Eyelid and Lacrimal Apparatus Disorders MCQs

Ophthalmology · 25 free questions with answers & explanations.

1. A 40-year-old woman presents with a painless, firm, round swelling on the upper eyelid of 3 weeks' duration, not adherent to skin but adherent to the tarsal plate. There is no tenderness or regional lymphadenopathy. The most likely diagnosis is:
2. A 6-month-old infant has persistent watering from the left eye with mucoid discharge since birth. The left lacrimal sac swells with pressure and mucus can be regurgitated. Digital pressure over the sac relieves the swelling. The most likely cause and initial management are:
3. A 65-year-old man has a slowly progressive painless loss of eyelashes and recurrent 'chalazion-like' swellings in the upper eyelid that recur at the same site after drainage. On eversion of the upper lid, the conjunctiva shows a velvety, hyperemic, diffusely thickened area. What is the most important diagnosis to exclude and what investigation is indicated?
4. A 55-year-old woman with chronic sinusitis presents with a palpable swelling in the medial canthal area that has been present for 3 months and is not tender. Pressure over the swelling expresses mucus from the lower punctum. CT shows a dilated lacrimal sac and dacryolithiasis. The definitive surgical treatment is:
5. A 35-year-old man presents with a unilateral painless upper eyelid swelling of 3 months duration. Examination shows firm, nontender nodule in the tarsal plate, with granulomatous material on eversion. The lid skin is unaffected. The most appropriate management is:
6. A 6-month-old infant presents with persistent epiphora, mucopurulent discharge, and a mucous reflux on pressure over the lacrimal sac (Regurgitation test positive). The condition persists despite conservative management (Crigler massage, topical antibiotics). At what age is probing of the nasolacrimal duct MOST appropriate, and what is the failure mode that necessitates earlier intervention?
7. In congenital nasolacrimal duct obstruction (CNLDO), the most common site of obstruction and the correct timing for probing if conservative treatment fails are:
8. In congenital nasolacrimal duct obstruction, spontaneous resolution occurs in what percentage of cases by 12 months of age, informing the decision to delay probing?
9. Floppy eyelid syndrome (FES) has a strong association with obstructive sleep apnea. The mechanism of upper eyelid eversion during sleep causing ocular surface disease involves:
10. Jones Dye Test I and II are used to evaluate lacrimal drainage patency. A positive Jones I test result means:
11. In congenital nasolacrimal duct obstruction (CNLDO), the Jones dye test is used to evaluate lacrimal drainage. A positive Jones I test (fluorescein appearing at the nose within 5 minutes) indicates:
12. A patient with long-standing floppy eyelid syndrome (FES) is most likely to have which associated systemic condition that requires evaluation?
13. A 50-year-old woman presents with a chronic non-tender medial canthal mass with mucous reflux on digital pressure over the lacrimal sac. Dacryocystography reveals a complete nasolacrimal duct obstruction below the common canaliculus. The preferred surgical treatment is:
14. The mechanism of cicatricial ectropion following chemical burns differs from involutional ectropion in that cicatricial ectropion involves:
15. In the Jones dye test for nasolacrimal drainage assessment, Jones I test is positive when:
16. In Marcus Gunn jaw-winking ptosis, the synkinesis occurs because of aberrant connection between which nerves?
17. The Jones dye test (primary Jones test) is positive when fluorescein dye instilled in the conjunctival sac appears at the inferior meatus within 5 minutes. A negative primary Jones test with a positive secondary Jones test indicates:
18. Dacryocystorhinostomy (DCR) creates a new anastomosis between the lacrimal sac and which structure?
19. A 55-year-old woman with epiphora and mucopurulent discharge has nasolacrimal duct obstruction (NLDO). Syringing and probing confirm distal NLDO. She has undergone probing twice without success. The DEFINITIVE surgical treatment is:
20. The Jones dye test I and II are used to evaluate lacrimal drainage. A positive Jones I (fluorescein dye recovered from the nose within 2–5 minutes of instillation in the conjunctival sac) indicates:
21. A 3-year-old child is brought with a medial canthal swelling present since birth that transilluminates. It is non-tender and becomes tense when the child cries. Probing the nasolacrimal duct reveals mucoid regurgitation. The diagnosis is:
22. A 65-year-old woman with entropion has the lower eyelid margin turned inward, causing trichiasis and constant corneal irritation. On examination, there is horizontal lid laxity (snap-back test > 8 seconds, distraction test > 8 mm), and the preseptal orbicularis is overriding the pretarsal orbicularis. The appropriate surgical procedure targeting the primary mechanisms is:
23. A 45-year-old presents with epiphora and a medial canthal swelling that regurgitates mucopurulent material on pressure (Anel test: syringe pressure regurgitation from lower punctum). DCR (dacryocystorhinostomy) is planned. Which anatomical structure forms the anterior lacrimal crest that is used as a landmark during DCR?
24. A 50-year-old farmer presents with a painless, yellowish subconjunctival fibrovascular lesion encroaching from the nasal limbus onto the cornea, crossing the 4 mm mark from the limbus toward the pupil axis. What is the most appropriate management?
25. A 45-year-old woman presents with recurrent unilateral medial canthal swelling and epiphora. Pressure on the lacrimal sac produces mucopurulent reflux through the punctum. The Jones primary dye test is negative (no dye in the nasal cavity at 5 minutes) but Jones II test is positive (dye recovered in recovered irrigant). This pattern suggests: