Myopia

MYOPIA

Q. 1

A 15-year-old female presents with primary amen­orrhea.  Her breasts are Tanner 4 but she has no axillary or pubic hair The most likely diagnosis is :

 A

Turner’s syndrome

 B

Mullerian agenesis

 C

Testicular feminization syndrome

 D

Premature ovarian failure

Q. 1

A 15-year-old female presents with primary amen­orrhea.  Her breasts are Tanner 4 but she has no axillary or pubic hair The most likely diagnosis is :

 A

Turner’s syndrome

 B

Mullerian agenesis

 C

Testicular feminization syndrome

 D

Premature ovarian failure

Ans. C

Explanation:

Testicular feminization syndrome


Q. 2 Most common type of staphyloma in myopia is:
 A Posterior
 B Intercalary
 C Equatorial
 D Ciliary
Q. 2 Most common type of staphyloma in myopia is:
 A Posterior
 B Intercalary
 C Equatorial
 D Ciliary
Ans. A

Explanation:

Posterior


Q. 3

Which of the following is the MOST common type of staphyloma in myopia?

 A

Posterior

 B

Intercalary

 C

Equatorial

 D

Ciliary

Q. 3

Which of the following is the MOST common type of staphyloma in myopia?

 A

Posterior

 B

Intercalary

 C

Equatorial

 D

Ciliary

Ans. A

Explanation:

Posterior staphylomas are commonly seen in patients with high myopia. Staphylomas are defined as the ectatic cicatrisation of the outer coat of the eyeball with uveal incarceration. 
  • Anterior staphylomas can be caused by smallpox, keratomalacia, sloughing corneal ulcer and trauma.
  • intercalary staphylomas occur due to a penetrating wound at the limbus.
  • Ciliary staphylomas occur due to buphthalmos, long standing absolute glaucoma, scleritis, scleromalacia, rhinosporidiosis, traumatic and idiopathic reasons.
  • equatorial staphylomas are often congenital in origin.
Ref: Clinical Examination In Ophthalmology By P. K. Mukherjee page 125.

Q. 4

A 45-year-old female with a long history of progressive myopia develops sudden patchy loss of vision in her right eye. She is very alarmed and rushes to her family doctor. Funduscopic examination reveals a large retinal detachment in the right eye. The retina in the left eye is normal. When the pupillary light reflex is tested by shining a light in the right eye, the physician would likely note?

 A

Constriction of the right pupil and constriction of the left

 B

Constriction of the right pupil and dilatation of the left

 C

Dilatation of the right pupil and constriction of the left

 D

Dilatation of the right pupil and dilatation of the left

Q. 4

A 45-year-old female with a long history of progressive myopia develops sudden patchy loss of vision in her right eye. She is very alarmed and rushes to her family doctor. Funduscopic examination reveals a large retinal detachment in the right eye. The retina in the left eye is normal. When the pupillary light reflex is tested by shining a light in the right eye, the physician would likely note?

 A

Constriction of the right pupil and constriction of the left

 B

Constriction of the right pupil and dilatation of the left

 C

Dilatation of the right pupil and constriction of the left

 D

Dilatation of the right pupil and dilatation of the left

Ans. D

Explanation:

This patient is exhibiting the Marcus-Gunn phenomenon. When light strikes the retina, the pupillary light reflex is automatically triggered, leading to simultaneous constriction of both pupils. In the absence of adequate light entering the eye, for example following retinal detachment or optic neuritis, paradoxical dilatation of the pupils occurs. The retina receives far less light than it normally would, and the pupils dilate in order to absorb as much light as possible.

 


Q. 5

In a town of population 5000, 500 are already myopic on January 1, 2011. Number of new myopia cases is 90 till December 31, 2011. Calculate incidence of Myopia in the town in 2011-

 A

0.018

 B

0.02

 C

0.05

 D

18

Q. 5

In a town of population 5000, 500 are already myopic on January 1, 2011. Number of new myopia cases is 90 till December 31, 2011. Calculate incidence of Myopia in the town in 2011-

 A

0.018

 B

0.02

 C

0.05

 D

18

Ans. B

Explanation:

Ans. is `b’ i.e., 0.02 


Q. 6

Treatment modalities for myopia are:

 A

Radial keratotomy

 B

LASER Keratomileusis

 C

Epikeratophakia

 D

a and b

Q. 6

Treatment modalities for myopia are:

 A

Radial keratotomy

 B

LASER Keratomileusis

 C

Epikeratophakia

 D

a and b

Ans. D

Explanation:

A i.e. Radial keratotomy; B i.e . LASER keratomileusis 


Q. 7

A 20 year student has a myopia of -2.0 D and a post traumatic nebular corneal opacity in her right eye. Which of the following is the best refractive surgery option of her?

 A

Photorefractive keratectomy

 B

LASIK.

 C

Radial keratotomy

 D

Epikeratoplasty

Q. 7

A 20 year student has a myopia of -2.0 D and a post traumatic nebular corneal opacity in her right eye. Which of the following is the best refractive surgery option of her?

 A

Photorefractive keratectomy

 B

LASIK.

 C

Radial keratotomy

 D

Epikeratoplasty

Ans. D

Explanation:

D i.e. Epikeratoplasty 

Epikeratoplasty or Lamellar Keratoplasty

It is a surgical procedure in which a lens made of human corneal tissue is sutured on to the anterior surface of the cornea to change the anterior curvature & hence refractory properties of cornea. In this the greater part of corneal epithelium is removed, except for small central area that contain the visual axis. It is indicated in correction of refractory error along with‑

–  Corneal scar, so long as the visual axis is not involved.

U/L traumatic aphakia

Aphakic pediatric patients. Compliance with optical & occlusive therapy is a major problem for the ophthalmologist & family of a unilateral aphakic child. For such children epikeratoplasty & secondary IOL implantations are the only alternative & are procedure of choice.

Children over 1 year age for unilateral aphakia in which contact lenses are not possible because of intolerance or socioeconomic conditions.

B/L aphakia for which spectacle therapy has been unsuccessful, it may be used to minimize risk of amblyopia.

* Haze or scar formation of cornea may occur after photorefractive keratectomy which is treated by surgical removal of scar by excimer laser.


Q. 8

Which of the following is used for treatment of myopia:

 A

Nd: YAG laser

 B

Excimer laser

 C

Argon laser

 D

Holmium laser

Q. 8

Which of the following is used for treatment of myopia:

 A

Nd: YAG laser

 B

Excimer laser

 C

Argon laser

 D

Holmium laser

Ans. B

Explanation:

Ans. Excimer laser


Q. 9

Radial keratotomy corrects myopia by causing:

 A

Steepening of cornea

 B

Flattening of cornea

 C

Shortening of cornea

 D

Pin-hole effect

Q. 9

Radial keratotomy corrects myopia by causing:

 A

Steepening of cornea

 B

Flattening of cornea

 C

Shortening of cornea

 D

Pin-hole effect

Ans. B

Explanation:

Ans. Flattening of cornea


Q. 10

Haemorrhage at macular spot in high myopia is called:

 A

Lacquer’s lines

 B

Foster-Fuchs fleck

 C

Dalen-Fuchs nodules

 D

Berlin’s oedema

Q. 10

Haemorrhage at macular spot in high myopia is called:

 A

Lacquer’s lines

 B

Foster-Fuchs fleck

 C

Dalen-Fuchs nodules

 D

Berlin’s oedema

Ans. B

Explanation:

Ans. Foster-Fuchs fleck


Q. 11

Which is the most common complication of high myopia:

 A

Glaucoma

 B

Cataract

 C

Haemorrhage

 D

Retinal detachment

Q. 11

Which is the most common complication of high myopia:

 A

Glaucoma

 B

Cataract

 C

Haemorrhage

 D

Retinal detachment

Ans. D

Explanation:

Ans. Retinal detachment


Q. 12

Presently surgical treatment of choise in a 22 year male with – 10D myopia is

 A

Phakic refractive lens

 B

Refractive lens exchange

 C

Wavefront guided LASIK

 D

LASIK with femtosecond laser

Q. 12

Presently surgical treatment of choise in a 22 year male with – 10D myopia is

 A

Phakic refractive lens

 B

Refractive lens exchange

 C

Wavefront guided LASIK

 D

LASIK with femtosecond laser

Ans. A

Explanation:

Ans.

Phakic refractive lens


Q. 13

Laser used in LASIK for correcting myopia:

September 2005, March 2007 & 2009

 A

Excimer

 B

Xenon

 C

Nd:Yag

 D

None of the above

Q. 13

Laser used in LASIK for correcting myopia:

September 2005, March 2007 & 2009

 A

Excimer

 B

Xenon

 C

Nd:Yag

 D

None of the above

Ans. A

Explanation:

Ans. A: Excimer

Laser-assisted in situ keratomileusis/LASIK with the excimer laser is the most popular and widely accepted treatment modality among all the choices for correcting myopia.

Surgical treatment is undertaken in individuals 21 years of age and above who have a stable refractive error, who have had unsatisfactory results with non-surgical treatment, and in whom corneal thinning disorders that lead to curvature myopia such as keratoconus have been ruled out.

An excimer laser typically uses a combination of an inert gas (Argon, krypton, or xenon) and a reactive gas (fluorine or chlorine).


Q. 14

True statement regarding myopia:       

September 2006

 A

Parallel rays comes to focus posterior to the retina

 B

Parallel rays comes to focus anterior to the retina

 C

An abnormal shortness of the axial length of the eye

 D

Newborns eye is myopic

Q. 14

True statement regarding myopia:       

September 2006

 A

Parallel rays comes to focus posterior to the retina

 B

Parallel rays comes to focus anterior to the retina

 C

An abnormal shortness of the axial length of the eye

 D

Newborns eye is myopic

Ans. B

Explanation:

Ans. B: Parallel rays comes to focus anterior to the retina

In people with myopia, the eyeball is too long or the cornea has too much curvature, so the light entering the eye is not focused correctly. Light rays of images focus in front of the retina, the light-sensitive part of the eye, rather than directly on the retina, causing blurred vision.

Myopia runs in families and usually appears in childhood. Sometimes the condition plateaus, or sometimes it worsens with age.


Q. 15

Patient with open angle glaucoma with 71) of myopia, complains of blurring of vision on administration of pilocarpine. What is the reason for the blurring?

 A

Small pupil

 B

Increased myopic asymmetry

 C

Increased hypermetropic asymmetry

 D

Increased astigmatism

Q. 15

Patient with open angle glaucoma with 71) of myopia, complains of blurring of vision on administration of pilocarpine. What is the reason for the blurring?

 A

Small pupil

 B

Increased myopic asymmetry

 C

Increased hypermetropic asymmetry

 D

Increased astigmatism

Ans. A

Explanation:

Ans. is ‘a’ i.e., Small pupil

Pilocarpine

  • Pilocarpine induces contraction of the ciliary muscles and results in accommodation and ensuing fluctuating myopia.
  • Pilocarpine is a miotic and thus results in the pin point pupils. This leads to decreased amount of light entering the eyes and thus worsens night blindness and also causes contraction of the peripheral visual field.
  • Thus we can say that pilocarpinewosens the myopia in an already myopic patient and causes blurring of vision due to miosis (small/ pin point pupils, contraction of the ciliary muscles.
  • It also causes decreased visual acuity in the patients with axial lens opacities.

Q. 16

Maximum correction of myopia can be done by ‑

 A

Radial keratotomy

 B

LASIK

 C

Photorefractive keratotomy

 D

Orthokeratology

Q. 16

Maximum correction of myopia can be done by ‑

 A

Radial keratotomy

 B

LASIK

 C

Photorefractive keratotomy

 D

Orthokeratology

Ans. B

Explanation:

Ans. is ‘b’ i.e., LASIK

  • Amongst the given options, maximum correction can be achieved by LASIK.
Surgical ocedure

Myopia orrection

Radial keratomy  -2 to -6 D 
Photorefractive keratotomy  -2 to -6 D 

LASIK

Upto -12D 

Extraction of lens

-16 to -18 D 

Phakic IOL

> -12 D

Interconaeal ring (ICR

1-6 D

Orthokeratology

upto – 5D


Q. 17

Refractive surgeries for Myopia are all except

 A

Radial keratotomy

 B

 LASIK

 C

Photorefractive keratotomy

 D

Holium laser thermoplasty

Q. 17

Refractive surgeries for Myopia are all except

 A

Radial keratotomy

 B

 LASIK

 C

Photorefractive keratotomy

 D

Holium laser thermoplasty

Ans. D

Explanation:

Ans. is ‘d.’ i.e., Holium laser thermoplasty 


Q. 18

Refractive surgery most commonly performed formyopia ‑

 A

Radial keratotomy

 B

LASIK

 C

Photorefractive keratectomy

 D

Lensectomy

Q. 18

Refractive surgery most commonly performed formyopia ‑

 A

Radial keratotomy

 B

LASIK

 C

Photorefractive keratectomy

 D

Lensectomy

Ans. B

Explanation:

Ans. is ‘b’ i.e., LASIK

Treatment of myopia

  • a Treatment includes non-surgical or surgical methods.
  1. Non-surgical: – Most commonly used method for treatment of myopia is correction by concave (divergent or minus) lens. These may be spectacles (most commonly used method for low myopia i.e., < -3D) or contact lens. Keep in mind that though most commonly used method is spectacles, the preferred treatment is contact lens.
  2. Refractive surgery : – The most common procedures are performed with an excimer laser. LASIK is the most commonly used procedure.
  3. Orthokeratology : – is a non-surgical procedure where special contact lenses are worn that slowly reshape the cornea over time to correct myopia.
  • High myopia is defined as myopia > -6 D. Treatment of choice for high myopia is contact lens. LASIK is an alternative


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