Orbit and Ocular Injuries MCQs

Ophthalmology · 24 free questions with answers & explanations.

1. A 25-year-old man is hit on the left eye by a fist. He develops enophthalmos, restricted upgaze, and diplopia on upward gaze. CT orbit shows a fracture of the orbital floor with herniation of orbital fat and inferior rectus into the maxillary sinus. The mechanism responsible for the restricted upgaze is:
2. A chemical injury to the eye with alkali (lime) is considered more dangerous than acid injury because:
3. A 50-year-old woman presents with progressive, painless unilateral proptosis that worsens on the Valsalva manoeuvre and a low, soft compressible mass in the inferomedial orbit. MRI shows a lobulated, well-circumscribed lesion within the orbital fat with high T2 signal and fluid levels. The most likely diagnosis is:
4. A 35-year-old man sustains a penetrating ocular injury with a metallic intraocular foreign body (IOFB) from grinding. He is referred 2 weeks later. Slit-lamp shows golden-brown rust deposits in the anterior lens capsule and iris (Vossius ring), and visual field constriction. This pattern of injury is called:
5. A patient sustains a direct blow to the periorbital region. Examination reveals enophthalmos, diplopia on upward gaze, restriction of elevation, and hypesthesia of the ipsilateral cheek. CT orbit shows a fracture of the orbital floor. The specific sign of entrapment neuro-vagal reaction that warrants immediate surgical consultation even without significant enophthalmos in pediatric patients is:
6. A 30-year-old man presents with pulsatile proptosis, chemosis, bruit over the orbit, and dilated tortuous episcleral vessels. He had a road traffic accident 3 weeks ago. The MOST likely diagnosis and the investigation of choice is:
7. A patient presents 48 hours after blunt trauma to the orbit with enophthalmos, restricted upgaze, and diplopia on upgaze. CT scan shows a blow-out fracture of the orbital floor. On forced duction test, upgaze is restricted. The most appropriate timing for surgical repair is:
8. Siderosis bulbi following a retained intraocular iron foreign body is characterized by which specific clinical triad?
9. In traumatic hyphema, the management guideline that distinguishes patients with sickle cell trait from normal patients regarding IOP management threshold is:
10. Chemical injury to the eye is classified using the Roper-Hall classification. A Grade IV injury (worst) is defined by which findings?
11. Sympathetic ophthalmia following penetrating trauma develops through which immunological mechanism, and the minimum time interval after injury before it can present is:
12. A 10-year-old child presents with diplopia and limited elevation of the right eye after a sports injury. CT orbit shows an inferior orbital wall fracture with a 'trap-door' morphology and herniation of the inferior rectus muscle. The most appropriate management is:
13. In chemical eye injuries, the Roper-Hall classification (grade IV) is characterized by which combination of features?
14. Traumatic optic neuropathy (TON) following blunt orbital trauma is classified by the International Optic Nerve Trauma Study (IONTS). The IONTS showed that corticosteroids versus observation in TON resulted in:
15. The sympathetic ophthalmia risk following penetrating ocular injury peaks at which time window and requires prophylactic enucleation of the injured eye only if performed within:
16. A child after blunt facial trauma has enophthalmos, restriction of upgaze, and inferior rectus entrapment on CT scan through an orbital floor fracture with a small defect ('white-eyed blowout'). Nausea and bradycardia are also noted. The appropriate management is:
17. Following unilateral perforating injury to the right eye with uveal tissue prolapse, sympathetic ophthalmia can develop in the fellow eye. The histological hallmark of sympathetic ophthalmia in the excised sympathizing eye is:
18. The ophthalmological equivalent of the 'Seidel test' uses 2% fluorescein under cobalt blue illumination. In a penetrating ocular injury, a positive Seidel sign (streaming dilution of fluorescein) indicates:
19. In orbital blowout fracture involving the orbital floor, the most important early surgical indication (within 2 weeks) regardless of diplopia severity is:
20. Thyroid-associated orbitopathy (TAO) with corneal exposure is classified using the VISA classification. The 'S' (Strabismus) component is graded by:
21. A child presents with enophthalmos, limited upgaze, and diplopia following blunt orbital trauma. CT orbit shows a trapdoor fracture of the orbital floor with a soft tissue density in the maxillary sinus and a small bone defect. The urgency for surgical repair is based on which finding?
22. A 25-year-old man sustains a blow to the orbit from a squash ball. He develops diplopia on upward gaze, enophthalmos, and infraorbital paraesthesia. CT orbit shows a blowout fracture of the orbital floor with herniation of inferior rectus muscle and periorbital fat into the maxillary sinus. What is the mechanism of the diplopia?
23. A 12-year-old boy is struck in the orbit by a cricket ball. He develops enophthalmos and diplopia on upward gaze. CT scan shows a 'trapdoor' fracture of the orbital floor with inferior rectus muscle entrapment. What is the MOST URGENT indication for early surgical repair in a paediatric blowout fracture?
24. A 6-year-old child sustains blunt orbital trauma and develops progressive proptosis, severe periorbital ecchymosis, and restriction of all extraocular movements within 2 hours. CT reveals no obvious fracture but demonstrates intraorbital haemorrhage with a dark crescentic subperiosteal mass. The MOST urgent intervention is: