Lens and cataract: small pupil in uveitic cataract: 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 · Lens and cataract: small pupil in uveitic cataract

Sample item

In a patient with old uveitis, the pupil is 3 mm after full dilatation because of posterior synechiae. How should the surgeon manage this at cataract surgery?

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

The answer and the reasoning

B. Release synechiae and enlarge the pupil with hooks or an expansion ring

A small, rigid pupil needs synechiolysis, then mechanical expansion with iris hooks or a pupil expansion ring to give a safe view. Drug dilatation fails against fibrosis. Iridotomy and keratoplasty do not enlarge the pupil.

Option by option

  • A. Convert to a penetrating keratoplasty

    Keratoplasty is a corneal procedure and does not address the pupil.

  • B. Release synechiae and enlarge the pupil with hooks or an expansion ring (correct)

    Correct. Mechanical pupil expansion allows safe capsulorhexis and phacoemulsification.

  • C. Use topical atropine alone for a week

    Atropine cannot open a pupil bound by synechiae.

  • D. Perform a large Nd:YAG iridotomy before surgery

    An iridotomy makes a small peripheral hole and does not widen the pupil.

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 B, Release synechiae and enlarge the pupil with hooks or an expansion ring. A small, rigid pupil needs synechiolysis, then mechanical expansion with iris hooks or a pupil expansion ring to give a safe view.

Why is "Convert to a penetrating keratoplasty" not the answer?

Keratoplasty is a corneal procedure and does not address the pupil.

Why is "Use topical atropine alone for a week" not the answer?

Atropine cannot open a pupil bound by synechiae.

Why is "Perform a large Nd:YAG iridotomy before surgery" not the answer?

An iridotomy makes a small peripheral hole and does not widen the pupil.

What concept does this question test?

It tests Lens and cataract: small pupil in uveitic cataract in Ophthalmology. Drug dilatation fails against fibrosis. Iridotomy and keratoplasty do not enlarge the pupil.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Lens and cataract: small pupil in uveitic cataract?

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.