Welcome to your ⚠️ Angle-Closure, Secondary Glaucoma & Glaucoma Treatment Arena — 40 Integrated MCQs
1.
A 64-year-old woman presents with severe ocular pain, vomiting, corneal edema and markedly elevated intraocular pressure. Pilocarpine given immediately produces little pupillary response. Which mechanism best explains this finding?
2.
A patient with a hypermature cataract develops ocular pain and raised intraocular pressure. The anterior chamber is relatively deep and contains inflammatory material. Which mechanism best explains the pressure rise?
3.
Which finding distinguishes primary angle-closure glaucoma from primary angle closure?
4.
A patient with suspected angle-closure disease requires direct assessment of the anterior chamber angle. Which examination is most appropriate?
5.
A patient with neovascular glaucoma has extensive retinal ischemia. Which treatment directly reduces the ischemic retinal drive for new-vessel formation?
6.
A patient with advanced neovascular glaucoma has a painful eye with very poor visual potential. Medical treatment fails to control the intraocular pressure, and the main therapeutic aim is relief of pressure and pain. Which procedure is most appropriate?
7.
A 61-year-old woman has experienced several brief episodes of ocular discomfort and blurred vision in dim light. Examination later shows persistent impairment of aqueous drainage from portions of the anterior chamber angle. Which structural change most likely explains this progression from intermittent to permanent angle obstruction?
8.
Pilocarpine can assist treatment of pupillary-block angle closure after the intraocular pressure begins to fall. Which effect contributes to its benefit?
9.
A patient develops raised intraocular pressure after ocular trauma has disrupted the lens capsule and released lens material into the anterior chamber. Which condition is most likely?
10.
A 66-year-old man with severe retinal ischemia has fine abnormal iris vessels. Gonioscopy shows neovascularization of an angle that is still partly open. Without adequate treatment, which change is most likely to produce permanent angle closure?
11.
A patient with acute angle closure develops marked corneal haze and sees colored halos around lights. Which functional disturbance most directly produces this visual finding?
12.
In primary acute angle closure due to pupillary block, increased pressure behind the iris primarily causes which structural change?
13.
A patient with neovascular glaucoma receives intravitreal anti-VEGF therapy. The iris vessels regress rapidly, but extensive retinal non-perfusion remains. Why is additional retinal treatment still required?
14.
A patient has progressive glaucomatous optic-nerve damage despite tolerated medical and laser treatment. Which treatment option is appropriate when substantial additional intraocular pressure reduction is required?
15.
A 62-year-old woman develops sudden severe ocular pain, blurred vision, colored halos and vomiting. Examination shows a red eye with a hazy cornea. Which diagnosis is most likely?
16.
A 75-year-old man with a hypermature cataract develops a painful red eye. The anterior chamber is relatively deep and contains cells and proteinaceous material, while intraocular pressure is markedly elevated. After initial stabilization, which management principle best addresses the cause?
17.
A patient with acute pupillary-block angle closure improves after initial reduction of intraocular pressure. Which procedure provides definitive relief of the pupillary-block mechanism?
18.
A woman receiving long-term topical glaucoma therapy notices gradual darkening of her iris and increased eyelash growth. Her intraocular pressure is well controlled. Which drug class is most consistent with these treatment effects?
19.
Which pupil abnormality is most characteristic of an acute angle-closure attack?
20.
A 67-year-old man with a painful high-pressure eye requires topical aqueous-suppressing therapy. He has a history of bronchial asthma and develops wheezing after one of the prescribed eye drops. Which drug class most likely caused this problem?
21.
A 65-year-old man with proliferative diabetic retinopathy develops a painful red eye and raised intraocular pressure. Slit-lamp examination shows fine new vessels over the iris. Which diagnosis is most likely?
22.
Intravitreal anti-VEGF therapy is used as an adjunct in neovascular glaucoma primarily because it causes:
23.
Systemic acetazolamide is given during an acute rise in intraocular pressure. What is its principal therapeutic action?
24.
A 63-year-old woman is treated for an acute primary pupillary-block attack in her right eye. Examination of the asymptomatic left eye shows a similarly narrow anterior chamber angle. Which intervention best reduces the risk of a comparable attack in the fellow eye?
25.
A 69-year-old man with neovascular glaucoma has undergone treatment for retinal ischemia and receives maximal tolerated pressure-lowering medication. His intraocular pressure remains markedly elevated with progressive ocular damage. Which surgical option is particularly appropriate for this refractory secondary glaucoma?
26.
A patient with markedly raised intraocular pressure is being considered for systemic short-term drug therapy. He has significant renal impairment and is at increased risk of electrolyte and metabolic disturbance. Which treatment requires particular caution in this setting?
27.
Which feature best differentiates phacomorphic glaucoma from phacolytic glaucoma?
28.
Which process initiates the development of neovascular glaucoma in severe retinal vascular disease?
29.
A patient with glaucoma requires an additional topical agent. The ophthalmologist chooses a drug that lowers intraocular pressure by decreasing aqueous formation while also enhancing uveoscleral drainage. Which drug class has this combined action?
30.
A 65-year-old man requires long-term topical treatment for open-angle glaucoma. He has bronchial asthma and resting bradycardia, making topical beta-blockade undesirable. Which drug class is a reasonable pressure-lowering option for chronic therapy?
31.
A patient develops persistent ocular inflammation and raised intraocular pressure after ocular surgery. Slit-lamp examination shows retained lens fragments in the anterior chamber despite adequate pressure-lowering medication. Which next management principle is most appropriate?
32.
A patient with open-angle glaucoma requires a laser procedure designed to improve aqueous drainage through the trabecular meshwork. Which treatment is most appropriate?
33.
A patient with an advanced cataract develops a painful red eye, markedly raised intraocular pressure and a shallow anterior chamber. The lens appears swollen. Which diagnosis is most likely?
34.
A 70-year-old woman with an acute angle-closure attack remains in severe pain with dangerously elevated intraocular pressure despite topical aqueous suppressants and systemic acetazolamide. Which additional treatment is most appropriate for rapid short-term pressure reduction?
35.
A 71-year-old woman has a swollen cataractous lens, corneal edema, a very shallow anterior chamber and raised intraocular pressure. Initial medical therapy is being planned before definitive lens surgery. Which treatment could worsen anterior-segment crowding and is therefore inappropriate as routine therapy in this setting?
36.
A 58-year-old woman with angle-closure disease undergoes successful laser peripheral iridotomy. At follow-up, the iridotomy is patent, but the peripheral iris continues to crowd the drainage angle. Which treatment is most appropriate for this residual anatomical problem?
37.
A 72-year-old woman with an intumescent cataract presents with severe ocular pain, corneal edema, a shallow anterior chamber and markedly elevated intraocular pressure. The pressure is initially reduced medically and the inflammation settles. Which intervention provides definitive treatment of the underlying problem?
38.
A patient continues to demonstrate appositional angle narrowing despite a patent peripheral iridotomy. Intraocular pressure rises intermittently when the pupil dilates. Which mechanism best explains the persistent tendency to closure?
39.
A 58-year-old hypermetropic woman is found to have a narrow anterior chamber angle on gonioscopy. Intraocular pressure is normal, and there is no optic-disc damage. Which stage of primary angle-closure disease is most likely?
40.
A patient has iridotrabecular contact with raised intraocular pressure and peripheral anterior synechiae, but no glaucomatous optic-nerve damage. Which diagnosis is most appropriate?
