A 64-year-old woman with migraine and cold, white fingers in winter is referred because her optician noted cupping. Diurnal phasing shows IOP between 14 and 18 mmHg, central corneal thickness is 540 µm, and the angles are open. The right disc has a cup-disc ratio of 0.7 with a splinter haemorrhage at the inferotemporal rim, and fields show a dense paracentral defect. MRI of the brain and orbits is normal. What is the most likely diagnosis?

Anterior ischaemic optic neuropathy

A 58-year-old daily-wage labourer from Nashik has early POAG in both eyes, with IOP of 26 mmHg and open angles on gonioscopy. He often forgets his drops and finds them costly, and his IOP stays high at each visit. Which treatment can lower his IOP without daily medication?

Selective laser trabeculoplasty

Three days after an uneventful trabeculectomy for chronic angle-closure glaucoma, a 58-year-old hypermetropic woman's operated eye has an anterior chamber that is flat both centrally and peripherally. IOP is 40 mmHg, the surgical iridectomy is patent, and the bleb is flat. B-scan shows no choroidal detachment or haemorrhage. What is the initial treatment?

Atropine with aqueous suppressants

Revision of the trabeculectomy flap

Pilocarpine with aqueous suppressants

A further laser peripheral iridotomy

Glaucoma: types and treatment

30 NEET-PG practice questions on Glaucoma: types and treatment, part of Ophthalmology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 58-year-old woman from Madurai develops severe pain in the right eye, haloes round lights and vomiting after an evening film in a dark cinema hall. The eye is red, the cornea hazy, the pupil fixed and mid-dilated, the anterior chamber shallow and IOP 52 mmHg. The ophthalmology resident's plan: 1. IV mannitol and acetazolamide to lower the IOP. 2. Topical atropine to relieve ciliary spasm and pain. 3. Pilocarpine drops once the IOP has fallen. 4. Laser peripheral iridotomy in both eyes. Which parts of the plan are correct?
1. A1, 3 and 4 only
2. B1, 2 and 4 only
3. C1, 2, 3 and 4
4. D1 and 4 only
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Answer: A · 1, 3 and 4 only
Steps 1, 3 and 4 are correct for acute primary angle closure, in which dim light dilates the pupil and the peripheral iris blocks the drainage angle of a small eye with a shallow anterior chamber. IOP is lowered first with IV mannitol, acetazolamide and topical beta-blockers; pilocarpine is added once the pressure falls, because the ischaemic sphincter does not respond at very high IOP, and it pulls the iris away from the angle. Laser peripheral iridotomy is the definitive treatment, and the fellow eye, which shares the same anatomy, receives a prophylactic iridotomy. Step 2 is wrong: atropine dilates the pupil and worsens angle closure.
- B: Includes atropine, which dilates the pupil and worsens the block.
- C: Includes atropine; mydriatics are contraindicated in angle closure.
- D: Omits pilocarpine, which is used once the IOP has come down.
Question 2 · Medium
A 64-year-old woman with migraine and cold, white fingers in winter is referred because her optician noted cupping. Diurnal phasing shows IOP between 14 and 18 mmHg, central corneal thickness is 540 µm, and the angles are open. The right disc has a cup-disc ratio of 0.7 with a splinter haemorrhage at the inferotemporal rim, and fields show a dense paracentral defect. MRI of the brain and orbits is normal. What is the most likely diagnosis?
1. AOcular hypertension
2. BNormal-tension glaucoma
3. CAnterior ischaemic optic neuropathy
4. DChronic angle-closure glaucoma
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Answer: B · Normal-tension glaucoma
Glaucomatous cupping and field loss with an open angle and IOP always within the normal range is normal-tension glaucoma. Vascular dysregulation is thought to play a part, and it is linked with migraine, Raynaud phenomenon and nocturnal hypotension; disc haemorrhages and dense paracentral defects close to fixation are common. Compressive lesions and other causes of optic atrophy must be excluded, which the normal MRI does here. Treatment still aims to lower IOP, by about 30% from baseline in the landmark trial.
- A: Ocular hypertension means raised IOP with a normal disc and field.
- C: Ischaemic neuropathy causes sudden loss with disc swelling, then pallor rather than cupping.
- D: The angle is open, so angle-closure glaucoma is excluded.
Question 3 · Medium
A 58-year-old daily-wage labourer from Nashik has early POAG in both eyes, with IOP of 26 mmHg and open angles on gonioscopy. He often forgets his drops and finds them costly, and his IOP stays high at each visit. Which treatment can lower his IOP without daily medication?
1. ASelective laser trabeculoplasty
2. BLaser peripheral iridotomy
3. CDiode cyclophotocoagulation
4. DNd:YAG posterior capsulotomy
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Answer: A · Selective laser trabeculoplasty
Selective laser trabeculoplasty uses short pulses of a frequency-doubled Nd:YAG laser absorbed by pigmented trabecular meshwork cells, triggering a biological response that increases trabecular outflow without scarring. It is a first-line option in open-angle glaucoma and particularly useful where adherence or cost is a problem. The effect may wane over years, and the procedure can be repeated. Cyclophotocoagulation is reserved for refractory or blind painful eyes.
- B: Iridotomy treats pupillary block in angle closure, not open-angle glaucoma.
- C: Cyclodestruction is reserved for refractory glaucoma or blind painful eyes.
- D: Capsulotomy treats posterior capsule opacification after cataract surgery.
Question 4 · Hard
Three days after an uneventful trabeculectomy for chronic angle-closure glaucoma, a 58-year-old hypermetropic woman's operated eye has an anterior chamber that is flat both centrally and peripherally. IOP is 40 mmHg, the surgical iridectomy is patent, and the bleb is flat. B-scan shows no choroidal detachment or haemorrhage. What is the initial treatment?
1. ARevision of the trabeculectomy flap
2. BPilocarpine with aqueous suppressants
3. CAtropine with aqueous suppressants
4. DA further laser peripheral iridotomy
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Answer: C · Atropine with aqueous suppressants
A flat chamber with high IOP, a patent iridectomy and no choroidal effusion or haemorrhage after filtering surgery in a small hypermetropic eye is malignant glaucoma (aqueous misdirection). Aqueous flows backwards into the vitreous, pushing the lens-iris diaphragm forward. Initial treatment is intensive cycloplegia with atropine to pull the diaphragm back, aqueous suppressants and hyperosmotic agents; if this fails, Nd:YAG disruption of the anterior hyaloid or vitrectomy is needed. Miotics make it worse.
- A: The problem is behind the iris; revising the flap does not reverse misdirection.
- B: Miotics move the lens-iris diaphragm forward and worsen aqueous misdirection.
- D: The iridectomy is already patent, so this is not pupillary block.
Question 5 · Medium
A 6-year-old girl has had a port-wine stain over the right forehead and upper eyelid since birth, and had seizures in infancy. Her right cornea is larger than the left, IOP is 28 mmHg on that side, and the right disc shows an enlarged cup. Which condition explains her glaucoma?
1. ASturge-Weber syndrome
2. BNeurofibromatosis type 1
3. CAxenfeld-Rieger syndrome
4. DAniridia
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Answer: A · Sturge-Weber syndrome
A facial port-wine stain in the ophthalmic (V1) territory with seizures from leptomeningeal angiomatosis is Sturge-Weber syndrome. Glaucoma on the side of the stain occurs in a sizeable minority, from angle anomaly in early-onset cases and from raised episcleral venous pressure in later ones. Both eyes need IOP checks throughout childhood. Filtering surgery carries a risk of choroidal effusion or haemorrhage from the choroidal haemangioma.
- B: NF1 can cause glaucoma with a plexiform neurofibroma of the lid, not a port-wine stain.
- C: Axenfeld-Rieger causes angle and iris anomalies with dental and facial features, not a port-wine stain.
- D: Aniridia gives absent irises, usually bilateral, without a facial stain.
Question 6 · Medium
At a glaucoma screening camp at a PHC in Tamil Nadu, a resident teaches health workers how primary open-angle and primary angle-closure glaucoma differ: 1. In POAG the angle is open on gonioscopy and the disease is usually painless. 2. Laser peripheral iridotomy is the first treatment for POAG. 3. Eyes with primary angle closure tend to be short and hypermetropic, with a shallow anterior chamber. 4. The lens thickening and moving forward with age contributes to angle closure. Which statements are correct?
1. A2, 3 and 4 only
2. B1 and 3 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 7 · Hard
A 42-year-old woman had laser peripheral iridotomies for narrow angles a year ago. Both iridotomies are patent and the central anterior chamber is of normal depth with a flat iris plane, yet gonioscopy still shows appositional angle closure, and IOP rises after dilatation. Indentation gonioscopy shows a 'double hump' sign, and ultrasound biomicroscopy shows anteriorly placed ciliary processes holding the peripheral iris against the meshwork. What is the most appropriate treatment?
1. ASelective laser trabeculoplasty
2. BRepeat laser peripheral iridotomy
3. CNd:YAG laser hyaloidotomy
4. DArgon laser peripheral iridoplasty
Answer and explanation in LearnFree account
Question 8 · Medium
A 38-year-old software engineer had LASIK for high myopia six years ago. His Goldmann IOP is 15 mmHg in both eyes, yet over two years his discs have shown progressive cupping with arcuate field loss; the angles are open and central corneal thickness is 460 µm. Why are his IOP readings misleading?
1. AThin corneas make applanation read falsely low
2. BMyopic eyes give falsely high applanation readings
3. CLASIK steepens the cornea and raises readings
4. DThin corneas make applanation read falsely high
Answer and explanation in LearnFree account
Question 9 · Hard
A 29-year-old woman started topiramate for migraine ten days ago. She now has sudden blurring of distance vision and aching in both eyes; acuity is 6/36 and improves with -3.0 D lenses. Both anterior chambers are uniformly shallow, IOP is 42 and 44 mmHg, and gonioscopy shows closed angles. B-scan shows shallow choroidal effusions in both eyes. Besides stopping topiramate, what is the most appropriate treatment?
1. AUrgent trabeculectomy in both eyes
2. BPilocarpine drops in both eyes
3. CLaser peripheral iridotomy in both eyes
4. DCycloplegic drops with aqueous suppressants
Answer and explanation in LearnFree account
Question 10 · Medium
A 45-year-old man with advanced POAG that keeps progressing on three drugs is listed for trabeculectomy. During surgery, the surgeon applies a sponge soaked in mitomycin C to the sclera before making the scleral flap. What is the purpose of this step?
1. AControl bleeding from the scleral flap
2. BPrevent scarring that would close the bleb
3. CPrevent infection of the filtering bleb
4. DReduce aqueous production by the ciliary body
Answer and explanation in LearnFree account
Question 11 · Medium
A 63-year-old retired clerk with POAG, controlled on latanoprost, stops his drops after a year, saying his vision is fine and he feels no different with them. At review his IOP is 30 mmHg and his field defect has deepened. What is the most important point to explain to him?
1. ASurgery will restore the field he has lost
2. BDrops are needed only while he has symptoms
3. CLost field cannot be restored, only further loss prevented
4. DA normal IOP on review means drops can stop
Answer and explanation in LearnFree account
Question 12 · Easy
A 52-year-old hypermetropic woman is found at a screening camp to have a narrow peripheral anterior chamber on van Herick slit-lamp grading; her IOP is 20 mmHg and her discs look normal. Which investigation is the gold standard to decide whether her angle is open or closed?
1. APachymetry
2. BPerimetry
3. CTonography
4. DGonioscopy
Answer and explanation in LearnFree account
Question 13 · Hard
A 61-year-old diabetic woman from Kochi is referred from a diabetic retinopathy screening. Goldmann IOP is 27 mmHg in the right eye and 25 mmHg in the left, central corneal thickness is 545 µm in both, and gonioscopy shows open angles. The right disc has a vertical cup-disc ratio of 0.75 with inferior rim thinning and perimetry shows a matching superior arcuate defect; the left disc and field are normal. She has mild asthma and a resting pulse of 58/min. Consider: 1. The right eye has primary open-angle glaucoma. 2. The left eye fits ocular hypertension and needs monitoring for change. 3. A topical prostaglandin analogue is a suitable first drug. 4. Timolol is the safest first drug for her. Which statements are correct?
1. A2, 3 and 4 only
2. B1 and 3 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 14 · Medium
A 26-year-old myopic (-4 D) male gym trainer notices blurring and haloes after intense workouts. The slit lamp shows a vertical band of brown pigment on the corneal endothelium and slit-like radial defects in the mid-peripheral iris on retroillumination; the anterior chamber is deep, and gonioscopy shows an open angle with dense, even pigmentation of the trabecular meshwork. What is the most likely diagnosis?
1. AIridocorneal endothelial syndrome
2. BPosner-Schlossman syndrome
3. CPigment dispersion syndrome
4. DPseudoexfoliation syndrome
Answer and explanation in LearnFree account
Question 15 · Easy
A 5-month-old boy is brought to the eye OPD because he keeps his eyes shut in daylight and they water constantly. Both corneas are enlarged (13 mm) and hazy, with horizontal breaks in Descemet's membrane, and IOP under anaesthesia is 30 mmHg in both eyes. What is the treatment of choice?
1. AGoniotomy or trabeculotomy
2. BLifelong topical timolol
3. COral acetazolamide alone
4. DLaser peripheral iridotomy
Answer and explanation in LearnFree account
Question 16 · Medium
A 12-year-old boy from Rajasthan with vernal keratoconjunctivitis has been buying dexamethasone eye drops over the counter and using them for most of a year. His vision is now 6/18, IOP is 38 mmHg in both eyes with open angles, and the discs show a cup-disc ratio of 0.7. Besides drops to lower IOP, what is the most appropriate change in his treatment?
1. AReplace the steroid with topical cyclosporine
2. BLaser peripheral iridotomy in both eyes
3. CAdd a topical NSAID to the steroid drops
4. DSwitch to a stronger topical steroid
Answer and explanation in LearnFree account
Question 17 · Hard
A 16-year-old boy from a tribal area of Chhattisgarh is hit in the right eye by a stone. He has a 3 mm hyphaema and an IOP of 34 mmHg. A sickling solubility test is positive, and haemoglobin electrophoresis shows HbAS. Which IOP-lowering drug should be avoided in him?
1. ATopical timolol
2. BTopical dorzolamide
3. COral acetazolamide
4. DTopical brimonidine
Answer and explanation in LearnFree account
Question 18 · Medium
A 70-year-old woman has a painful, blind (no perception of light) left eye after years of untreated chronic angle-closure glaucoma. IOP is 52 mmHg despite maximal drops, and the eye looks cosmetically acceptable. Which procedure is preferred to relieve her pain while keeping the eye?
1. ASelective laser trabeculoplasty
2. BTrabeculectomy with mitomycin C
3. CLaser peripheral iridotomy
4. DDiode laser cyclophotocoagulation
Answer and explanation in LearnFree account
Question 19 · Medium
During diabetic retinopathy screening, a resident measures the neuroretinal rim of a 56-year-old man's right optic disc (as a fraction of the disc diameter): inferior 0.12, superior 0.30, nasal 0.25, temporal 0.18. The left disc follows the usual pattern. What does this right disc suggest?
1. ADisc oedema from raised intracranial pressure
2. BA normal disc that follows the ISNT rule
3. CTemporal pallor from optic atrophy
4. DInferior rim loss suspicious for glaucoma
Answer and explanation in LearnFree account
Question 20 · Medium
A 72-year-old man is seen before cataract surgery. After dilatation, the anterior lens capsule shows a central disc and a peripheral ring of grey-white flaky material separated by a clear zone, with dandruff-like flakes at the pupillary margin; IOP in that eye is 30 mmHg with an open angle. Consider these statements: 1. A wavy line of pigment anterior to Schwalbe's line may be seen on gonioscopy. 2. Weak zonules raise the risk of zonular dialysis during cataract surgery. 3. The glaucoma usually runs a milder course than primary open-angle glaucoma. 4. Variants of the LOXL1 gene are linked to the condition. Which statements are correct?
1. A1, 2 and 4 only
2. B1, 2, 3 and 4
3. C2, 3 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 21 · Medium
Consider these pairs of anti-glaucoma eye drops and their adverse effects: 1. Latanoprost: darkening of the iris and longer eyelashes. 2. Brimonidine: allergic follicular conjunctivitis. 3. Timolol: bradycardia and heart block. 4. Pilocarpine: brow ache and induced myopia. Which pairs are correctly matched?
1. A2, 3 and 4 only
2. B1, 2 and 3 only
3. C1 and 3 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 22 · Medium
A 32-year-old man has had three episodes in two years of mild discomfort and blurring in the right eye only. Each time the IOP is above 50 mmHg, the cornea is slightly oedematous with a few fine keratic precipitates, flare is minimal and the angle is open; the attack settles within two weeks, and IOP and discs are normal between attacks. The most likely diagnosis is:
1. AFuchs heterochromic iridocyclitis
2. BPigment dispersion syndrome
3. CPosner-Schlossman syndrome
4. DRecurrent primary angle closure
Answer and explanation in LearnFree account
Question 23 · Medium
A 66-year-old man with long-standing, poorly treated POAG now bumps into furniture and door frames. His central acuity is 6/9 in each eye, but the cup-disc ratio is 0.95 in both, and perimetry shows only a small central island of field. Which other part of the visual field is typically the last to be lost in end-stage glaucoma?
1. AA nasal island
2. BA superior island
3. CA temporal island
4. DAn inferior island
Answer and explanation in LearnFree account
Question 24 · Medium
A 68-year-old woman with a long-standing cataract in the left eye has sudden pain, redness and vomiting. The left lens is swollen, white and intumescent, the anterior chamber is very shallow, and IOP is 54 mmHg. The right eye has a deep anterior chamber and an early cataract. The most likely diagnosis is:
1. APhacolytic glaucoma
2. BPhacomorphic glaucoma
3. CNeovascular glaucoma
4. DPrimary acute angle closure
Answer and explanation in LearnFree account
Question 25 · Easy
A 55-year-old woman sees rainbow-coloured rings around street lights in the evenings, with a dull brow ache, for a few weeks; both clear after a night's sleep. Her anterior chambers are shallow. What produces the coloured rings she sees?
1. AMucus in the tear film
2. BFloaters in the vitreous
3. CCorneal epithelial oedema
4. DOpacities in the lens fibres
Answer and explanation in LearnFree account

5 more Glaucoma: types and treatment questions

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Study Ophthalmology

Glaucoma: types and treatment

A 58-year-old daily-wage labourer from Nashik has early POAG in both eyes, with IOP of 26 mmHg and open angles on gonioscopy. He often forgets his drops and finds them costly, and his IOP stays high at each visit. Which treatment can lower his IOP without daily medication?

A 6-year-old girl has had a port-wine stain over the right forehead and upper eyelid since birth, and had seizures in infancy. Her right cornea is larger than the left, IOP is 28 mmHg on that side, and the right disc shows an enlarged cup. Which condition explains her glaucoma?

A 38-year-old software engineer had LASIK for high myopia six years ago. His Goldmann IOP is 15 mmHg in both eyes, yet over two years his discs have shown progressive cupping with arcuate field loss; the angles are open and central corneal thickness is 460 µm. Why are his IOP readings misleading?

A 45-year-old man with advanced POAG that keeps progressing on three drugs is listed for trabeculectomy. During surgery, the surgeon applies a sponge soaked in mitomycin C to the sclera before making the scleral flap. What is the purpose of this step?

A 63-year-old retired clerk with POAG, controlled on latanoprost, stops his drops after a year, saying his vision is fine and he feels no different with them. At review his IOP is 30 mmHg and his field defect has deepened. What is the most important point to explain to him?

A 52-year-old hypermetropic woman is found at a screening camp to have a narrow peripheral anterior chamber on van Herick slit-lamp grading; her IOP is 20 mmHg and her discs look normal. Which investigation is the gold standard to decide whether her angle is open or closed?

A 5-month-old boy is brought to the eye OPD because he keeps his eyes shut in daylight and they water constantly. Both corneas are enlarged (13 mm) and hazy, with horizontal breaks in Descemet's membrane, and IOP under anaesthesia is 30 mmHg in both eyes. What is the treatment of choice?

A 16-year-old boy from a tribal area of Chhattisgarh is hit in the right eye by a stone. He has a 3 mm hyphaema and an IOP of 34 mmHg. A sickling solubility test is positive, and haemoglobin electrophoresis shows HbAS. Which IOP-lowering drug should be avoided in him?

A 70-year-old woman has a painful, blind (no perception of light) left eye after years of untreated chronic angle-closure glaucoma. IOP is 52 mmHg despite maximal drops, and the eye looks cosmetically acceptable. Which procedure is preferred to relieve her pain while keeping the eye?

During diabetic retinopathy screening, a resident measures the neuroretinal rim of a 56-year-old man's right optic disc (as a fraction of the disc diameter): inferior 0.12, superior 0.30, nasal 0.25, temporal 0.18. The left disc follows the usual pattern. What does this right disc suggest?

A 55-year-old woman sees rainbow-coloured rings around street lights in the evenings, with a dull brow ache, for a few weeks; both clear after a night's sleep. Her anterior chambers are shallow. What produces the coloured rings she sees?