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1. A 7 day-old newborn develops a unilateral discharge on his right eye.

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

3. These statement about pigmentary glaucoma is true, except


a. There is pigmented line anterior to schwalbe’s line which often refferred to
sampaolesi’s line
b. A vertical spindle pattern on the corneal endothelium which called krukenberg
spindle
c. Zentmayer’s line on the lens capsule
d. Characteristic spokelike loss of the iris pigment epithelium
e. The signs and symptoms may decrease with age

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

6. In the CNTG, Collaborative Normal Tendion Glaucoma Treatment Study,


progression of patients with NTG was reduced by nearly threefold by a reduction
in IOP of
a. 10%
b. 20%
c. 30%
d. 40%
e. 50%

7. Screening for glaucoma based solely on IOP > 21 mmHg


a. May miss up to half of the people with glaucoma in the screened population
b. Is a good strategy because glaucomatous damage is caused exclusively by
pressures that are higher than 21 mmHg
c. Is effective because IOPs is a population have a gaussian distribution
d. Is effective because a clear line exists between safe and unsafe IOP
e. IOP diurnal fluctuation of grater than 6 mmHg is suggestive glaucoma

8. Which of the following preoperative measures has proven most effective in


reducing the risk of endophthalmitis?
a. Administering oral amoxicillin 3 days before surgery
b. Prescribing topical antibiotics for 1 weeks following surgery
c. Decreasing the duration of surgery
d. Administering topical 5% povidone iodine solution at the time of surgery
e. Injecting vancomycin into the irrigating solution

9. True about Intra Capsular Cataract Extraction except


a. CME is more common than ECCE
b. Retinal detachment is more common than ECCE
c. Safe for people under 40 years of age
d. Endothelial cell loss is greater than ECCE
e. Have larger incision than ECCE

10. Treatment of visually threatening ocular toxoplasmosis should include which of


the following
a. Amphotericin B
b. Periocular corticosteroid injection
c. Pyrimethamine and sulfonamides
d. acylovir
e. Photocoagulation therapy
11. Streak retinoscopy was perfomed on a 3 years japanese old boy. Working distance
was 67 cm. You find with the movement sweeping the 180 meridian and against
movement sweeping 90 meridian. The power cross is

-2D

What is the correct spectacle prescription? +3D


a. +3.50-5.00x180
b. -3.50+1.50x180
c. -2.00 +5.00x180
d. +1.50 -5.00x180
e. +1.50 -5.00x90

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

10. C (BCSC 9 p 168)


Loading dose 150 mg pyrimethamine followed by 25 mg daily for 6 weeks, with
loading dose of 4 g sulfadiazine followed by 1 g four times a day for 6 weeks.
Give folinic acid (prevents leukopenia+thrombocytopenia)
Clindamycin 300mg 4x/d
Pregnant à spiramycin+sulfadiazine

11. D -2D (-3.50D)

+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

2. These appropriate therapy for this patient are true:


1. Ceftriaxone
2. Azithromycin
3. Minocyclin
4. Tetracyclin

3. The causes of neonatal bacterial conjunctivitis are


as follows :
1. Moraxella catarrhalis
2. H. influenzae
3. N.gonorrhoeae
4. E.cuniculi

4. Lagophthalmus can be caused by


1. Neurogenic diseases such as six nerve palsy
2. Blepharoplasty
3. Keratoplasty
4. Drug abuse

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

8. Modalitas therapy that could be used for these patients are :


1.Iodoxamide tromethamine
2.Topical ketorolac 0.5 %
3.Cyclosporine topical
4.Ceftriaxone

9. The appropriate diagnosis is :


a.Giant papillary conjunctivitis
b.Vernal conjunctivitis
c.Ligneous conjunctivitis
d.Adenoviral conjunctivitis
e.Chlamydial conjunctivitis

10.Corneal hydration involves the following factors, except :


a.Stromal swelling pressure
b.The endothelial pump
c.Evaporation from the corneal surface
d.Extraocular pressure
e.Intraocular pressure
1. 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 diagnosis for this patient are true :
a. Gonoccocal conjunctivitis
b. Chlamydial conjuctivitis
c. Microsporidial conjunctivitis
d. Trachoma
e. Loisiasis
Answer : A ( AAO External Disease and Cornea 2005-6 P.160)
Gonoccocal conjunctivitis is characterized by rapid progression,
copious purulent conjunctival discharge, marked conjunctival
hyperemia and chemosis.
Trachoma, Loisiasis, Microsporidial is a Chlamydial conjunctivitis.
Chlamydial conjunctivitis is characterized by foreign body sensation,
redness, tearing, mucopurulent discharge. ( AAO P. 163)

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)

3. The causes of neonatal bacterial conjunctivitis are as follows :


1. Moraxella catarrhalis
2. H. influenzae
3. N.gonorrhoeae
4. E.cuniculi
Answer : A 1,2,3 true ( AAO External Disease and Cornea 2005-6 P.161)
The causes of neonatal bacterial conjunctivitis are as follows :
- Chlamydia trachomatis
- Streptococcus viridans
- Streptococcus aureus
- Haemophilus influence
- Group D Streptococcus
- Moraxella catarrhalis
- E.Coli
- Neisseria gonorrhea
4. Lagophthalmos can be caused by
1. Neurogenic diseases such as six nerve palsy
2. Blepharoplasty
3. Keratoplasty
4. Drug abuse
Answer : C 2,4 true ( AAO External disease and cornea 2005-6 P.87)
Lagopthalmos can be caused by following :
- Neurogenic diseases such as seventh nerve palsy
- Degenerative neurologic conditions such as Parkinson disease
- Cicatricial or restrictive eye lid disease such as ectropion
- Blepharoplasty
- Drug abuse

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)

8. Modalitas therapy that could be used for these patients are :


1.Iodoxamide tromethamine
2.Topical ketorolac 0.5 %
3.Cyclosporine topical
4.Ceftriaxone
Answer : A 1.2.3 true(AAO External disease and cornea 2005-6 P.197)
Ceftriaxone is a appropriate therapy for Gonococcal conjunctivitis
(AAO P.160)

9. The appropriate diagnosis is :


a.Giant papillary conjunctivitis
b.Vernal conjunctivitis
c.Ligneous conjunctivitis
d.Adenoviral conjunctivitis
e.Chlamydial conjunctivitis
Answer : B. Vernal conjunctivitis
(AAO External disease and cornea 2005-6 P.197)

10. Corneal hydration involves the following factors, except :


a.Stromal swelling pressure
b.The endothelial pump
c.Evaporation from the corneal surface
d.Extraocular pressure
e.Intraocular
Answer : D. Extraocular (AAO External disease and cornea 2005-6 P.395)

Corneal hydration involves the following factors, except :


1.Stromal swelling pressure
2.The endothelial pump
3.Evaporation from the corneal surface
4.Intraocular pressure

1. These statements are true about endotel cornea except :


a. Cell density fewer than 1000 cells/mm2 might not tolerate intraocular
surgery
b. Donor corneas for transplantation should have at least 2000 cells/mm2
c. Polymegethism (Coefficient of variation greater than 0,40) might not
tolerate intraocular surgery
d. Pleomorphism (percentage of hexagonal cells less than 50%) might not
tolerate intraocular surgery
e. Normally concentration is highest in the central of the cornea

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

2. These are true about corneal donor except:


a. The McCarey Kaufman tissue is the transport medium
b. Corneal button safely transplanted after being stored for up to 4 days at
40 C
c. Most eye banks establish a lower age limit of 24 months and an upper
age limit of 70 years
d. Death to preservation time < 12-18 hours
e. There is a reduction in the incidence of rejection with the use of HLA
matched or cross matched tissue

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

a. Topical miconazol 1% (10mg/mL) is the agent of choice to combat


Paecilomyces lilacinus;p175
b. Oral fluconazole 200-400 mg/day for severe yeast keratitis;p175
c. Chlorhexidine topical 0,02% initial therapy for acanthamoeba keratitis;p178
d. Propamidine isethionate 0,1% is a combination therapy for acanthamoeba
keratitis;p178
e.Natamycin 5% suspension is recommended for treatment of most cases of
filamentous fungal keratitis, particularly those cause by Fusarium spp;p175

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

SLK is achronic, 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 1-10 years. The condition usually resolves spontaneously. It is often
bilateral,although one eye may be more severely affected than other;p89.
Patients with SLK should have thyroid function test including T4,TSH, and
antithyroid antibody levels;p90.
Treatments include chemical cauterization of superior bulbar conjungtiva and
superior tarsal conjungtiva with 0.5%-1% silver nitrat solution;p90

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

C. trachomatis can be demonstrated by immunodiagnostic methods or culture


isolation using McCoy cells and others.p;118
Topical tetracycline 1% or erythromycin ointment should be administered twice
daily for 2 months.p;164
Left untreated, adult chlamydial conjungtivitis often resolves spontaneously 6-
18 months.p;165
Currently, one of the following antibiotic regimen is recommended:
- Oral tetracycline 250 mgqid for 3 weeks.
- Doxycycline 100 mg bid for 3 weeks.
- Oral erythromycin 500 mg qid for 3 weeks.

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

The most important step in the management of chemical injuries is immediate


and copious irrigation of ocular surface with water or normal saline solution.p;367
There is currently no widely accepted standart for administration of ascorbate to
corneas after chemical injury, but one recommendation is for patiens to receive 2
grams of oral ascorbic acid(vitamin C) per day.p;368
Corticosteroids are excellent inhibitors of PMN function, and intensive topical
steroid administration is recommended for the acute phase(first 2 weeks) following
chemical injuries.p;368.
Topical cycloplegics are recommended for patients with significant anterior
chamber reaction.p;368

8. These statements about the cornea are false except


1. Cornea has a little elasticity and streches only 0,5% at normal IOP
2. Water content of the corneal stroma at 87%
3. The corneal epithelium have 0,05 m thickness
4. Refractive index is 1,367
5. The major corneal proteoglican is decorin and lumican

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

a. Refractive Index is 1,336.p;49


b. Produced at rate 1.2 l/minute.p;49
c. Cranial nerve V is the afferent pathway in the reflex tear arc.p;49
d. The aqueous layer transports all of water- solube nutrients, and aqueous
tear deficiency (ATD) is most common cause of dry eye.p;48
e. Precorneal tear volume is 7,0 l in precorneal film.p49

10. False about corneal degeneration


1. Opacity located centrally
2. Usually Slow progression
3. Hereditary
4. Presents later in life

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

1. Which of the criteria are true for atopic dermatitis :

1. A personal or family history of atopic disorders

2. Lession on the eyelid, face and extensor surfaces in adult

3. History of aspirin hypersensitivity

4. Acute conjunctivitis

Jawaban : B (AAO BCSC 8 p. 195)

Criteria for atopic dermatitis :

1. A personal or family history of atopic disorders

2. Lession on the eyelid, face and extensor surfaces in infant and young children

3. History of aspirin hypersensitivity

4. Chronic conjunctivitis

2. Uncommon organism who causes the bacterial keratitis are :

1. Pseudomanas aeruginosa

2. Moraxella species

3. Streptococcus species

4. Corynebacterium species

Jawaban : C (AAO BCSC 8 p. 171)

Uncommon organism :

Neisseria species, Moraxella species, Mycobacterium species, Nocardia species,

Non-spore-forming anaerobes, Corynebacterium species.

Common organism : Pseudomanas aeruginosa, Streptococcus species


3. Corneal findings of apert syndrome is :

A. Exposure keratitis secondary to severe proptosis

B. Sclerocornea

C. Microcornea

D. Flatcornea

E. Megalocornea

Jawaban : E (AAO BCSC 8 p. 333)

Corneal findings of apert syndrome :

- Exposure keratitis with severe proptosis

- Keratoconus

- Megalocornea

Exposure keratitis secondary to severe proptosis & microcornea → Carpeter

Syndrome

Sclerocornea → Hallerman-Streiff-Francois syndrome

Flatcornea → Marian syndrome


4. The classic syndrome of most adenoviral eye diseases presents clinically are :

1. Simple follicular conjunctivitis

2. Pharyngoonjunctival fever

3. Epidemic keratoconjunctivitis

4. Stromal keratitis

Jawaban : A (AAO BCSC 8 p. 131)

Most adenoviral eye disease present clinically as the classic syndromes :

- Simple follicular conjunctivitis

- Pharyngoconjunctival fever

- Epidemic keratoconjunctivitis

5. Conditions that may produce dendritiform epithelial lesions include:

A. Cogan syndrome

B. Sarcoidosis

C. Lyme disease

D. Mumps keratitis

E. Thygeson’s superficial punctuate keratitis

Jawaban : E (AAO BCSC 8 p. 139)

Dendritiform epithelial lesions include :

Varicella-zoster virus, Adenovirus, Epstein-Barr virus, Epithelial regeneration

line, Neurotrophic keratopathy, soft contact lens wear, Topical medications,

Acanthamoeba, Thygeson’s superficial punctuate keratitis, epithelial deposits.

Stromal Keratitis → Cogan syndrome, Sarcoidosis, Lyme disease, Mumps keratitis


6. Keratinized epithelial cells are clinical interpretation of disease, except :

A. Graft versus host disease

B. Vernal conjunctivitis

C. Stevens johnsons syndrome

D. Severe keratoconjunctivitis sicca

E. Ocular cicatricial pemphigoid

Jawaban : B (AAO BCSC 8 p. 191)

Keratinized epithelial cells :

Graft versus host disease, Stevens johnsons syndrome, Severe

keratoconjunctvitis sicca, Ocular cicatrical pemphigoid.

Basophils or mast cells :

Vernal conjunctivitis

7. Conjunctival granuloma is common cause of :

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

C. Alloplastic material addition

D. Laser effect

E. Collagen shrinkage

Jawaban : A (AAO BCSC 8 p. 454)

Keratorefractive surgery can alter corneal biomechanics in several ways :


Tissue addition, incisional effect, Allopastic material addition, Laser effect,
Collagen shrinkage

9. Signs which may be seen during biomicroscopic examination of the contact lens

wearing are :

1. Mild papillary reaction on the superior tarsal

2. Conjunctiva subepithelial erosions

3. Peripheral corneal infiltrates and vascularization

4. Peripheral corneal neovascularization

Jawaban : B (AAO BCSC 8 p. 202)

Biomicroscopic examination of the contact lens wearing :

Mild papillary reaction on the superior tarsal, peripheral corneal infiltrates

and vascularization, punctate epithelial erosions.


10. Predisposing causes of marginal cornea infiltrates associated with

Blepharokonjunctivitis are :

1. Trauma

2. Endophthalmitis

3. Contact lens wear

4. Blepharoconjunctivitis

Jawaban : E (AAO BCSC 8 p. 216)

Predisposing causes of marginal cornea infiltrates :


- Trauma

- Endophthalmitis

- Contact lens wear

- 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

2. Which is true regarding orbital anatomy


a. Lacrimal gland fossa is located within the lateral orbital bone
b. The orbital wall are composed of seven bones; ethmoid, frontal, maxillary,
palatine, nasal,sphenoid and zygomaticus
c. The optic canal is located within the lesser wing of the sphenoid
d. The inferior orbital fissure transmits ophthalmic division of CN V. zygomatic
nerve and branches of inferior ophthalmic vein
e. The sympathetic innervation to the orbit provides for pupillary constriction,
vasoconstiction, smooth muscle function of the eyelid, orbit and hidrosis

3. Compared to CT- Scanning, MRI Scanning provides better:


a. view bone and calcium
b. view of the orbital apex and orbitocranial junction
c. elimination of moving artifact
d. comfort for claustrophobic patients
e. safety to patients with prosthetic implants

4. Which of the following statements about Graves ophthalmopathy as true:


a. Ophthalmopathy generally develops prior to the diagnosis of Thyroid dysfunction.
b. Ophthalmopathy resolves after hypertyroidism is adequately treated
c. Serum T3 and T4 level is a good marker for the intensity of ophthalmopathy
d. Ophthalmopathy may develop eventhough a patients is euthyroid
e. The correction of Thyroid function abnormalities is not important part of te
overall care

5. Which of the following statements is true


1. In Ankyloblepharon, the lower eyelid pretarsal muscle and skin ride above the
lower eyelid margin
2. Epicanthus is medial canthal fold that may result from fold of skin and
subcutaneous tissue
3. Epiblepharon is partial or complete fusion of the eyelid by webs of skin
4. Euryblepharon is a unilateral or bilateral widening of the palpebral tissue

6. This statements are true about Pseudoproptosis


1. True asymmetry of the eye
2. Cause by enlarge globe
3. Cause by ipsilateral eyelid retraction
4. Increased of orbital contents.
7. A 4 year old child is referred for a new onset of bilateral epiphora. Examination shows
on both lower eyelids rubbing against the inferior cornea. The parents state that similar
symptoms occurred in an older sibling but resolved without treatment.
What is the most likely diagnosis:
a. Epiblepharon
b. Entropion
c. Euryblepharon
d. Trichiasis
e. Ankyloblepharon

8. What is the pathophysiologic mechanism underlying the condition in question no 7


a. Laxity of tarsal plate
b. Laxity of the canthal tendons
c. Abnormal attachment of the orbital septum
d. redudancy of skin and pretarsal muscle
e. none of above

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

10. Treatment of this patient should be:


a. Topical and systemic corticosteroid
b. Broad spectrum antibiotic intravena
c. Incision and drainage
d. Antithyroid drugs
e. Biopsy should be perform before treatment.

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

6. Which of the following in the clinical evaluation is most significant to compare


acquired type than congenital type of diagnosis in question 4 ?
1. Upper eyelid crease
2. Levator function
3. Eyelid displacement on downgaze
4. Palpebra fissure height

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

8. The most appropriate management in question 7 :


1. Warm compresses
2. Irrigation
3. Dacryocystorhinostomy
4. Probing

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

1. Resume : Age : 8 yr (child)


Symptoms & Signs : periorbital swelling, vision was normal, RAPD (-),
no proptotic, no pain.
Onset : acute
Key word : periorbital swelling, no proptotic, no pain
Answers : B
Discussion :
a. Orbital cellulitis : is active infection of the orbital soft tissue is present
posterior to the orbital septum. Clinical finding that suggest orbital
cellulitis include fever, proptosis, chemosis, restriction of ocular motility
and pain on movement of the globe. Decrease vision and pupillary
abnormalities suggest involvement of the orbital apex. (Sec 7, 2003/4,
Page 42)
b. Preseptal cellulitis : Commonly occur in children. Clinical finding is
eyelid edema, erythema and inflammation may be severe. Pupillary
reaction, visual acuity and ocular motility are not disturbed. Proptosis
and pain on eye movement are absent. (Sec 7, 2003/4, Page 41)
c. Idiopathic orbital inflammation : Both children and adults may be
afflicted. Typically, patients presents with acute onset of orbital pain,
restricted eye movement and proptotis. Conjungtival injection and
chemosis are common, as are eyelid erythema and soft tissue swelling.
(Sec 7, 2003/4, Page 56)
d. Rhabdomyosarcoma : Most common primary orbital malignancy of
childhood. Average age of onset is 8-10 years. Classic clinical picture is
one of child with sudden onset and rapid evolution of unilateral proptosis.
Restriction of ocular motility and pain on movement of the globe can be
affected with gradual progression of proptotis. (Sec 7, 2003/4, Page 79)
e. Carotid cavernous sinus fistula : Most frequent in younger male after
facial trauma. Characteristic, tortuous epibulbar vessels, proptotis
accompanied by bruit, retrobulbar pain and severe restriction eye
movement. (Sec 7, 2003/4, Page 71)

2. Answer : E (Sec 7, 2003/4, Page 41)


About Preseptal Cellulitis :
a. Commonly occurs in children : Preseptal cellulitis due to haemophilus
influenzae generally occurs in children.
b. The most frequent cause is ethmoidal sinusitis : The thinnest walls of the
orbit are the lamina papyracea. Among the children infection of the
ethmoid sinuses commonly extend through the lamina papyracea to cause
preseptal/orbital cellulitis. ( Page 10, 41 )
c. Imaging studies should be performed : CT of the orbit and sinuses should
proceed quickly to confirm the diagnosis and treatment.
d. Respond to single antibiotic theraphy. Because in children preseptal
cellulitis more often caused by a single organism. In contrast, in adults is
more often caused by multiple organisms, thus antibiotic therapy should
provide broad spectrum.

e. Involvement of the orbital apex. Preseptal Cellulitis is defined as


inflammation and infection confined to the eyelids and periorbital
structure anterior to the orbital septum but orbital structure posterior
uninvolved. Pupillary reaction and ocular motility are not disturbed and
no proptotic suggest uninvolvement of the orbital apex.

3. Resume : Age : 50 years old (adult), sex : woman


Symptoms & signs : erythema and tenderness around the right eye .
Blurred vision, fever. visual acuity was normal, proptotic, fundus normal.
CT demonstrated thickening extraocular muscle and tendons of right
orbital and ethmoid sinuses are clear. Good respons to corticosteroid.
Onset : akut
Key word : CT image : thickening extraoculer muscle with tendon
and ethmoid clear, good respons to corticosteroid.
Answer : C
Discussion :
a. Orbital cellulitis :
Signs : fever, proptosis, chemosis, restriction of ocular motility
and pain on movement of the globe. Orbital cellulitis is a manifestation of
underlying sinusitis in 90 % of cases and ethmoidal sinusitis is the
most common cause. Good respons to initial intervention with
antibiotics. ( Pg 42 )
b. Preseptal cellulitis :
Signs : eyelid edema, erythema and inflammation may be
severe. Proptosis and pain on eye movement are absent. Common
cause is underlying ethmoidal sinusitis. Good respons to initial
intervention with antibiotics. (Pg 41 )
c. Idiopathic orbital inflammation : Typically, patients presents with acute
onset of orbital pain, restricted eye movement and proptotis. A CT scan is
generally standard procedure and reveals thickening of extraocular
muscles and tendons. Initial therapy consists of systemic corticosteroid.
Acute cases generally respond rapidly to corticosteroid. ( Pg 58 )
d. Rhabdomyosarcoma : Most common primary orbital malignancy of
childhood. Presents with sudden onset and rapid evolution of unilateral
proptosis. CT scan : bone destruction is typical. Radiation and systemic
chemotherapy mainstays of treatment. ( Pg 80 )
e. Thyroid orbitopathy : is an autoimmune inflammatory disorder whose
occurs usually in patients with systemic thyroid disease. Although
typically associated with hyperthyroidism, but may accompany
hypothyroidism. The clinical signs, combination of eyelid retraction, lid
lag, proptosis, restrictive extraocular, myopathy and optic neuropathy.
CT scan to show thickening extraocular muscle involvement without
tendon are necessary ( in contrast to idiopathic orbital inflamation with
tendon involvement ). Although a response to steroids could be seen in
the treatment of thyroid related orbitopathy, the CT findings make thyroid
related orbitopathy a unlikely diagnosis. ( Pg 48 )

4. Resume : Age : 70 years old (older)


Symptoms & signs : droopy eyelids, superior fields defect and difficulty
for reading, pupillary reaction normal and marginal reflex distance is
1 mm. Tensilon test (-)
Key word : droop eyelids, difficulty for reading, pupillary normal, tensilon
test (-),older
Answer : D
a. Myastenia gravis : droopy eyelids that seems to worsen when the
individualis fatigue or prolonged upgaze, diplopia, no pupillary
abnormalities. Tensilon test positive suggest MG. ( Pg 209, 214)
b. Dermatochalasis : complaints of droop eyelid with heavy feeling around
the eyes, brow ache, eyelash in the visual axis and reduction in the
superior visual field. Unlikely to cause problems with reading . More
common in older but can also occur in middle age people. ( Pg 224)
c. Cranial nerve III palsy : manifested as droop eyelid together with
inability to elevate, depress or adduct the globe. The pupils may also
dilated. Onset commonly occur congenital. ( Pg 211 )
d. Blepharoptosis : droop eyelid, appearance of malaise. Not only lose the
superior field defect but also note visual impairment in down gaze, so
result difficulty for reading. The age risk is older. ( Pg 205)
e. Horner’s syndrome : characteristic, droop eyelid, pupil anisocoria,
anhidrosis and decreased pigmentation of the iris. Both congenital and
older may be affected. ( Pg 213)

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

Congenital ptosis Acquired ptosis

Upper eyelid crease Weak or absent crease in Higher than normal


normal position
Levator function Reduced Near normal
Eyelid displacement on Eyelid lag Eyelid drop
downgaze
Palpebra fissure height Mild to severe ptosis Mild to severe ptosis

7. Resume : Age : 60 year old (adult)


Symptom & signs : tearing and pain in her right eye, history of trauma or
surgery of the eyelids, nose or sinuses. Painful red lump near the right
inner canthus, erythematous swelling over the right lacrimal sac. Purulent
material was expressed when pressure was applied over the right lacrial
sac,vision was normal.
Onset : acute
Key word : adult, tearing with purulent, inflammation sign (+)
Answer : D
1. Nasolacrimal duct obstruction : Caused of the membranous block of the valve of
Hasner, the most common in infant with the clinical feature tearing with mucous
material. Most obstruction open spontaneously within 4-6 weeks after birth.
( Pg 257 )

2. Canaliculitis : Caused by a variety of organism. The patiens presents with


persistent weeping sometimes accompanied by follicular conjunctivitis in medial
canthus. The punctum was open and pouting, purulent discharge. Milking or
yellow cheesy material may be expressed from canaliculus. ( Pg 272 )
3. Dacryocystocele : Presents as dilated lacrimal sac at birth caused fluid or mucus
is trapped in the tear sac without of inflammatory signs. ( Page 255 )
4. Dacryocystitis : Caused by primary and secondary nasolacrimal duct obstruction
in adults. Incidence higher in adult people, a female than male (3:1) and in
individu with a narrow face and flat nose. Tearing with purulent discharge is
the most common presentation. In more cases, there is warm, tender and
swollen pyocele ( Page 275 )

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. Can be performed on intraocular malignancy cases : Should be considered only


if the presence of an intraocular malignancy has been rule out. Enucleation
is indicated for primary intraocular malignancies ( Page 119)
2. Less disruption of orbital anatomy )
3. Allow complete specimen for pathologic examination : evisceration affords a
less complete specimen, while enucleation allow for the complete specimen.
( Page 119)
4. Technically simpler procedure
GLAUKOMA

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

2. The diagnosed in these is


a. Phacolytic glaucoma
b. Phacoanaphylaxis glaucoma
c. Phacomorphic glaucoma
d. Lens particle glaucoma
e. Ectopia lentis

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

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

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

10. Treatment of choice in this case is:


a. Glycerin oral
b. Pilocarpine Hcl 10%
c. Timolol Maleat 0.5%
d. Acetazolamide oral
e. Laser iridectomy
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

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.

10. Treatment of choice in this case is:


a. Glycerin oral
b. Pilocarpine Hcl 10%
c. Timolol Maleat 0.5%
d. Acetazolamide oral
e. Laser iridectomy

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

3. Laser trabeculoplasty (LTP) effectively reduces IOP in patient with :


A. Neovascular glaucoma
B. Pigmentary glaucoma
C. Iridocorneal endothelial (ICE)
D. Developmental glaucoma
E. Inflammatory glaucoma

4. Late complication of filtering surgery is :


A. Cataract
B. Loss of vision
C. Persistent uveitis
D. Choroidal effusion
E. Cystoid macular edema

5. Which of the following is not associated with exfoliation syndrome :


A. Earlier cataract formation
B. Higher incidence of vitrous loss during cataract surgery
C. Spontaneous lens dislocation
D. Most commonly between the ages of 20 and 50 years
E. Basement membrane disorder

6. The iridocorneal endothelial (ICE) syndrome include all of the following :


1. Chandler syndrome
2. Iris nevus syndrome
3. Essential iris atrophy
4. Axenfeld-Rieger syndrome

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

8. Which of the following statements is true of apraclonidine:


1. It causes systemic hypertension
2. It decrease episcleral venous pressure
3. It is an alpha-1 adrenergic agonist
4. It decrease aquous production.
9. Which of the following are associated with inflammatory open-angle glaucoma :
1. Herpes zoster iridocyclitis
2. Toxoplasmosis
3. Herpes simplex keratouveitis
4. Rheumatoid arthritis

10. Axenfeld-Rieger syndrome :


1. Is unilateral
2. Is approximately 50% of case are associated with glaucoma
3. Is most common autosomal resesif inheritance pattern
4. Is the result of abnormal development of tissues derived from the neural crest
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

Answer : C (AAO section 10, 2005-2006, page 136-138)


ICE syndrome is a group of disorders characterized by abnormal corneal
endothelium that causes variable degrees of iris atrophy, secondary angle-closure
glaucoma, & corneal edema. The condition is clinically unilateral, present between
20 qnd 50 years of age, and occurs more often in women. High PAS are
characteristic of ICE syndrome. Progressive iris atrophy is characterized by severe
iris athropy resulting in heterochromia, corectopia, ectropion uveae, iris stromal and
pigment epithelial atrophy, & hole formation.
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

Answer : E (AAO section 10, 2005-2006, page 138)


Therapy ICE is directed toward the corneal edema and secondary glaucoma.
Hypertonic saline solutions and medications to reduce the IOP. The angle-closure
glaucoma can be treated medically with aquous suppressants. When medical
therapy fails, filtering surgery can be effective. Active intraocular inflammation is
not associated with an ICE syndrome, topical corticosteroid therapy would not help.

3. Laser trabeculoplasty (LTP) effectively reduces IOP in patient with :


A. Neovascular glaucoma
B. Pigmentary glaucoma
C. Iridocorneal endothelial (ICE)
D. Developmental glaucoma
E. Inflammatory glaucoma

Answer : B (AAO section 10, 2005-2006, page 180-181)


LTP effectively reduces IOP in patient with POAG, pigmentary glaucoma &
exfoliation syndrome. LTP not advised in patient with neovascular glaucoma, ICE,
developmental glaucoma, inflammatory glaucoma.

4. Late complication of filtering surgery is :


A. Cataract
B. Loss of vision
C. Persistent uveitis
D. Choroidal effusion
E. Cystoid macular edema

Answer : A (AAO section 10, 2005-2006, page 193)


Late complications of filtering surgery include leakage or failure of the filtering
bleb, cataract, blebitis, endophthalmitis/bleb infection, symptomatic bleb
(dysesthetic bleb), bleb migration, hypotony. Loss of vision, persistent uveitis,
choroidal effusion, CME are early complications of filtering surgery.

5. Which of the following is not associated with exfoliation syndrome :


A. Earlier cataract formation
B. Higher incidence of vitrous loss during cataract surgery
C. Spontaneous lens dislocation
D. Most commonly between the ages of 20 and 50 years
E. Basement membrane disorder

Answer : D (AAO section 10, 2005-2006, page 100)


Exfoliation syndrome occurs most commonly in individuals over the age of 70

6. The iridocorneal endothelial (ICE) syndrome include all of the following :


1. Chandler syndrome
2. Iris nevus syndrome
3. Essential iris atrophy
4. Axenfeld-Rieger syndrome

Answer : A (AAO section 10, 2005-2006, page 136)


ICE syndrome include Chandler syndrome, essential/progressive iris atrophy, iris
nevus/Cogan-Reese syndrome.

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

Answer : B (AAO section 10, 2005-2006, page 154)


Sturge-Weber syndrome is usually unilateral, there is no race or gender predilection
& no inheritance pattern. Glaucoma occurs in 30-70% of patients

8. Which of the following statements is true of apraclonidine:


1. It causes systemic hypertension
2. It decrease episcleral venous pressure
3. It is an alpha-1 adrenergic agonist
4. It decrease aquous production.

Answer : C (AAO section 10, 2005-2006, page 161)


Apraclonidine lowers IOP by decreasing aquous production & episcleral venous
pressure. Systemic side effects of apraclonidine include hypotension, vasovagal
attack, dry mouth and nose, fatigue. Apraclonidine is selective alpha-2 adrenergic
agonist.

9. Which of the following are associated with inflammatory open-angle glaucoma :


1. Herpes zoster iridocyclitis
2. Toxoplasmosis
3. Herpes simplex keratouveitis
4. Rheumatoid arthritis
Answer : E (AAO section 10, 2005-2006, page 107)
Uveitides commonly associated with open-angle inflammatory glaucoma include
herpes zoster iridocyclitis, herpes simplex keratouveitis, toxoplasmosis, rheumatoid
arthritis, & pars planitis. .

10. Axenfeld-Rieger syndrome :


1. Is unilateral
2. Is approximately 50% of case are associated with glaucoma
3. Is most common autosomal resesif inheritance pattern
4. Is the result of abnormal development of tissues derived from the neural crest

Answer : C (AAO section 10, 2005-2006, page 152)


Axenfald-Rieger syndrome is bilateral congenital anomalies. It has an autosomal
dominant inheritance pattern in most case. Approximately 50% of case are
associated with glaucoma. Axenfeld-Rieger syndrome is the result of abnormal
development of tissues derived from the neural crest