Oral Questions in Ophthalmology - Dr Abdelbaset El-naggar

1. Oral Questions
Dr. Abdelbaset El-naggar

2. What’s the normal external
appearance of the eye?
• The eye lid are in normal position, the
upper and lower lashes are attached to the
corresponding lids.
• Normal eyes have parallel lenses without
deviation (no squint).
• Corneal corneal luster.
• Normal position of brows.

3. Can a patient with hypermature
cataract see without surgery?
• Yes
• Degeneration of zonules leads to
displacement of the lens backwards. Light
can enter the eye and the patient can see.

4. A common cause for decreased VA
post cataract surgery with IOL
• Opacification of posterior capsule

5. Can a cataract operation cause
binocular diplopia?
• Yes
• If an IOL was implanted with a power different
from the other eye.
• When a patient uses glasses for the operated
eye and the other eye have no lens in front of it.
• If there’s sublaxation of the lens in one eye
leading to formation of two images on its retina
and the patient sees more than one picture.

6. Does monocular diplopia occurs in
hypermature sublaxating lens?
• No
• In hyper mature cataract there’s complete
opacity of the lens
• When sublaxation occurs, there are two
refractive media of the light, the lens & the
cornea.
• In hypermature sublauxation only one
medium refracts the light & there’s no
diplopia.

7. A patient has bilateral cataract, normal lens
thickness. and bilateral shallow A.C. What is
the refractive error?
• The patient has bilateral hypermetropia
• A patient has bilateral cataract, normal
lens thickness. and bilateral deep A.C.
What is the refractive error?
• The patient has bilateral myopia

8. Common drugs causing cataract?
• Pilocarpine Starts anterior Capsular &
subcapsular.
• Cortisone Starts posterior capsular(post
surface of the lens).

9. What’s the normal iris pattern ?
• It is the anterior circular muscular part of
the eye
• Formed of ciliary border, pupillary border
and collarette
• Papillary border with serrated ruffle
• There is regular crypts near the ciliary
border and contraction furrows
• The collarette has radial lines

10. What is the importance of D.M. and
Hypertension in past hx in the diagnosis of
cataract?
• To control before an operation.
• To treat DR before an operation
• These may be additional causes of
progressive painless decrease of vision

11. Importance of history
• Decrease in vision or other complain.
• Progressive or not & incidence.
• Painful or painless.
• In which eye.
• Since how long.

12. How can Pterygium affect the vision?
• By compression on cornea leading to
irregular astigmatism.
• In advanced cases, by reaching the pupil.

13. What are the causes of lens
induced glaucoma?
1. Hypermature cataract  denaturated protein  exit of
lens fibres  engulfing by macrophage  closure of
angle of filtration
(It’s called phacolytic glaucoma - 2ry. Open angle type).
2. Phacomorphic glaucoma  swelling of lens  contact
between Iris & lens  collection of aqueous behind the
iris  bulging of iris  closure of angle of filtration.
3. Spherophakia (ronded lens)  Irido-lenticular touch.
4. Microspherophakia (small rounded lens)  touch of the
periphery of the lens by the iris  closure of the angle.
5. Anterior dislocated lens.

14. What are the causes of lens
induced glaucoma?
6. Posterior dislocation of the lens  causing bulging of
vitreous.
N.B.: Anterior dislocation is more dangerous than posterior
dislocation (if left for 24 hrs.  corneal opacity due to
destruction of the endothelium  needs keratopathy plus
glaucoma operation.)
7. Traumatic rupture of lens  exit of lens material 
peripheral anterior synechiae  closure of the angle.
8. Pseudo-exfoliation of lens: rubbing movement of
amyloid-like-material by iris movement  distribution &
accumulation of the material to the periphery and the
centre becomes clear  closure of the angle.
9. Pigmentary glaucoma: rubbing of iris to the lens 
dispersion of pigmented cells of the iris  2ry open
angle glaucoma.