liter
c. Volume of 7,0 ul in the precorneal film
d. Produced at a rate of 1,2 ul per minute
e. Has a refractive index of 1,376
-2D
12. A young myopic patient has an uncorrected far point of 25 cm and an amplitude
of accommodation of 8 D. Wearing -2D lenses, OU, The nearest distance that he
can still see clearly is
a. 5cm
b. 10 cm
c. 12,5 cm
d. 16.7 cm
e. 50 cm
JAWABAN
1. C (BCSC 8 p161)
Chemical conjunctivitis typically begins a few hours after delivery and lasts no longer
than 24-36h. Neisseria gonorrhea conjunctivitis typically begins 24 to 48h after birth.
Chlamydia has an incubation period 5-14 days. Herpes simplex virus usually occurs
within 2 weeks after birth. The appropriate treatment for chlamydia is topical and
systemic erythromycin
2. C
a. Stromal degeneration. Quiet non inflamatpry, unilatera or asymmertically bilateral,
slowly progressive thinning of the peripheral cornea. (BCSC 8 p348)
b. is a chronic progressive, painful, idiopathic ulceration of the peripheral corneal
stroma and epithelium, the ulcer starts in the periphery of the cornea and spreads
circumferentially and then centripetally. (BCSC 8 p220)
c. SLK is a chronic, recurrent condition of ocular irritation and redness. The condition
typically develops in adult women 20-70 years of age. SLK may recur over a period
of -10years. The condition udually resolves spontaneously. It is often bilateral. Ocular
findings may include:
-fine papillary reaction on the superior tarsal conjunctiva
-injection and thickerning of the superior bulbar conjunctiva
-hyperthropy of the superior limbus
-fine punctate fluorescein and rose bengal staining of the superior bulbar conjunctiva
above the limbus and superior cornea just below the limbus
-superior corneal filamentary keratopathy(BCSC 8 p 89)
d. Infection by chlamydia trachomatis. Symptoms include foreign body sensation,
redness, tearing, mucopurulent discharge. Severe follicular reaction, most
prominently in the superior tarsal conjunctiva.(BCSC 8 p 163)
e. (BCSC 8 p 217-219)
3. A
a. There is pigmented line anterior to schwalbe’s line which often refferred to
sampaolesi’s line (sign of pseudoexfoliation syndrome) (BCSC 10 p 99)
b. A vertical spindle pattern on the corneal endothelium which called
krukenberg spindle(BCSC 10 p 101-2)
c. Zentmayer’s line on the lens capsule(BCSC 10 p 101-2)
d. Characteristic spokelike loss of the iris pigment epithelium(BCSC 10 p
101-2)
e. The signs and symptoms may decrease with age(BCSC 10 p 101-2)
4. D (BCSC 10 p 159-166)
Dorsolamide is carbonic anhidrase inhibitors which have no correlation with
asthmatic attack
5. E (BCSC 8 p 48-49)
a. pH at about 7,2
b. Osmolarity af 302mOsm per liter
c. Volume of 7,0 ul in the precorneal film
d. Produced at a rate of 1,2 ul per minute
e. Has a refractive index of 1,336
6. C (BCSC 10 p 92)
CNTGS found that reducing IOP by greater than 30% reducen the rate of visual field
progression from 35% to 12%
7. A
Screening for glaucoma based solely on IOP > 21 mmHg may miss up to half of
the people with glaucoma in the screened population(BCSC 10 p 23)
8. D
Administering topical 5% povidone iodine solution at the time of surgery
9. C
Children and young adults under 40 years have absolute contraindication, because
posterior capsule is densely adherent to the anterior hyaloid, attempted ICCE will
usually result in vitreous loss
+3D (+1.50D)
+1.50 -5.00x180
-3.50 +5.00x90
12. B
PR=25 cm à 4D
Myopia (4D) corrected with 2D à 2D left
A=P-R
8D = P – 2D
P = 10 D
P=1/f
F=1/10=0,1m=10cm
EXTERNAL EYE DISEASE AND CORNEA
1. A 3 days old baby come to eye clinic with chief complain copious purulent
conjunctival discharge, with marked conjunctival hyperemia and chemosis since 2
days ago. The appropriate diagnosis for this patient are true :
a. Gonoccocal conjunctivitis
b. Chlamydial conjuctivitis
c. Microsporidial conjunctivitis
d. Trachoma
e. Loisiasis
5. The following condition have been found in patient with mooren ulcer :
1.Deficiency of suppressor T-cells
2.Decreased level of Ig A
3.Tissue-fixed immunoglobulins and complement
in the conjunctival epithelium and peripheral cornea.
4.Decreased concentration of plasma cells
and lymphocytes in conjunctiva adjacent to
the ulcerated areas.
6. Microorganisms are causes of Interstitial keratitis :
a.M.leprae
b.M.catarrhalis
c.N.gonorrhoeae
d.S.aureus
e.E.coli
7. 7 years old male came with chief complains itchyness on his both eye. Itchiness
associated with blepharospasm, photofobia, blurred vision and mucoid discharge.
This symptomp usually recurs seasonally. On ophthalmic examination: diffuse
papillary hypertrophy, hyperemia bulbar conjunctiva, chemosis. There is whitish
dots in the hypertrophied limbus. These dots called …….
a.Artl’s line
b.Horner-Trantas
c.Vogt lines
d.Waite- Beetham
e.Rizzutti’s sign
2. A baby 3 days old come to eye clinic with complain copious purulent
conjunctival discharge, marked conjunctival hyperemia and chemosis since 2 days
ago. The appropriate therapy for this patient are true:
1. Ceftriaxone
2. Azithromycin
3. Minocyclin
4. Tetracyclin
Answer : E. 1,2,3,4 true ( AAO External Disease and Cornea 2005-6 P.160-1)
5. The following condition have been found in patient with mooren ulcer :
1.Deficiency of suppressor T-cells
2.Decreased level of Ig A
3.Tissue-fixed immunoglobulins and complement in the conjunctival
epithelium and peripheral cornea.
4.Decreased concentration of plasma cells and lymphocytes in
conjunctiva adjacent to the ulcerated areas.
Answer : B. 1,3 true (AAO External disease and cornea 2005-6 P.220)
The following condition have been found in patient with mooren ulcer :
- Deficiency of suppressor T-cells
- Increased level of Ig A
- Tissue-fixed immunoglobulins and complement in
the conjunctival epithelium and peripheral cornea.
- Increased concentration of plasma cells and lymphocytes in
conjunctiva adjacent to the ulcerated areas.
6. The microorganisms are causes of Intertitial keratitis :
a.M.leprae
b.M.catarrhalis
c.N.gonorrhoeae
d.S.aureus
e.E.coli
Answer : A (AAO External disease and cornea 2005-6 P.213)
The microorganisms are causes of Intertitial keratitis :
- M tuberculosis
- M leprae
- Borrelia burgdorferi
- Rubeolla
- Ebstein Barr virus
M catarrhalis, N gonorrhoeae, S aureus, E.colli caused Bacterial conjunctivitis
(AAO P. 161)
7. 7 years old male came with chief complains itchyness on his both eye Itchiness
associated with blepharospasm, photofobia,blurred vision and mucoid discharge.
On ophthalmic examination, we found diffuse papillary hypertrophy, hyperemia
bulbar conjunctiva, chemosis. This symptomp usually recurs seasonally. There is
whitish dots in the hypertrophied limbus. These dots called …….
a.Artl’s line
b.Horner-Trantas
c. Vogt lines
d.Waite Beetham
e.Rizzutti’s sign
Answer : B. Horner-Trantas dots
(AAO External disease and cornea 2005-6 P.213)
- Arlt’s line ia a linear or stellate scarring of the superior tarsus .
(AAO P 163)
- Waite-Betham lines is a Faint vertical folds in descemet,s membrane
and deep stroma (AAO P.320)
- Rizzutti’s sign is a conical reflection on the nasak cornea when
The penlight is shone the temporal side (AAO P.312)
- Vogt lines is a roughly parallel striations/ stress lines of the stroma
(AA) P.312)
Answer : E
A-D BSCS p33
E BSCS p12
a. Corneal with low cell density (eg,fewer 1000 cells/mm2) might not tolerate
intraocular surgery;p33
b. donor corneas for transplantation should have at least 2000
cells/mm2;p33
c. Corneas with significant polymegethism (greater than 0.40) might not tolerate
intraocular surgery;p33
d. Corneas with high pleomorphism ( more than 50% nonhexagonal ) might not
tolerate intra ocular surgery;33
e. Cell density varies over the endothelial surface; normally, concentration is highest
in the periphery ;p12
Answer E
BSCS 422-424
a. The McCarey-Kaufman tissue transport medium developed in the early 1970s
significantly reduced endothelial cell attrition,;p422
b. Allowing corneal buttons to be safely transplanted after being stored for up to4days
at 40 C;p422
c. Most eye banks astablish a lower of 24 months and an upper age limit of 70
years ;p424
d. Death to preservation time (optimal range < 12-18 hours);p424
e. Although previous smaller studies have shown benefit from HLA matching, a
recent multicenter study of high-risk grafts found no reduction in incidence of
rejection with the use of HLA-matched or cross-matched tissue;p423
3. A 60 years old male came to the eye clinic with the chief complain redness on his
left eye for 3 days. Patient also complain a painful vesicular dermatitis that
localized to single dermatome. The most appropriate treatment is except
a.Famciclovir 500mg 3x/day
b.Valacyclovir 1 gr 3xday
c.Acyclovir 800mg 5x/day
d.Antiviral oral treatment for 7-10 days
e.Topical antiviral therapy
Answer E
BSCS 149
Topical antiviral medications are not effective;p149
4. 30 years old male came to you with redness on his left eye since 2 days ago. The
redness of the eye occurred since he had trauma from a branch of three. On slit
lamp examination : little conjunctival injection, gray white, dry appearing corneal
infiltrate with feathery margins. Corneal scrapping reveals fusarium spp as the
infectious cause. The treatment for this patient is
a. Miconazole 1%
b. Oral fluconazole 200-400 mg/day
c. Chlorhexidine topical 0,02%
d. Propamidine isethionate 0,1%
e. Natamycin 5%
Answer E
BSCS 175,178
5. 30 years old female came with chronic, recurrent irritation of her eye. Ocular
findings: fine papillary reaction on the superior tarsal conjunctiva, injection of the
superior bulbar conjunctiva, fine punctate fluorescein staining of the superior
bulbar conjunctiva and superior cornea just below the limbus. The true statements
about this patient is
1. The condition usually resolve spontaneously
2. It is often bilateral
3. The patient should have thyroid function tests
4. One of the treatments is chemical cauterization
Answer E
BSCS 89-90
6. A 25 years beautiful girl came to your clinic with redness of the eye for 2 months.
Examination reveals follicle in superior tarsus conjunctiva, diffuse papillary hypertrophy,
artl’s line and herbert’s pits. These statements are true
1. Isolation the causative agent with McCoy cells
2. Topical tetracycline 1% twice daily for 2 months
3. Resolve spontaneously in 6-18 months if left untreated
4. Oral erythromycin 500 mg 4 times a day for 3 weeks
Answer E
BCSC 118, 163-166
7. A 31 years old handsome boy came to the emergency unit because his eyes was
exposed to chemical liquid 30 minutes prior to hospital. pH meter showed pH on
the conjunctiva was 9,6. The appropriate approach is
1. Copious irrigation
2. Ascorbic acid 2 gr per day
3. Steroid topical and cycloplegia
4. Tetracycline oral
Answer E
BCSC 367-8
Answer E
BCSC 8-10
a. Cornea has a little elasticity and streches only 0,25% at normal IOP.p;10
b. Water content of the corneal stroma at 78%. p;10
c. The corneal epithelium have 5 % ( 0,05 mm) total corneal thickness.p;9
d. Refractive index is 1,376.p;8
e. The major corneal proteoglican is decorin and lumican p;10.
9. These statements about tear film are true :
1. Refractive Index is 1,336
2. Produced at rate 2,1 l/minute
3. Cranial nerve III is the afferent pathway in the reflex tear arc
4. Lipid tear deficiency is the most common cause of dry eye.
5. Precorneal tear volume is 0,7 l
Answer A
BCSC 48-50
Answer A
BCSC 342
Degeneration Dystrophy
Opacity often peripherally located Centrally located
May be asymmetric Bilateral and symmetric
Present later in life, associated with aging Present early in life, hereditary
Progresion can be very slow or rapid Progresion usually slow.
PEMBAHASAN
4. Acute conjunctivitis
2. Lession on the eyelid, face and extensor surfaces in infant and young children
4. Chronic conjunctivitis
1. Pseudomanas aeruginosa
2. Moraxella species
3. Streptococcus species
4. Corynebacterium species
Uncommon organism :
B. Sclerocornea
C. Microcornea
D. Flatcornea
E. Megalocornea
- Keratoconus
- Megalocornea
Syndrome
2. Pharyngoonjunctival fever
3. Epidemic keratoconjunctivitis
4. Stromal keratitis
- Pharyngoconjunctival fever
- Epidemic keratoconjunctivitis
A. Cogan syndrome
B. Sarcoidosis
C. Lyme disease
D. Mumps keratitis
B. Vernal conjunctivitis
Vernal conjunctivitis
A. Chlamydial conjunctivitis
B. Ocular cicatrical pemphigoid
C. Graft versus host disease
D. Sarcoidosis
E. Chemical burn
Jawaban : D (AAO BCSC 8 p. 22)
Conjunctival granuloma :
Cat-Scratch disease, Sarcoidosis, Foreign body reaction
Follicular conjunctivitis → Chamydial conjunctivitis
Conjunctival erosion or ulceration → Ocular cicatrical pemphigoid, Graft versus
host
Conjunctival psedumembrane or membrane → Chemical burn
8. Keratorefractive surgery can alter the corneal biomechanics in several ways, except:
A. Tissue reduction
B. Incisional effect
D. Laser effect
E. Collagen shrinkage
9. Signs which may be seen during biomicroscopic examination of the contact lens
wearing are :
Blepharokonjunctivitis are :
1. Trauma
2. Endophthalmitis
4. Blepharoconjunctivitis
- Endophthalmitis
- Blepharoconjunctivitis
1. This bones are the most frequently fragmented as a result of indirect blowout fracture:
a. Lamina payracea and palatine bones
b. Ethmoid and lacrimal bones
c. Lamina papyracea and ehtmoid bones
d. Lamina papyracea and maxillary bones
e. Ethmoid and sphenoid bones
9. A 24 male patient comes to the hospital with acute onset of orbital pain, restricted eye
movement and proptosis in his left eye. No history of trauma. The other clinical finding
are injection and chemosis, eyelid erythema, soft tissue swelling and the visual acuity
was reduced to 20/200. CT Scan of the orbit shows thickening of extraocular muscle and
thickening of the insertion muscle tendon and normal sinus.
The most likely diagnosis is:
a. Graves ophthalmopathy
b. Orbital cellulitis
c. Orbital pseudotumor
d. Preseptal cellulitis
e. None of above
11. A 50 year old man came to the eye clinic with the chief complain of pain on his right
eye since 3 days ago, pain associated with tearing, edema and erythema within his medial
canthal regio with distension of the lacrimal sac.
These are true except:
a. One of the treatment is therapeutic probing of the nasolacrimal duct with
Bowman probe
b. Topical antibiotics are limited value when stasis is present
c. Aspiration of the lacrimal sac if the mucocele/pyocele is localised and pointing
d. A localized abscess requires incision and drainage, the incised abscess is
packed open
e. Gram positive bacteria is the most common cause
STUDY QUESTIONS ;
ORBIT, EYELIDS AND LACRIMAL SYSTEM
ORBIT
1. A 8 years old girl presents with a left upper eyelid edema and erythema. According
her mother this condition has been presents for 2 days without history of trauma. On
examination revealed her vision 20/20, pupillary reaction was normal, proptotic is not
presents and no limitation of ocular motility. Pain on movement of the globe is absent.
The most likely diagnosis is :
a. Orbital cellulitis
b. Preseptal cellulites
c. Idiopathic orbital inflammation
d. Rhabdomyosarcoma
e. Carotid cavernous sinus fistula
2. Which of the following statement about above condition is false:
a. Commonly occurs in children
b. The most frequent cause is ethmoidal sinusitis
c. Imaging studies should be performed
d. Respond to single antibiotic theraphy
e. Involvement of the orbital apex
3. A 50 years old woman complains of mild erythema and tenderness around the right
eye . One week ago, he noted blurred vision and a low grade fever. Examination
revealed visual acuity was normal, right globe proptotic, fundus examination are normal.
CT demonstrated difuse infiltration of right orbital tissue and ethmoid sinuses are clear.
The symptoms disappear after 48 hours of prednisone 80 mg daily.
The most likely diagnosis is :
a. Orbital cellulitis
b. Preseptal cellulites
c. Idiopathic orbital inflammation
d. Rhabdomyosarcoma
e. Thyroid orbitopathy
EYELID
4. A 70 years old actrist presents complaining of droopy eyelids, superior fields defect
and difficulty for reading. Examination reveals pupillary reaction was normal and
marginal reflex distance is found to be 1 mm. A tensilon test was negative. The most
likely diagnosis is :
a. Myastenia gravis
b. Dermatochalasis
c. Cranial nerve III palsy
d. Blepharoptosis
e. Horner’s syndrome
5. What is pathophysiologic mechanism underlying the condition in question 4 ?
a. Muscle dysfunction
b. Neurogenic pathology
c. Aponeurotic dysfunction
d. Redudancy of skin
e. Orbital fat prolapse
LACRIMAL
7. A 60 year old woman complains of tearing and pain in her right eye. He had no
history of trauma or surgery of the eyelids, nose or sinuses. He had had tearing and
discharge for several days. Recently he had developed a painful red lump near the right
inner canthus. Examination showed his vision was normal. There was an erythematous
swelling over the right lacrimal sac. Purulent material was expressed when pressure was
applied over the right lacrial sac area. The most likely diagnosis is :
1. Nasolacrimal duct obstruction
2. Canaliculitis
3. Dacryocystocele
4. Dacryocystitis
SURGERY
9. The majority of blow out fracture do not require surgical intervention. Indication for
repair of orbital blowout fracture is :
1. Diplopia
2. Enophtalmos
3. Large fracture
4. Negative forced ductions
10. Compare to enucleation, evisceration provides advantage :
1. Can be performed on intraocular malignancy cases
2. Less disruption of orbital anatomy
3. Allow complete specimen for pathologic examination
4. Technically simpler procedure
ANSWERS
5. Answer C
Pathophysiologic mechanism of acquire blepharoptosis most common cause of
stretching or disinsertion of the levator aponeurosis. This condition most often in
elderly. ( Pg 211 )
Poorly developed levator muscle ( myogenic), most common caused congenital
ptosis. ( Pg 210 )
Neurogenic ptosis is relatively rare and is most commonly associated with
congenital cranial nerve III palsy ( Pg 211 )
Redudancy of skin and Orbital fat prolapse associated with dermatochalasis
( Pg 224)
6. Answer A
The guidelines blepharoptosis comparison ( congenital and acquired ) : Page 213
8. Answer B
The guidelines management in acute dacryosistitis : warm compress, antibiotic
(topical,oral,perenteral), incision and drainage if the abscess involving lacrimal
sac, dacryocystorhinostomy.( Page 275 )
1. Warm compresses : should be applied to he affected area
2. Irrigation or probing : avoid irrigation or probing until the infection subsides
3. Dacryocystorhinostomy : that is definitive treatment
4. Crigler massage : conservative management to congenital nasolacrimal
obstruction. ( Page 257 )
9. Answer A
Guidelines in determining when surgery is advisable for repair of orbital blowout
fracture : ( Pg 104 -106 )
1. Diplopia : with limitation of upgaze and or downgaze
2. Enophtalmos : sxceeding 2 mm that is cosmetically unacceptable to the patient
3. Large fracture : involving at least half of the orbital floor frature
4. Inferior rectus weaknes : generally caused by a contusive injury to the inferior
rectus muscle and is more likely to worsen after surgical repair.
10. Answer C
Advantage of evisceration is : Less disruption of orbital anatomy, good motility of
the prosthesis, better treatmen of endoftalmitis and a technically simpler
procedure. ( Page 123)
1. A 60 years old woman had headache, red eye, microcystic corneal edema following
cataract extraction in the left eye 2 days ago
The treatment of choice in these case are:
a. Parasympathomimetic agent
b. Corticosteroids and carbonic anhidrase inhibitors
c. Prostaglandin analogues
d. Cholinergic agonists
e. Anticholine esterase agents
3. A 50 year old white man came in for an eye examination. Visual acuity 20/60 OU
with correction. With a history of 4 months ago he has a filtering surgery at his right
eye. He suffer of mucopurulent infiltrate within the bleb, localized conjunctival
hyperemia, and minimal intraocular inflammation at his right eye. What is the
diagnose of these symptoms:
a. Sellulitis
b. Blebitis
c. Persistent uveitis
d. Dellen formation
e. Bleb migration
4. A 60 years old black man came in for an eye examination. He did not have any
specific complaints. He uses only over the counter reading glasses and had never
visited an ophthalmologist in the past. Visual acuity was 20/60 OU with correction.
The anterior segment of both eyes was normal with the exception of early cataractous
changes OU. The IOP was 30 mm Hg OU. What kind of further examination must be
done to diagnose this complaints:
1. Opthalmoscopy
2. Gonioscopy
3. Visual field test
4. Contrast sensitivity test
5. In the examination Ophthalmoscopy showed a CD ratio of 0.7 OU. Gonioscopy
showed Shaffer grade 4. Humphrey visual field testing revealed an inferior nasal step
OD, What is the diagnosis of this symptoms:
a) Primary Open angle Glaucoma
b) Glaucoma Malignan
c) Exfoliation Glaucoma
d) Lens Induced Glaucoma
e) Secondary Glaucoma
7. A 15 year old student was brought to the Clinic with a history of trauma to the left eye
while playing football. The visual acuity was hand movement OS and 20/20 OD.
Examination of the left eye showed circumcorneal congestion, a moderately haze
cornea, and small haemorhage in AC. The IOP was 50 mm Hg. Gonioscopy reveals
angle recession. The treatment is often best accomplish with, except:
a. Timolol Maleat 0.5%
b. Acetazolamide
c. Laser Trabeculoplasty
d. Apraclonidin Hcl
e. Latanoprost
8. A 20 year old male came to eye clinic with a history of trauma to the right eye. The
visual acuity was hand movement OD and 20/20 OS. Examination of the right eye a
moderately haze cornea, and moderate haemorhage in AC. The IOP was 30 Hg. He
had a sickle cell hemoglobinopathies. What medicine can be best suggested for this
patient to reduce the IOP:
a. Glycerin oral
b. Pilocarpine Hcl 10%
c. Timolol Maleat 0.5%
d. Acetazolamide oral
e. Dipivefrin Hcl 0.1%
9. A 56 year-old woman presented to the eye clinic with sudden blurred vision,
headaches sometimes her eye feel mild pain and see halos. The pain and blurred
vision resolve spontaneously, especially during sleep-induced miosis. She routine
came to ophthalmologist with the IOP sometimes raised and sometimes normal. The
visual acuity was 6/60 OD and 20/20 OS. The right eye showed circumcorneal
injection, mild diffuse corneal haze, shallow anterior chamber and the pupil slow
adapted to the light. The lens was early cataractous changes. The left eye was normal
except for a shallow AC. The IOP was 40 mm Hg OD and 16 mm Hg OS.
Gonioscopy OD revealed narrow angle and PAS at 11-12 o’clock. Gonioscopy OS
revealed a narrow angle. The Diagnosis is:
a. Primary Angle-closure Glaucoma
b. Chronic Angle Closure
c. Intermitten angle Closure
d. Primary Open Angle
e. Phacomorphic glaucoma
Answer:
1. B. (BSCS section 10, 2005-2006 page 105, table 7-1 Glaucoma Medications page 160-
163 )
Appropriate therapy includes medications decrease aqueous formation, mydriatic
to inhibit posterior synechiae formation, and topical corticosteroids to reduce
inflammation.
Parasympathomimetic agent, Cholinergic agonists, and Anticholine esterase
agents are miotic agents. Prostaglandin analogues is an agents which work by increasing
uveoscleral outflow.
2. The diagnosed in these is
a. Phacolytic glaucoma
b. Phacoanaphylaxis glaucoma
c. Phacomorphic glaucoma
d. Lens particle glaucoma
e. Ectopia lentis
Answer:
2. D. (BSCS section 10, 2005-2006 page 104-105)
Lens particle glaucoma usually occurs within weeks of the initial surgery or
trauma, but may occur months or years later. Clinical findings include free cortical
material in anterior chamber, elevated IOP, moderate anterior chamber reaction,
microcystic corneal edema, and, with time, the development of posterior and peripheral
anterior synechiae.
3. A 50 year old white man came in for an eye examination. Visual acuity 20/60 OU
with correction. With a history of 4 months ago he has a filtering surgery at his right
eye. He suffer of mucopurulent infiltrate within the bleb, localized conjunctival
hyperemia, and minimal intraocular inflammation at his right eye. What is the
diagnose of these symptoms:
a. Sellulitis
b. Blebitis
c. Persistent uveitis
d. Dellen formation
e. Bleb migration
Answer:
3. B. (BSCS section 10, 2005-2006, page 192-193)
Table 8-1. Bleb related complications may occur early (within 3 months of surgery)
or late (after 3 months postoperatively).
Figure 8-10. Bleb-related infection. Patients may present with belbitis, which is
characterized by mucopurulent infiltrate within the bleb, localized conjunctival
hyperemia, and minimal intraocular inflammation.
4. A 60 years old black man came in for an eye examination. He did not have any
specific complaints. He uses only over the counter reading glasses and had never
visited an ophthalmologist in the past. Visual acuity was 20/60 OU with correction.
The anterior segment of both eyes was normal with the exception of early cataractous
changes OU. The IOP was 30 mm Hg OU. What kind of further examination must be
done to diagnose this complaints:
1. Opthalmoscopy
2. Gonioscopy
3. Visual field test
4. Contrast sensitivity test
Answer:
4. A. (BSCS Section 10, 2005-2006, page 96)
A glaucoma suspect is defined as an adult who has one of the following findings in at
least 1 eye:
An optic nerve or nerve fiber layer defect suggestive of glaucoma
A Visual field abnormality consistent with glaucoma
An elevated IOP consistently greater than 22 mm Hg
Usually, if 2 or more of these findings are present, the diagnosis of POAG is
supported, especially in the presence of other risk factors, such as age >50, family
history of glaucoma, and African descent. Diagnosis of POAG is also dependent on a
normal open angle on gonioscopy.
5. In the examination Ophthalmoscopy showed a CD ratio of 0.7 OU. Gonioscopy
showed Shaffer grade 4. Humphrey visual field testing revealed an inferior nasal step
OD, What is the diagnosis of this symptoms:
a) Primary Open angle Glaucoma
b) Glaucoma Malignan
c) Exfoliation Glaucoma
d) Lens Induced Glaucoma
e) Secondary Glaucoma
Answer:
5. A. (BSCS Section 10, 2005-2006, page 96)
A glaucoma suspect is defined as an adult who has one of the following findings in at
least 1 eye:
An optic nerve or nerve fiber layer defect suggestive of glaucoma
A Visual field abnormality consistent with glaucoma
An elevated IOP consistently greater than 22 mm Hg
Usually, if 2 or more of these findings are present, the diagnosis of POAG is
supported, especially in the presence of other risk factors, such as age >50, family
history of glaucoma, and African descent. Diagnosis of POAG is also dependent on a
normal open angle on gonioscopy.
6. Seorang laki-laki berusia 60 tahun datang dengan keluhan lapang pandangannya
makin menyempit. Dari pemeriksaan, gonioskopi kedua mata didapatkan sudut bilik
mata depan yang terbuka. Dari funduskopi didapatkan glaucomatous optic neuropathy
pada ke 2 mata. Hal dibawah ini yang bukan merupakan faktor resiko dari glaukoma
sudut terbuka primer adalah:
a. Tekanan intra okuler
b. Usia
c. Ras
d. Diabetes
e. Riwayat keluarga
Answer:
6. D. (BCSC section 10, 2005-2006 page86-87)
Risk factors for POAG other than IOP
Age is an important risk factor for presence of POAG. In CIGTS, visual field defects
were 7 times more likely to develop in patients 60 years of age or older than in those
under 40 years old.
Race is another important risk factor for POAG. The prevalence of POAG is 4 to 5
times greater in African Americans than in Others.
Family History is risk factor for glaucoma. The Baltimore Eyes Survey found that
the relative risk of having POAG is increased approximately 3.7-fold for individuals
having a sibling with POAG
Associated Disorders
The following conditions are also associated, although not as strongly, with
glaucoma:
Myopia, Diabetes mellitus, Cardiovascular disease, and Retinal vein occlusion.
7. A 15 year old student was brought to the Clinic with a history of trauma to the left eye
while playing football. The visual acuity was hand movement OS and 20/20 OD.
Examination of the left eye showed circumcorneal congestion, a moderately haze
cornea, and small haemorhage in AC. The IOP was 50 mm Hg. Gonioscopy reveals
angle recession. The treatment is often best accomplish with, except:
a. Timolol Maleat 0.5%
b. Acetazolamide
c. Laser Trabeculoplasty
d. Apraclonidin Hcl
e. Latanoprost
Answer:
7. C. (BCSC Section 10, 2005-2006, page 114, table 7-1)
The treatment of angle-recession glaucoma is often best accomplish with aqueous
suppressant, Hypotensive lipids, and alpha2-adrenergic agonist. Laser Trabeculoplasty
has a limited role and a reduced chance of success.
8. A 20 year old male came to eye clinic with a history of trauma to the right eye. The
visual acuity was hand movement OD and 20/20 OS. Examination of the right eye a
moderately haze cornea, and moderate haemorhage in AC. The IOP was 30 Hg. He
had a sickle cell hemoglobinopathies. What medicine can be suggested for this patient
to reduce the IOP:
a. Glycerin oral
b. Pilocarpine Hcl 10%
c. Timolol Maleat 0.5%
d. Acetazolamide oral
e. Dipivefrin Hcl 0.1%
Answer:
8. C. (BCSC Section 10, 2005-2006, page 111-112)
In the cases of Hyphema, If the IOP is elevated, aqueous suppressants and hyperosmotic
agent are recommended. Physician should aware of potential of systemic carbonic
anhydrase inhibitors and hyperosmotic agents to induce sickle crises. Sickling may be
enhanced by both drugs, as they may each exacerbation dehydration, and carbonic
anhydrase inhibitors may additionally promote acidosis. Adrenergic agonists with
significant alpha1 agonist effects (apraclonidine, dipivefrin, epinephrine) should also be
avoided in sickle cell disease because of concerns regarding anterior segment
vasoconstriction. Parasympathomimetic agents should be avoided in all patients with
hyphemas.
9. A 56 year-old woman presented to the eye clinic with sudden blurred vision,
headaches sometimes her eye feel mild pain and see halos. The pain and blurred
vision resolve spontaneously, especially during sleep-induced miosis. She routine
came to ophthalmologist with the IOP sometimes raised and sometimes normal. The
visual acuity was 6/60 OD and 20/20 OS. The right eye showed circumcorneal
injection, mild diffuse corneal haze, shallow anterior chamber and the pupil slow
adapted to the light. The lens was early cataractous changes. The left eye was normal
except for a shallow AC. The IOP was 40 mm Hg OD and 16 mm Hg OS.
Gonioscopy OD revealed narrow angle and PAS at 11-12 o’clock. Gonioscopy OS
revealed a narrow angle. The Diagnosis is:
a. Primary Angle-closure Glaucoma
b. Chronic Angle Closure
c. Intermitten angle Closure
d. Primary Open Angle
e. Phacomorphic glaucoma
answer:
9. C. (BCSC Section 10, 2005-2006, page125-126)
Subacute or Intermittent Angle Closure
Subacute (intermittent or prodromal) angle closure is a condition characterized by
episodes of blurred vision, halos, and mild pain caused by elevated IOP. These Symptoms
resolve spontaneously, especially during sleep-induced miosis, and IOP is usually normal
between the episodes, which occur periodically over days or weeks. These episodes may
confused with headaches or migraines. The correct diagnosis can be made only with high
index of suspicion and gonioscopy. The typical history and gonioscopic appearance of a
narrow chamber angle with or without PAS help establish the diagnosis.
Answer:
10 E. (BCSC Section 10, 2005-2006, page125-126)
Laser iridectomy is the treatment of choice in subacute angle closure.
GLAUCOMA
1. A 35-year-old woman complain of decrease vision in her right eye. The intraocular
pressure is 38 mmHg. The clinical finding in the right eye : corectopia, ectropion
uveae, peripheral anterior synechiae, protrusions of iris stroma created by
proliferation of the endothelial-like membrane on the iris surface. What the
diagnosis of the patient? :
A. Pseudoexfoliation
B. Acute angle-closure glaucoma
C. Iridocorneal endothelial (ICE) syndrome
D. Posner-Schlossman syndrome
E. Fuch heterochromic iridocyclitis
2. Which one of the following is most likely to provide the greatest reduction of intra
ocular pressure? (case number 1) :
A. Topical corticosteroid
B. Laser iridotomy
C. Laser trabeculoplasty (LTP)
D. Incisional surgery
E. Acetazolamide
7. Sturge-Weber syndrome :
1. Is usually unilateral
2. Is always inherited in an autosomal dominant pattern
3. There is no gender predilection
4. Is rarely associated with glaucoma
7. Sturge-Weber syndrome :
1. Is usually unilateral
2. Always inherited in an autosomal dominant pattern
3. There is no gender predilection
4. Is rarely associated with glaucoma