Ocular Trauma and Emergencies (Chemical Burns, Open Globe, Endophthalmitis) MCQs

Ophthalmology · 50 free questions with answers & explanations.

  1. A 28-year-old construction worker presents with severe pain, blepharospasm, and whitening of the conjunctiva and cornea immediately after splashing of a cement slurry (alkaline) in his eye. The MOST important IMMEDIATE management step is:
  2. Roper-Hall classification of chemical eye injuries grades severity. A Grade III injury is characterized by:
  3. Post-cataract surgery endophthalmitis presenting at day 2–5 post-operatively with severe hypopyon and pain is most likely caused by which organism?
  4. According to the Endophthalmitis Vitrectomy Study (EVS), which factor MOST strongly determined whether immediate pars plana vitrectomy or vitreous tap/biopsy was the appropriate treatment for acute post-cataract endophthalmitis?
  5. In the management of an open globe injury (globe rupture/laceration), which action is CONTRAINDICATED before surgical repair?
  6. A 25-year-old factory worker splashes alkali (10% NaOH) into his right eye. On presentation 20 minutes later, the cornea shows diffuse haze with loss of clarity, the limbal vessels are completely blanched (ischaemia 360°), and the conjunctiva is white. According to Roper-Hall/Ballen grading, this injury is:
  7. After blunt trauma to the eye, a patient develops a peaked pupil pointing towards a clock position of 6 o'clock, hypotony (IOP 5 mmHg), and 360° conjunctival chemosis. There is no visible wound on slit-lamp examination. The next most appropriate investigation to confirm occult open globe injury is:
  8. A 65-year-old diabetic patient presents 5 days after uncomplicated phacoemulsification with pain, decreased vision, hypopyon, and vitritis. Vitreous aspirate Gram stain shows Gram-positive cocci in clusters. The most appropriate treatment according to Endophthalmitis Vitrectomy Study (EVS) guidelines for this scenario (presenting vision light perception or worse) is:
  9. A patient sustains a penetrating injury with a retained intraocular metallic foreign body. Months later he develops golden-brown Kayser-Fleischer-like ring, anterior subcapsular cataract with distinctive 'sunflower' appearance, and heterochromia iridis (affected eye is darker). The pathological ion responsible is:
  10. A 25-year-old construction worker presents with a chemical splash to the right eye. Vision is hand movements. Slit-lamp shows total corneal opacification with a white avascular limbal zone of 360°. The grade of chemical burn (Roper-Hall classification) and immediate treatment priority are:
  11. A 30-year-old man presents with a history of blunt trauma from a fist to the left eye 2 hours ago. VA is 6/60. Slit-lamp shows 8-ball hyphema (total hyphema filling the entire anterior chamber). IOP is 52 mmHg. The most concerning systemic complication to screen for in this patient is:
  12. Post-cataract surgery endophthalmitis due to Staphylococcus epidermidis most commonly presents at which time point, and what is the first-line treatment if visual acuity is hand movements or better?
  13. In a suspected open globe injury, the examination finding that most definitively confirms full-thickness scleral or corneal laceration even when the wound is self-sealing is:
  14. A patient with an intraocular foreign body (IOFB) from a metallic hammer-and-chisel injury requires management. The IOFB is 3 mm copper fragment in the vitreous visible on B-scan. The urgency is related to the specific toxic reaction caused by copper, which is:
  15. A 22-year-old student was accidentally splashed with a strong alkaline solution (NaOH). At 30 minutes post-injury, there is complete corneal opacification, obliteration of limbal vessels with white chemosis (perilimbal ischaemia), and the anterior chamber is not visible. This injury is classified as:
  16. The SINGLE MOST IMPORTANT immediate management step for a chemical eye injury (acid or alkali) before any other assessment is:
  17. A 35-year-old metalworker presents to the emergency with suspected intraocular foreign body (IOFB) after hammering metal. He has a small conjunctival laceration with a self-sealing corneal entry wound. The BEST initial imaging investigation to confirm and localise the IOFB is:
  18. Post-cataract surgery endophthalmitis occurring within 6 weeks of surgery most commonly involves which organism?
  19. According to the Endophthalmitis Vitrectomy Study (EVS), immediate pars plana vitrectomy (PPV) is superior to vitreous tap/biopsy in endophthalmitis ONLY when the presenting visual acuity is:
  20. In ocular chemical burns, the Roper-Hall classification grade IV injury is defined by which corneal and limbal findings?
  21. In the initial management of open globe injury, the MOST important step before surgical repair is:
  22. Traumatic hyphema following blunt ocular trauma is graded. A grade III hyphema (by the 4-grade system) is defined as:
  23. Post-cataract extraction endophthalmitis caused by Staphylococcus epidermidis (coagulase-negative Staphylococci) typically presents with which TEMPORAL pattern?
  24. The Endophthalmitis Vitrectomy Study (EVS) demonstrated that immediate vitrectomy (rather than vitreous tap alone) is beneficial in which subset of post-cataract endophthalmitis patients?
  25. A patient presents with alkali chemical burn to the eye. The single most important immediate first-aid step is:
  26. The Roper-Hall classification of chemical eye burns is based on:
  27. Post-cataract surgery endophthalmitis presenting 6 weeks after surgery with gradual painless visual decline is most likely caused by:
  28. In the Endophthalmitis Vitrectomy Study (EVS), immediate pars plana vitrectomy (compared to vitreous tap/biopsy alone) showed a significant visual benefit in patients with endophthalmitis who presented with:
  29. A patient presents with alkali chemical injury to the right eye. Limbal ischaemia involves 240° of the limbal circumference and the cornea is hazy with 50% stromal loss. The anterior chamber is visible. Which Roper-Hall grade is this?
  30. A worker is struck by a metal fragment at a grinding wheel. He presents with a dark uveal prolapse, shallowed anterior chamber, and hypotony (IOP 4 mmHg). What is the FIRST step in emergency management of this open globe injury?
  31. Post-cataract surgery endophthalmitis presents on day 6 with vision drop to hand movements, hypopyon of 2 mm, and severe vitreous haze. The ESCRS Endophthalmitis Study guides management. Which intervention is definitively indicated in this scenario?
  32. A 25-year-old is hit by a squash ball. He develops a hyphaema filling 30% of the anterior chamber. His IOP is 38 mmHg. He is of African ancestry. Which complication is he at highest risk for compared to Caucasian patients?
  33. A factory worker sustains a lime (calcium hydroxide) splash to both eyes. The FIRST and MOST CRITICAL immediate management step is:
  34. Roper-Hall classification of chemical eye injuries uses corneal clarity and limbal ischaemia to grade severity. Grade III injury is characterised by:
  35. A 35-year-old man sustains a high-velocity metallic foreign body injury. On examination, there is a small self-sealing corneal entry wound with uveal prolapse visible at the limbus. Seidel's test is positive. The PRIORITY before any other intervention is:
  36. Endophthalmitis after cataract surgery presenting on day 2 post-op with severe pain, hypopyon, and 3+ vitreous cells on B-scan is MOST likely caused by:
  37. The Endophthalmitis Vitrectomy Study (EVS) established that immediate vitrectomy is superior to vitreous tap and injection ONLY in which subset of post-cataract endophthalmitis patients?
  38. A patient sustains orbital blowout fracture. On examination there is enophthalmos, restricted upgaze, and diplopia on upward gaze. CT scan shows herniation of inferior rectus and orbital fat into the maxillary sinus. The MECHANISM causing restricted upgaze is:
  39. A 22-year-old chemistry student splashes acid from a battery into his right eye. On examination, there is corneal haziness but the limbal vessels are visible. According to the Roper-Hall classification, this represents which grade and what is the prognosis?
  40. Alkali burns to the eye are more damaging than acid burns of equivalent pH. The reason is:
  41. The Seidel test is performed to confirm which of the following findings in ocular trauma?
  42. Traumatic hyphema (blood in the anterior chamber) following blunt ocular trauma is most dangerous on which day post-injury, and why?
  43. The Endophthalmitis Vitrectomy Study (EVS) recommended immediate pars plana vitrectomy (PPV) over vitreous tap and inject for post-cataract endophthalmitis in which subset of patients?
  44. A construction worker sustains a chemical splash to both eyes from cement (calcium hydroxide — pH 12.5). Immediate first aid at the site was delayed by 20 minutes. On examination, conjunctival pallor (blanching), limbal ischemia of 4 clock hours, corneal haze, and markedly elevated IOP of 42 mmHg are noted. According to Roper-Hall classification, this injury is grade:
  45. A 28-year-old man sustains penetrating injury to the right eye with a metal fragment. Slit lamp shows a full-thickness corneal laceration, iris prolapse, and flat anterior chamber. Intraocular pressure is 4 mmHg. According to the Birmingham Eye Trauma Terminology (BETT) system, this is classified as:
  46. A 70-year-old patient presents 5 days after uncomplicated phacoemulsification with acute painful red eye, hypopyon, and vitreous haze. The most feared causative organism associated with an acute post-operative endophthalmitis within the first week is:
  47. The Endophthalmitis Vitrectomy Study (EVS) found that immediate vitrectomy (compared to vitreous tap/biopsy) was superior in which specific clinical situation?
  48. In cases of orbital blowout fracture of the orbital floor, which clinical sign on elevation test (forced duction test) distinguishes entrapment of the inferior rectus from pure contusion palsy?
  49. A laboratory worker sustains a concentrated sodium hydroxide (NaOH) splash to the right eye. He presents 20 minutes after the injury. Examination shows marked chemosis, perilimbal ischaemia involving 8 clock hours, a hazy cornea with loss of corneal epithelium, and an IOP of 40 mmHg. Using the Roper-Hall classification, this injury is classified as:
  50. A 70-year-old patient develops acute endophthalmitis 3 days following uncomplicated cataract surgery. Vision has dropped to light perception. The most likely organism and the first-line management are:
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