Glaucoma previous year questions

Q:1 Which of the following drug is not used in Acute Angle closure Glaucoma?
A: Pilocarpine
B: Clozapine
C: Fluphenazine
D: Duloxetine
Correct Ans:B
Explanation
Clozapine will precipitate acute angle closure glaucoma.
Reference:
1. KDT 6th Edition, Pages 429, 442
2. Atlas of Psychiatric Pharmacotherapy, 2nd Edition, Page 42
3. Medicinal Natural Products: A Biosynthetic Approach By Paul M.
Dewick, Page 400
4. Modell's Essential Drugs in Current Use and New Drugs By Milagros
Fernandez, Walter Modell, Lydia Calix, Page 18
5. Clinical Pharmacy By Jeff Hughes, William Hughes, Page 15
6. Kaplan and Sadock's Psychiatry, 10th Edition, Page 1083
7. American Psychiatric Association Practice Guidelines for The
Treatment of Psychiatric Disorders By American Psychiatric Association,
2006, Page 654
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Q:2 Which of the following arachidonic acid derivative is used in treatment of
glaucoma?
A: Latanoprost
B: Iloprost
C: Alprostadil
D: None of the above
Correct Ans:A
Explanation
Latanoprost, a stable longacting PGF2derivative, was the first prostanoid used for
glaucoma. The success of latanoprost has stimulated development of similar
prostanoids with ocular hypotensive effects, and bimatoprost, travoprost, and
unoprostone are now available. These drugs act at the FP receptor and are
administered as drops into the conjunctival sac once or twice daily. Adverse effects
include irreversible brown pigmentation of the iris and eyelashes, drying of the eyes,
and conjunctivitis.

Ref: Katzung 11th edition Chapter 18.
Q:3 Which of the following is NOT correct regarding glycopyrrolate?
A: Inhibitory action on salivary glands
B: Heart rate usually increases after intravenous administration
C: Should be avoided in glaucoma
D: Longer duration of action than atropine
Correct Ans:C
Explanation
Because of its quaternary structure, glycopyrrolate cannot cross the blood–brain barrier
and is almost devoid of central nervous system and ophthalmic activity. Potent
inhibition of salivary gland and respiratory tract secretions is the primary rationale for
using glycopyrrolate as a premedication. Heart rate usually increases after intravenous
—but not intramuscular—administration. Glycopyrrolate has a longer duration of action
than atropine (2–4 h vs 30 min after intravenous administration).

Ref: Butterworth IV J.F., Butterworth IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C.,
Wasnick J.D. (2013). Chapter 13. Anticholinergic Drugs. In J.F. Butterworth IV, J.F.
Butterworth IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan &
Mikhail's Clinical Anesthesiology, 5e.
Q:4 Which of the following is the indication for using phenylsubstituted prostaglandin
F2 alpha, Latanoprost:
A: Maintenance of ductus arteriosus
B: Pulmonary hypertension
C: Gastric mucosal protection
D: Glaucoma
Correct Ans:D
Explanation
Latanoprost is a derivative of PGF2 alpha that reduces intraocular pressure (IOP) by
increasing uveoscleral outflow without effects on aqueous flow. It is indicated in
reduction of elevated IOP in patients with open angle glaucoma, ocular hypertension
and capsular glaucoma. The only apparent side effect is darkening of the pigment of the
eyes, such as hazel, that are made up of multiple colors.
Ref: Clinical Ophthalmology: Contemporary Perspectives By Gupta, 2009, Page 80;
Desk Reference of Clinical Pharmacology, Second Edition By Manuchair S. Ebadi, 2008,
Page 381; Goodman and Gillman's 11th edition, Page 1103.

Q:5
A 41yearold woman with glaucoma is treated with acetazolamide. Several weeks
later the woman has an arterial pH of 7.34, an arterial PCO2 of 29mmHg, and a
plasma HCO3− of 15 mEq/L. Which of the following abnormalities has this women
most likely developed?
A: Metabolic acidosis
B: Metabolic alkalosis
C: Mixed acidosis
D: Mixed alkalosis
Correct Ans:A
Explanation
The laboratory results indicate that the arterial pH, arterial PCO2, and plasma HCO3
concentrations are all low. These changes clearly demonstrate metabolic acidosis,
which occurs commonly when a carbonic anhydrase inhibitor is administered. The
carbonic anhydrase enzyme attached to the brush border of the tubular epithelial cells
normally catalyzes the dissociation of carbonic acid into water and carbon dioxide.
Inhibition of carbonic anhydrase prevents the removal of bicarbonate ions from the
tubular fluid, which initially increases urine pH. The result is heavy spillage of
bicarbonate in the urine, which is the hallmark of type 2 RTA (renal tubular acidosis).
However, once the plasma levels of bicarbonate have decreased sufficiently, the
bicarbonaturia ceases and the plasma HCO3 levels stabilize at a lower than normal
level. Consequently, the urine pH falls typically to 4.55.0.
Q:6
Acetazolamide is administered to a glaucoma patient. Given that this drug inhibits
carbonic anhydrase in the renal proximal tubule, which of the following
substances will be excreted at a lower rate?
A: Na+
B: H2O
C: HCO3
D: NH4
Correct Ans:D
Explanation
The primary effect of carbonic anhydrase inhibitors such as acetazolamide is to inhibit
both H+ secretion and NaHCO3 reabsorption, making the urine alkaline. NH4+
excretion is reduced as a result of the diminished H+ secretion. Carbonic anhydrase
inhibitors restrict H+ secretion by inhibiting the intracellular hydration of CO2, a
primary source of intracellular H+. The decline in H+ secretion inhibits the Na+H+
exchange at the luminal membrane of the proximal tubule, which is the primary site of
NaHCO3 diuresis. Carbonic anhydrase inhibitors also block the dehydration of H2CO3
formed in the tubular lumen. Chronic doses of such drugs can lead to hyperchloremic
acidosis (metabolic acidosis).

Ref: McNamara J.O. (2011). Chapter 21. Pharmacotherapy of the Epilepsies. In L.L.

Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The
Pharmacological Basis of Therapeutics, 12e.
Q:7
A 30 year old female, presents with episodic throbbing headache associated with
nausea and vomiting for past 4 yrs. What will be the most likely diagnosis is:
A: Migraine
B: Cluster headache
C: Angle closure glaucoma
D: Temporal arteritis
Correct Ans:A
Explanation
Migraine is the second most common form of headaches affecting ~15% of woman and
~6% of men. It is an episodic headache associated with sensitivity to light, sound and
movement. Often accompanied by nausea and vomiting. Migraine is a benign and
recurring syndrome of headache recognized by its activators, termed as triggers.

Ref: Harrison’s Principle of Internal Medicine, 16th Edition, Pages 8889
Q:8
A 20 year old unmarried girl complaining of visual aura lasting for 20 minutes
described as a small central disturbance in the field of vision marches towards the
periphery, leaving a transient scotoma in its wake. The expanding border of that
has a scintillating, dancing, or zigzag edge. This phenomena also remain visible in
the dark or with the eyes closed. After the visual symptoms recede, headache
develops. She gives a long standing history of stereotypic attacks. What is the
most likely diagnosis?
A: Glaucoma
B: Classic migraine
C: Transient ischemic attacks
D: Non organic visual loss
Correct Ans:B
Explanation
This is the classical description of classic migraine. No other diagnosis would fit in this
scenario.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 234

Q:9 Painless loss of vision is seen in all, EXCEPT:
A: Papilledema
B: Papillitis
C: Angle closure glaucoma
D: CRAO
Correct Ans:C
Explanation
Acute angleclosure glaucoma is an ophthalmic emergency that
causes severe visual loss without treatment. Symptoms include
ocular pain, blurred vision, lacrimation, halos around lights,
frontal headache, nausea, and vomiting.
Causes of Sudden Painless Loss of Vision:
1. Retinal detachment
2. Vitreous haemorrhage
3. Retinal vein occlusion
4. Retinal artery occlusion
5. Wet age related macular degeneration
6. Anterior ischemic optic neuropathy
7. Optic neuritis
8. Cerebrovascular accident
9. Papillitis
10. Papilledema
Q:10
All of the following can be seen in patients with accelerated hypertension which
can lead to visual loss, EXCEPT:
A: Vitreous haemorrhage
B: Glaucoma
C: Cotton wool spots
D: Retinal detachment
Correct Ans:B
Explanation
In young patients with accelerated malignant hypertension, an extensive retinopathy is
seen, with hemorrhages, retinal infarcts (cottonwool spots), choroidal infarcts, and
occasionally serous detachment of the retina.

Severe disk edema is a prominent feature and may be accompanied by a macular star
of hard exudates. Vision may be impaired and may deteriorate further if blood pressure
is reduced too quickly.

Ref: Pringle E., Graham E.M. (2011). Chapter 15. Ocular Disorders Associated with
Systemic Diseases. In P. RiordanEva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's
General Ophthalmology, 18e.
Q:11 Ring scotoma is seen in:
A: Macular edema
B: Night blindness
C: Severe myopia
D: Angle closure glaucoma
Correct Ans:C
Explanation
Ring scotoma involves the point of fixation. Conditions resulting in ring scotoma are
pigmentary retinopathies, retinitis, choroiditis, myopia, open angle glaucoma and optic
neuropathies.
Bilateral annular scotomas occur due to bilateral retinal or optic nerve disease but may
also occur with bilateral occipital pole damage or occur on a functional basis.
Scotomas are abnormal blind spots in visual fields.
Types of scotomas:
Central scotomas: In this the point of fixation is involved and central visual acuity is
impaired.
Centrocecal scotoma: It involve the point of fixation and extend to the normal blind
spot.
Paracentral scotoma: It involves the area adjacent to the point of fixation.
Scintillating scotoma: They are subjective experiences of bright colorless and colored
lights in the line of vision. They are often reported by patients as part of the aura
preceding migraine headache.
Ref: Waxman S.G. (2010). Chapter 15. The Visual System. In S.G. Waxman
(Ed),Clinical Neuroanatomy, 26e. Clinical Pathways in NeuroOphthalmology: An
EvidenceBased Approach By Andrew Lee, Paul Brazis page 2018.
Q:12 Dalen Fuch nodules are seen in:
A: Sympathetic opthalmitis
B: Anterior uveitis
C: Eye injury
D: Glaucoma

Correct Ans:A
Explanation
Dalen Fuchs nodules are seen in patients with sympathetic ophthalmia, a bilateral,
granulomatous panuveitis that follows penetrating ocular injury, intraocular surgery or
laser cyclo coagulation.

Dalen Fuchs nodules are small, discrete, yellow elevated infiltrates commonly seen in
the midperipheral fundus of patients with sympathetic uveitis. They consist of
lymphocytes and epithelioid cell collections between bruch membrane and RPE.

Ref: Clinical Pathways In Vitreoretinal Disease edited by Scott M Steidl, page 77
Q:13 Which type of senile cataract is notorious for glaucoma formation?
A: Incipient cataract
B: Hypermature morgagni
C: Intumescent cataract
D: Nuclear cataract
Correct Ans:C
Explanation
In intumescent cataract, the lens may take up fluid during cataractous change,
increasing markedly in size. It may then encroach upon the anterior chamber,
producing both pupillary block and angle crowding and resulting in acute angle closure.
Treatment consists of lens extraction once the intraocular pressure has been controlled
medically.

Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. RiordanEva, E.T. Cunningham,
Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

Q:14 The mode of action of Lanatoprost in glaucoma:
A: Increasing trabecular outflow
B: Releasing pupillary block
C: Decreasing aqueous humour formation
D: Increasing uveoscleral outflow
Correct Ans:D
Explanation
Lantanoprost is prastoglandin in nature and decrease the intraocular pressure by
increasing uveoscleral outflow of aqueous humour. It is very good adjunctive therapy
along with betablockers, dorzolamide and pilocarpine.

Ref: A.K KHURANA (2005), Chapter 9, “Glaucoma”, In the book, “Opthalmology”, 3rd
Edition, Newdelhi, Page 229 ; KDT 5th Edition, Page 88
Q:15 A patient having glaucoma develops blepharoconjunctivitis after instilling some
antiglaucoma drug. Which of the following drug can be responsible for it:
A: Timolol
B: Latanosprost
C: Dipiverine
D: Pilocarpine
Correct Ans:A
Explanation
Allergic blepharoconjunctivitis is a side effect of beta blockers.
Ref: Essentials of Medical Pharmacology By K D Tripathi, 4th Edition, Page 95
Q:16 Kusumlata presents with acute painful red eye and mild dilated vertically oval
pupil. Most likely diagnosis is:
A: Acute retrobulber neuritis
B: Acute angle closure glaucoma
C: Acute anterior uveitis
D: Severe keratoconjunctivitis
Correct Ans:B
Explanation
Acute painful red eye and mild dilated vertically oval pupil give the diagnosis of acute
angle closure glaucoma.
Ref: Comprehensive Ophthalmology By AK Khurana, 2nd Edition, Page 232
Q:17 Babloo a 5 yrs old child presents with large cornea, lacrimation and photophobia;
Diagnosis is:
A: Megalocornea
B: Congenital glaucoma

C: Congenital cataract
D: Anterior uveitis
Correct Ans:B
Explanation
In this scenario signs and symptoms occur as a result of congenital glaucoma.

Ref: Comprehensive Ophthalmology A K Khurana 4th Edition, Pages 21112 ; Textbook
of Ophthalmology By Neema, 3rd Edition, Page 190
Q:18 A woman complains of coloured halos around lights in the evening, with nausea
and vomiting, IOP is normal; Diagnosis is:
A: Incipient stage glaucoma open angle
B: Prodromal stage, closed angle glaucoma
C: Migraine
D: Raised ICT
Correct Ans:B
Explanation
The patient in question presents with symptoms suggestive of glaucoma, but a normal
IOP on examination. This is therefore most likely a case of Prodromal stage of
Glaucoma.

Ref: Concise Textbook Of Ophthalmology By Sharma, Page119 ; Clinical Ophthalmology
By Kanski, 3rd Edition, Page 255 and 4th Edition, Page 213 ; Comprehensive
Ophthalmology A K Khurana 4th Edition, Page 225
Q:19 Which of the following antiglaucoma medications can cause drowsiness?
A: Timolol
B: Latanoprost
C: Brimonidine
D: Dorzolamide
Correct Ans:C
Explanation
Among the anti glaucoma medications given in the question, brimonidine can cause
drowsiness.
Brimonidine is a selective alpha 2 adrenergic agonist that lowers intra ocular pressure

by decreasing aqueous humor production and enhancing uveoscleral outflow. Most
common adverse effects associated with its use are dry mouth, ocular hyperemia,
ocular burning, headache, blurred vision, foreign body sensation and drowsiness.
Ref: Mastering the Tech. of Glaucoma Diagnosis and Management By Garg, Page
161; Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 425, 427.
Q:20
Which of the following drugs is not used topically for treatment of open angle
glaucoma?
A: Latanoprost
B: Brimonidine
C: Acetazolamide
D: Dorzolamide
Correct Ans:C
Explanation
Acetazolamide is a carbonic anhydrase inhibitor used orally and not topically for
treatment of open angle glaucoma. It acts by inhibiting carbonic anhydrase enzyme
involved in the synthesis of aqueous humor.
Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 4257.
Q:21
A 64yearold woman in otherwise excellent health is referred by her optician to
ophthalmology outpatients. The optician has noticed cupping of the optic disc and
enlargement of the blind spot. Tonometry confirms the diagnosis of chronic
simple (open angle) glaucoma. Choose the most appropriate drug from the
choices below.
A: Brimonidine
B: Tropicamide
C: Timolol
D: Hypromellose
Correct Ans:C
Explanation
Chronic simple (open angle) glaucoma is one of the major causes of blindness. In
contrast to acute (closed angle) glaucoma, its onset is insidious and painless. Initial
treatment is with a topical betablocker, such as timolol, with the provison that
significant systemic absorption may occur; the usual cautions and contraindications to
betablockers should be observed. If initial treatment does not reduce intraocular
pressure sufficiently, additional treatments may include parasympathomimetics (e.g.
pilocarpine); selective alpha2adrenoceptor agonists (e.g. brimonidine); carbonic
anhydrase inhibitors (e.g. dorzolamide) and prostaglandin analogues (e.g. latanoprost).

If medical treatment fails, surgical trabeculectomy or laser trabeculoplasty may be
necessary.
Q:22
A 55yearold woman presents to her physician complaining of acute pain and
redness in her right eye, with nausea and vomiting. She reports seeing halos
around lights. On examination, lacrimation, lid edema, conjunctival injection, a
steamy cornea, and a fixed middilated pupil are seen. She has markedly
elevated intraocular pressure (IOP), and a visual acuity of 20/200 in her right
eye. She has no family history of eye diseases. Which of the following is the most
likely diagnosis?
A: Acute closedangle glaucoma
B: Corneal laceration
C: Ocular hypertension without glaucoma
D: Open angle glaucoma
Correct Ans:A
Explanation
This patient has acute closedangle glaucoma, as evidenced by the pain and redness of
her eye, the steamy cornea, her description of halos around lights, and her markedly
elevated intraocular pressure. The fixed middilated pupil indicates ischemia to the iris.
Unlike open angle glaucoma, closedangle glaucoma (also called narrowangle or
angleclosure glaucoma) is a medical emergency, and requires immediate diagnosis
and treatment to prevent permanent visual impairment.
The anterior and posterior chambers of the eye are filled with aqueous humor, which
flows from the posterior chamber, through the pupil, into the anterior chamber, into the
trabecular network, and then exits the eye via the canal of Schlemm.
Individuals with a shallow or narrow anterior chamber or thickened lens may be
predisposed to this type of glaucoma because their iris is in close opposition to the
chamber angle and cornea (narrow angle). If the aqueous humor is produced at a
greater rate than it can be drained, intraocular pressure rises. Any stimulus that causes
pupillary dilation (e.g., anticholinergic medications, sympathomimetics, emotional
upset, dim lighting) can precipitate an attack.
The cornea may look hazy because of edema, but corneal laceration is produced by
trauma. There is no history of trauma in this patient and the symptoms exhibited by
this patient strongly suggest acute closedangle glaucoma.
Intraocular hypertension is a condition in which IOP is higher than normal (greater
than 21 mm Hg), but there is no damage to the optic nerve or visual loss. About 90% of
people with elevated IOP never develop glaucoma. There is no associated pain or visual
symptoms associated with this.

Known as the "sneak thief of sight," openangle glaucoma has no early warning signs
or symptoms, and accounts for 90% of all glaucoma cases. It is a slow progressive
condition, usually affecting both eyes, in which there is an increase in resistance to the
outflow of aqueous humor. This resistance is associated with a normal rate of
production of the fluid and normal anterior chamber angle. Elevated IOP is the most
common finding and agerelated changes in the trabecular region are the most likely
explanation of this disease.

Q:23
A 45 year old male presents to the clinic with insidious onset of loss of vision,
mild headache and eye ache. He also gives a history of frequent change in
reading glass. On examination he was found to glaucomatous visual field defects
but his intraocular pressure was normal. Fundus examination showed pale disc
with a large cup.
Assertion: Betaxolol is the drug of choice for this condition.
Reason: Lowering the intraocular pressure and increasing the optic nerve blood flow are
helpful in this condition.

A:
Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B:
Both Assertion and Reason are true, and Reason is not the correct explanation
for Assertion
C: Assertion is true, but Reason is false
D: Assertion is false, but Reason is true
Correct Ans:A
Explanation
Patient is suffering from normal tension glaucoma. It is said to occur when typical
glaucomatous disc changes with or without visual field defects are associated with an
IOP below 21 mmHg. It is believed to result from chronic low vascular perfusion which
makes the optic nerve head susceptible to normal intraocular pressure. Betaxolol is the
drug of choice for this condition, because in addition to lowering the intraocular
pressure, it also increases the optic nerve blood flow.

Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page 224
Q:24 A patient who is on long term steroid developed certain ocular symptoms since
few weeks. Which of the following condition is caused by chronic steroid use?
A: Open angle glaucoma
B: Conjunctival papillomatosis
C: Uveitis
Correct Ans:A
Explanation
Topical, periocular, and intraocular corticosteroids may produce a type of
glaucoma that simulates primary openangle glaucoma, particularly in individuals
with a family history of the disease, and will exaggerate the intraocular pressure
elevation in those with established primary openangle glaucoma.
Systemic steroid therapy is less likely to cause a rise in intraocular pressure.

Q:25
A 56 year old female is brought to casualty with acute narrow angle glaucoma.
She has severe pain in her eye and it spreads. The radiation of pain in acute
narrow angle glaucoma is in the distribution of:
A: Ill nerve
B: V nerve
C: VII nerve
D: II nerve
Correct Ans:B
Explanation
Acute primary angle glaucoma:
It occurs due to a sudden total angle closure leading to severe rise in intraocular
pressure (IOP).

Typically acute attack is characterized by sudden onset of very severe pain in the eye
which radiates along the branches of 5th nerve.
Nausea, vomiting and prostrations are frequently associated with pain.

Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 229.
Q:26
A patient presents with h/o evening halos and occasional headache for some
months. His examination shows normal IOP but shallow AC. He is in which stage
of glaucoma?
A: Acute
B: Absolute
C: Prodrome
D: Constant instability
Correct Ans:C
Explanation
Five clinical stages are discernable in primary angle closure glaucoma (PACG):
Prodromal stage: Patient sees coloured haloes due to high intraocular pressure

(IOP) with some obscuration of vision
Chronic instability stage: The intermittency of the prodromal stage is replaced by
the regularity of attacks.
Acute ACG stage: Acute attacks glaucoma
Chronic ACG stage: The recurrent attacks of angle closure eventually lead to
peripheral anterior synechiae that may permanently block the exit pathways
Absolute glaucoma: It is the end result of untreated attacks ACG or chronic ACG.
It results in a stony hard, painful, blind eye.
Ref: Concise Textbook Of Ophthalmology By Sharma, 2006, Page 118.
Q:27 All of the following can predispose to development of angle closure glaucoma,
EXCEPT:
A: Small cornea
B: Smaller diameter of lens
C: Shallow AC
D: Small eyeball
Correct Ans:B
Explanation
Anatomical risk factors for developing primary angle closure glaucoma are:
Hypermetropic eyes with shallow anterior chamber
Eyes in which irislens diaphragm is placed anteriorly
Eyes with narrow angle of anterior chamber, which may be due to: small eyeball,
relatively large size of the lens and smaller diameter of the cornea or bigger size
of the ciliary body
Plateau iris configuration
Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 225.
Q:28 Which of the following type of glaucoma is treated by Argon Laser
Trabeculoplasty?
A: Open angle glaucoma
B: Secondary glaucoma
C: Angle recession glaucoma
D: Angle closure glaucoma
Correct Ans:A
Explanation
Laser trabeculoplasty is effective in the initial treatment of primary openangle

glaucoma. Application of laser (either argon or frequencydoubled Qswitched Nd:YAG)
burns via a goniolens to the trabecular meshwork facilitates aqueous outflow by virtue
of its effects on the trabecular meshwork and Schlemm's canal or cellular events that
enhance the function of the meshwork. The pressure reduction usually allows decrease
of medical therapy and postponement of glaucoma surgery.

Q:29 Which among the following is the indication for using Fincham's test?
A: To diagnose congenital glaucoma
B: To diagnose acute congestive glaucoma
C: For differential diagnosis of acute congestive glaucoma from cataract
D: To diagnose congenital cataract
Correct Ans:C
Explanation
The coloured halos in glaucoma must be differentiated from those found in acute
purulent conjunctivitis and early cataractous changes. In conjunctivitis, the halos can
be eliminated by irrigating the discharge. The halos of glaucoma and immature cataract
may be differentiated by Fincham’s test in which a stenopaic slit is passed across the
pupil. During this test glaucomatous halo remains intact, while a halo due to cataract is
broken up into segments.

Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 228.

Q:30 Following anatomic factors predispose to glaucoma, EXCEPT:
A: Flat cornea
B: Increased length of eyeball
C: Shallow anterior chamber
D: Big size of ciliary body
Correct Ans:B
Explanation
Anatomic risk factors for the development of acute angle closure glaucoma are small
eyes with shallow anterior chamber, short axial length, small corneal diameter, shallow
limbal chamber depth and thick, relatively anteriorly positioned lens.

Risk factors for primary open angle glaucoma:

Age
Race
Family history
Diabetes mellitus
Thin central cornea
Systemic hypertension
REF: Pearls of Glaucoma Management edited by JoAnn A. Giaconi, page 415.
Q:31
A 30 days old neonate presented with excessive lacrimation and photophobia. He
has a large and hazy cornea. I lis both lacrimal duct systems arc normal. The
diagnosis is:
A: Megalocornea
B: Keratoconus
C: Congenital glaucoma
D: Hunter's syndrome
Correct Ans:C
Explanation
Congenital glaucoma is often bilateral. The most striking symptom is extreme
photophobia. Early signs are corneal haze or opacity, increased corneal diameter, and
increased intraocular pressure. Since the outer coats of the eyeball are not as rigid in
the child, the increased intraocular pressure expands the corneal and scleral tissues,
producing an eye that is larger than normal (buphthalmos). Early recognition is
essential to prevent permanent blindness.

Ref: Fredrick D.R. (2011). Chapter 17. Special Subjects of Pediatric Interest. In P.
RiordanEva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology,
18e.
Q:32
Cholinergic drugs such as pilocarpine are routinely used to treat glaucoma. What
is their mechanism of action in the eye that accounts for this ophthalmologic
use?
A: Reduction in the formation of aqueous humor
B: Blockade of adrenergic receptors to potentiate cholinergic effects
C: Alkalinization of aqueous humor
D: Improved drainage of aqueous humor
Correct Ans:D
Explanation
Like other cholinergics with muscarinic action, pilocarpine improves the drainage of
aqueous humor from the anterior chamber angle of the eye. The cholinomimetic effect
results in contraction of the ciliary body and causes a change in its position. This
altered position increases flow of aqueous humor through the trabecular network and
into the canal of Schlemm, thus decreasing the intraocular pressure of glaucoma.

Ref: Brown J.H., Laiken N. (2011). Chapter 9. Muscarinic Receptor Agonists and
Antagonists. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's
The Pharmacological Basis of Therapeutics, 12e.

Q:33 Von Recklinghausen disease is associated with:
A: Glaucoma
B: Optic Nerve glioma
C: Neurofibroma of the lids
D: All the above
Correct Ans:D
Explanation
Glaucoma, Optic nerve glioma and Neurofibroma of the lids are all seen in
Neurofibromatosisi 1.
Ref: Comprehensive Manual of Ophthalmology, By E. Ahmed, Page 148; Ocular
Pathology, By Myron Yanoff, Joseph W. Sassani, Page 33; Kanski 6th Edition, Page 917
Q:34 Which of the following will not cause pupillary white reflex?
A: Retinoblastoma
B: Glaucoma
C: Cataract
D: Retrolental fibroplasia
Correct Ans:B
Explanation
Glaucoma is not a cause of white pupillary reflex (cat’s eye reflex). The patient should
be evaluated immediately as an important differential diagnosis is retinoblastoma.
Ref: A.K KHURANA (2005), In the book, “Opthalmology”, 3rd Edition, Newdelhi, Page
23, 170, 269

Q:35 Which statement regarding glaucoma is true?
A: If recognized early, the optic neuropathy of glaucoma is reversible
B:
Topical Badrenergic antagonists have few if any side effect due to their
systemic absorption
C:
The initial symptom oh optic neuropathy due to glaucoma is loss of central
vision
Correct Ans:D
Explanation
Glaucoma  is  the  leading  cause  of  irreversible blindness in the world. When
sufficient axinal loss occurs, peripheral vision declines. Loss of central vision occurs
much later in  the disease process. Retinopathy due to glaucoma is irreversible.
Treatment is focused on lowering intraocular pressure. Reduction in intracecular
pressure has been   demonstrated   to   protect   against   further damage to the optic
nerve. Primary openangle is by far the most common type of glaucoma in the United
States. Closedangle glaucoma is more common among Asians. The  Schijltz
tonometer, due to the fact that it is inexpensive, is the most frequently used device to
measure intraoccular pressure in the United States. It is used in both hospitals and
outpatient clinics. βAdrenergic antagonists are one of the more commonly used drugs
and are initially started as a topical agent. Unfortunately, excess drug drains through
the nasolacrimal duct into the  nose and is absorbed into the systemic circulation.
Therefore systemic side effects can occur and may be severe. It is not unusual for
patients to be treated with a bronchodilater drug for newonset bronchospasms
without the physician considering the use of topical βadrenergic antagonist, used for
glaucoma treatment, which may have contributed to the condition.
Q:36 Circumcorneal congestion is not seen in?
A: Acute bacterial conjunctivitis
B: Acute iritis
C: Acute glaucoma
D: Scleritis
Correct Ans:D
Explanation
Scleritis
REF: khurana 4th ed p. 147
"Scleritis usually presents as diffuse erythema of the conjunctiva and sclera rather
than circumcorneal congestion"

Q:37 In Acute angle closure glaucoma all are seen EXCEPT:
A: Cupping of disc
B: Bayonetting sign
C: Snow banking
D: Oval cup
Correct Ans:C
Explanation
Snow banking REF: Khurana 4th ed p. 216
"Snow banking is seen in pars planitis not acute angle closure glaucoma"
Optic disc changes in POAG include:
High cup:disc ratio
Cup:disc ratio asymmetry between eyes (usually considered significant if greater
than 0.2)
Vertical elongation of cup
Focal neuroretinal rim thinning or notching
Vessel bayoneting
Betazone peripapillary atrophy
Disc hemorrhage

Glaucoma previous year questions

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