Ophthalmology MCQs for NEET PG
891 worked Ophthalmology questions across 102 areas. Each one has its own page with the reasoning for every option.
What this set is
Ophthalmology is compact and picture-driven. Learn the red eye, glaucoma, retina, lens and neuro-ophthalmology by sign and by image.
This page lists the 891 Ophthalmology questions that have a full worked page: 627 application questions that put a fact to use on a patient or a finding, and 264 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Ophthalmology practice bank in the app is larger, with 3,186 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Ophthalmology test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Ophthalmology covers in the exam
- Anatomy and physiology of the eye
- Conjunctiva and cornea
- Lens and cataract
- Glaucoma
- Uvea
- Retina
- Neuro-ophthalmology and pupils
- Community ophthalmology
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Ophthalmology study guide.
Worked questions by area
102 areas, largest first. Open an area to see its questions.
Retina117
- Retina · ApplicationA pale retina with a cherry-red spot at the macula and sudden painless loss of vision indicates:
- Retina · ApplicationA 16-year-old boy has poor vision in dim light since childhood and gradually narrowing visual fields. Fundus shows bone-spicule pigmentation in the mid-periphery, atten…
- Retina · ApplicationA baby born at 28 weeks with a low birth weight receives prolonged oxygen therapy. Which retinal process underlies retinopathy of prematurity?
- Retina · Multi-stepA highly myopic 45-year-old reports flashes and new floaters followed by a curtain-like shadow in the upper field. Pigment cells are seen in the anterior vitreous, and…
- Retina: hypertensive retinopathy · ApplicationA 50-year-old man with severe hypertension has fundus findings of flame-shaped haemorrhages, cotton-wool spots and swelling of the optic disc. How is this graded in the…
- Retina: central retinal vein occlusion · ApplicationThe fundus shows widespread flame-shaped haemorrhages, dilated tortuous veins and disc oedema in one eye. What is the diagnosis?
- Retina: branch retinal vein occlusion · Multi-stepA hypertensive 62-year-old has sudden blurring with sector retinal haemorrhages in the superotemporal quadrant. What is the site of the occlusion?
- Retina: rhegmatogenous detachment · ApplicationA myopic man reports flashes, a shower of floaters and then a curtain across his vision. What is the likely diagnosis?
- Retina: detachment predisposition · ApplicationWhich retinal degeneration is most commonly associated with rhegmatogenous detachment in myopes?
- Retina: tractional detachment · ApplicationA patient with proliferative diabetic retinopathy has a taut fibrovascular membrane pulling the retina forward. What is the best treatment?
- Retina: exudative detachment · Multi-stepIn which condition is a retinal detachment shifting with posture and lacking any retinal break expected?
- Retina: retinitis pigmentosa · ApplicationA teenager has night blindness, tunnel vision, bone-spicule pigmentation, arteriolar attenuation and waxy pallor of the disc. What does the ERG show?
- Retina: Usher syndrome · Multi-stepA child with retinitis pigmentosa also has congenital sensorineural deafness. What is the diagnosis?
- Retina: Stargardt disease · Multi-stepA teenager has progressive central vision loss, a beaten-bronze macula and a dark choroid on fluorescein angiography. What is the diagnosis?
- Retina: Best disease · Multi-stepA child with a normal ERG has a yolk-like macular lesion and an abnormal electro-oculogram. What is the finding in the EOG?
- Retina: dry age-related macular degeneration · ApplicationAn elderly smoker with intermediate dry AMD asks which measure reduces progression. What is recommended?
- Retina: wet AMD · ApplicationA 72-year-old has sudden distortion of straight lines and a macular haemorrhage with subretinal fluid on OCT. What is the treatment of choice?
- Retina: central serous chorioretinopathy · ApplicationA 35-year-old stressed executive on corticosteroids has sudden unilateral blurring with micropsia and a serous neurosensory detachment at the macula. What is the diagno…
- Retina: macular hole · Multi-stepAn elderly woman has central distortion and a Watzke-Allen test showing a break in the slit beam. What is the diagnosis?
- Retina: retinopathy of prematurity · ApplicationWhich baby needs ROP screening according to standard criteria?
- Retina: ROP plus disease · Multi-stepIn ROP, what does the term plus disease indicate?
- Retina: Coats disease · Multi-stepA 7-year-old boy has unilateral leukocoria with massive yellow subretinal exudates and telangiectatic vessels, but no calcification. What is the diagnosis?
- Retina: sickle cell retinopathy · Multi-stepA patient with HbSC disease has peripheral retinal neovascularisation in a sea-fan configuration. How should this be managed?
- Retina: fluorescein angiography · ApplicationWhich statement about fluorescein angiography is correct?
- Retina: hydroxychloroquine toxicity · Multi-stepA woman on long-term hydroxychloroquine for lupus has a paracentral ring scotoma and a bull's eye lesion at the macula. Which is the key risk factor?
- Retina: Eales disease · Multi-stepA young Indian man has recurrent painless vitreous haemorrhages with peripheral periphlebitis and neovascularisation. What is the diagnosis?
- Retina: Roth spots · Multi-stepA patient with fever and a new cardiac murmur has retinal haemorrhages with white centres. What is the diagnosis?
- Retina: Purtscher retinopathy · Multi-stepAfter a crush chest injury a patient has multiple cotton wool spots and haemorrhages around the disc. What is the diagnosis?
- Retina: Terson syndrome · Multi-stepA patient with a ruptured intracranial aneurysm has vitreous haemorrhage. What is this called?
- Retina: cotton wool spots · ApplicationCotton wool spots represent which pathology?
- Retina: epiretinal membrane · ApplicationA 65-year-old has mild central distortion and a glistening cellophane-like reflex at the macula. What is the diagnosis?
- Retina: Leber congenital amaurosis · Multi-stepAn infant has roving eye movements, a poor pupillary response, an oculodigital sign and a flat ERG. What is the diagnosis?
- Retina: choroidal haemangioma · Multi-stepA child with a port-wine stain over the face has an orange-red choroidal mass and glaucoma in the ipsilateral eye. Which syndrome is this?
- Retina: retinal haemangioblastoma · Multi-stepA young adult has a red round retinal tumour with dilated feeder vessels and a family history of cerebellar haemangioblastoma and renal cell carcinoma. Which gene is mu…
- Retina: indirect ophthalmoscopy advantage · ApplicationWhat is the main advantage of binocular indirect ophthalmoscopy over direct ophthalmoscopy in retinal detachment surgery?
- Retina: immediate CRAO measures · Multi-stepA patient presents within 1 hour of CRAO. Which immediate steps are recommended to try to dislodge the embolus?
- Retina: ischaemic CRVO · ApplicationA patient with CRVO has an RAPD, extensive retinal haemorrhages, cotton wool spots and more than 10 disc areas of capillary non-perfusion. What is the major risk in the…
- Retina: proliferative diabetic retinopathy · ApplicationA diabetic patient shows new vessels on the optic disc covering more than one third of the disc area. This is classified as:
- Retina: ETDRS CSME definition · Multi-stepAccording to the ETDRS, which finding defines clinically significant macular oedema?
- Retina: stages of ROP · ApplicationIn the international classification of ROP, which stage is characterised by a raised ridge with neovascular tufts (extraretinal fibrovascular proliferation)?
- Retina: treatment of type 1 ROP · Multi-stepA 32-week premature infant has zone I ROP with plus disease. What is the recommended management?
- Retina: Lincoff rules · Multi-stepA patient has an inferior rhegmatogenous retinal detachment in which the subretinal fluid level is higher on the temporal side than on the nasal side. According to Linc…
- Retina: lattice degeneration · ApplicationA high myope whose fellow eye has had a retinal detachment now shows lattice degeneration with atrophic holes in the peripheral retina. What is the appropriate prophyla…
- Retina: posterior vitreous detachment symptoms · ApplicationA 62-year-old emmetropic woman notices a sudden onset of a large floater and flashes of light in one eye with normal acuity. What is the most important next step?
- Retina: pigmentary retinopathy with systemic disease · Multi-stepA child with ataxia, anosmia, deafness, ichthyosis and night blindness has raised serum phytanic acid. Which disease is this?
- Retina: fundus fluorescein angiography · ApplicationIn fundus fluorescein angiography, which finding in the late phase is typical of a classic choroidal neovascular membrane in wet AMD?
- Retina: retinoblastoma spread and treatment · Multi-stepA child with advanced unilateral retinoblastoma has a tumour that fills the globe and shows invasion of the post-laminar optic nerve on histopathology. What is appropri…
- Retina: proliferative vitreoretinopathy · Multi-stepTwo months after a repair of rhegmatogenous detachment, the retina redetaches with star folds and fixed retinal creases, and no new break. What is the process?
- Retina: embolic work-up in artery occlusion · ApplicationA 55-year-old smoker has had a central retinal artery occlusion with a cherry red spot. Which pair of investigations best identifies an embolic source?
- Retina: choroidal rupture · ApplicationAfter blunt trauma with a ball, a boy has vision of 6/60 and a curved yellow-white subretinal streak concentric to the disc. Which late complication should be watched f…
- Retina: commotio retinae · ApplicationA cricketer is hit by a ball and has vision of 6/18 with a grey-white cloudiness of the posterior retina with a normal choroid. What is the expected course?
- Retina: early worsening with glycaemic control · ApplicationA diabetic with HbA1c of 12.5 percent starts intensive insulin. Three months later he has more cotton wool spots and haemorrhages. What is this?
- Retina: cone dystrophy · ApplicationA 20-year-old has slowly progressive central vision loss, photophobia and poor colour vision with a nearly normal fundus early on. The ERG shows a reduced photopic resp…
- Retina: abetalipoproteinaemia · Multi-stepA child has steatorrhoea, failure to thrive, acanthocytes, ataxia and a pigmentary retinopathy with night blindness. Which treatment can slow the retinal and neurologic…
- Retina: retinal arterial macroaneurysm · Multi-stepA 70-year-old hypertensive woman has sudden painless vision loss, with haemorrhages in the subretinal, intraretinal and pre-retinal planes around a round lesion on an a…
- Retina: dietary supplements in macular degeneration · ApplicationA 68-year-old non-smoker has intermediate dry age-related macular degeneration in both eyes. Which measure is supported to reduce progression to advanced disease?
- Retina: optic disc pit · ApplicationA young adult has a grey, oval depression at the temporal disc margin and a serous detachment of the macula without a retinal break. What is the congenital anomaly?
- Retina: angioid streaks · ApplicationA 40-year-old woman has leathery, plucked-chicken-like skin folds at the neck and axillae and reduced central vision. Fundus shows dark irregular lines radiating from t…
- Retina: arteriovenous crossing changes · ApplicationIn a long-standing hypertensive patient, the fundus shows a retinal vein that appears tapered where an arteriole crosses it. Why does the vein look compressed?
- Retina: cherry red spot in an infant · ApplicationA 9-month-old child has an exaggerated startle to sounds, loss of earlier motor skills and hypotonia. The fovea shows a cherry red spot surrounded by pale retina. What…
- Retina: Hollenhorst plaque · ApplicationA 66-year-old smoker has had a brief episode of curtain-like vision loss in one eye. Fundus shows a bright, refractile yellow plaque at a retinal arteriolar bifurcation…
- Retina: retinal haemorrhages in abusive head trauma · Multi-stepA 4-month-old infant is brought unconscious with subdural haemorrhage and no history of trauma. The ophthalmologist finds extensive multilayer retinal haemorrhages exte…
- Retina: Eales disease · Multi-stepA 24-year-old Indian man has sudden floaters from a vitreous haemorrhage. Both eyes show peripheral retinal periphlebitis, sheathed veins and areas of capillary non-per…
- Retina: choroidal detachment · Multi-stepTwo days after glaucoma filtering surgery, a patient has a very low intraocular pressure, a shallow anterior chamber and, on fundoscopy, smooth, dark brown, convex elev…
- Retina: ocular cysticercosis · ApplicationA 25-year-old from a rural area who has had seizures presents with blurred vision. Fundus examination shows a translucent subretinal cyst with an eccentric white spot t…
- Retina: polypoidal choroidal vasculopathy · Multi-stepA 62-year-old Asian man has recurrent serous and haemorrhagic pigment epithelial detachments with orange-red subretinal nodules near the optic disc, only partly respons…
- Retina: nitrous oxide and intraocular gas · ApplicationA patient had a vitrectomy with intraocular sulphur hexafluoride gas tamponade a week ago and now needs another operation under general anaesthesia. Which agent must be…
- Retina: silicone oil tamponade · ApplicationA surgeon discusses long-acting tamponade after vitrectomy for complex retinal detachment. Which statement correctly describes intraocular silicone oil, as distinct fro…
- Retina: Stickler syndrome · Multi-stepA child has high myopia, a flat midface, micrognathia with cleft palate, early joint problems and hearing loss. The vitreous appears optically empty with membranous str…
- Retina: choroideremia · Multi-stepA 15-year-old boy has night blindness and progressive loss of peripheral vision. Fundus examination shows widespread chorioretinal atrophy exposing white sclera with a…
- Retina: gyrate atrophy · Multi-stepA 12-year-old with myopia and night blindness has sharply demarcated, scalloped patches of chorioretinal atrophy in the mid-periphery and early cataract. Plasma amino a…
- Retina: thioridazine retinopathy · ApplicationA psychotic patient on a high dose of an antipsychotic reports poor night vision and brownish discolouration of vision. The fundus shows coarse pigment clumping and mot…
- Retina: sildenafil and the retina · Multi-stepA man taking sildenafil reports a transient bluish tinge to everything he sees about an hour after the dose. Which mechanism explains this?
- Retina: ocular ischaemic syndrome · Multi-stepA 68-year-old diabetic smoker has dull ocular pain and a unilateral picture of mid-peripheral dot-blot haemorrhages, narrowed arterioles, dilated non-tortuous veins, sp…
- Retina: familial exudative vitreoretinopathy · Multi-stepA healthy full-term child has avascular peripheral temporal retina in both eyes, temporal dragging of the disc and macula, and an affected parent. There is no history o…
- Retina: Oguchi disease · Multi-stepA boy has lifelong non-progressive night blindness. His fundus has a golden-yellow sheen that returns to a normal colour after several hours in the dark and reappears a…
- Retina: angiography in central serous chorioretinopathy · ApplicationA 34-year-old man with sudden blurring and micropsia in one eye has a shallow neurosensory detachment at the macula. Fluorescein angiography is done to find the source…
- Retina: management of central serous chorioretinopathy · ApplicationA 38-year-old man has been taking oral prednisolone for asthma. He now has painless blurring and micropsia in the right eye with a serous macular detachment on OCT and…
- Retina: retinoschisis versus detachment · Multi-stepA 65-year-old hypermetropic man has a smooth, dome-shaped, transparent elevation in the inferotemporal periphery. There are no retinal breaks in the outer layer, no tob…
- Retina: solar retinopathy · ApplicationA 19-year-old student watched a solar eclipse for several minutes without any filter. Two days later he has blurred central vision in both eyes with a small yellowish s…
- Retina: trilateral retinoblastoma · Multi-stepA 3-year-old child treated for bilateral retinoblastoma now has persistent morning vomiting, headache and drowsiness. MRI shows a midline mass near the third ventricle.…
- Retina: second tumours after retinoblastoma · ApplicationA man in his twenties who was treated in childhood for bilateral retinoblastoma, including external beam radiotherapy, develops a painful swelling of the femur. Which s…
- Retina: arteriovenous crossing changes · ApplicationA 55-year-old man with long-standing hypertension has retinal veins that appear to taper and be compressed where a thickened arteriole crosses them. What is this sign c…
- Retina: vitelliform dystrophy electrophysiology · Multi-stepA 9-year-old boy with a family history of a dominantly inherited macular disease has a well-circumscribed yellow lesion at the fovea, like a sunny-side-up egg. His full…
- Retina: von Hippel-Lindau retinal lesion · ApplicationA 25-year-old has a round orange-red retinal tumour with dilated feeding vessels in the periphery. His father had a cerebellar tumour and renal cancer. Which additional…
- Retina: retinal astrocytic hamartoma · ApplicationA 7-year-old with infantile spasms and hypomelanotic skin patches has a whitish, mulberry-like elevated lesion at the edge of the optic disc. Which lesion is this?
- Retina: pathological myopia macular complication · ApplicationA 40-year-old woman with a refractive error of -14 D has sudden central distortion. The macula shows a small, round, dark pigmented lesion with a surrounding haemorrhag…
- Retina: Valsalva retinopathy · ApplicationA 28-year-old woman develops sudden painless blurring of the central vision while lifting a heavy box. Fundus shows a round haemorrhage with a flat level at its lower e…
- Retina: tamoxifen retinopathy · ApplicationA 58-year-old woman on long-term endocrine therapy after breast cancer surgery is found on examination to have fine glittering yellow-white crystals in the inner retina…
- Retina: limits of pneumatic retinopexy · ApplicationA surgeon plans to repair a rhegmatogenous detachment with an inferior retinal break by injecting an intraocular gas bubble. Why is this approach unsuitable for the inf…
- Retina: side effects of panretinal photocoagulation · ApplicationA diabetic patient with high-risk proliferative retinopathy has just completed panretinal photocoagulation. Which complaint should he be told to expect because of the t…
- Retina: cilioretinal artery and artery occlusion · Multi-stepA 60-year-old man has sudden loss of vision in one eye from central retinal artery occlusion. Despite a diffusely pale retina, a tongue of normal-coloured retina and go…
- Retina: early lesion in diabetic microangiopathy · ApplicationIn a patient with long-standing diabetes, which early change in the retinal capillary wall is thought to lead to microaneurysm formation?
- Retina: retinal changes in toxaemia of pregnancy · Multi-stepA 27-year-old woman with eclampsia has bilateral blurred vision. Examination shows bilateral serous retinal detachments and yellowish patches at the level of the pigmen…
- Retina: X-linked juvenile retinoschisis · Multi-stepA 7-year-old boy has poor reading vision and his maternal uncle had similar trouble. The fovea shows a spoke-wheel pattern of cystic spaces, and a small peripheral infe…
- Retina: pathology of cotton wool spots · ApplicationA patient with severe hypertension has several white, fluffy patches with feathery edges in the posterior pole. What is the underlying pathology of these patches?
- Retina · ApplicationNew disc vessels in diabetes indicate what?
- Retina · ApplicationWidespread hemorrhages and tortuous veins suggest what?
- Retina · ApplicationNew floaters flashes and curtain suggest what?
- Retina · ApplicationCherry-red fovea indicates what?
- Retina · ApplicationBlood-and-thunder fundus suggests what?
- Retina · ApplicationWhat symptom may suggest retinal detachment?
- Retina · ApplicationWhich retinal area provides the sharpest central vision?
- Retina · ApplicationWhat vision complaint is typical of macular disease?
- Retina · ApplicationWhat finding is associated with diabetic retinopathy?
- Retina · ApplicationWhat is a key modifiable factor in diabetic retinopathy prevention?
- Retina · ApplicationWhat symptom warrants urgent assessment for possible retinal tear?
- Retina · ApplicationWhat condition causes central retinal vision distortion in older adults?
- Retina · ApplicationWhat test photographs or documents the retinal circulation?
- Retina · ApplicationWhat symptom can suggest retinal detachment?
- Retina · ApplicationWhat retinal area provides sharpest central vision?
- Retina · ApplicationWhich symptom is a classic warning sign of retinal detachment?
- Retina · ApplicationWhat is the commonest cause of severe vision loss in proliferative diabetic retinopathy?
- Retina · ApplicationWhat retinal lesion defines proliferative diabetic retinopathy?
- Retina · ApplicationWhat is the hallmark symptom of wet age-related macular degeneration?
- Retina · ApplicationWhat is the first urgent management goal in central retinal artery occlusion?
- Retina · ApplicationWhat is the typical fundus appearance in central retinal vein occlusion?
Glaucoma89
- Glaucoma · ApplicationWhich topical glaucoma medicine lowers intraocular pressure mainly by increasing uveoscleral outflow?
- Glaucoma · ApplicationWhich drug is given systemically to reduce intraocular pressure in acute angle-closure glaucoma?
- Glaucoma · ApplicationWhich optic disc change is typical of primary open-angle glaucoma?
- Glaucoma · ApplicationA 58-year-old woman has sudden severe eye pain, halos around lights and vomiting after sitting in a dim cinema. Which ocular feature most likely predisposed her to this…
- Glaucoma · ApplicationA 2-month-old infant has persistent watering, photophobia, blepharospasm and a hazy cornea that looks larger than normal. What is the most likely diagnosis?
- Glaucoma: Schiotz · Multi-stepIn Schiotz tonometry, which factor leads to a falsely low IOP reading?
- Glaucoma: POAG disc changes · ApplicationWhich optic disc finding is most suggestive of primary open-angle glaucoma?
- Glaucoma: ISNT rule · ApplicationIn a healthy optic disc, which is the correct order of neuroretinal rim thickness from thickest to thinnest?
- Glaucoma: visual field defects · ApplicationWhich is the earliest typical field defect in glaucoma?
- Glaucoma: angle closure risk · ApplicationWhich patient is most at risk of primary angle closure glaucoma?
- Glaucoma: acute angle closure features · ApplicationA 58-year-old woman has severe headache, vomiting, halos around lights and a hazy cornea. What pupil finding is expected?
- Glaucoma: acute angle closure management · Multi-stepIn acute primary angle closure, which drug should be used only after IOP has been lowered, because the iris sphincter is ischaemic?
- Glaucoma: definitive treatment in angle closure · ApplicationWhat is the definitive treatment for pupillary block angle closure?
- Glaucoma: gonioscopy grading · Multi-stepOn the Shaffer grading system, a grade 2 angle indicates what?
- Glaucoma: prostaglandin analogues · ApplicationA patient started on latanoprost develops darkening of the iris and longer eyelashes. What is the mechanism of the drug's pressure-lowering effect?
- Glaucoma: alpha-2 agonists · ApplicationWhich antiglaucoma drug is contraindicated in infants because of central nervous system depression?
- Glaucoma: carbonic anhydrase inhibitors · ApplicationWhich adverse effect is associated with oral acetazolamide?
- Glaucoma: congenital · ApplicationAn infant has watering, photophobia and blepharospasm with an enlarged hazy cornea of 13 mm diameter. What is the treatment of choice?
- Glaucoma: Haab's striae · Multi-stepWhich statement about Haab's striae is correct?
- Glaucoma: neovascular · ApplicationA diabetic patient with ischaemic central retinal vein occlusion presents with a painful eye and rubeosis iridis. What is the mechanism of the raised IOP?
- Glaucoma: steroid-induced · ApplicationAfter 6 weeks of topical dexamethasone for allergic conjunctivitis, a patient has raised IOP. What is the mechanism?
- Glaucoma: pigment dispersion · Multi-stepA 30-year-old myopic man has a vertical spindle of pigment on the central corneal endothelium and mid-peripheral iris transillumination defects. What is the diagnosis?
- Glaucoma: pseudoexfoliation · Multi-stepAn elderly man has white dandruff-like deposits on the anterior lens capsule in a target pattern and a high IOP. What is the diagnosis?
- Glaucoma: normal tension · Multi-stepWhich feature is associated with normal tension glaucoma?
- Glaucoma: trabeculectomy · Multi-stepWhich adjunct is commonly applied during trabeculectomy to reduce scarring of the filtering bleb?
- Glaucoma: malignant glaucoma · Multi-stepAfter trabeculectomy for angle closure, a patient develops a very shallow central and peripheral chamber with high IOP despite a patent iridotomy. Which drug is useful?
- Glaucoma: perimetry · ApplicationWhich statement is true about automated static perimetry in glaucoma follow-up?
- Glaucoma: low-tension drug effect · ApplicationWhich topical antiglaucoma drug lowers IOP by inhibiting carbonic anhydrase in the ciliary body?
- Glaucoma: Posner-Schlossman · Multi-stepA middle-aged man has recurrent unilateral episodes of markedly raised IOP with mild discomfort, few keratic precipitates and an open angle. What is the diagnosis?
- Glaucoma: end-stage field · ApplicationA patient with advanced glaucoma has central 10 degrees of vision and a small island of temporal field. Visual acuity is preserved. This is called:
- Glaucoma: OCT RNFL · ApplicationWhich test objectively measures retinal nerve fibre layer thickness to detect glaucoma before field loss?
- Glaucoma: OHTS trial · Multi-stepIn ocular hypertension, which trial showed that topical hypotensive treatment reduced the incidence of POAG by about half?
- Glaucoma: normal tension glaucoma · ApplicationA woman with migraine and cold hands has glaucomatous cupping and field loss, but all IOP readings are 14 to 18 mmHg and the angle is open. What is the likely diagnosis?
- Glaucoma: Van Herick grading · ApplicationOn slit-lamp examination the peripheral anterior chamber depth is less than one quarter of the adjacent corneal thickness. What is the interpretation?
- Glaucoma: glaukomflecken · Multi-stepFollowing an attack of acute angle closure many weeks ago, a patient has small greyish white anterior subcapsular lens opacities. These are called:
- Glaucoma: provocative tests · ApplicationIn a suspected narrow angle patient, which provocative test is performed by keeping the patient in a dark room for 60 to 90 minutes?
- Glaucoma: dorzolamide · ApplicationA glaucoma patient has a known severe sulfonamide allergy. Which topical agent should be avoided?
- Glaucoma: pilocarpine mechanism · ApplicationHow does pilocarpine lower IOP in open angle glaucoma?
- Glaucoma: netarsudil · Multi-stepWhich antiglaucoma drug acts by Rho kinase inhibition, increasing trabecular outflow and reducing episcleral venous pressure?
- Glaucoma: selective laser trabeculoplasty · ApplicationA patient with early POAG cannot tolerate drops. Which laser treatment targets the trabecular pigmented cells with a 532 nm Q-switched Nd:YAG laser?
- Glaucoma: blebitis · Multi-stepThree years after trabeculectomy, a patient has a red eye with a milky white bleb and anterior chamber reaction, but a clear vitreous. This is:
- Glaucoma: ICE syndrome · Multi-stepA young woman has unilateral glaucoma, corneal oedema, and iris atrophy with corectopia and hammered silver endothelium. Which condition is this?
- Glaucoma: pupillary block mechanism · Multi-stepIn primary angle closure, why does the iris bow forward?
- Glaucoma: surgery for congenital glaucoma · Multi-stepA 3-month-old with watering, photophobia and a corneal diameter of 12.5 mm has a hazy cornea that prevents a clear view of the angle. Which procedure is best?
- Glaucoma: hypotony maculopathy · Multi-stepTwo weeks after trabeculectomy with mitomycin, a patient has IOP of 3 mmHg, vision of 6/60, choroidal folds and macular oedema. The bleb is large and thin. What explain…
- Glaucoma: plateau iris · Multi-stepA 45-year-old woman had a patent laser iridotomy for an angle-closure attack. The central anterior chamber is of normal depth, yet gonioscopy shows a closed angle and t…
- Glaucoma: ghost cell glaucoma · Multi-stepFour weeks after a dense vitreous haemorrhage, a patient who has had cataract surgery develops high intraocular pressure. The anterior chamber shows khaki-coloured cell…
- Glaucoma: blebitis after trabeculectomy · Multi-stepTwo years after trabeculectomy, a patient has sudden pain, redness and reduced vision. The filtering bleb is opaque and milky with a hazy anterior chamber but no hypopy…
- Glaucoma: indentation gonioscopy · Multi-stepOn static gonioscopy the angle of an eye appears closed. When the cornea is gently indented with a four-mirror lens, the iris falls back and the trabecular meshwork bec…
- Glaucoma: topiramate-induced angle closure · Multi-stepA woman started on a migraine prophylactic two weeks ago presents with bilateral blurred vision, new myopia of about 5 dioptres, shallow anterior chambers and raised in…
- Glaucoma: uveitic glaucoma and drug choice · ApplicationA patient with active HLA-B27 anterior uveitis has an intraocular pressure of 34 mmHg and early posterior synechiae. Which antiglaucoma drug is best avoided?
- Glaucoma: drainage device surgery · ApplicationA diabetic patient has neovascular glaucoma with an intraocular pressure of 42 mmHg despite maximal medical therapy and a closed angle with extensive new vessels. Trabe…
- Glaucoma: angle-recession glaucoma · ApplicationA 40-year-old man was hit in the left eye by a shuttlecock 12 years ago. He now has an intraocular pressure of 32 mmHg in that eye, although the angle looks open. Which…
- Glaucoma: epithelial downgrowth · Multi-stepThree weeks after repair of a penetrating corneal wound that leaked, a man develops raised intraocular pressure and a thin translucent sheet with a sharp edge on the ba…
- Glaucoma: Sturge-Weber in adults · Multi-stepA 35-year-old man with a facial port-wine stain has raised pressure in one eye. Gonioscopy shows a wide-open angle with blood visible in Schlemm canal. Which mechanism…
- Glaucoma: Axenfeld-Rieger syndrome · Multi-stepA child has an anteriorly displaced Schwalbe line with iris strands attached to it, iris stromal hypoplasia, hypodontia and raised intraocular pressure. Which gene is m…
- Glaucoma: perimetry global indices · Multi-stepA patient with glaucoma also has a developing cataract. On automated static perimetry, which global index best reflects localised glaucomatous loss while being relative…
- Glaucoma: Collaborative Normal Tension Glaucoma Study · ApplicationIn the Collaborative Normal-Tension Glaucoma Study, lowering intraocular pressure by roughly what proportion from baseline slowed progression of field loss?
- Glaucoma: painful blind eye · ApplicationA 70-year-old has an old neovascular glaucoma in an eye with no perception of light, a pressure of 50 mmHg despite maximal medication, and constant severe pain. Which p…
- Glaucoma: management of the fellow eye · ApplicationA woman has had an acute angle-closure attack in her right eye, treated with laser iridotomy. Her left eye is quiet but has an equally narrow angle. What is the best ma…
- Glaucoma: reversible cupping in infants · Multi-stepAfter a successful goniotomy in an infant with raised pressure, the enlarged optic disc cup becomes smaller on follow-up. Why can cupping regress in infants but not in…
- Glaucoma: Sampaolesi line · Multi-stepA 70-year-old with high intraocular pressure has a wavy line of brown pigment anterior to Schwalbe line on gonioscopy, and the pupil dilates poorly. Which condition is…
- Glaucoma: cardioselective beta-blocker · ApplicationA glaucoma patient with mild chronic airway disease needs a topical beta-blocker. Which drug has relative beta-1 selectivity and is the usual choice in this situation?
- Glaucoma: stages of primary angle closure · ApplicationA 55-year-old hypermetropic woman has episodes of blurred vision with coloured halos, mainly in the evening or in dim light, that settle after sleep. Between episodes h…
- Glaucoma: brimonidine allergy · ApplicationAfter several months of brimonidine drops, a patient has red itchy eyes with follicles on the lower tarsal conjunctiva. What is the most likely cause?
- Glaucoma: topical carbonic anhydrase inhibitor and endothelium · ApplicationA patient with Fuchs endothelial dystrophy needs a pressure-lowering drop. Which topical class carries a risk of corneal decompensation in such eyes?
- Glaucoma: steroid responders · ApplicationWhich group is most likely to show a marked rise in intraocular pressure after weeks of topical corticosteroid?
- Glaucoma: miotics and retinal detachment · ApplicationWhich serious posterior segment complication is a recognised risk of long-term pilocarpine use, particularly in myopic patients?
- Glaucoma · ApplicationPainless peripheral field loss and cupping suggest what?
- Glaucoma · ApplicationHalos, pain, nausea, and mid-dilated pupil suggest what?
- Glaucoma · ApplicationGradual peripheral field loss and cupping suggest what?
- Glaucoma · ApplicationPainful red eye with nausea and halos suggests what?
- Glaucoma · ApplicationWhat is the major modifiable risk factor for glaucomatous optic damage?
- Glaucoma · ApplicationWhat symptom pattern is concerning for acute angle-closure glaucoma?
- Glaucoma · ApplicationWhat type of visual-field loss is classically associated with chronic glaucoma?
- Glaucoma · ApplicationWhat procedure creates an opening in the iris for selected angle-closure risk?
- Glaucoma · ApplicationWhat structural change is assessed in glaucoma monitoring?
- Glaucoma · ApplicationWhat can lower intraocular pressure in open-angle glaucoma?
- Glaucoma · ApplicationWhat optic-disc change can indicate glaucomatous structural progression?
- Glaucoma · ApplicationWhat symptom pattern suggests acute angle-closure glaucoma?
- Glaucoma · ApplicationWhich symptom cluster is most concerning for acute angle-closure glaucoma?
- Glaucoma · ApplicationWhy is primary open-angle glaucoma often detected late?
- Glaucoma · ApplicationWhat is the typical visual-field defect in early primary open-angle glaucoma?
- Glaucoma · ApplicationWhich structure determines resistance to aqueous humour drainage in open-angle glaucoma?
- Glaucoma · ApplicationWhat structure drains aqueous humour in open-angle glaucoma?
- Glaucoma · ApplicationWhat symptom pattern suggests acute angle closure?
- Glaucoma: open-angle glaucoma · ApplicationWhich feature is most typical of primary open-angle glaucoma?
- Glaucoma · ApplicationWhat is the purpose of gonioscopy?
- Glaucoma · ApplicationWhat optic-disc change is typical of glaucomatous damage?
Cornea50
- Cornea · ApplicationA man has a red, watering, photophobic eye. Slit-lamp examination after fluorescein staining shows a branching linear ulcer with terminal bulbs, and corneal sensation i…
- Cornea · ApplicationA farmer hit his eye with a paddy straw a week ago. He now has a dense, dry-looking, greyish-white corneal infiltrate with feathery edges, satellite lesions and a hypop…
- Cornea · Multi-stepA soft contact lens wearer who swims with the lenses in has had severe, disproportionate eye pain for ten days. The slit lamp shows a ring-shaped stromal infiltrate and…
- Cornea · ApplicationA 19-year-old with atopy and frequent eye rubbing has progressive blurring of vision. Retinoscopy shows an irregular scissoring reflex, and the lower lid shows a V-shap…
- Cornea: herpes zoster ophthalmicus · ApplicationA 70-year-old man has a painful vesicular rash on the right forehead and scalp, and now a vesicle on the tip of his nose. His right eye is red and photophobic. What doe…
- Cornea: transparency · ApplicationWhich mechanism is chiefly responsible for keeping the normal cornea clear?
- Cornea: layers · ApplicationAfter a deep corneal injury, which layer is secreted by the endothelium and can regenerate?
- Cornea: herpes simplex keratitis · ApplicationA patient has a branching corneal ulcer with terminal bulbs that stains with fluorescein. What is the initial treatment?
- Cornea: disciform keratitis · Multi-stepA patient with prior herpetic keratitis has a central disc-shaped stromal oedema with keratic precipitates and an intact epithelium. What is the mainstay of treatment?
- Cornea: keratoconus signs · ApplicationA young man has progressive myopic astigmatism, scissoring reflex on retinoscopy and a V-shaped indentation of the lower lid on downgaze. What is the diagnosis?
- Cornea: keratoconus management · Multi-stepWhich procedure is used to halt progression of early keratoconus?
- Cornea: Fuchs endothelial dystrophy · Multi-stepA 60-year-old woman has morning blurring that improves through the day, with guttae seen on specular microscopy. Which procedure restores vision when the cornea decompe…
- Cornea: donor contraindications · ApplicationWhich condition is an absolute contraindication to using a donor cornea?
- Cornea: band keratopathy · ApplicationA child with juvenile idiopathic arthritis develops a horizontal greyish band of calcium in the interpalpebral cornea. What treatment removes it?
- Cornea: Kayser-Fleischer ring · ApplicationA 17-year-old with tremor and hepatic dysfunction shows a golden brown ring at the corneal periphery. At which layer is the copper deposited?
- Cornea: drug-induced deposits · Multi-stepA patient on long-term amiodarone has fine whorl-like corneal epithelial deposits. What is this called?
- Cornea: neurotrophic keratitis · Multi-stepAfter a trigeminal neurectomy, a patient develops a persistent central epithelial defect with no pain. What is the underlying cause?
- Cornea: Mooren ulcer · Multi-stepA middle-aged patient has a painful peripheral crescentic ulcer with an overhanging undermined edge and no scleral inflammation. What is the likely diagnosis?
- Cornea: marginal keratitis · ApplicationA patient with staphylococcal blepharitis has peripheral corneal infiltrates separated from the limbus by a clear zone. What is the mechanism?
- Cornea: pachymetry and IOP · Multi-stepA patient with a thin central cornea has an applanation IOP of 17 mmHg. How should this be interpreted?
- Cornea: limbal stem cell deficiency · Multi-stepAfter an alkali burn, the cornea becomes covered by vascularised conjunctival tissue with a persistent epithelial defect. Which procedure addresses the root problem?
- Cornea: shield ulcer in vernal disease · ApplicationA 10-year-old boy with itching and ropy discharge presents with a horizontally oval, sterile, greyish ulcer in the upper cornea with cobblestone papillae under the uppe…
- Cornea: chemical injury · ApplicationA worker has splashed lime into his eye. Which statement about alkali burns versus acid burns is correct?
- Cornea: Roper-Hall classification · Multi-stepIn the Roper-Hall classification of chemical injury, which finding indicates the worst prognosis (grade IV)?
- Cornea: pneumococcal ulcer · ApplicationA farmer presents with an ulcer in the central cornea with an advancing yellowish edge and an undermined opposite border, with hypopyon. This is typical of:
- Cornea: geographic ulcer · ApplicationA patient with dendritic herpetic keratitis was given topical steroids by a local practitioner and the ulcer enlarged to a large map-like lesion with smooth borders. Th…
- Cornea: interstitial keratitis · ApplicationA teenager with Hutchinson teeth, saddle nose and deafness presents with bilateral corneal haze with deep stromal vascularisation giving a pink patch. This is classical…
- Cornea: neurotrophic keratitis · Multi-stepAfter a trigeminal neuralgia ablation, a patient develops a painless, non-healing central epithelial defect with reduced corneal sensation. Which agent is approved for…
- Cornea: small perforation management · ApplicationA 2 mm central corneal perforation with a formed anterior chamber is best managed initially by:
- Cornea: Descemet hydrops · Multi-stepA long-standing keratoconus patient develops sudden painful loss of vision with a milky corneal oedema over the cone. This is due to:
- Cornea: granular dystrophy · ApplicationA corneal dystrophy shows discrete white crumb-like deposits in the central anterior stroma with clear intervening stroma. The deposits stain with Masson trichrome. The…
- Cornea: lattice dystrophy staining · Multi-stepA biopsy from a corneal dystrophy with branching refractile lines shows apple-green birefringence under polarised light after a certain stain. Which stain?
- Cornea: Khodadoust line · Multi-stepTwo months after a penetrating keratoplasty, a patient has a red eye with a linear line of keratic precipitates moving across the graft endothelium. This sign indicates:
- Cornea: choice of keratoplasty · ApplicationA patient has keratoconus with scarring but a healthy endothelium. Which keratoplasty technique preserves the host endothelium?
- Cornea: Sjogren syndrome · ApplicationA 50-year-old woman has dry eyes, dry mouth and a low Schirmer value. What is the underlying lacrimal gland pathology?
- Cornea: exudative versus serous features of contact lens ulcer · Multi-stepA soft contact lens wearer with a red painful eye and a central infiltrate is advised initial management. What is the most appropriate step before starting antibiotics?
- Cornea · ApplicationBranching fluorescein-staining lesion suggests what?
- Cornea · ApplicationA superficial epithelial defect after trauma is what?
- Cornea · ApplicationContact lens wearer with infiltrate requires what?
- Cornea · ApplicationDendritic corneal lesion suggests what?
- Cornea · ApplicationWhat is a cardinal symptom of corneal inflammation?
- Cornea · ApplicationWhat is an urgent symptom complex suggesting microbial keratitis in a contact-lens user?
- Cornea · ApplicationWhat is fluorescein dye used to identify?
- Cornea · ApplicationWhat symptom is common in corneal inflammation?
- Cornea · ApplicationWhich contact-lens complaint needs same-day assessment for microbial keratitis?
- Cornea · ApplicationWhat does fluorescein staining demonstrate on ocular examination?
- Cornea · ApplicationWhat does fluorescein staining identify?
- Cornea · ApplicationWhich contact-lens symptom needs urgent assessment?
- Cornea · ApplicationWhat corneal finding is characteristic of keratoconus?
- Cornea · ApplicationWhy is herpes simplex keratitis managed cautiously with topical steroid?
Uvea48
- Uvea · ApplicationA patient has a painful red eye with photophobia, ciliary congestion, a small irregular pupil and keratic precipitates. What is the diagnosis?
- Uvea: infectious retinitis · ApplicationA man with advanced HIV (CD4 count 20 cells/mm3) has painless floaters and loss of peripheral vision. The fundus shows areas of white, necrotic retina with haemorrhages…
- Uvea: choroidal melanoma · Multi-stepA 55-year-old has a dome-shaped pigmented subretinal mass that breaks through Bruch's membrane into a mushroom shape. What is the commonest site of metastasis?
- Uvea: coloboma · ApplicationA child has a keyhole-shaped pupil with the defect located inferonasally. What is the embryological cause?
- Uvea: aniridia · Multi-stepA child with absent iris and sporadic aniridia is at risk of which tumour, and which chromosomal region is involved?
- Uvea: sarcoid uveitis · Multi-stepA patient with bilateral granulomatous uveitis, bilateral hilar lymphadenopathy and perivenous sheathing described as candle-wax drippings most likely has:
- Uvea: enucleation to prevent sympathetic ophthalmia · ApplicationA badly traumatised eye with no light perception is being considered for removal to prevent sympathetic ophthalmia. Ideally enucleation should be done within:
- Uvea: CMV retinitis treatment · ApplicationWhich regimen is appropriate for a patient with sight-threatening CMV retinitis and AIDS?
- Uvea: acute retinal necrosis · Multi-stepA healthy adult has pain, vitritis, occlusive retinal arteritis and sharply demarcated peripheral confluent necrotising retinitis. Which organisms are the usual causes?
- Uvea: syphilitic chorioretinitis · ApplicationA child with congenital syphilis shows a diffuse mottled fundus appearance with pigment clumps and pale patches. What is this fundus picture?
- Uvea: uveitic cystoid macular oedema · ApplicationThe commonest cause of visual loss in chronic uveitis is:
- Uvea: COMS trial · Multi-stepIn the Collaborative Ocular Melanoma Study of medium-sized choroidal melanoma, what did the trial show comparing iodine-125 plaque brachytherapy and enucleation?
- Uvea: hyphaema management · ApplicationA boy has a hyphaema after a cricket ball injury. Which advice is correct?
- Uvea: panophthalmitis · Multi-stepA diabetic man with a perforated corneal ulcer develops severe pain, marked proptosis, loss of ocular movements, chemosis and fever with pus visible in the eye. This is:
- Uvea: dexamethasone implant · ApplicationA pseudophakic patient has persistent uveitic macular oedema despite topical therapy, and repeated systemic steroids are poorly tolerated. Which local option can be used?
- Uvea: progressive outer retinal necrosis · Multi-stepA man with advanced HIV has rapid loss of vision with multifocal deep outer retinal whitening from the periphery, minimal vitritis and no haemorrhage. He had herpes zos…
- Uvea: dengue maculopathy · ApplicationTen days after dengue haemorrhagic fever with a platelet count of 20,000, a young man has central blurring and perifoveal haemorrhages with macular oedema. What is the…
- Uvea: rifabutin uveitis · Multi-stepA man with advanced HIV is on rifabutin and clarithromycin for Mycobacterium avium complex prophylaxis. He develops a painful red eye with hypopyon. Which is the most l…
- Uvea: leptospirosis uveitis · Multi-stepA paddy field worker in coastal Kerala recovers from fever with jaundice and conjunctival suffusion. Six weeks later he has hypopyon uveitis and vitritis. Which infecti…
- Uvea: post-chikungunya uveitis · ApplicationThree weeks after a febrile illness with severe joint pains during the monsoon, a woman has granulomatous anterior uveitis. Which preceding infection is most likely?
- Uvea: pars planitis · ApplicationA 24-year-old woman has floaters and blurred vision in both eyes. The anterior chamber is quiet, there are cells in the vitreous, and a white exudate lies over the infe…
- Uvea: acute retinal necrosis · Multi-stepA healthy 35-year-old has a painful red eye with vitritis, peripheral confluent patches of retinal whitening and occlusive arteriolitis. Which is the correct initial tr…
- Uvea: sympathetic ophthalmia presentation · ApplicationSix weeks after a perforating injury in one eye, the other uninjured eye becomes photophobic and red with mutton-fat keratic precipitates. What is the most appropriate…
- Uvea: iris pearls in leprosy · ApplicationA man with multibacillary leprosy and loss of the lateral eyebrows is found at the slit lamp to have tiny glistening yellow-white beads at the pupillary margin of the i…
- Uvea: endogenous Candida endophthalmitis · ApplicationA 34-year-old man in the intensive care unit with a central venous catheter and parenteral nutrition develops blurred vision. Fundus examination shows creamy white fluf…
- Uvea: Bacillus cereus endophthalmitis · Multi-stepA farmer sustains a penetrating eye injury from a soil-contaminated object. Within 24 hours he has severe pain, rapidly falling vision, fever, leucocytosis and a ring a…
- Uvea: choroidal melanoma shape · ApplicationA B-scan of a pigmented choroidal mass shows a mushroom or collar-stud shape with an acoustically hollow interior. The tumour has broken through which structure to prod…
- Uvea: biologic therapy for juvenile arthritis uveitis · ApplicationA 9-year-old girl with oligoarticular juvenile idiopathic arthritis has chronic anterior uveitis that keeps relapsing despite topical steroids and methotrexate. Which a…
- Uvea: HLA-B27 acute anterior uveitis · ApplicationA 28-year-old man has recurrent episodes of unilateral acute anterior uveitis, the right and left eyes being affected at different times. He also has low back pain that…
- Uvea: cytomegalovirus anterior uveitis · Multi-stepA 45-year-old immunocompetent man has recurrent unilateral episodes of raised pressure with coin-shaped keratic precipitates and sectoral iris atrophy. Topical steroids…
- Uvea: herpes zoster uveitis management · Multi-stepA 50-year-old with earlier vesicles over the forehead and tip of the nose now has a red eye with raised pressure, reduced corneal sensation and sectoral iris atrophy. W…
- Uvea: fluorescein angiography in VKH · Multi-stepIn the acute uveitic stage of Vogt-Koyanagi-Harada disease, which fluorescein angiographic pattern is typical?
- Uvea: sunset glow fundus · ApplicationMonths after treatment of bilateral serous retinal detachments with headache and tinnitus, a patient's fundi appear orange-red because of loss of choroidal pigment. Wha…
- Uvea: pathergy test in Behcet disease · ApplicationA man with recurrent oral aphthae and hypopyon uveitis develops a sterile pustule 24 to 48 hours after a skin needle prick. What is this response called?
- Uvea: ocular toxocariasis · Multi-stepA 7-year-old with a pet puppy has a unilateral white peripheral retinal granuloma with vitreous bands. Ultrasound shows no intralesional calcification. Which test best…
- Uvea: toxoplasma treatment · ApplicationA patient with sight-threatening toxoplasma retinochoroiditis is started on pyrimethamine and sulfadiazine. Which supplement is added to prevent bone marrow suppression?
- Uvea: vitreoretinal lymphoma masquerade · Multi-stepA 68-year-old has bilateral vitritis with yellow-white sub-retinal pigment epithelial infiltrates that do not respond to corticosteroids. MRI later shows a periventricu…
- Uvea: immune recovery uveitis · Multi-stepA man with AIDS and treated CMV retinitis starts antiretroviral therapy, and his CD4 count rises from 40 to 250. Three months later he has new vitritis and macular oede…
- Uvea: chronic postoperative endophthalmitis · Multi-stepEight weeks after uneventful cataract surgery, an eye has low-grade granulomatous inflammation with a white plaque on the posterior capsule. It improves on steroids and…
- Uvea: CHARGE syndrome · Multi-stepA newborn has iris and choroidal coloboma, a heart defect, choanal atresia, growth retardation, genital hypoplasia and ear anomalies. Which gene is typically mutated?
- Uvea: choroidal metastasis · ApplicationA 52-year-old woman has multiple creamy yellow-white choroidal lesions in both eyes with overlying serous retinal detachment. Which is the most probable primary tumour?
- Uvea: risk factors for choroidal nevus growth · Multi-stepOn review of a choroidal naevus, which finding most strongly suggests malignant transformation to melanoma?
- Uvea: Heerfordt syndrome · ApplicationA young adult has anterior uveitis, bilateral parotid swelling, low-grade fever and a lower motor neuron facial palsy. Which syndrome is this?
- Uvea: ocular syphilis treatment · Multi-stepA man with HIV has posterior placoid chorioretinitis and vitritis, and a very high RPR titre. What is the recommended treatment?
- Uvea: uveal effusion syndrome · Multi-stepA hypermetropic man with a small eye of 17 mm axial length and thickened sclera has recurrent shifting serous retinal and choroidal detachments without any retinal brea…
- Uvea: Lisch nodules · ApplicationA child with multiple cafe-au-lait macules and axillary freckling has bilateral, tan, dome-shaped nodules on the iris. Which gene and chromosome are involved?
- Uvea: Fuchs heterochromic iridocyclitis management · Multi-stepA young adult with Fuchs heterochromic iridocyclitis has a white, quiet eye with a lighter iris, stellate precipitates and a cataract. Which statement about management…
- Uvea: steroid choice in steroid responders · ApplicationWhich topical corticosteroid has the least tendency to raise intraocular pressure, at the cost of weaker anti-inflammatory action?
Neuro-ophthalmology and pupils47
- Neuro-ophthalmology and pupils: traumatic optic neuropathy · Multi-stepAn unconscious man after a road accident with a brow injury has a normal-looking fundus. Which sign most strongly suggests an indirect optic nerve injury?
- Neuro-ophthalmology and pupils: teprotumumab · ApplicationA 42-year-old woman with active moderate to severe thyroid eye disease has proptosis and diplopia not controlled by earlier measures. Which targeted drug can reduce pro…
- Neuro-ophthalmology and pupils: frontal mucocele · Multi-stepA 50-year-old with chronic sinusitis has slowly progressive painless proptosis with the globe pushed downward and outward and a soft swelling in the superomedial orbit.…
- Neuro-ophthalmology and pupils: amaurosis fugax · ApplicationA 66-year-old smoker has had a curtain-like loss of vision in one eye lasting three minutes. Which is the most appropriate next investigation?
- Neuro-ophthalmology and pupils: Kestenbaum procedure · Multi-stepA 4-year-old has horizontal jerk nystagmus since infancy that reduces on convergence, with a head turn to the left that gives the best vision. What is the surgical prin…
- Neuro-ophthalmology and pupils: Miller Fisher syndrome · Multi-stepA young man two weeks after a diarrhoeal illness develops ophthalmoplegia, ataxia and loss of tendon reflexes. Which antibody is associated?
- Neuro-ophthalmology and pupils: Anton syndrome · ApplicationAfter bilateral posterior cerebral artery infarcts, a 70-year-old man cannot see and bumps into furniture, yet insists he can see normally and describes the room confid…
- Neuro-ophthalmology and pupils: macular sparing · Multi-stepA patient with a right posterior cerebral artery stroke has a left homonymous hemianopia, but the central 5 degrees of the visual field is preserved. What best explains…
- Neuro-ophthalmology and pupils: thyroid optic neuropathy · Multi-stepA woman with Graves disease has bilateral proptosis, little congestion, falling visual acuity and dull colours. The discs look normal and CT shows enlarged muscles crow…
- Neuro-ophthalmology and pupils: Uhthoff phenomenon · ApplicationA 30-year-old woman recovering from optic neuritis notices that her vision blurs after a hot bath and during exercise, and clears when she cools down. What is this phen…
- Neuro-ophthalmology and pupils: pharmacological mydriasis · Multi-stepA nurse has a unilaterally dilated pupil of 8 mm that does not react to light. Ptosis and eye movements are normal. After instillation of 1 percent pilocarpine, the pup…
- Neuro-ophthalmology and pupils: idiopathic orbital inflammation · Multi-stepA 40-year-old has sudden painful proptosis, red eyelids and limited eye movements in one eye, without fever or sinusitis. CT shows diffuse enlargement of muscles includ…
- Neuro-ophthalmology and pupils: visual evoked potential · ApplicationMonths after optic neuritis, a woman's acuity is 6/6 and the disc looks normal, but she says vision remains abnormal. Which test would show a delayed P100 latency to co…
- Neuro-ophthalmology and pupils: Worth four dot test · ApplicationA child wearing red and green goggles looks at a lit box of four dots (one red, two green, one white). He sees five dots. What does this indicate?
- Neuro-ophthalmology and pupils: nutritional optic neuropathy · ApplicationA 55-year-old chronic tobacco smoker and heavy drinker has gradual, painless, symmetrical loss of central vision with dyschromatopsia and bilateral centrocaecal scotoma…
- Neuro-ophthalmology and pupils: Wernicke ophthalmoplegia · ApplicationA malnourished chronic alcoholic is confused and unsteady, with horizontal nystagmus and bilateral lateral rectus weakness. What should be given immediately?
- Neuro-ophthalmology and pupils: Parks three-step test · Multi-stepA patient has a right hypertropia that increases on looking to the left and increases when the head is tilted to the right. Which muscle is paretic?
- Neuro-ophthalmology and pupils: Hess chart · ApplicationHess charting is done in a patient with a recent paralytic squint to analyse ocular movement. How is the paretic eye recognised on the chart?
- Neuro-ophthalmology and pupils: latent nystagmus · ApplicationA 4-year-old with infantile esotropia has a jerk nystagmus that appears only when one eye is covered, and its fast phase beats towards the uncovered eye. What is this n…
- Neuro-ophthalmology and pupils: dissociated vertical deviation · Multi-stepA child operated for infantile esotropia has an eye that drifts upward when it is covered or when attention lapses, and it returns down on uncovering. The fellow eye sh…
- Neuro-ophthalmology and pupils: spasmus nutans · ApplicationA 12-month-old has small-amplitude, rapid, asymmetric pendular nystagmus with intermittent head nodding and a head tilt. Although spasmus nutans is usually benign, what…
- Neuro-ophthalmology and pupils: downbeat nystagmus · Multi-stepA 40-year-old woman has a vertical nystagmus with the fast phase downward, worst on lateral and downgaze, with oscillopsia. Where should imaging concentrate?
- Neuro-ophthalmology and pupils: macular star in neuroretinitis · Multi-stepA young adult has painless blurring with optic disc swelling. As the oedema resolves over two weeks, a star-shaped figure forms around the fovea. Which best explains th…
- Neuro-ophthalmology and pupils: rhino-orbital mucormycosis · ApplicationA 55-year-old man with uncontrolled diabetes and ketoacidosis has facial pain, unilateral proptosis, ptosis, complete ophthalmoplegia, loss of vision and a black necrot…
- Neuro-ophthalmology and pupils: management of mucormycosis · ApplicationA diabetic patient with ketoacidosis has been diagnosed with rhino-orbital mucormycosis on nasal biopsy. Which management is most appropriate?
- Neuro-ophthalmology and pupils: morning glory disc anomaly · Multi-stepA child has poor vision in one eye. The optic disc is enlarged and funnel-shaped with a central white glial tuft and retinal vessels radiating like spokes. Which associ…
- Neuro-ophthalmology and pupils: Riddoch phenomenon · Multi-stepA patient with a large occipital infarct is blind to static targets in the right hemifield, yet reports seeing a waved hand in that field. What is this phenomenon?
- Neuro-ophthalmology and pupils: junction scotoma · Multi-stepPerimetry shows a central scotoma in the left eye and a superotemporal field defect in the right eye. Where is the lesion?
- Neuro-ophthalmology and pupils: one-and-a-half syndrome · Multi-stepAfter a brainstem infarct, a patient cannot move the right eye horizontally in either direction. The left eye cannot adduct but abducts normally, with nystagmus. Where…
- Neuro-ophthalmology and pupils: intermittent exotropia · ApplicationA 5-year-old closes one eye in bright sunlight. The eyes are straight at near but drift outwards when the child looks at distant objects or is tired, with good vision i…
- Neuro-ophthalmology and pupils: apraclonidine test · Multi-stepA man with left ptosis and a smaller left pupil is given 1 percent apraclonidine in both eyes. After 40 minutes the left pupil dilates and the left lid lifts, while the…
- Neuro-ophthalmology and pupils: painful Horner syndrome · ApplicationA 38-year-old man develops sudden right neck and facial pain after vigorous neck manipulation, followed by right ptosis and a small pupil. Sweating is preserved on the…
- Neuro-ophthalmology and pupils: congenital Horner syndrome · ApplicationAn infant has mild right ptosis and a smaller right pupil since birth. The right iris is lighter in colour than the left. What explains the iris colour?
- Neuro-ophthalmology and pupils: aberrant regeneration · Multi-stepA man has recovered partially from a third nerve palsy caused by a meningioma. When he looks down, the right upper lid rises, and on adduction the pupil constricts. Whi…
- Neuro-ophthalmology and pupils: investigation after diagnosing myasthenia · ApplicationA 32-year-old woman with fatigable ptosis and diplopia is found to have antibodies against the acetylcholine receptor. Which investigation is essential next?
- Neuro-ophthalmology and pupils: threatened vision in idiopathic intracranial hypertension · Multi-stepAn obese woman with idiopathic intracranial hypertension has progressive loss of visual field and worsening disc swelling despite the maximum tolerated dose of acetazol…
- Neuro-ophthalmology and pupils: early papilloedema · ApplicationA young woman with headaches is examined for early papilloedema. Which finding is generally the earliest sign on fundus examination?
- Neuro-ophthalmology and pupils: pituitary apoplexy · ApplicationA man with a known pituitary adenoma develops a sudden severe headache, vomiting, bilateral visual loss and a partial third nerve palsy. He is hypotensive. Which manage…
- Neuro-ophthalmology and pupils: visual release hallucinations · ApplicationAn 80-year-old woman with advanced macular degeneration sees vivid, well-formed pictures of people and animals. She knows they are not real and has no cognitive decline…
- Neuro-ophthalmology and pupils: opsoclonus in children · ApplicationA 18-month-old child has chaotic, conjugate, multidirectional eye jerks, jerky limb movements and irritability. Which underlying condition must be excluded?
- Neuro-ophthalmology and pupils: see-saw nystagmus · Multi-stepA man with bitemporal hemianopia from a large suprasellar tumour also has an oscillation in which one eye rises and intorts while the other falls and extorts, alternati…
- Neuro-ophthalmology and pupils: septo-optic dysplasia · ApplicationA newborn has small optic discs with a double-ring sign, pendular nystagmus and later develops hypoglycaemia and short stature. MRI shows absent septum pellucidum. What…
- Neuro-ophthalmology and pupils: Weber syndrome · Multi-stepA 62-year-old hypertensive man has a left ptosis, a dilated left pupil with the eye down and out, and weakness of the right arm and leg. Where is the lesion?
- Neuro-ophthalmology and pupils: light-near dissociation compared · Multi-stepTwo patients show light-near dissociation. One has small irregular pupils after neurosyphilis. The other, a teenager with a pineal tumour, has mid-dilated pupils and im…
- Neuro-ophthalmology and pupils: dense cataract and afferent defect · Multi-stepA 70-year-old has a mature cataract in the right eye with 6/60 vision and a visible relative afferent pupillary defect on swinging flashlight testing. How should the fi…
- Neuro-ophthalmology and pupils: optic nerve sheath meningioma · Multi-stepA 45-year-old woman has slowly progressive visual loss in one eye with a pale optic disc and small opticociliary shunt vessels. CT of the orbit shows linear calcified t…
- Neuro-ophthalmology and pupils: neuromyelitis optica treatment caution · Multi-stepA woman with aquaporin-4 antibody positive neuromyelitis optica is being considered for long-term therapy. Which drug used for multiple sclerosis can worsen her disease…
Conjunctiva and cornea42
- Conjunctiva and cornea: filamentary keratitis · ApplicationA woman with severe dry eye has foreign body sensation and pain on blinking. Slit lamp shows short comma-shaped strands of mucus and epithelium attached at one end to t…
- Conjunctiva and cornea: preventing herpetic recurrence · ApplicationA man has had four attacks of herpes simplex keratitis in the same eye in two years. Which long-term measure reduces the chance of further recurrences?
- Conjunctiva and cornea: primary acquired melanosis · ApplicationA fair-skinned 58-year-old man has a flat, patchy, brown, unilateral pigmentation of the bulbar conjunctiva that has spread over a year. Biopsy shows atypical melanocyt…
- Conjunctiva and cornea: posterior scleritis on B-scan · Multi-stepA 40-year-old woman with rheumatoid arthritis has deep boring eye pain worse on movement, blurred vision, mild proptosis and choroidal folds, with a quiet anterior segm…
- Conjunctiva and cornea: punctal occlusion · ApplicationA 55-year-old woman with Sjogren syndrome has a Schirmer value of 3 mm at 5 minutes and remains symptomatic on frequent artificial tears. Which step conserves her own t…
- Conjunctiva and cornea: contact lens abrasion · ApplicationA 24-year-old soft contact lens wearer has a painful red eye after removing a lens. Fluorescein shows a corneal epithelial defect with no infiltrate. What is appropriat…
- Conjunctiva and cornea: keratitis after LASIK · Multi-stepThree weeks after LASIK, a patient has multiple small grey-white indolent infiltrates in the flap interface that worsen despite a fluoroquinolone. Which organism class…
- Conjunctiva and cornea: preservative toxicity · ApplicationA glaucoma patient on four topical drops daily for three years develops diffuse punctate epithelial erosions, redness and burning, with normal tear production. Which co…
- Conjunctiva and cornea: topical anaesthetic abuse · Multi-stepA 30-year-old who has repeatedly used numbing drops to relieve eye pain now has a ring-shaped stromal infiltrate and a persistent epithelial defect, with pain that ease…
- Conjunctiva and cornea: giant papillary conjunctivitis · ApplicationA man with an artificial eye has itching, ropy mucus and giant papillae on the upper tarsal conjunctiva. What is the mechanism?
- Conjunctiva and cornea: chemical conjunctivitis of the newborn · ApplicationA healthy full-term baby, born at a district hospital, has mild watery redness and lid swelling in both eyes on the first day after routine prophylactic drops. There is…
- Conjunctiva and cornea: symblepharon · ApplicationThree weeks after a lime splash to one eye, a labourer finds that the lower fornix is shortened, the eye cannot look down fully, and a band joins the inner lid to the e…
- Conjunctiva and cornea: Terrien against Mooren · Multi-stepA 55-year-old man has painless, slowly progressive thinning of the superior peripheral cornea with a yellow lipid line at the leading edge, a clear zone next to the lim…
- Conjunctiva and cornea: dellen · ApplicationA week after a squint operation, a 30-year-old has a small saucer-shaped thinning of the cornea next to a raised conjunctival swelling at the limbus. Fluorescein pools…
- Conjunctiva and cornea: recurrent corneal erosion · ApplicationA man scratched his eye with a fingernail two months ago. Since then he wakes with sudden severe pain, watering and photophobia in the same eye, which settles by midday…
- Conjunctiva and cornea: topography in keratoconus · ApplicationA 20-year-old with worsening astigmatism has a normal slit-lamp appearance on first look. Corneal topography is done. Which finding supports keratoconus?
- Conjunctiva and cornea: molluscum contagiosum of the lid · ApplicationA 10-year-old has a chronic follicular conjunctivitis in one eye and a small umbilicated, pearly nodule on the lid margin. What is the likely cause?
- Conjunctiva and cornea: atopic keratoconjunctivitis and the lens · ApplicationA 28-year-old man with long-standing atopic dermatitis has year-round bilateral itching and burning, thick eyelid skin, fine papillae on a fibrotic lower tarsal conjunc…
- Conjunctiva and cornea: Thygeson superficial punctate keratitis · Multi-stepA 28-year-old has had recurrent bilateral foreign body sensation and photophobia for years. Each episode shows clusters of coarse, slightly raised grey-white epithelial…
- Conjunctiva and cornea: Salzmann nodular degeneration · ApplicationA woman with old trachomatous scarring has reduced vision and glare. Slit lamp shows a few elevated, bluish-white nodules on the superficial cornea, and the surrounding…
- Conjunctiva and cornea: macular corneal dystrophy · ApplicationA 20-year-old has progressive bilateral corneal clouding that extends right out to the limbus, with diffuse haze between grey-white spots. His parents are unaffected an…
- Conjunctiva and cornea: Peters anomaly · Multi-stepA newborn has a dense central corneal opacity in both eyes. Slit lamp shows iris strands running from the collarette to the edge of the opacity, and a posterior corneal…
- Conjunctiva and cornea: ocular rosacea · ApplicationA 45-year-old woman with facial flushing and cheek telangiectasia has recurrent chalazia, blocked meibomian orifices, inferior corneal vascularisation and marginal infi…
- Conjunctiva and cornea: Demodex blepharitis · ApplicationAn elderly patient has chronic itching of the lid margins. Slit lamp shows waxy cylindrical sleeves clasping the base of the lashes, with lash misdirection but no ulcer…
- Conjunctiva and cornea: ophthalmia nodosa · ApplicationA 9-year-old boy plays with hairy caterpillars in a garden. The next day his eye is red and irritable, with multiple small grey-yellow conjunctival nodules and fine bar…
- Conjunctiva and cornea: Parinaud oculoglandular syndrome · ApplicationA 7-year-old with a new kitten has a unilateral red eye with a granulomatous nodule on the conjunctiva, a tender enlarged preauricular lymph node and low-grade fever. W…
- Conjunctiva and cornea: floppy eyelid syndrome · ApplicationAn obese man with loud snoring wakes with red, irritated eyes. His upper lids evert very easily with a rubbery, lax tarsus and the upper tarsal conjunctiva shows a papi…
- Conjunctiva and cornea: choice of keratoplasty or keratoprosthesis · Multi-stepA 55-year-old has had three failed penetrating grafts for corneal scarring and now has an opaque, vascularised cornea. Lids, blink and tear film are normal. Which optio…
- Conjunctiva and cornea: lissamine green staining · ApplicationIn a patient with suspected Sjogren dry eye, which stain highlights devitalised epithelial cells of the conjunctiva and cornea that lack a protective mucin coat?
- Conjunctiva and cornea: Hudson-Stahli line · ApplicationA 65-year-old man has a faint horizontal brown line in the corneal epithelium at the junction of the lower third with the upper two-thirds. He is asymptomatic. What is…
- Conjunctiva and cornea: Reis-Bucklers dystrophy · Multi-stepA 20-year-old has recurrent painful corneal erosions since childhood and bilateral geographic grey-white subepithelial opacities, with reduced vision. Which layer is ma…
- Conjunctiva and cornea: epithelial basement membrane dystrophy · ApplicationA 55-year-old woman has sharp pain on waking that settles by midday. Slit lamp shows bilateral map-like grey lines, dots and fingerprint patterns within the corneal epi…
- Conjunctiva and cornea: acute ocular Stevens-Johnson syndrome · Multi-stepA young man two weeks after starting a sulphonamide has mucocutaneous blisters, with pseudomembranes on both conjunctivae and early adhesion of the lids to the globe. W…
- Conjunctiva and cornea: ocular cicatricial pemphigoid · Multi-stepA 68-year-old woman has chronic bilateral red eyes, subepithelial fibrosis, shortened fornices and symblepharon. Conjunctival biopsy with immunofluorescence is done. Wh…
- Conjunctiva and cornea: Morax-Axenfeld conjunctivitis · ApplicationA man with chronic angular blepharoconjunctivitis has macerated skin at the outer canthi. A smear shows large Gram-negative diplobacilli. Which organism is responsible?
- Conjunctiva and cornea: pellucid marginal degeneration · Multi-stepA 32-year-old has gradually worsening against-the-rule astigmatism. Slit lamp shows a crescentic band of inferior peripheral thinning with an intact, protruding cornea…
- Conjunctiva and cornea: management of a corneal rust ring · ApplicationA welder had an embedded iron foreign body removed from his cornea; a brown rust ring remains at the site. What is the appropriate management?
- Conjunctiva and cornea: exposure keratopathy in facial palsy · ApplicationA man with Bell palsy cannot close his right eye fully and has punctate fluorescein staining of the inferior cornea on waking. What is the best initial treatment?
- Conjunctiva and cornea: superior limbic keratoconjunctivitis · ApplicationA 45-year-old woman has recurrent redness of the superior bulbar conjunctiva with fine papillae on the upper tarsus and filaments near the superior limbus. Which system…
- Conjunctiva and cornea: evaporative dry eye · Multi-stepA 50-year-old man has gritty eyes with a tear break-up time of 4 seconds, normal Schirmer test, telangiectatic lid margins and toothpaste-like plugs in the gland orific…
- Conjunctiva and cornea: diffuse lamellar keratitis · ApplicationOn the second day after LASIK, a patient has mild photophobia and diffuse granular white haze under the flap with a clear flap periphery and no pain. Which condition is…
- Conjunctiva and cornea: peripheral ulcerative keratitis · Multi-stepA woman with long-standing rheumatoid arthritis has a painful red eye with a crescentic peripheral corneal ulcer, stromal melt and an adjacent scleral inflammation. Wha…
Lens and cataract25
- Lens and cataract: retained viscoelastic · ApplicationOn the first morning after uneventful phacoemulsification, a patient has headache, a hazy cornea and IOP of 38 mmHg. The anterior chamber is deep with minimal cells, an…
- Lens and cataract: Nd:YAG capsulotomy risk · ApplicationA high myope develops posterior capsule opacification a year after cataract surgery and needs Nd:YAG capsulotomy. Which late complication should be mentioned in consent?
- Lens and cataract: toric intraocular lens · ApplicationA cataract patient has 2.5 dioptres of regular corneal astigmatism and wants spectacle independence for distance. Which implant best suits?
- Lens and cataract: multifocal lens symptoms · ApplicationA 62-year-old woman is delighted with distance and near vision after bilateral multifocal lens implants, but complains of halos around night lights and difficulty readi…
- Lens and cataract: complication of retrobulbar block · Multi-stepWithin minutes of a retrobulbar injection, a patient becomes drowsy and apnoeic and the opposite pupil dilates. What has happened?
- Lens and cataract: persistent fetal vasculature · Multi-stepA 2-month-old has unilateral leukocoria. The eye is smaller than the other, the anterior chamber is shallow, elongated ciliary processes are drawn toward a retrolental…
- Lens and cataract: IOL power after myopic LASIK · Multi-stepA 60-year-old had myopic LASIK 12 years ago. Cataract surgery uses an IOL power from standard keratometry, and on day 1 the refraction is +2.5 D. What explains the surp…
- Lens and cataract: cataract surgery in uveitis · Multi-stepA child with juvenile idiopathic arthritis and uveitis has a visually significant complicated cataract. When is surgery best undertaken?
- Lens and cataract: pre-operative ultrasound · ApplicationA 70-year-old high myope has a dense brunescent cataract that prevents any fundus view. Which investigation is essential before surgery?
- Lens and cataract: small pupil in uveitic cataract · ApplicationIn 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?
- Lens and cataract: capsular tension ring · ApplicationDuring phacoemulsification in an eye with pseudoexfoliation, wrinkling of the capsule suggests zonular weakness after the capsulorhexis. Which device placed inside the…
- Lens and cataract: dropped nucleus · Multi-stepDuring phacoemulsification the posterior capsule ruptures and hard nuclear fragments sink into the vitreous. After the anterior chamber is cleared of vitreous, what is…
- Lens and cataract: pseudophakic bullous keratopathy · ApplicationA 72-year-old who had cataract surgery with an anterior chamber IOL two years ago has painful blurred vision, a hazy oedematous cornea and epithelial bullae that ruptur…
- Lens and cataract: index myopia in nuclear sclerosis · ApplicationA 68-year-old presbyope notices that she can read without her reading glasses, but her distance vision has become worse. Slit lamp shows brunescent nuclear lens changes…
- Lens and cataract: hypocalcaemic cataract · ApplicationA 38-year-old woman with long-standing hypoparathyroidism and recurrent carpopedal spasm is found to have bilateral cataracts. What is the usual morphology?
- Lens and cataract: phenothiazine deposits · ApplicationA man on long-term high-dose chlorpromazine for schizophrenia shows fine stellate pigment deposits on the anterior lens capsule. How are these best described?
- Lens and cataract: purpose of hydrodissection · ApplicationDuring phacoemulsification, balanced salt solution is injected beneath the anterior capsule edge until a fluid wave passes behind the lens. What is the purpose?
- Lens and cataract: posterior capsule rupture with vitreous loss · Multi-stepDuring phacoemulsification the posterior capsule ruptures and vitreous presents into the anterior chamber and wound. What is the correct handling of the vitreous?
- Lens and cataract: suprachoroidal haemorrhage · Multi-stepIn the middle of cataract surgery in a hypertensive patient, the eye suddenly becomes very painful, the red reflex is lost, the chamber shallows and the iris and lens p…
- Lens and cataract: intracameral antibiotic prophylaxis · ApplicationIn a large multicentre European trial of cataract surgery, which prophylactic measure significantly reduced the rate of postoperative endophthalmitis?
- Lens and cataract: aldose reductase in diabetic cataract · ApplicationIn a lens exposed to prolonged hyperglycaemia, which enzyme converts excess glucose into sorbitol that leads to osmotic swelling?
- Lens and cataract: galactosaemia screen in congenital cataract · ApplicationA newborn has bilateral cataracts, jaundice and vomiting after milk feeds. Which treatable condition must be urgently excluded?
- Lens and cataract: oculocerebrorenal syndrome · ApplicationA boy has bilateral congenital cataracts, glaucoma, hypotonia, intellectual disability and renal tubular acidosis with aminoaciduria. What is the likely diagnosis?
- Lens and cataract: primary posterior capsulotomy in children · Multi-stepDuring surgery for a congenital cataract in a 3-year-old, the surgeon also performs a posterior capsulorhexis and anterior vitrectomy. What is the main reason?
- Lens and cataract: contraindication to intracapsular extraction · Multi-stepWhy is intracapsular cataract extraction avoided in children and young adults?
Neuro-ophthalmology22
- Neuro-ophthalmology · Multi-stepA 60-year-old woman has a sudden severe headache followed by drooping of the right upper lid. The right eye is deviated down and out and the pupil is dilated and non-re…
- Neuro-ophthalmology · ApplicationA smoker with shoulder pain from an apical lung tumour (Pancoast tumour) has mild ptosis, a small pupil and reduced sweating on the same side of the face. Which structu…
- Neuro-ophthalmology · ApplicationA 28-year-old woman has painful loss of vision in one eye, a central scotoma, a relative afferent pupillary defect and impaired colour vision. The optic disc looks norm…
- Neuro-ophthalmology · ApplicationAn obese young woman has daily headaches and transient visual obscurations. Both optic discs are swollen, visual acuity is normal and MRI of the brain and venography ar…
- Neuro-ophthalmology · Multi-stepA man develops vertical double vision after a head injury. The diplopia is worst on looking down and inwards, as when reading or climbing stairs, and he tilts his head…
- Neuro-ophthalmology: optic nerve glioma · Multi-stepA child with café-au-lait macules and axillary freckling has unilateral painless proptosis and optic nerve enlargement. What is the diagnosis?
- Neuro-ophthalmology · ApplicationWhat cranial nerve carries visual impulses to the brain?
- Neuro-ophthalmology · ApplicationA relative afferent pupillary defect indicates dysfunction of what pathway?
- Neuro-ophthalmology · ApplicationWhat finding suggests optic neuritis?
- Neuro-ophthalmology · ApplicationWhat visual defect can occur with a pituitary mass compressing the optic chiasm?
- Neuro-ophthalmology · ApplicationWhat term describes unequal pupil sizes?
- Neuro-ophthalmology · ApplicationOptic-disc swelling in a patient with suspected intracranial hypertension is termed what?
- Neuro-ophthalmology · ApplicationWhat pathway carries visual impulses from eye to brain?
- Neuro-ophthalmology · ApplicationWhat does papilledema specifically refer to?
- Neuro-ophthalmology · ApplicationWhich visual-field defect results from a pituitary mass compressing the optic chiasm?
- Neuro-ophthalmology · ApplicationWhat sign is most characteristic of optic neuritis?
- Neuro-ophthalmology · ApplicationWhat field loss follows optic-chiasm compression?
- Neuro-ophthalmology · ApplicationWhich symptom is classic for optic neuritis?
- Neuro-ophthalmology: third nerve palsy · Multi-stepA patient has ptosis, a down-and-out eye, diplopia, and a dilated poorly reactive pupil. What is the urgent concern?
- Neuro-ophthalmology: homonymous hemianopia · ApplicationA patient cannot see the left visual field of either eye after a stroke. Where is the lesion most likely?
- Neuro-ophthalmology · ApplicationWhat does papilloedema indicate?
- Neuro-ophthalmology · ApplicationWhich pupil abnormality is common in optic neuritis?
Conjunctiva21
- Conjunctiva · ApplicationDuring an outbreak at a school, a child has bilateral watery red eyes with a follicular conjunctivitis, tender preauricular lymphadenopathy and later multiple subepithe…
- Conjunctiva: follicles and papillae · ApplicationA student sees lymphoid follicles on the inferior palpebral conjunctiva. Which cause is most likely?
- Conjunctiva: adenoviral · ApplicationA child has fever, sore throat, follicular conjunctivitis and a tender preauricular node. What is the most likely diagnosis?
- Conjunctiva: epidemic keratoconjunctivitis · ApplicationWhich feature distinguishes epidemic keratoconjunctivitis from simple viral conjunctivitis?
- Conjunctiva: adult inclusion conjunctivitis · ApplicationA sexually active adult has chronic follicular conjunctivitis not responding to topical antibiotics. Which organism is likely?
- Conjunctiva: phlyctenular · ApplicationA child with a tuberculous contact has a small nodule at the limbus with surrounding hyperaemia. What is the mechanism of phlyctenular conjunctivitis?
- Conjunctiva: hyperacute gonococcal conjunctivitis · Multi-stepA sexually active young man has profuse purulent discharge, severe lid swelling and chemosis since 24 hours, with a Gram stain showing Gram-negative intracellular diplo…
- Conjunctiva: acute haemorrhagic conjunctivitis · ApplicationWhich pair of viruses is associated with acute haemorrhagic conjunctivitis (Apollo disease)?
- Conjunctiva: trachoma features · ApplicationA child from an endemic area has follicles on the upper tarsal conjunctiva, superior pannus and small depressions at the limbus after healed follicles. These depression…
- Conjunctiva: WHO simplified trachoma grading · ApplicationIn the WHO simplified grading of trachoma, which sign indicates a need for lid surgery?
- Conjunctiva: OSSN treatment · Multi-stepA 60-year-old farmer has a gelatinous, leukoplakic, vascularised lesion at the limbus. Biopsy shows ocular surface squamous neoplasia. What is a non-surgical option?
- Conjunctiva · ApplicationPurulent discharge with normal vision suggests what?
- Conjunctiva · ApplicationItch and watery bilateral redness suggests what?
- Conjunctiva · ApplicationWhat finding is typical of uncomplicated viral conjunctivitis?
- Conjunctiva · ApplicationWhat is a key hygiene recommendation in infectious conjunctivitis?
- Conjunctiva · ApplicationWhat symptom favors allergic conjunctivitis?
- Conjunctiva · ApplicationWhat is an important feature distinguishing conjunctivitis from acute glaucoma?
- Conjunctiva · ApplicationWhich ultraviolet-associated ocular-surface lesion grows from conjunctiva across the limbus toward the cornea?
- Conjunctiva · ApplicationWhat is a subconjunctival hemorrhage?
- Conjunctiva · ApplicationWhat condition appears as a painless sharply demarcated red patch beneath conjunctiva?
- Conjunctiva · ApplicationWhat hygiene advice helps infectious conjunctivitis?
Uveitis21
- Uveitis · ApplicationThree weeks after a penetrating injury to his right eye, a 25-year-old develops pain, photophobia and reduced vision in the uninjured left eye as well. Histology of the…
- Uveitis: HLA association · ApplicationA young man with low back pain and recurrent unilateral acute anterior uveitis with fibrin is most likely to have which HLA type?
- Uveitis: management · ApplicationWhat is the standard topical treatment of acute anterior uveitis?
- Uveitis: juvenile idiopathic arthritis · Multi-stepA 4-year-old girl with oligoarticular juvenile idiopathic arthritis has a white quiet eye. Which investigation result puts her at highest risk of chronic anterior uveit…
- Uveitis: sarcoidosis · Multi-stepA patient with bilateral hilar lymphadenopathy has granulomatous uveitis. What is a characteristic corneal finding?
- Uveitis: Fuchs heterochromic cyclitis · Multi-stepA young adult has a unilateral lighter iris, fine stellate keratic precipitates all over the cornea, mild cells and a cataract, with no synechiae. What is the diagnosis?
- Uveitis: sympathetic ophthalmia · Multi-stepTwo weeks after a penetrating injury of one eye, the fellow eye becomes photophobic with granulomatous uveitis. What is the histological hallmark?
- Uveitis: VKH syndrome · Multi-stepA young Asian woman has bilateral serous retinal detachments, headache, tinnitus and later poliosis and vitiligo. What is the diagnosis?
- Uveitis: Behcet disease · ApplicationA young man from the Silk Route region has recurrent oral ulcers, genital ulcers and hypopyon uveitis without redness. Which HLA is associated?
- Uveitis: toxoplasmosis · ApplicationA patient has blurred vision with a white fluffy retinal lesion adjacent to an old pigmented scar and overlying vitritis, described as a headlight in the fog. What is t…
- Uveitis: intermediate · Multi-stepA young adult with floaters has snowballs in the vitreous, a white exudate over the pars plana and macular oedema. What is this?
- Uveitis: birdshot · Multi-stepA middle-aged woman has floaters, night vision problems and multiple cream-coloured oval choroidal lesions radiating from the disc. Which HLA type is strongly associated?
- Uveitis: tuberculosis · Multi-stepA patient from an endemic area has granulomatous panuveitis with choroidal tubercles and positive tuberculin test. What is the principle of treatment?
- Uveitis: complications · ApplicationA patient with recurrent iritis has an irregular pupil with 360 degree posterior synechiae and raised IOP. What is this complication called?
- Uveitis: iris nodules · ApplicationIn granulomatous uveitis, nodules at the pupillary margin are named what?
- Uveitis · ApplicationWhat is a common symptom of anterior uveitis?
- Uveitis · ApplicationWhat anterior-chamber finding reflects inflammatory cells in anterior uveitis?
- Uveitis · ApplicationWhich feature should raise suspicion for anterior uveitis?
- Uveitis · ApplicationWhich finding favors anterior uveitis?
- Uveitis · ApplicationWhich systemic association is important in recurrent anterior uveitis?
- Uveitis · ApplicationWhat symptom in uveitis requires urgent retinal assessment?
Refraction20
- Refraction: hypermetropia · ApplicationA 6-year-old has recurrent headache, esotropia on near work and 5 D hypermetropia. What is the first-line treatment?
- Refraction: astigmatism · ApplicationIn regular astigmatism with the rule, which meridian of the cornea is steeper?
- Refraction: pathological myopia · Multi-stepA patient with 14 D axial myopia has a sudden loss of central vision with a small dark subretinal haemorrhage at the macula. What is the likely cause?
- Refraction: retinoscopy · ApplicationDuring retinoscopy with a plane mirror, the reflex moves in the same direction as the mirror. What does this indicate at the neutralising point?
- Refraction: duochrome test · ApplicationDuring the duochrome test, a patient sees letters on the red background more clearly. What does this suggest?
- Refraction: anisometropia · Multi-stepA patient with 4 D difference between the two eyes cannot tolerate spectacles because of unequal image size. What is this called and its best remedy?
- Refraction · ApplicationMyopia is corrected with which lens?
- Refraction · ApplicationHypermetropia is usually corrected with what?
- Refraction · ApplicationWhat refractive error results when the eye focuses light behind the retina?
- Refraction · ApplicationWhat age-related loss of near focusing ability is called?
- Refraction · ApplicationWhat refractive error results from unequal curvature in different meridians of the eye?
- Refraction · ApplicationWhat is anisometropia?
- Refraction · ApplicationWhat refractive error focuses light behind the retina?
- Refraction · ApplicationWhat age-related loss of near focusing is called?
- Refraction · ApplicationWhat optical defect causes myopia?
- Refraction · ApplicationWhich lens corrects uncomplicated hyperopia?
- Refraction · ApplicationWhich lens corrects myopia?
- Refraction: astigmatism · ApplicationWhat optical abnormality causes regular astigmatism?
- Refraction · ApplicationWhat refractive error is caused by unequal curvature in different corneal meridians?
- Refraction · ApplicationWhat physiological change causes presbyopia?
Anatomy and physiology of the eye19
- Anatomy and physiology of the eye: endothelial pump · ApplicationAfter intraocular surgery damages the corneal endothelium, the stroma swells and the cornea turns hazy even though the epithelium is intact. Which function of the endot…
- Anatomy and physiology of the eye: blood supply of the optic nerve head · ApplicationA 68-year-old with sudden painless inferior altitudinal field loss has a pale swollen optic disc. Which vessels chiefly supply the prelaminar and laminar parts of the o…
- Anatomy and physiology of the eye: horizontal raphe · ApplicationA patient with early glaucoma has an arcuate field defect that stops abruptly along the horizontal meridian on the nasal side, forming a nasal step. Which retinal featu…
- Anatomy and physiology of the eye: blood-aqueous barrier · ApplicationFluorescein given intravenously does not appear in the normal anterior chamber, although it leaks freely into the stroma of the ciliary body. Where are the tight juncti…
- Anatomy and physiology of the eye: macular nutrition · ApplicationIn a patient with a choroidal vascular occlusion, central vision falls sharply even though the retinal arteries look normal. Which tissue supplies the photoreceptors of…
- Anatomy and physiology of the eye: lacrimal drainage test · ApplicationAn adult with watering of one eye has patent puncta, and on syringing the fluid passes into the nose. Fluorescein dye placed in the conjunctival sac is still seen in th…
- Anatomy and physiology of the eye: pleomorphic adenoma of the lacrimal gland · Multi-stepA 40-year-old woman has a painless mass in the superolateral orbit with slow, progressive downward and inward displacement of the globe. CT shows a smooth, well-circums…
- Anatomy and physiology of the eye: retrobulbar haemorrhage · Multi-stepAfter a blow to the lateral orbit, a man has severe pain, tense proptosis, a rock-hard orbit with a tight lid, vision down to counting fingers and a relative afferent p…
- Anatomy and physiology of the eye: Hughes procedure · ApplicationA large full-thickness defect of the lower eyelid is left after tumour excision. Which reconstruction uses a tarsoconjunctival flap raised from the upper lid to restore…
- Anatomy and physiology of the eye: first step of phototransduction · ApplicationA photon is absorbed by rhodopsin in a rod outer segment. Which event occurs first?
- Anatomy and physiology of the eye: renewal of photoreceptor discs · ApplicationRod outer segment discs are shed from their tips every day and must be removed. Which cells phagocytose them?
- Anatomy and physiology of the eye: oculocardiac reflex · ApplicationA 7-year-old under general anaesthesia develops sudden bradycardia when the surgeon pulls on the medial rectus during squint surgery. What is the reflex arc?
- Anatomy and physiology of the eye: composition of aqueous humour · ApplicationCompared with plasma, aqueous humour contains a markedly higher concentration of which substance?
- Anatomy and physiology of the eye: inheritance of red-green colour defect · ApplicationA boy fails the red-green Ishihara plates. His parents have normal colour vision, but his maternal grandfather has the same defect. What is the most likely mode of inhe…
- Anatomy and physiology of the eye: acquired colour vision defect · ApplicationA 28-year-old woman with painful loss of vision in one eye and a relative afferent pupillary defect also notes that red objects look washed out. Which pattern of colour…
- Anatomy and physiology of the eye: division of the lacrimal gland · ApplicationDuring an orbital approach to the lacrimal fossa, a surgeon sees a band that indents the lacrimal gland and divides it into orbital and palpebral lobes. What is this ba…
- Anatomy and physiology of the eye: Muller cells · ApplicationWhich retinal cell spans the full thickness of the retina and forms both the inner and outer limiting membranes?
- Anatomy and physiology of the eye: lacrimal pump failure · Multi-stepA 40-year-old man with a complete left lower motor neuron facial palsy complains of persistent watering of the left eye, though Schirmer testing is normal and syringing…
- Anatomy and physiology of the eye: absent follicles in neonates · ApplicationA 10-day-old baby with conjunctivitis due to Chlamydia trachomatis shows papillae but no follicles. Why do follicles not form at this age?
Cataract19
- Cataract: nuclear sclerosis · ApplicationAn elderly patient who previously needed reading glasses now reads without them but has poor distance vision. What explains this?
- Cataract: cortical type · ApplicationA patient complains of glare and monocular diplopia and has wedge-shaped spokes at the lens periphery. Which type of cataract is this?
- Cataract: posterior subcapsular · ApplicationA patient on long-term oral prednisolone develops reduced vision in bright light and poor near vision. Which cataract is typical?
- Cataract: metabolic causes · ApplicationA young man with long-standing poorly controlled diabetes develops bilateral rapidly progressing lens opacities. What are these called?
- Cataract: myotonic dystrophy · Multi-stepA man with frontal balding, ptosis and grip myotonia has multicoloured iridescent lens opacities. What are these called?
- Cataract: galactosaemia · ApplicationA neonate with jaundice, hepatomegaly and vomiting on milk feeds develops oil droplet cataracts. Which enzyme deficiency is likely?
- Cataract: rubella · ApplicationAn infant of a mother who had rubella in the first trimester has a white pupil with a dense pearly nucleus. What is notable about the virus?
- Cataract: hypermature · Multi-stepA hypermature cataract with shrunken cortex and a nucleus that sinks inferiorly within the liquefied cortex is called what?
- Cataract: phacolytic glaucoma · Multi-stepA patient with a hypermature cataract develops a painful red eye with high IOP, an open angle and white flakes in the anterior chamber. What is the mechanism?
- Cataract: rosette · ApplicationWhich cataract appears days to months after blunt trauma as a feathery rosette in the posterior cortex?
- Cataract: complicated cataract · Multi-stepA patient with chronic iridocyclitis develops a lens opacity beginning at the posterior pole. What is it called?
- Cataract · ApplicationAn older adult has gradually progressive painless blur and a reduced red reflex on examination. Opacity of which ocular structure most likely explains this finding?
- Cataract · ApplicationWhat is the definitive treatment for a visually significant cataract?
- Cataract · ApplicationWhat symptom often occurs with cataract progression?
- Cataract · ApplicationWhat may make cataract symptoms more troublesome at night?
- Cataract · ApplicationAn older adult develops painless glare and progressive blurred vision because which structure has become opaque?
- Cataract · ApplicationWhat is definitive treatment for visually significant cataract?
- Cataract · ApplicationWhat visual complaint is common in cataract?
- Cataract · ApplicationAn older adult has painless progressive blurred vision, glare in bright light, and reduced red reflex. What is the most likely diagnosis?
Lens18
- Lens · ApplicationA tall child with intellectual disability and a history of a thromboembolic event is found to have a lens displaced downward. What is the most likely diagnosis?
- Lens: congenital cataract · ApplicationA 6-week-old infant has a dense white pupillary reflex in the right eye with no red reflex. When should surgery ideally be performed to give the best visual outcome?
- Lens: accommodation · ApplicationAccording to Helmholtz's theory, what happens to increase the lens power during accommodation?
- Lens: ectopia lentis · Multi-stepA tall patient with arachnodactyly and aortic root dilatation has a lens displaced superotemporally. What is the diagnosis?
- Lens: spherophakia · Multi-stepA short, stocky child with brachydactyly and small spherical lenses presents with acute angle closure. Which syndrome is this?
- Lens: lenticonus · Multi-stepA boy with haematuria and sensorineural hearing loss has an oil-droplet reflex on retinoscopy from a conical anterior lens surface. What is the diagnosis?
- Lens: phacomorphic glaucoma · Multi-stepAn elderly woman with a swollen white cataract has acute eye pain, a shallow anterior chamber and IOP of 50 mmHg. What is the definitive treatment?
- Lens: lens-induced uveitis · Multi-stepA patient develops granulomatous inflammation after cataract extraction with retained cortical material. What is the cause?
- Lens: infrared cataract · ApplicationA glassblower develops a cataract. The characteristic early location is:
- Lens: UGH syndrome · Multi-stepA patient with a malpositioned anterior chamber IOL has recurrent iritis, raised IOP and bleeding in the anterior chamber. This is called:
- Lens: post-cataract endophthalmitis organism · ApplicationWhich organism is most commonly responsible for acute postoperative endophthalmitis after cataract surgery?
- Lens: Endophthalmitis Vitrectomy Study · Multi-stepA patient with post cataract surgery endophthalmitis has vision of perception of light only. According to the EVS, what is the management?
- Lens: toxic anterior segment syndrome · Multi-stepA patient on the first day after uneventful phaco has diffuse limbus-to-limbus corneal oedema and heavy anterior chamber fibrin, with little pain. Cultures are negative…
- Lens: problems with aphakic spectacles · ApplicationWhich set of problems is associated with high plus aphakic spectacles?
- Lens · ApplicationWhat is the usual symptom of cataract development?
- Lens · ApplicationWhy is posterior capsule opacification not considered a recurrent cataract?
- Lens · ApplicationWhat is a usual cataract symptom?
- Lens · ApplicationWhat is posterior subcapsular cataract commonly associated with?
Community ophthalmology16
- Community ophthalmology: Vision 2020 · ApplicationWhat is the goal of the global VISION 2020 initiative?
- Community ophthalmology: Vitamin A prophylaxis · ApplicationIn the national vitamin A prophylaxis schedule, how much vitamin A is given at 9 months with the measles vaccine?
- Community ophthalmology: onchocerciasis · ApplicationWhich drug is used for mass treatment of river blindness?
- Community ophthalmology: low vision · ApplicationWhich device benefits a patient with macular degeneration and low vision for reading?
- Community ophthalmology: trachoma grading · ApplicationIn the WHO simplified trachoma grading, which sign is defined as five or more follicles of at least 0.5 mm in the upper tarsal conjunctiva?
- Community ophthalmology: glaucoma screening · ApplicationWhich group should be prioritised for opportunistic glaucoma screening?
- Community ophthalmology: diabetic eye care · ApplicationA pregnant woman with type 1 diabetes should have a dilated eye examination when?
- Community ophthalmology: childhood blindness · Multi-stepWhich of the following is a recognised avoidable cause of childhood blindness in India?
- Community ophthalmology: low-dose atropine for myopia · ApplicationA 9-year-old child has myopia that has worsened by more than one dioptre in a year. Which drug, in a very low concentration, is used to slow progression?
- Community ophthalmology: rapid assessment of avoidable blindness · ApplicationA district health manager needs a quick, standardised population survey of people aged 50 years and above to estimate the prevalence and causes of blindness and the cov…
- Community ophthalmology: trachoma mass treatment threshold · ApplicationA district survey finds that 14 percent of children aged 1 to 9 years have trachomatous inflammation (follicular). By the WHO strategy, what community-level action is n…
- Community ophthalmology: chlamydial ophthalmia neonatorum · ApplicationA neonate born at home to a mother with untreated genital infection develops mucopurulent discharge and lid swelling on day 9. Cultures for gonococcus are negative. Wha…
- Community ophthalmology: cluster of post-operative infections after eye camp · Multi-stepAfter a surgical eye camp, 12 of 60 patients develop severe endophthalmitis within 48 hours, all from the same operating session. What is the most likely common source?
- Community ophthalmology: corneal xerosis stage · ApplicationA malnourished 3-year-old with measles has a dry, hazy, lustreless cornea with no ulcer, along with night blindness. According to the WHO xerophthalmia classification,…
- Community ophthalmology: retinopathy screening method · ApplicationA primary health centre without an ophthalmologist wants to screen many diabetic patients for retinopathy. Which approach is most practical for population screening?
- Community ophthalmology: firework eye injury first aid · ApplicationA boy is brought to a health post with severe pain and bleeding in the eye after a firework burst near his face. What first-aid advice is most appropriate before transf…
Ocular trauma15
- Ocular trauma · ApplicationA worker is splashed in the eye with wet lime plaster and has severe pain. What is the first step in management?
- Ocular trauma: cyclodialysis cleft · Multi-stepAfter blunt trauma, an eye has hypotony, a shallow anterior chamber and choroidal folds. Gonioscopy shows a gap between the ciliary body and scleral spur. What is the f…
- Ocular trauma: canalicular laceration · ApplicationA child with a dog bite has a laceration of the medial lower lid involving the canaliculus. What is the ideal management?
- Ocular trauma: white-eyed blowout fracture · Multi-stepA 10-year-old struck by a cricket ball has little bruising and a white eye, but severe pain, vomiting, bradycardia and limited upgaze. CT shows a trapdoor floor fractur…
- Ocular trauma: retinal dialysis · ApplicationAfter blunt injury, which is the commonest site of a traumatic retinal dialysis?
- Ocular trauma · ApplicationWhat is the first action for chemical injury to the eye?
- Ocular trauma · ApplicationWhat should be avoided when an open-globe injury is suspected?
- Ocular trauma · ApplicationWhat is the priority in a suspected intraocular foreign body?
- Ocular trauma · ApplicationWhat is the appropriate action for a corneal foreign body with persistent pain?
- Ocular trauma · ApplicationWhat is a key warning sign after blunt eye trauma?
- Ocular trauma · ApplicationWhat is the first action for chemical eye injury?
- Ocular trauma · ApplicationWhat should be avoided in suspected open-globe injury?
- Ocular trauma · ApplicationWhat is the safest immediate action when an open-globe injury is suspected?
- Ocular trauma: chemical injury · Multi-stepA worker splashes alkali into one eye. What is the first immediate management step?
- Ocular trauma: globe rupture · Multi-stepAfter high-velocity eye trauma, a patient has reduced vision, irregular pupil, and extrusion of ocular contents. What is the appropriate action?
Trauma15
- Trauma: hyphaema · ApplicationA child hit by a ball has blood layered in the anterior chamber. Which complication is most dreaded in the first week?
- Trauma: open globe · ApplicationA patient with suspected penetrating eye injury has a teardrop pupil and prolapsed uveal tissue. What is the correct first aid?
- Trauma: intraocular foreign body · Multi-stepA worker hammering metal has a corneal entry wound and suspected intraocular foreign body. Which imaging is contraindicated?
- Trauma: siderosis bulbi · Multi-stepAn iron foreign body retained for months causes rusty brown deposits on the lens and iris with a poor ERG. What is this?
- Trauma: blunt injury · ApplicationA man struck on the eye by a fist has an inability to see in the central field with a whitish retinal haze. What is this?
- Trauma · ApplicationPositive Seidel test indicates what?
- Trauma · ApplicationChemical eye injury first priority is what?
- Trauma · ApplicationBlood in anterior chamber is what?
- Trauma · ApplicationFirst action in chemical injury is what?
- Trauma · ApplicationWhat should be suspected after blunt ocular trauma with an irregular pupil and layered blood in the anterior chamber?
- Trauma · ApplicationWhich action is appropriate for suspected open globe injury?
- Trauma · ApplicationWhat is correct first aid for suspected open globe injury?
- Trauma · ApplicationWhat does blood layered in anterior chamber after blunt trauma indicate?
- Trauma · ApplicationWhat finding suggests an orbital blowout fracture?
- Trauma · ApplicationWhy should a contact lens be removed in suspected corneal infection when feasible?
Orbit13
- Orbit · ApplicationA child with a recent sinus infection develops fever, eyelid swelling, proptosis, painful and restricted eye movements. What is the commonest source of this infection?
- Orbit: thyroid eye disease · ApplicationA woman with Graves disease has lid retraction, proptosis and lid lag on downgaze. What is the commonest cause of unilateral or bilateral proptosis in adults?
- Orbit: thyroid eye disease muscles · Multi-stepOn CT of thyroid eye disease, which muscle is most commonly enlarged, and what is the tendon feature?
- Orbit: orbital cellulitis · ApplicationA child with sinusitis has fever, painful proptosis, ophthalmoplegia and reduced vision. What is the next best step?
- Orbit: rhabdomyosarcoma · ApplicationA 7-year-old child has rapidly progressive unilateral proptosis with a downward displaced globe. What is the likely tumour?
- Orbit: carotid cavernous fistula · Multi-stepAfter head trauma a patient develops pulsatile proptosis, a bruit, chemosis and dilated corkscrew episcleral vessels. What is the diagnosis?
- Orbit: blowout fracture · ApplicationAfter being hit by a cricket ball, a patient has diplopia on upgaze, enophthalmos and numbness of the cheek. What is the diagnosis?
- Orbit: infantile capillary haemangioma · ApplicationAn infant has a strawberry-red periocular lesion that enlarged rapidly in the first months and now threatens the visual axis. Which treatment is preferred?
- Orbit: commonest orbital tumours · ApplicationWhich pair gives the commonest primary orbital malignant tumour in children and the commonest benign tumour in adults?
- Orbit: sphenoid wing meningioma · Multi-stepA 48-year-old woman has slowly progressive painless proptosis with temporal fullness and a bony hardness at the lateral orbital wall. CT shows hyperostosis of the sphen…
- Orbit: lymphatic malformation · ApplicationA 6-year-old suddenly develops painless proptosis after an upper respiratory infection. MRI shows a multicystic lesion with fluid-fluid levels. What is the diagnosis?
- Orbit · ApplicationProptosis, fever, and painful eye movements suggest what?
- Orbit · ApplicationProptosis with painful eye movement and fever suggests what?
Anatomy12
- Anatomy: structures through the annulus of Zinn · ApplicationWhich of the following structures passes through the common tendinous ring (annulus of Zinn) and not outside it in the superior orbital fissure?
- Anatomy: parts of the optic nerve · ApplicationThe optic nerve is about 47 mm long. Which part is the longest?
- Anatomy: corneal layers · ApplicationFrom anterior to posterior, which sequence of corneal layers is correct?
- Anatomy: corneal endothelium regeneration · ApplicationA patient develops persistent corneal oedema after cataract surgery with a low endothelial cell count. Why is the oedema persistent?
- Anatomy: limbal stem cells · ApplicationA patient with a severe alkali burn has total loss of limbal tissue. Which limbal structure is the main reservoir of corneal epithelial stem cells?
- Anatomy: angle structures on gonioscopy · Multi-stepOn gonioscopy the structures are identified from anterior to posterior in an open angle. Which order is correct?
- Anatomy: retinal layers · ApplicationThe retina has ten layers. Which layer lies immediately internal to the photoreceptor layer of rods and cones?
- Anatomy: muscle actions of obliques · ApplicationWhich statement correctly describes the primary and secondary actions of the superior oblique?
- Anatomy: spiral of Tillaux · ApplicationIn the spiral of Tillaux, the insertions of the recti lie at increasing distances from the limbus. Which rectus is nearest to the limbus?
- Anatomy: secondary action of superior rectus · Multi-stepWhich rectus muscle has intorsion as a secondary action?
- Anatomy: lid muscles and innervation · ApplicationA patient with Horner syndrome shows mild ptosis. Which lid muscle is paralysed and what is its supply?
- Anatomy: lacrimal passage · ApplicationThe nasolacrimal duct opens into which part of the nose, and which valve guards the opening?
Squint11
- Squint · Multi-stepIn a child fixing a torchlight with the right eye, the corneal light reflex in the left eye falls at the pupillary margin on the temporal side. What does this indicate…
- Squint: paralytic features · ApplicationWhich feature differentiates paralytic squint from concomitant squint?
- Squint: infantile esotropia · ApplicationA 6-month-old infant has a large angle constant esotropia with cross-fixation. What is the usual management?
- Squint: amblyopia treatment · ApplicationA 5-year-old with unilateral anisometropic amblyopia has had glasses for 3 months with no improvement. What is the next step?
- Squint: accommodative esotropia · Multi-stepIn accommodative esotropia with a high AC/A ratio, the deviation is greater at near than distance. Which treatment is added to full correction?
- Squint: Duane retraction syndrome · Multi-stepA child has limited abduction of the left eye, with narrowing of the palpebral fissure and globe retraction on adduction. What is the diagnosis?
- Squint: Brown syndrome · Multi-stepA child has inability to elevate the right eye in adduction that improves in abduction, from a tight superior oblique tendon. What is the diagnosis?
- Squint: Moebius syndrome · Multi-stepA newborn has bilateral facial paralysis with inability to abduct either eye. What is the diagnosis?
- Squint: Bruckner test · ApplicationIn a screening camp, both eyes of a child are viewed together at arm's length with an ophthalmoscope, and one red reflex is brighter than the other. What does this sugg…
- Squint: V pattern · Multi-stepA child has exotropia of 10 prism dioptres in downgaze and 30 prism dioptres in upgaze, with overaction of both inferior obliques. Which pattern is this?
- Squint: sensory exotropia · Multi-stepA 40-year-old with a dense traumatic cataract since childhood now has an outward deviation of that eye. What is the cause?
Neuro10
- Neuro: neuromyelitis optica · Multi-stepA young woman has severe bilateral optic neuritis, followed by longitudinally extensive transverse myelitis. Which antibody is diagnostic?
- Neuro: optic disc drusen · ApplicationA young patient has bilateral elevated discs with irregular margins and no haemorrhages, and normal vision. Which test shows calcified bodies in the optic nerve head?
- Neuro: craniopharyngioma field defect · Multi-stepA child with a suprasellar calcified cystic mass compressing the chiasm from above will first show which field defect?
- Neuro: Horner syndrome cocaine test · Multi-stepA patient has ptosis, miosis and anhidrosis on the left. After instilling 4 percent cocaine, the left pupil fails to dilate. What does this indicate?
- Neuro: diabetic third nerve palsy · ApplicationA 58-year-old diabetic hypertensive man has painful ptosis and ophthalmoplegia with normal pupillary reaction. Which statement is true?
- Neuro: sixth nerve palsy · ApplicationA child with raised intracranial pressure has an esotropia and inability to abduct one eye. The sixth nerve palsy in raised ICP is called:
- Neuro: cavernous sinus syndrome · Multi-stepA patient has a left ptosis, ophthalmoplegia, loss of sensation on the forehead and cheek, and a Horner syndrome with proptosis. Which structure is involved?
- Neuro: Tolosa-Hunt syndrome · Multi-stepA patient has severe periorbital pain with painful ophthalmoplegia, and MRI shows enhancing soft tissue in the cavernous sinus. Symptoms resolve within 72 hours of star…
- Neuro: pupillary light reflex pathway · ApplicationWhich sequence correctly traces the afferent and efferent pathway of the pupillary light reflex?
- Neuro: anisocoria in dark or light · Multi-stepA patient has anisocoria that is greater in dim light than in bright light. What is the most likely cause?
Ocular anatomy10
- Ocular anatomy · ApplicationWhich structure focuses incoming light onto the retina?
- Ocular anatomy · ApplicationWhich layer contains retinal photoreceptors?
- Ocular anatomy · ApplicationWhich structure regulates the amount of light entering the eye?
- Ocular anatomy · ApplicationWhat is the transparent front surface of the eye?
- Ocular anatomy · ApplicationWhich layer supplies blood to the outer retina?
- Ocular anatomy · ApplicationWhat structure forms the white outer coat of the eye?
- Ocular anatomy · ApplicationWhat gel-like material fills the posterior cavity of the eye?
- Ocular anatomy · ApplicationWhat structure drains aqueous humor from the anterior chamber?
- Ocular anatomy · ApplicationWhich transparent biconvex structure changes shape to fine-tune ocular focus?
- Ocular anatomy · ApplicationWhat layer supplies blood to the outer retina?
Ocular motility10
- Ocular motility · ApplicationFailure to abduct eye indicates palsy of what nerve?
- Ocular motility · ApplicationFailure to depress adducted eye indicates palsy of what nerve?
- Ocular motility · ApplicationWhich cranial nerve supplies most extraocular muscles?
- Ocular motility · ApplicationA patient reports seeing two images of a single object; what symptom is being described?
- Ocular motility · ApplicationWhich nerve palsy causes an eye positioned down and out with ptosis?
- Ocular motility · ApplicationWhich symptom is typical of a trochlear nerve palsy?
- Ocular motility · ApplicationWhich nerve palsy produces a down-and-out eye with ptosis?
- Ocular motility · ApplicationWhat complaint is typical of trochlear nerve palsy?
- Ocular motility · ApplicationWhat does a cover-uncover test detect?
- Ocular motility · ApplicationWhat is the major risk from long-standing childhood strabismus?
Eyelids7
- Eyelids: epiblepharon · ApplicationAn 18-month-old child has tearing and lower lashes turned up against the cornea because of a horizontal skin fold, with the lid margin in normal position. What is the m…
- Eyelids: distichiasis with lymphoedema · Multi-stepA young woman has a double row of eyelashes and swelling of both legs since puberty. Mutation of which gene is responsible?
- Eyelids · ApplicationWhat is a stye (hordeolum)?
- Eyelids · ApplicationA patient has an abnormally low upper eyelid position; what is this finding called?
- Eyelids · ApplicationWhich eyelid malposition turns the lid margin and eyelashes inward toward the cornea?
- Eyelids · ApplicationWhat is a stye or hordeolum?
- Eyelids · ApplicationWhich finding suggests orbital cellulitis rather than preseptal cellulitis?
Ocular pharmacology7
- Ocular pharmacology: beta-blockers · ApplicationA 60-year-old man with open-angle glaucoma and well-controlled asthma is started on timolol 0.5% eye drops. He returns with wheeze and breathlessness. What explains this?
- Ocular pharmacology: intravitreal triamcinolone · ApplicationA diabetic patient receives intravitreal triamcinolone for macular oedema. Which two adverse effects should be monitored?
- Ocular pharmacology: bisphosphonate uveitis · ApplicationA postmenopausal woman has a painful red eye with anterior uveitis two days after her first intravenous infusion for osteoporosis. Which drug class is responsible?
- Ocular pharmacology: interferon retinopathy · ApplicationA man on pegylated interferon for hepatitis C has asymptomatic cotton wool spots and a few retinal haemorrhages. What is the usual course?
- Ocular pharmacology · ApplicationWhy are topical beta blockers used cautiously in asthma?
- Ocular pharmacology · ApplicationWhy are topical beta blockers risky in asthma?
- Ocular pharmacology · ApplicationWhy are dilating drops used before fundus examination?
Paediatric ophthalmology7
- Paediatric ophthalmology · ApplicationWhy is early treatment of significant childhood strabismus important?
- Paediatric ophthalmology · ApplicationA child has reduced best-corrected vision from abnormal early visual input despite no structural lesion sufficient to explain it; what condition is this?
- Paediatric ophthalmology · ApplicationWhich condition must be excluded urgently in a child with leukocoria?
- Paediatric ophthalmology · ApplicationWhy is amblyopia treatment most effective in early childhood?
- Paediatric ophthalmology · ApplicationWhich diagnosis must be excluded in childhood leukocoria?
- Paediatric ophthalmology · ApplicationWhy is congenital cataract treated urgently when visually significant?
- Paediatric ophthalmology · ApplicationWhich sign suggests congenital glaucoma in an infant?
Pediatric ophthalmology7
- Pediatric ophthalmology · ApplicationWhy is early treatment of amblyopia important?
- Pediatric ophthalmology · ApplicationDuring red-reflex screening, a child has an abnormal white appearance visible through the pupil; what finding is this?
- Pediatric ophthalmology · ApplicationWhy does a white pupillary reflex in a child need urgent evaluation?
- Pediatric ophthalmology · ApplicationWhy is early amblyopia treatment important?
- Pediatric ophthalmology: congenital glaucoma · ApplicationAn infant has tearing, photophobia, blepharospasm, and an enlarged cloudy cornea. What diagnosis should be considered?
- Pediatric ophthalmology: retinoblastoma · Multi-stepA parent notices a white pupillary reflex in photographs of a toddler. What is the appropriate action?
- Pediatric ophthalmology: amblyopia · ApplicationWhy is early treatment of significant childhood strabismus or anisometropia important?
Pupil7
- Pupil · Multi-stepA 30-year-old has pain on eye movement and reduced vision in the right eye. On the swinging flashlight test, when the light moves from the left eye to the right eye, bo…
- Pupil: RAPD · ApplicationOn the swinging flashlight test, both pupils dilate when light is moved to the right eye. What does this indicate?
- Pupil: Argyll Robertson · Multi-stepA patient has small irregular pupils that do not react to light but constrict on accommodation. What is the most likely cause?
- Pupil: Adie tonic pupil · Multi-stepA young woman has a dilated right pupil with poor light response, slow tonic constriction to near and absent knee jerks. Which test is diagnostic?
- Pupil: Horner syndrome · ApplicationWhich combination of findings defines Horner syndrome?
- Pupil: Horner testing · Multi-stepA patient with suspected Horner syndrome has no dilatation on 4 percent cocaine drops and also none on hydroxyamphetamine. Where is the lesion?
- Pupil: third nerve palsy · Multi-stepA patient has sudden headache, ptosis, a dilated fixed pupil and a down-and-out eye. What is the most important cause to exclude?
Red eye7
- Red eye · ApplicationSevere pain and photophobia with ciliary flush suggest what?
- Red eye · ApplicationItchy bilateral watery eyes are most consistent with what?
- Red eye · ApplicationWhich feature suggests acute angle-closure glaucoma rather than simple conjunctivitis?
- Red eye · ApplicationWhat is the key initial management priority in suspected chemical eye injury?
- Red eye: acute angle-closure glaucoma · Multi-stepA patient has sudden severe eye pain, headache, nausea, halos around lights, a red eye, and a fixed mid-dilated pupil. What is the diagnosis?
- Red eye: anterior uveitis · ApplicationA patient has painful photophobic red eye with consensual photophobia and ciliary flush. What is the most likely diagnosis?
- Red eye: conjunctivitis · ApplicationA patient has bilateral itchy red eyes with watery discharge and chemosis during pollen season. What is most likely?
Visual pathway7
- Visual pathway · ApplicationA woman with amenorrhoea and galactorrhoea complains of bumping into objects on both sides. Field testing shows bitemporal hemianopia. Where is the lesion?
- Visual pathway: pituitary adenoma · ApplicationA pituitary macroadenoma compressing the chiasm from below first affects which part of the field?
- Visual pathway: optic tract · Multi-stepA lesion in the right optic tract causes which visual deficit?
- Visual pathway: temporal lobe · ApplicationA patient with a temporal lobe tumour involving Meyer's loop has what visual field defect?
- Visual pathway: occipital lobe · Multi-stepA patient with a posterior cerebral artery occlusion has a left homonymous hemianopia with sparing of the central 10 degrees. Why is the macula spared?
- Visual pathway: parietal lobe · ApplicationWhich field defect arises from a lesion of the right parietal optic radiation?
- Visual pathway: cortical blindness · Multi-stepA patient after bilateral occipital infarcts is blind but has normal pupillary reactions and a normal fundus. What explains the normal pupillary response?
Eyelid6
- Eyelid · ApplicationA 30-year-old has a painless, firm, round swelling in the upper lid, away from the lid margin, that has persisted for two months after an earlier tender lump settled. W…
- Eyelid: ptosis · ApplicationA newborn has drooping of the right upper eyelid, which retracts briskly when the baby sucks or moves the jaw to the left. What is the diagnosis?
- Eyelid: sebaceous carcinoma · Multi-stepA recurrent chalazion in an elderly woman with loss of lashes should raise suspicion of which tumour?
- Eyelid: basal cell carcinoma · ApplicationWhich is the commonest malignant tumour of the eyelid and its typical site?
- Eyelid: entropion · ApplicationA patient with long-standing trachoma has inturning of the lid margin with lashes rubbing the cornea. What is this called?
- Eyelid: blepharospasm · ApplicationAn elderly woman has involuntary bilateral forceful eye closure with a normal eye examination. What is the treatment of choice?
Optic neuropathy6
- Optic neuropathy: arteritic AION · Multi-stepA 75-year-old has sudden vision loss, jaw claudication, scalp tenderness and a pale swollen disc. What is the most urgent step?
- Optic neuropathy: non-arteritic AION · Multi-stepA 55-year-old diabetic hypertensive with a small crowded cup has painless sudden inferior altitudinal field loss on waking. What is the likely diagnosis?
- Optic neuropathy: Foster Kennedy syndrome · Multi-stepA frontal lobe meningioma causes ipsilateral optic atrophy and contralateral papilloedema. What is this called?
- Optic neuropathy: Leber hereditary · Multi-stepA 22-year-old man has sequential painless central vision loss in both eyes with disc hyperaemia and peripapillary telangiectasia. How is this inherited?
- Optic neuropathy: ethambutol · ApplicationA patient on antitubercular therapy complains of reduced vision and loss of red-green colour discrimination. Which drug is responsible?
- Optic neuropathy: methanol · ApplicationA man develops blurred vision, a hyperaemic disc and severe metabolic acidosis after drinking illicit liquor. What antidote is used?
Physiology6
- Physiology: dark adaptation · ApplicationWhich photoreceptor and pigment are responsible for scotopic vision?
- Physiology: conventional aqueous outflow · ApplicationIn the conventional outflow pathway, aqueous leaves the anterior chamber by which route?
- Physiology: blood-retinal barrier · Multi-stepThe outer blood-retinal barrier is formed by which structure?
- Physiology: rod distribution · ApplicationRod photoreceptors reach their peak density at about how far from the fovea?
- Physiology: phototransduction · Multi-stepIn phototransduction, what is the immediate effect of light on a rod photoreceptor?
- Physiology: cone pigment sensitivity · Multi-stepA student is asked about the peak absorption wavelengths of cone pigments. Which pairing is correct?
Cataract surgery5
- Cataract surgery: small incision · ApplicationWhich procedure is widely used in India for mature senile cataract in resource-limited settings, removing the nucleus through a tunnel incision without phacoemulsificat…
- Cataract surgery: capsulorhexis · ApplicationWhat is the purpose of a continuous curvilinear capsulorhexis during phacoemulsification?
- Cataract surgery: endophthalmitis · Multi-stepA patient develops pain, hypopyon and marked visual loss 3 days after cataract surgery. Which is the most important next step?
- Cataract surgery: Irvine-Gass · Multi-stepA patient has blurred vision 6 weeks after uneventful cataract surgery with cystoid macular oedema on OCT. What is the treatment?
- Cataract surgery: floppy iris · Multi-stepA man on tamsulosin for prostatism has progressive pupil constriction and iris billowing during cataract surgery. What is this called?
Diabetic retinopathy5
- Diabetic retinopathy · ApplicationA diabetic patient's fundus shows new vessels at the optic disc and a vitreous haemorrhage in one eye. What is the primary treatment to reduce the risk of severe visual…
- Diabetic retinopathy: severe NPDR · Multi-stepWhich findings define severe non-proliferative diabetic retinopathy under the 4-2-1 rule?
- Diabetic retinopathy: PDR treatment · ApplicationWhich treatment is standard for high-risk proliferative diabetic retinopathy?
- Diabetic retinopathy: macular oedema · ApplicationA diabetic has centre-involving macular oedema and 6/18 vision. What is the first-line treatment?
- Diabetic retinopathy · ApplicationWhich retinal finding is characteristic of nonproliferative diabetic retinopathy?
Motility5
- Motility: internuclear ophthalmoplegia · Multi-stepA young woman with multiple sclerosis cannot adduct her right eye on left gaze, while the left eye abducts with nystagmus. Where is the lesion?
- Motility: Parinaud syndrome · Multi-stepA teenager with a pineal tumour has impaired upgaze, convergence-retraction nystagmus and light-near dissociation. What is this called?
- Motility: myasthenia gravis · ApplicationA 30-year-old woman has fatigable ptosis and variable diplopia that improve after resting. Which bedside test supports the diagnosis?
- Motility · ApplicationFailure to abduct eye indicates palsy of what?
- Motility · ApplicationDown-gaze vertical diplopia indicates palsy of what?
Ocular examination5
- Ocular examination · ApplicationWhat instrument measures intraocular pressure?
- Ocular examination · ApplicationWhat examination visualizes the retina and optic disc?
- Ocular examination · ApplicationWhat chart is commonly used to measure distance visual acuity?
- Ocular examination · ApplicationWhat test evaluates color discrimination?
- Ocular examination · ApplicationWhich technique flattens a small corneal area to measure ocular pressure accurately?
Ocular surface5
- Ocular surface · ApplicationFibrovascular growth crossing limbus is what?
- Ocular surface · ApplicationWhat is a common symptom of dry-eye disease?
- Ocular surface · ApplicationWhat simple measure can improve evaporative dry-eye symptoms?
- Ocular surface · ApplicationWhat is the main mechanism of dry-eye disease in aqueous tear deficiency?
- Ocular surface · ApplicationWhich lid condition commonly worsens evaporative dry eye?
Systemic disease5
- Systemic disease · ApplicationWhy are regular dilated retinal examinations important in diabetes even when vision seems normal?
- Systemic disease · ApplicationWhich retinal finding is most associated with malignant hypertension?
- Systemic disease · ApplicationWhat fundus feature is typical of non-proliferative diabetic retinopathy?
- Systemic disease · ApplicationWhich fundus finding suggests malignant hypertension?
- Systemic disease · ApplicationWhat is an early sign of non-proliferative diabetic retinopathy?
Corneal disease4
- Corneal disease · ApplicationWhy does a contact-lens wearer with painful red eye and reduced vision need urgent assessment?
- Corneal disease · ApplicationWhat does fluorescein dye help reveal on examination of a painful eye?
- Corneal disease: abrasion · ApplicationA contact-lens wearer has acute painful red eye, photophobia, tearing, and a fluorescein-staining epithelial defect after minor trauma. What is most likely?
- Corneal disease: microbial keratitis · Multi-stepA contact-lens wearer has severe pain, photophobia, reduced vision, and a corneal infiltrate with overlying epithelial defect. What is the priority?
Corneal ulcer4
- Corneal ulcer: bacterial · ApplicationA contact lens wearer has a rapidly spreading ulcer with greenish mucopurulent discharge and a ring infiltrate. Which organism is most likely?
- Corneal ulcer: hypopyon · ApplicationHypopyon in an ulcer with sterile aqueous is explained by which mechanism?
- Corneal ulcer: fungal · ApplicationA farmer with a vegetable matter injury develops a corneal ulcer with feathery margins and satellite lesions. Which drug is the first-line topical treatment for filamen…
- Corneal ulcer: Acanthamoeba · Multi-stepA soft contact lens wearer who swims in lens has severe pain out of proportion to signs, a ring infiltrate and radial keratoneuritis. What is the best treatment?
Cranial nerves4
- Cranial nerves: fourth nerve palsy · Multi-stepA patient with right superior oblique palsy has vertical diplopia. To compensate, which head posture is adopted?
- Cranial nerves: sixth nerve palsy · ApplicationA patient has horizontal diplopia worse on looking to the left, with an inability to abduct the left eye. Which muscle is paralysed?
- Cranial nerves: Gradenigo syndrome · Multi-stepA patient with otitis media has facial pain and a sixth nerve palsy. What is the diagnosis?
- Cranial nerves: cavernous sinus · Multi-stepWhich nerve is most commonly affected first in cavernous sinus thrombosis because of its position in the sinus?
Eye examination4
Lacrimal4
- Lacrimal: dacryocystitis · ApplicationAn adult woman has a painful red swelling below the medial canthus with watering. What is the definitive treatment of chronic dacryocystitis?
- Lacrimal: regurgitation test · ApplicationOn pressing over the lacrimal sac, mucopurulent fluid regurgitates through the punctum. What does this show?
- Lacrimal: dacryocystitis in adults · Multi-stepWhich statement regarding lacrimal drainage is correct?
- Lacrimal: congenital nasolacrimal duct obstruction · ApplicationA 7-month-old baby has watering and mucoid discharge since birth in one eye. Crigler massage has been tried for months without response. What is the next step?
Lacrimal system4
- Lacrimal system · ApplicationA three-month-old infant has had watering and mucoid discharge from one eye since birth. There is no redness of the eye and no swelling over the lacrimal sac. What is t…
- Lacrimal system · ApplicationWhat is the usual role of tears?
- Lacrimal system · ApplicationWhat condition commonly presents with painful swelling near the medial canthus?
- Lacrimal system · ApplicationWhat is a main role of tears?
Lids4
- Lids: congenital ptosis management · Multi-stepA 3-year-old child has unilateral congenital ptosis with levator function of 2 mm. Which procedure is preferred?
- Lids: blepharophimosis syndrome · ApplicationA child has ptosis, telecanthus, epicanthus inversus and small palpebral fissures. This is the typical presentation of which condition?
- Lids · ApplicationPainful eyelash-margin swelling is what?
- Lids · ApplicationPainless eyelid lump from meibomian blockage is what?
Optics4
- Optics · Multi-stepRefraction of a patient with astigmatism shows that one principal meridian is focused exactly on the retina while the other is focused in front of the retina. Which typ…
- Optics: contact lens and spectacle · ApplicationCompared with spectacles, which statement about a contact lens in aphakia or high myopia is correct?
- Optics: Prentice rule · Multi-stepA patient wears -6.00 D lenses and looks through a point 8 mm from the optical centre. What is the prismatic effect?
- Optics: photostress test · ApplicationA patient has visual acuity of 6/18 in one eye with an unremarkable fundus. After bleaching the retina with a bright light, recovery of acuity takes 120 seconds against…
Pediatrics4
- Pediatrics · ApplicationTearing infant with quiet conjunctiva suggests what?
- Pediatrics · ApplicationEnlarged cloudy cornea with photophobia in infant suggests what?
- Pediatrics · ApplicationWhite pupil in child requires exclusion of what?
- Pediatrics · ApplicationTearing infant with quiet eye suggests what?
Pharmacology4
- Pharmacology: atropine toxicity · Multi-stepA child given atropine drops becomes flushed with a dry mouth, fever and agitation. What antidote is used for severe toxicity?
- Pharmacology: steroids · ApplicationWhich is the most likely complication of prolonged topical steroid use in the eye?
- Pharmacology: anti-VEGF · ApplicationWhich agent is an intravitreal anti-VEGF drug commonly used off label for retinal disease?
- Pharmacology: mydriatics and glaucoma · Multi-stepWhat is the safest approach to pupil dilation in a patient with an occludable angle?
Visual pathways4
- Visual pathways · ApplicationBitemporal hemianopia localizes to what?
- Visual pathways · ApplicationHomonymous hemianopia localizes where?
- Visual pathways · ApplicationWhich examination test detects a relative afferent pupillary defect?
- Visual pathways · ApplicationWhich test detects a relative afferent pupillary defect?
Diabetic eye disease3
- Diabetic eye disease · ApplicationWhat examination helps screen for diabetic retinopathy?
- Diabetic eye disease · ApplicationWhat retinal lesion represents a small capillary outpouching in early diabetic retinopathy?
- Diabetic eye disease · ApplicationWhich retinal finding is associated with diabetic retinopathy?
Optic neuritis3
- Optic neuritis: clinical · ApplicationA 28-year-old woman has painful loss of vision in one eye that worsens on eye movement, with a normal disc, a relative afferent pupillary defect and impaired colour vis…
- Optic neuritis: treatment · Multi-stepIn optic neuritis, which treatment hastens visual recovery but does not alter final visual outcome, according to the Optic Neuritis Treatment Trial?
- Optic neuritis · ApplicationA young adult has subacute unilateral visual loss, pain on eye movement, reduced color vision, and a relative afferent pupillary defect. What is the likely diagnosis?
Sclera3
- Sclera: scleritis · ApplicationA 55-year-old woman with rheumatoid arthritis has a severe, deep, boring eye pain that wakes her at night and radiates to the brow. The eye is red with a violaceous hue…
- Sclera: episcleritis versus scleritis · Multi-stepA patient with a sectoral red eye and mild discomfort is given 10 percent phenylephrine drops and the redness blanches. The diagnosis is:
- Sclera: scleromalacia perforans · Multi-stepA 65-year-old woman with long-standing rheumatoid arthritis has painless, yellow-grey scleral thinning with exposed uvea and no inflammation. This is:
Amblyopia2
Colour vision2
- Colour vision: inheritance · ApplicationA boy is unable to distinguish red from green and his maternal grandfather has the same problem. What is the inheritance?
- Colour vision: acquired · ApplicationWhich type of colour vision defect is typically seen in optic nerve disease such as ethambutol toxicity?
Community2
- Community: trachoma elimination target · ApplicationThe WHO target for elimination of trachoma as a public health problem includes TF prevalence below what level in children aged 1 to 9 years?
- Community: ocular trauma classification · ApplicationIn the Birmingham Eye Trauma Terminology system, which term is used for a full-thickness wound of the eye wall made by a sharp object, with entry only?
Dry eye2
Lid disorders2
Macula2
Macular disease2
Nystagmus2
Ocular oncology2
Optic nerve2
Papilloedema2
- Papilloedema: features · ApplicationA patient with a headache has bilateral hyperaemic disc swelling with obliteration of the cup but normal visual acuity. What is the field finding?
- Papilloedema: idiopathic intracranial hypertension · ApplicationAn obese young woman has daily headaches, bilateral papilloedema and a normal MRI. What is the first-line drug?
Public health ophthalmology2
Refractive2
Refractive errors2
Refractive surgery2
Retinal vascular disease2
- Retinal vascular disease · Multi-stepA 65-year-old hypertensive man has sudden painless visual loss in one eye. The fundus shows widespread flame-shaped haemorrhages in all quadrants, dilated tortuous vein…
- Retinal vascular disease · ApplicationWhich retinal finding can occur with severe hypertensive retinopathy?
Retinal vascular emergencies2
Retinal vascular occlusion2
- Retinal vascular occlusion · Multi-stepA patient has sudden painless profound monocular visual loss. Fundoscopy shows a pale retina with a cherry-red fovea. What is the diagnosis?
- Retinal vascular occlusion · ApplicationFundoscopy shows dilated tortuous veins, widespread retinal hemorrhages, and cotton-wool spots in a patient with painless monocular blur. What is most likely?
Retinoblastoma2
Strabismus2
Vitreous2
- Vitreous: asteroid hyalosis · ApplicationAn elderly man's fundus examination reveals numerous small white spherical bodies that move with eye movement but settle back, with good vision. What is this?
- Vitreous: haemorrhage management · ApplicationA patient has a dense vitreous haemorrhage with no view of the fundus. What is the most important reason to do ultrasonography?
Xerophthalmia2
Allergic conjunctivitis1
Angle-closure glaucoma1
Anterior uveitis1
Conjunctival disorders1
Eye movement disorders1
Neonatal eye disease1
Ophthalmia neonatorum1
Optic atrophy1
Optic nerve disorders1
Pupils1
Retinal emergencies1
Vernal keratoconjunctivitis1
Common questions
How many Ophthalmology questions are there?
891 original questions across 666 topics, and the bank grows over time.
Which Ophthalmology topics are covered?
Glaucoma, Ocular oncology, Uvea, Retina, Lens, Lacrimal system, Squint and amblyopia, Eyelid, Orbit, Pupil, Ocular trauma, Neonatal eye disease, and more.
How difficult are these Ophthalmology questions?
0 are recall, 627 are application and 264 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Ophthalmology questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Ophthalmology for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Ophthalmology test?
Yes. The Ophthalmology subject test is included with a paid term, with a countdown and a question palette.
How should I use these Ophthalmology questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Ophthalmology questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.