1. Dr A Rajendraprasad MS DO
Professor of Ophthalmology
Coimbatore Medical College, Coimbatore

2. 1. Gorlin's syndrome:
a. Is an inherited condition
b. Is associated with multiple basal cell
carcinoma
c. Increases the incidence of cataract
d. Is associated with liver carcinoma
e. Increases the risk of retinal
detachment

3. 1. a.T b.T c.F d.F e.F
GORLIN'S SYNDROME (BASAL CELL NAEVUS SYNDROME)
•Rare, autosomal dominant and multisystem disorder
•Characterised by multiple basal cell carcinoma, jaw
cysts,b skeletal anomalies, ectopic calcification of the falx
cerebri and pitting of the hand and feet
•ocular features also include hypertelorism, lateral
displacement of the medial canthi and prominent
supraorbital ridges

4. 2. Posterior polymorphous dystrophy :
a. Is present at birth
b. Causes corectopia
c. Is inherited in an autosomal
recessive fashion
d. Causes blindness in over 90% of
sufferers
e. Can be treated with lamellar
corneal grafts

5. 2. a.T b.T c.F d.F e.F
Posterior polymorphous dystrophy:
•A bilateral dominantly inherited dystrophy
•Vesicular polymorphous deposits with clear halos in Descemet's
membrane
•Usually asymptomatic, rarely endothelium decompensation requiring
penetrating corneal graft
• The abnormal endothelium may extend into the trabecular
meshwork and iris
• Glaucoma can occur as a result of trabecular meshwork
involvement iris involvement can lead to corectopia and ectopia
simulating iridocorneal endothelial syndrome except that the later is
unilateral

6. 3. Crystalline deposits in the conjunctiva may
be found in:
a. Amyloidosis
b. Cystinosis
c. Gold treatment
d. Contact lens wear
e. Uraemia

7. 3. a.T b.T c.T d.F e.T
Crystalline deposits occurs with:
•Myloidosis as in multiple myeloma
•Cystinosis
•Treatment with gold
•Uric acid from uraemia

8. 4. The histology of pterygium includes:
a. Myxoid degeneration
b. Epithelial inclusion bodies
c. Precancerous changes
d. Squamous metaplasia of the
epithleium
e. Elastotic degeneration

9. 4. a.T b.F c.F d.F e.T
Pterygium:
•Fibrovascular overgrowth of the bulbar
conjunctiva
•The stroma shows basophilic degeneration
(elastotic) of collagen
•The epithelium is often thin but may show
hyperplasia or dysplasia

10. 5. The following may be found in conjunctiva in
keratoconjunctivitis sicca
a. Dysplasia of the epithelium
b. Keratinisation
c. Eosinophils
d. Numerous goblet cells
e. Lymphocytic infiltrates

11. 5. a.T b.T c.F d.T e.T
Keratoconjunctivitis sicca (dry eyes):
•Causes dysplasia of the epithelium which may eventually
become keratinize
•The goblet cells may increase due to chronic irritation
from dry eyes
•In Sjogren's syndrome, there is lymphocytic infiltration of
the lacrimal and accessory glands

12. 6. Merkel cell carcinoma:
a. Is most common in the bulbar
conjunctiva
b. Is associated with good prognosis
c. Is an APUD cell tumour
d. Is associated with ultraviolet
exposure
e. Produces corneal pigmentation

13. 6. a.F b.F c.T d.F e.F
Merkel cell carcinoma:
•An aggressive primary tumour of the skin, arising from
papillary dermis
•Usually presents as a firm non-tender solitary skin
nodule on the face and neck
•Early metastasis through the lymphatic channels
•Contains APUD (amine precursor and uptake
decarboxylation) cells

14. 7. Histological changes in lens induced
uveitis include:
a. Ghost cells
b. Giant cell reaction
c. Amyloid in the cornea
d. Vasculitis
e. Non-caseating granuloma

15. 7. a.F b.T c.F d.F e.T
Lens-induce uveitis: - three types
•Phacoanalphylactic endophthalmitis
•Severe granulomatous inflammation when the lens protein is
exposed
• Zonal granulomatous reaction surrounding the exposed lens
material. The inflammation include neutrophils, epihtelioid cells,
macrophages and giant cells
•Phacotoxic uveitis
•Nongranulomatous inflammation when the lens protein is
exposed.
•Non-specific inflammation with lymphocytes, macrophages and
occasional giant cells
•Phacolytic glaucoma
•Occurs when the hypermature cataract leaks out protein
• Macrophages laden with eosinophilic lens materials are seen in
the anterior chamber and the trabecular meshwork

16. 8. Xeroderma pigmentosa is associated with:
a. Intraouclar tumours
b. Metabolic disorders
c. Photosensitivity
d. Autosomal recessive inheritance
e. Squamous cell carcinoma

17. 8 a.F b.F c.T d.T e.T
Xeroderma pigmentosa:
•Inheritance is autosomal recessive
•Marked sensitive of skin to sunlight
•Malignant skin tumours including squamous cell tumour,
basal cell carcinoma and fibrosacorma
•Main defect is due to the inability of the cells to repair
damaged DNA following ultraviolet exposure

18. 9. Pathological changes in thyroid
ophthalmopathy includes:
a. Lymphocytic infiltrates
b. Giant cell reaction
c. Mucopolysaccharides
d. Fat cells
e. Fibroblast proliferation

19. 9. a.T b.F c.T d.T e.T
Pathology of thyroid ophthalmopathy:
•There is enlargement and inflammation of orbital tissue especially
the extraocular muscles
•Histologically there is interstitial oedema and inflammatory cell
infiltration (mainly lymphocytes, plasma cells and sometimes mast
cells)
•Thecondition tend to involve the nontendinous part of extraocular
muscle
• The endomysial fibroblasts produces mucopolysaccharide especially
hyaluronic acid
• The muscles are initially inflammed and at later stage undergoes
fibrosis and shows fatty infiltrate

20. 10. In histological stains:
a. Chlamydia inclusion bodies stain
with Giemsa
b. Osmium tetroxide is the stain used in
electron microscopy
c. Fungi stain with Fuelgin's stain
d. Eosin stains the nuclei blue
e. Haematoxylin stains the nuclei pink

21. 10. a.T b.T c.T d.F e.F
Histological staining:
•Giemsa stain can demonstrate inclusion body such as Chlamydia
• Osmium tetroxide is used to fix and stain myelin for electron
microscopy
•Yeast and fungi can be stained with Fuelgin's stain, PAS, Luxol blue
fast and Gomori methenamine silver
• Eosin stains the cytoplasm pink whereas haematoxylin stains the
nuclei blue

22. 11. Sympathetic ophthalmitis
a. Is characterized by Dalen-Fuchs' nodule
b. Prevented by removal of the exciting eye
within 6 weeks of injury
c. Pigment laden macrophages are
diagnostic
d. Is associated with poliosis and vitiligo
e. Is a common cause of visual loss in
traumatic eye injury

23. 11. a.T b.F c.F d.T e.F
Sympathetic ophthalmitis
•A uncommon bilateral granulomatous panuveitis which occurs after
penetrating ocular injury or intraocular surgery
•The inflammation usually begins 4 to 8 weeks after the injury
•Dellen-Fuch's nodules are seen at the level of Bruch's membrane
and represent aggregates of epitheloid
•Cells, it is not diagnostic as the nodules also occur in VKH syndrome
•May have systemic manifestation identical to Vogt-Koyanagi-Harada
syndrome with cerebrospinal fluid
•Pleocytosis, miningismus, alopecia, vitiligo and poliosis
•Prevention is only useful if the injured eye were removed within the
first 2 weeks after injury

24. 12. Abnormal material which may be present
in the vitreous include:
a. Exfoliation
b. Lipofuscin
c. Haemosiderin
d. Amyloidosis
e. Calcium

25. 12. a.T b.F c.T d.T e.T
Abnormal material in the vitreous include:
•Pseudoexfoliation in pseudoexfoliation syndrome
•Haemosiderin from vitreous haemorrhage
•Amyloidosis in familial amyloidosis
•Calcium in asteroid hyalosis

26. 13. In giant cell arteritis:
a. Histological diagnosis is based on
fragmentation of the internal intimal
b. C-reactive protein is always raised
c. Giant cell is needed for diagnosis
d. Anterior cerebral artery is often involved
e. Anaemia is a feature

27. 13. a.T b .T c.F d.F e.T
Giant cell arteritis:
•Disease of the elderly
•Sudden, painless and profound visual loss
•Female more susceptible than male
•Head ache, low grade fever, anorexia, weight loss, tenderness upon
brushing hair and jaw claudication
•ESR and C-reactive proteins are always raised but not diagnostic of
the condition
•Diagnosis is base on biopsy which reveal fragmentation of the
internal elastic lamina and giant cell infiltration of the tunica media
of the artery. However, giant cells are not essential for diagnosis.

28. 14. The following conditions are pre-
malignant:
a. Oncocytoma of the caruncle
b. Actinic keratosis
c. Bowen's disease
d. Squamous papilloma
e. Syringoma

29. 14. a.F b.T c.T d.F e.T
The following conditions are pre-malignant:
• Actinic keratosis is the result of metaplasia due to
ultraviolet light
•Bowen's disease
•Oncocytoma of the caruncle results from metaplasia of
the accessory gland and is not thought to be pre-
malignant
•Squamous papilloma is benign hyperplasia of the skin
•Syringoma is benign tumour of the sweat glands

30. 15. Hypoxic damage in diabetic mellitus
is suggested by:
a. Nerve fibre layers haemorrhage
b. Iris neovascularisation
c. Anterior uveitis
d. Vascular loop
e. Decreased hard exudate

31. 15. a.T b.T c.T d.T e.F
Hypoxic damage in diabetic mellitus is
suggested by:
•Cotton-wool spots
•Extensive IRMA
•Vascular beading
•Extensive retinal haemorrhages
•Iris neovascularization

32. 16. The following biopsy report may be found
with rheumatoid arthritis:
a. Posterior scleritis
b. Loss of goblet cells in the conjunctiva
c. Episcleral necrotic tissue
d. Giant cell reaction
e. Vasculitis

33. 16. a.T b .F c.T d.F e.T
Biopsy report in rheumatoid arthritis include
•Posterior scleritis
•Episcleral necrotic tissue
•Vasculitis
-The dry eye in rheumatoid arthritis is caused by aqueous
deficiency and not goblet cell dysfunction

34. 17. The following report is associated with
increased mortality in an enucleated eye
with retinoblastoma:
a. Involvement of the optic nerve
b. Presence of calcification within the tumours
c. Necrosis within the tumours
d. Exophytic retinoblastoma
e. Presence of retinal detachment

35. 17. a.T b.F c.F d.F e.F
The prognosis of retinoblastma is detemined by:
•Evidence of external spread such as optic nerve
involvement
•Size of the tumours
•Cell differentiation
•Calcification and necrosis are common in
retinoblastoma.

36. 18. Diabetic microangiopathy include:
a. Endothelial vascular proliferation
b. Proliferation of pericytes associated with
microaneurysms
c. Deposition of calcium in the intima
d. Thickening of the basement membrane
e. Necrosis of the endothelium

37. 18. a.F b.F c.F d.T e.F
Microangiopathy in diabetes mellitus is
characterised by:
•Microvascular obstruction and non-perfusion of
capillaries
• Retinal capillary microaneurysms
• Absent membrane thickening
• Loss of pericytes
• Intraretinal microvascular abnormality

38. 19. Optic nerve glioma:
a. Is associated with neurofibromatosis
type I
b. Increased incidence after 30 years old
c. Majority is of pilocytic astrocytoma
d. Rarely infiltrate the perineural tissue
e. Mortality of 40%

39. 19. a.T b.F c.T d.T e.F
Optic nerve glioma:
•Associated with type I neurofibromatosis
•Most common type is pilocytic (hair-like)
astrocytoma
•The age of onset is usually before the age of 10
•Low-grade and rarely infiltrate the perineural
tissue
•Reactive meningeal hyperplasia
•Good long-term survival

40. 20. Mutton fat keratic precipitates are seen in:
a. Uveal effusion syndrome
b. Tuberculosis
c. Fuch's heterochromia cyclitis
d. Sarcoidosis
e. Fungal infection

41. 20 a.F b.T c.F d.T e.T
Mutton fat keratic precipitates:- occurs in chronic
granulomatous uveitis and seen in
•Tuberculosis
•Fungal
•Leprosy
•Syphilis
•Sarcoidosis
•Juvenile xanthogranuloma
•Histiocytosis X
•Sympathetic ophthalmia
•Vogt-Koyanagi-Harada syndrome
•Toxoplasmosis

42. Thank you