RECALLS: OPTHALMOLOGY Quiz # 2
DR. Sipin
QUESTIONS
1. A 1 month old with tearing (right eye) since birth. On
evaluation, infant is thriving, no avoidance to light,
eyelid is in good position. When you push the right
medial canthus, you note mucoid material into the
right eye. What would you discuss with the mother?
2. Which of the following will present with severe pain?
CHOICES/ANSWERS
A. the child need surgery to open tear
duct
B. Condition is due to extra roll of skin on
the lower eyelid
C. Condition will resolve with time
D. Antibiotic is needed to be prevent
infection
Note; According to Dr. Sipin, it’s a case of
congenital Nasolacrimal duct obstruction,
it should be observe for 1 year and after
that if no improvement, subject patient to
Surgery.
A. Conjunctival laceration
B. Subconjunctival hemorrhage
RATIONALE
Congenital Nasolacrimal Duct Obstruction
Canalization of the distal nasolacrimal duct normally
occurs before birth or during the first month of life,
with as many as 30% of infants having epiphora
during this time. Approximately 6% have more
prolonged symptoms, of which the majority will also
resolve aided by lacrimal sac massage and treatment
of episodes of conjunctivitis with topical antibiotics.
Nasolacrimal probing is usually curative in the
remainder and is best deferred until about 1 year of
age.
In infantile dacryocystitis the site of obstruction is
usually a persistent membrane covering the valve of
Hasner. Failure of canalization of the nasolacrimal
duct occurs in up to 87% of newborns, but it usually
becomes patent at the end of the first month of life in
90% of neonates. Chronic dacryocystitis is more
common than acute dacryocystitis, but prompt and
aggressive treatment of acute dacryocystitis should
be instituted because of the risk of orbital cellulitis.
Conjunctival laceration, Subconjunctival hemorrhage
and CRAO are “painless”
CRAO- emergency

3. Firm, dense plates of connective tissue that serves as
structural support of the eyelid?
4. The definitive management of acute angle closure
glaucoma?
5. Most common cause of eyelid retraction
6. A construction worker experienced eye pain after
working with metals. He feel a foreign body in his eye.
What will you do first before administering anesthesia?
7. Initial management of capillary hemangioma in
children, except?
8. Most important management of for chemical burns?
C. Corneal Abrasion Cornea has a lot of nerves sensation
D. CRAO
Tarsus Tarsal plate is a fibrous structure that give support to
upper and lower lids. Within this structure, you can
find the Meibomian gland which produces the oily
layer of the hair bed.
A. Acetazolamide The initial management for AACG is to lower the IOP
Acetazolamide (topical beta –blocker). IV mannitol
B. IV mannitol can also be used to lower the IOP.
C. Topical anti-glaucoma medication Topical anti-glaucoma medication includes your
D. Laser iridotomy (not sure) diuretic, beta -blocker, etc. Hence making it the
medical management as the definitive management
for AACG.
The Definitive treatment of AACG is surgery (ex.
Iridotomy), If medical management fail, do surgery. –
emedicine.medscape.
Thyroid eye disease Pls. see # 18 rationale.
A. Visual acuity Remember: the first thing to do in all Opthamologic
cases is do your Visual acuity, except in cases of your
B. Do funduscopy “true Opthalmic Emergencies Severe Chemical burn in
C. Check extraocular muscles which it need a prompt management right away by
irrigation ”- Dr. Sipin
D. Gonioscopy
Immediate excision Capillary hemangiomas regress spontaneously.
A. Analgesic Severe Chemical burn as True ophthalmic emergency
is irrigated first to remove the insulting chemical
B. Antiglaucoma agent, this is even done before any ocular testing.
C. Topical anesthetics Topical anesthetics can be given prior to irrigation.
D. Topical steroids Topical steroid and analgesic are also management
for Chemical burns.
E. Copious irrigation of saline
 solution to injury
9. Proptosis may be due to? A. Acute intracranial pressure
B. Preseptal cellulitis
C. Thyroid orbitopathy
D. Nota
Note: if the choices includes AOTA, it
should be the answer,
10. Basal cell carcinoma is commonly found in? A. Upper eyelid
B. Lower eyelid
C. Near median canthus
D. Lateral canthus
11. Fibrous outer layer, made up of collagen, continuous A. Tenon’s capsule
anteriorly with the cornea, posteriorly with the optic
nerve? B. Sclera
C. Conjunctiva
D. Bowman’s capsule
12. True of Orbicularis oculi, EXCEPT? A. Supplied by CN VII
B. Protractor of the eye
C. Depresses the eyelid
D. Supplied by CN III
E. AOTA
13. True of Orbicularis oculi? A. Supplied by CN VII
B. Protractor of the eye
C. Depresses the eyelid
Thyroid orbitopathy causes proptosis. Most cases of
proptosis in children is due to orbital cellulitis.
Preseptal cellulitis when complicate can lead to
proptosis. Bilateralproptosis can be seen also in cases
of neuromas, and othe tumor with increased
pressure. Intrcanial hypertension can cause Proptosis
Basal cell CA account for majority of malignant
tumors, commoly found on the lower median canthus.
SCC is found on the lower eyelid as well, while
Sebaceous gland and Merkel cell are located in the
upper eyelids.
The Sclera, also known as the white of the eye, is the
opaque, fibrous, protective outer layer containing
mainly collagen and some elastic fibers. Anteriorly it
continuous with the cornea and optic nerve
posteriorly.
The Orbicularis Oculi muscle serves to close the
eye/protractor by depressing the eyelids. It is
innervated by the temporal and zygomatic branches
of the Facial nerve (CN VII).
Refer to #12 rationale
 D. AOTA

14. Acute infection of the sebaceous secretions in the A. Chalazion A Chalazion can developed when the Meibomian
glands of Zeis or Meibomian glands? gland at the edge of the eyelid becomes block or
B. Hordeolum inflamed. It is usuall a slow-growing lump that is non-
C. Floppy eyelid painful affecting the upper lid.

D. blepharoptosis Hordeolum is acute focal infection f involving either

the gland of Zeis (External hordeola/ Sty) or the less
frequent Meibomian gland (Internal hordeola). Usually
upper lid.

Floppy eyelid syndrome is non-infectious

unilateral/bilateral papillary conjunctivitis

Blepharoptosis is an abnormal low-lying upper eyelid

margin.

15. The cause of naso-lacrimal duct obstruction? A. Trauma delivery Nasolacrimal duct obstruction is usually cause by
persistence of a membrane in the distal valve of
B. Membranous Hasner, not allowing it to open near the time of birth
C. … hasner (this is the most common cause).

Note: if the question is most common, Congenital causes:

the answer is C, however if causes, look  NLD obstruction, Hasner’s delayed opening,
for the provided causes. Cranio-facial anomalies, agenesis.

Acquired:

 Primary and secondary obstruction (tumors

and trauma)

 Nasal conditions (severe Deviated septum or

turbinate hypertrophy).

16. True for CRAO? A. White retina CRAO: sudden onset, painless, complete loss of
vision, pale retina and a cherry-red spot on the
B. 30 mmhg pressure macula.
C. CRAO- posterior pole retinal opacity or whitening ( sa
 D. White/grey retina
17. Management for capillary hemangioma except? A. Observe
B. Check for amblyopia
C. Give beta blocker
D. Make a slit
18. Most common cause of unilateral or bilateral eyelid Thyroid eye disease
retraction?
19. The most common cause of upper eyelid retraction is? A. Thyroid eye disease
B. Surgical overcorrection of
blepharoptosis
C. Congenital eyelid retraction
20. Definitive management of Hemangioma EXCEPT? A. Immediate surgery
B. Medical therapy
C. Steroid
book, it is whiten as Widespread Widespread retinal
whitening with a cherry-red spot indicates central
retinal)
artery occlusion
IOP usually is normal (11-21 mmhg).
Capillary hemangioma (strawberry nevus) is
composed of a hamartomatous proliferation of
vascular endothelial cells. It is estimated that 30%
completely involute by the age of 3 years and 75–
90% by the age of 7 years.
Since most capillary hemangiomas regress
spontaneously, the principal indications for treatment
are amblyopia, compressive optic neuropathy, and/or
exposure keratopathy.
The systemic beta-blocker propranolol has been
newly employed treatment.
Graves’ disease is the most common cause of
unilateral or bilateral proptosis and eyelid retractions.
The most common cause of upper eyelid retraction is
from thyroid disease while lower lid retraction most
commonly results from complication of lower
blepharoplasty.
In Hemangioma, Surgical excision is now typically
reserved for lesions that are refractory and result in
visual compromise.
In the past, systemic or intralesional steroids were
considered the first line of therapy to hasten tumor
regression.
New medical management using beta-blocker
Propranolol is being done.
 21. An eyeball smaller than normal is usually seen in what A. Congenital Glaucoma Microopthamia is an eye abnormality that arises
condition? before birth in which one or both eyes are abnormally
B. Thyroid opthalmopathy small.
C. Microopthalmia Diabetic retinopathy and thyroid problem both causes
D. Diabetic retinopathy ptosis (eyelid problem-nagmumukhang maliit yung
mata kasi natatakpan).

Abnormally small eyes can be divided into

nanophthalmos, in which function is normal, and
microphthalmos, in which function is abnormal.

Note: there question left unanswered, the reason being that the reference is not yet given during the making of this recall. Any comment for correction,
clarification is encourage