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PG Series Ophthalmology Buster PG Series Ophthalmology Buster PG Series Ophthalmology Buster E Ahmed Formerly Head, Department of Ophthalmology Calcutta National Medical College Consultant, Eye Care and Research Centre Kolkata JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd B-3, EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559 Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches • 2/B, Akruti Society, Jodhpur Gam Road Satellite, Ahmedabad 380 015 Phones: +91-079-26926233, Rel: +91-079-32988717, Fax: +91-079-26927094 e-mail: [email protected] • 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East, Bangalore 560 001 Phones: +91-80-22285971, +91-80-22382956, Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: [email protected] • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road, Chennai 600 008 Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089 Fax: +91-44-28193231 e-mail: [email protected] • 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095 Phones: +91-40-66610020, +91-40-24758498, Rel:+91-40-32940929 Fax:+91-40-24758499, e-mail: [email protected] • No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road, Kochi 682 018, Kerala Phones: +91-0484-4036109, +91-0484-2395739, +91-0484-2395740 e-mail: [email protected] • 1-A Indian Mirror Street, Wellington Square, Kolkata 700 013 Phones: +91-33-22451926, +91-33-22276404, +91-33-22276415, Rel: +91-33-32901926 Fax: +91-33-22456075, e-mail: [email protected] • 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel, Mumbai 400 012 Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896 Fax: +91-22-24160828, e-mail: [email protected] • “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road, Nagpur 440 009 (MS) Phones: Rel: 3245220, Fax: 0712-2704275 e-mail: [email protected] PG Series Ophthalmology Buster © 2007, E Ahmed All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2007 ISBN 81-8061-938-9 Typeset at JPBMP typesetting unit Printed at Rajkamal Press To My family members and well wishers PREFACE While appearing in entrance examinations of undergraduates aspiring for postgraduate degrees or diplomas like DO, MS/MD (Oph), and DNB (Oph) multiple choice questions (MCQs) have been accepted as the norm. During oral and practical examinations, the candidates are supposed to be familiar with the types of questions and their suitable answers. I have seen the emergence of MCQs with answers, MCQs with explanatory answers and subsequently quick reviews of postgraduate medical entrance examinations. For catering the needs of both entrance and postgraduate examinations I have been thinking of preparing a small volume and this process is enhanced by the appearance and acceptance of PG Buster series in other specialities. More than 1000 possible questions are selected and answered. Answers are prepared from A Textbook of Ophthalmology (2nd edition), Prentice-Hall of India, 2001 and also from several other reputed textbooks. I gratefully acknowledge the sincere support received from Shri Jitendar P Vij, Chairman and Managing Director and Mr Tarun Duneja, General Manager (Publishing) and Mr Sandeep Gupta and others of Kolkata branch of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi. This work would not be possible if I would not get uninterrupted moral support from my family members. E Ahmed CONTENTS 1. The Bony Orbit --------------------------------------------------------------------------------------------------------------- 1 2. The Eyelids -------------------------------------------------------------------------------------------------------------------21 3. The Lacrimal Apparatus ------------------------------------------------------------------------------------------------- 37 4. The Conjunctiva ------------------------------------------------------------------------------------------------------------ 48 5. The Cornea ------------------------------------------------------------------------------------------------------------------- 62 6. The Sclera--------------------------------------------------------------------------------------------------------------------- 86 7. The Uveal Tract and the Pupil ---------------------------------------------------------------------------------------- 90 8. The Crystalline Lens ----------------------------------------------------------------------------------------------------- 117 9. The Vitreous Humour --------------------------------------------------------------------------------------------------- 132 10. Glaucomas ------------------------------------------------------------------------------------------------------------------- 137 11. The Retina ------------------------------------------------------------------------------------------------------------------- 156 12. Diseases of the Visual Pathways ------------------------------------------------------------------------------------ 183 13. Optics and Errors of Refraction -------------------------------------------------------------------------------------- 199 14. Ocular Motility and Nystagmus ------------------------------------------------------------------------------------- 220 15. Systemic Diseases with Ocular Manifestations ----------------------------------------------------------------- 237 16. Ophthalmic Surgery ------------------------------------------------------------------------------------------------------ 254 17. Miscellaneous -------------------------------------------------------------------------------------------------------------- 271 REFERENCES Abbreviations are used throughout the book as follows: 1. Ahmed E. A Textbook of Ophthalmology, 2nd ed., Prentice-Hall of India, New Delhi, 2001. as Ahmed: A Textbook of Oph. 2nd ed. 2. Ferris J. Basic Sciences in Ophthalmology: A Self Assessment Text, 2nd ed., BMJ Books, 1st Indian ed., Jaypee Bros, New Delhi, 2000. as Ferris: Basic Sc. in Oph, 2nd ed. 3. Parsons’ Diseases of the Eye, 19th ed, revised by Sihota R and Tandon R, Butterworth-Heinemann, 2003. as Parsons’ Dis. of Eye, 19th ed. 4. Kanski JJ. Clinical Ophthalmology, 2nd ed., Butterworth-Heinemann, London, 1984, as Kanski: Clinical Oph., 2nd ed. 5. Kanski JJ, Thomas DJ. The Eye in Systemic Diseases, 2nd ed, Butterworth-Heinemann, 1994. as Kanski and Thomas: The Eye in Systemic Dis., 2nd ed. 6. Pavan-Langston D. Manual of Ocular Diagnosis and Therapy, 5th ed., Lippincott Williams and Wilkins, Philadelphia, 2002. as Pavan-Langston: Man.of Ocular Diag. & Therap. 5th ed. The Bony Orbit 1 1 The Bony Orbit 1. The shape of the bony orbit is: A. Round B. Oval C. Vertically oval D. Pear-shaped E. Triangular (Ahmed: A Textbook of Oph.2nd ed., p.3) D. See box under Q.9 2. The volume of the orbit is: A. 15 ml B. 20 ml C. 25 ml D. 30 ml (Ahmed: A Textbook of Oph.2nd ed, p.3) (AIIMS 78,90) D. See box under Q.9 3. The strongest wall of the body orbit is: A. Medial wall B. Roof C. Lateral wall D. Floor (Ahmed: A Textbook of Oph.2nd ed,p.3) C 4. The direction of the orbit is: A. Outward B. Forward, outward and slightly downward C. Forward, inward and downward (Ahmed: A Textbook of Oph.2nd ed p.3) B. See box under Q.9 5. The thinnest wall of the bony orbit is: A. Roof B. Floor C. Medial wall D. Lateral wall (Ahmed: A Textbook of Oph.2nd ed, p.3) C. See box under Q.9 6. The widest part of the bony orbit is: A. At the orbital margin B. At the apex C. 1.5 cm behind the orbital margin D. 1 cm behind the orbital margin C. See box under Q.9 1. D 2. D 3. C 4. B 5. C 6. C 2 Ophthalmology Buster 7. The incorrect statement regarding the roof of the orbit is: A. This is triangular in shape B. It is chiefly formed by orbital plate of frontal bone C. It is invaded by the frontal sinus D. This is very thick E. It contains fossa for the lacrimal gland (Ahmed: A Textbook of Oph.2nd ed,p.3) D. See box under Q.9 8. The correct statement regarding orbital floor is: A. This lies over the maxillary sinus B. This is roughly triangular C. It is chiefly formed by orbital plate of the maxilla D. Between the floor and the maxillary sinus there is 0.5 to 1 mm thick bone E. All of the above (Ahmed: A Textbook of Oph.2nd ed,p.3) E. 9. The apex of the orbit corresponds to the: A. Optic foramen B. Sphenoid fissure C. Sphenomaxillary fissure D. Optic canal (Ahmed: A Textbook of Oph.2nd ed p.3) A. • Seven bones form the pear-shaped bony orbit (Fig. 1.1) • It is directed forward, inward and slightly downward • It has four posteriorly-converging walls: roof, floor, thinnest medial and thickest lateral wall • The base corresponds to the open anterior end and the apex corresponds to the optic foramen. Its height, width and volume are 35, 40 mm and 30 ml respectively Fig. 1.1: Anatomy of the
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