Neuro-ophthalmology and pupils: threatened vision in idiopathic intracranial hypertension: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro-ophthalmology and pupils: threatened vision in idiopathic intracranial hypertension

Sample item

An obese woman with idiopathic intracranial hypertension has progressive loss of visual field and worsening disc swelling despite the maximum tolerated dose of acetazolamide and weight loss. Which procedure is most appropriate to protect her vision?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Optic nerve sheath fenestration or CSF shunting

When vision is threatened despite medical therapy, the aim is to decompress the optic nerves. Optic nerve sheath fenestration relieves the pressure on the nerve head, and a lumboperitoneal or ventriculoperitoneal shunt lowers the CSF pressure. These are reserved for failing vision, since most patients respond to weight loss and acetazolamide.

Option by option

  • A. Trabeculectomy

    Trabeculectomy lowers intraocular pressure and does not address the intracranial pressure.

  • B. Lateral tarsorrhaphy

    Tarsorrhaphy protects the cornea in exposure and has no effect on the optic nerve.

  • C. Panretinal photocoagulation

    Panretinal photocoagulation treats retinal ischaemia and does not relieve the optic nerve swelling.

  • D. Optic nerve sheath fenestration or CSF shunting (correct)

    Correct. Nerve sheath fenestration or a CSF shunt decompresses the optic nerve when vision is deteriorating.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Optic nerve sheath fenestration or CSF shunting. When vision is threatened despite medical therapy, the aim is to decompress the optic nerves.

Why is "Trabeculectomy" not the answer?

Trabeculectomy lowers intraocular pressure and does not address the intracranial pressure.

Why is "Lateral tarsorrhaphy" not the answer?

Tarsorrhaphy protects the cornea in exposure and has no effect on the optic nerve.

Why is "Panretinal photocoagulation" not the answer?

Panretinal photocoagulation treats retinal ischaemia and does not relieve the optic nerve swelling.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: threatened vision in idiopathic intracranial hypertension in Ophthalmology. Optic nerve sheath fenestration relieves the pressure on the nerve head, and a lumboperitoneal or ventriculoperitoneal shunt lowers the CSF pressure. These are reserved for failing vision, since most patients respond to weight loss and acetazolamide.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro-ophthalmology and pupils: threatened vision in idiopathic intracranial hypertension?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.