Free FRCOPHTH MCQs MCQs

1. 1

   Corneal Collagen Lamellae?

   • A50
   • B100
   • C200
   • D300
   Show answer and explanationHide answer

   Answer: C — 200

   Corneal stroma: ~90% corneal thickness, ~200–250 collagen lamellae centrally (more peripherally).

2. 2

   Decentered Ablation?

   • AComa
   • BTrefoil
   • CSpherical aberration
   • DQuadrafoil
   Show answer and explanationHide answer

   Answer: A — Coma

   | Aberration | Cause | | Coma | Decentered ablation | | Spherical aberration | Small optical zone, post-LASIK | | Trefoil | Irregular optics | | Quadrafoil | Fourth-order aberration |

3. 3

   Conductive Keratoplasty?

   • AAstigmatism
   • BRegression of effect
   • CUndercorrection
   • DOvercorrection
   Show answer and explanationHide answer

   Answer: B — Regression of effect

   CK uses radiofrequency to steepen central cornea for low hyperopia/presbyopia. Major problem: regression over time.

4. 4

   Optical Zone Size?

   • A5.5 mm
   • B6.0 mm
   • C6.5 mm
   • D7.0 mm
   Show answer and explanationHide answer

   Answer: B — 6.0 mm

   Most modern LASIK uses 6.0–6.5 mm optical zone. Smaller optical zone → halos, glare, night vision symptoms.

5. 5

   Potential Vision Worse Than Post-op Vision?

   • ACME
   • BDilated pupil during testing
   • CIrregular cornea
   • DAmblyopia
   Show answer and explanationHide answer

   Answer: B — Dilated pupil during testing

   Potential acuity can be falsely optimistic because of irregular cornea, pinhole effect, amblyopia underestimation. Pupil dilation does not produce falsely good results.

6. 6

   Wavefront Aberrations?

   • AMyopia
   • BPrism
   • CHyperopia
   • DAstigmatism
   Show answer and explanationHide answer

   Answer: B — Prism

   | Order | Aberration | | 0th | Defocus | | 1st | Horizontal prism, Vertical prism | | 2nd | Myopia, Hyperopia, Astigmatism | | 3rd | Coma, Trefoil | | 4th | Spherical aberration, Quadrafoil |

7. 7

   Corneal Topography?

   • AAxial map
   • BInstantaneous map
   • CSagittal map
   • DPower map
   Show answer and explanationHide answer

   Answer: B — Instantaneous map

   | Map | Best Use | | Axial (Sagittal) | Central cornea | | Instantaneous (Tangential) | Peripheral cornea | | Elevation | Keratoconus | | Difference map | Follow-up changes |

8. 8

   Peripheral Rays Focus in Front of Central Rays?

   • AComa
   • BTrefoil
   • CSpherical aberration
   • DQuadrafoil
   Show answer and explanationHide answer

   Answer: C — Spherical aberration

   Positive spherical aberration: peripheral rays focus anteriorly, causing halos and night vision problems. Common after myopic LASIK.

9. 9

   Peripheral Corneal Relaxing Incisions Contraindicated?

   • AHistory of PKP
   • BArcus senilis
   • CPseudophakia
   • DTerrien marginal degeneration
   Show answer and explanationHide answer

   Answer: D — Terrien marginal degeneration

   Why? Terrien: peripheral thinning, risk of perforation. Avoid relaxing incisions.

10. 10

    Best Astigmatism Evaluation Before LASIK?

    • ARefraction
    • BComputerized corneal topography
    • CRetinoscopy
    • DKeratometry
    Show answer and explanationHide answer

    Answer: B — Computerized corneal topography

    Why? Detects forme fruste keratoconus, corneal irregularity, ectasia risk.

11. 11

    Post-RK Cataract Surgery?

    • AAutomated keratometry
    • BPre-RK calculations
    • CManual keratometry
    • DContact lens method
    Show answer and explanationHide answer

    Answer: C — Manual keratometry

    After RK, central cornea flattened; automated K less reliable; manual keratometry preferred.

12. 12

    IOL Moves Anteriorly?

    • AHyperopic shift
    • BNo effect
    • CMyopic shift
    • DNot determinable
    Show answer and explanationHide answer

    Answer: C — Myopic shift

    | Lens movement | Result | | Anterior | Myopic shift | | Posterior | Hyperopic shift |

13. 13

    Central Retinal Artery Occlusion (CRAO)?

    • AHyperbaric oxygen
    • BAnterior chamber tap
    • CAcetazolamide + topical β-blockers
    • DAnticoagulation with Coumadin
    Show answer and explanationHide answer

    Answer: D — Anticoagulation with Coumadin

    CRAO treatments historically attempted: ocular massage, anterior chamber paracentesis, IOP lowering, hyperbaric oxygen, carbogen, intra-arterial tPA. Warfarin has no role in acute CRAO.

14. 14

    Uveal Effusion Syndrome?

    • AOccurs in eyes with abnormally short axial length
    • BPrevented by Flieringa ring
    • CTreated by vitrectomy
    • DAssociated with hypertension and atherosclerosis
    Show answer and explanationHide answer

    Answer: A — Occurs in eyes with abnormally short axial length

    Uveal effusion syndrome: nanophthalmos, thick sclera, impaired vortex vein drainage, recurrent choroidal effusions. Association: short eye + thick sclera.

15. 15

    Fastest Expanding Intraocular Gas?

    • AAir
    • B100% C3F8
    • C100% SF6
    • D14% C3F8
    Show answer and explanationHide answer

    Answer: C — 100% SF6

    | Gas | Expansion | | Air | None | | SF6 | Fastest | | C3F8 | Longest duration |

16. 16

    Silicone Oil Surface Tension?

    • AGreater than C3F8
    • BGreater than air
    • CLess than SF6
    • DEqual to water
    Show answer and explanationHide answer

    Answer: C — Less than SF6

    All gases have higher surface tension than silicone oil. Gas tamponade > Silicone oil tamponade.

17. 17

    Coats Disease?

    • AUsually unilateral
    • BIncreased risk of rhegmatogenous RD
    • CMale predominance
    • DMay require laser photocoagulation
    Show answer and explanationHide answer

    Answer: B — Increased risk of rhegmatogenous RD

    Classic Coats Disease: Young boys, unilateral, retinal telangiectasia, massive lipid exudation, exudative RD. ❌ Not rhegmatogenous RD.

18. 18

    Persistent Fetal Vasculature (PFV/PHPV)?

    • AInitially associated with clear lens or mild opacity that later becomes dense cataract
    • BOften bilateral
    • CAssociated with low birth weight
    • DAssociated with buphthalmos
    Show answer and explanationHide answer

    Answer: A — Initially associated with clear lens or mild opacity that later becomes dense cataract

    PFV: Failure of hyaloid regression, microphthalmos, leukocoria, usually unilateral.; ROP: Prematurity, low birth weight.; PFV is NOT associated with low birth weight.

19. 19

    Presumed Ocular Histoplasmosis Syndrome (POHS)?

    • AMild vitritis
    • BChoroidal neovascularization
    • CSmall punched-out chorioretinal scars
    • DPeripapillary atrophy
    Show answer and explanationHide answer

    Answer: A — Mild vitritis

    Punched-out scars, peripapillary atrophy, CNVM.

20. 20

    Young Patient with CRVO?

    • AHypercoagulable condition
    • BInfection
    • CGiant cell arteritis
    • DThromboembolic disease
    Show answer and explanationHide answer

    Answer: A — Hypercoagulable condition

    Young CRVO (<50 years): hypercoagulable workup (APS, Protein C/S deficiency, Factor V Leiden).

21. 21

    Branch Retinal Artery Occlusion (BRAO)?

    • AESR/CRP/Platelets
    • BLower IOP
    • CEmergent embolic workup
    • DOcular massage
    Show answer and explanationHide answer

    Answer: C — Emergent embolic workup

    BRAO = Stroke equivalent. Workup: carotid Doppler, echocardiography, brain imaging.

22. 22

    Ocular Ischemic Syndrome (OIS)?

    • ACarotid occlusive disease
    • BPDR
    • CRVO
    • DRadiation retinopathy
    Show answer and explanationHide answer

    Answer: A — Carotid occlusive disease

    Mid-peripheral hemorrhages, iris neovascularization, ocular pain, delayed choroidal filling, low retinal arterial pressure.

23. 23

    Multiple Cotton-Wool Spots?

    • ALiver transplantation
    • BEpisodes of weakness and numbness
    • CHigh-risk sexual behavior
    • DPolyuria, polydipsia, polyphagia
    Show answer and explanationHide answer

    Answer: B — Episodes of weakness and numbness

    Interferon retinopathy. Associated with liver transplant, hepatitis treatment, diabetes, HIV. Not multiple sclerosis.

24. 24

    Imaging Question: Most Specific Noninvasive Test for RPE Cell Death?

    • AFAF
    • BFluorescein angiography
    • CFundus photography
    • DOCTA
    Show answer and explanationHide answer

    Answer: A — FAF

    Lipofuscin in RPE fluoresces. Dead RPE → loss of autofluorescence → dark lesions on FAF. FAF best for geographic atrophy, Stargardt disease, pattern dystrophies.

25. 25

    Electrophysiology Question: Direct Measure of Retinal Ganglion Cell Function?

    • APERG
    • BEOG
    • CmfERG
    • DVEP
    Show answer and explanationHide answer

    Answer: A — PERG

    | Test | Measures | | PERG | Ganglion cells | | EOG | RPE function | | mfERG | Macular function | | VEP | Visual pathway |

26. 26

    Posterior Vitreous Detachment (PVD)?

    • AMore common after intracapsular cataract surgery
    • B<20% symptomatic PVD have retinal tears
    • C>50% symptomatic PVD + vitreous hemorrhage have tear
    • DPVD starts at optic disc and spreads temporally
    Show answer and explanationHide answer

    Answer: D — PVD starts at optic disc and spreads temporally

    OCT shows PVD typically begins in perifoveal macula, NOT optic disc.

27. 27

    Lattice Degeneration?

    • APrevalence 5–10% of population
    • B>75% RRD eyes have lattice
    • CBilateral in >75%
    • DLess common in myopes
    Show answer and explanationHide answer

    Answer: A — Prevalence 5–10% of population

    Population prevalence 5–10%; bilateral 30–50%; present in 20–30% of RRD.

28. 28

    Main Site of Resistance to Aqueous Outflow?

    • AUveal trabecular meshwork
    • BCorneoscleral trabecular meshwork
    • CJuxtacanalicular trabecular meshwork
    • DSchlemm's canal
    Show answer and explanationHide answer

    Answer: C — Juxtacanalicular trabecular meshwork

    Trabecular meshwork layers: uveal meshwork, corneoscleral meshwork, juxtacanalicular meshwork (cribriform layer) ← greatest resistance. Most common glaucoma board question.

29. 29

    Glaucoma Laser Trial (GLT)?

    • ABetter visual field score with laser first
    • BLower IOP with laser first
    • CMost laser-treated eyes did not require medication
    • DLaser trabeculoplasty ≈ timolol efficacy
    Show answer and explanationHide answer

    Answer: C — Most laser-treated eyes did not require medication

    After 2 years: ~56% still required medications. ALT comparable to timolol.

30. 30

    Infantile Glaucoma Progression?

    • AIncreasing axial length
    • BAmblyopia
    • CIncreasing horizontal diameter
    • DIncreasing myopia
    Show answer and explanationHide answer

    Answer: B — Amblyopia

    Increasing axial length, buphthalmos, increased corneal diameter, increasing myopia.

31. 31

    Late Bleb-Associated Endophthalmitis?

    • AStaph epidermidis
    • BStreptococcus pneumoniae
    • CPseudomonas
    • DPropionibacterium acnes
    Show answer and explanationHide answer

    Answer: B — Streptococcus pneumoniae

    Late bleb infection → Streptococcus species or H. influenzae. Early postop cataract endophthalmitis → Staph epidermidis.

32. 32

    Superior Visual Field Defect?

    • AGlaucoma
    • BLens rim artifact
    • CHigh false-positive rate
    • DPtosis
    Show answer and explanationHide answer

    Answer: C — High false-positive rate

    High false-positive VF: "trigger-happy" patient, artificially better sensitivity, white scotomas.

33. 33

    Most Urgent Post-Trabeculectomy Problem?

    • AChoroidal hemorrhage
    • BChoroidal effusion
    • CShallow AC with lens-cornea touch
    • DShallow AC with iris-cornea touch
    Show answer and explanationHide answer

    Answer: C — Shallow AC with lens-cornea touch

    Lens-cornea touch causes corneal decompensation and cataract progression. Needs immediate intervention.

34. 34

    Elevated IOP After Heavy PRP?

    • ACycloplegic
    • BLaser iridotomy
    • CLaser iridoplasty
    • DTrabeculectomy
    Show answer and explanationHide answer

    Answer: A — Cycloplegic

    PRP → ciliary body edema → forward rotation of ciliary body → angle closure.

35. 35

    Earlier Detection of Glaucoma?

    • ASuprathreshold testing
    • BOCT
    • CCSLO
    • DFrequency-doubling technology (FDT)
    Show answer and explanationHide answer

    Answer: D — Frequency-doubling technology (FDT)

    FDT targets magnocellular ganglion cells and can detect early glaucomatous damage.

36. 36

    Infantile Glaucoma with Corneal Clouding?

    • ATrabeculectomy
    • BTrabeculotomy
    • CCyclophotocoagulation
    • DGoniotomy
    Show answer and explanationHide answer

    Answer: B — Trabeculotomy

    | Cornea | Surgery | | Clear | Goniotomy | | Cloudy | Trabeculotomy |

37. 37

    Apraclonidine (Iopidine)?

    • AAlpha-1 agonist
    • BMay cause transient lid retraction
    • CCommonly causes hypotension
    • DCauses CME in aphakia
    Show answer and explanationHide answer

    Answer: B — May cause transient lid retraction

    Apraclonidine: alpha-2 agonist, conjunctival blanching, lid retraction, allergic blepharoconjunctivitis.

38. 38

    Pilocarpine in Young Myope?

    • ASmall pupil
    • BIncreased myopia
    • CRetinal detachment
    • DIncreased hyperopia
    Show answer and explanationHide answer

    Answer: B — Increased myopia

    Pilocarpine: accommodative spasm, lens thickening, forward lens movement, increased myopia.

39. 39

    Goldmann Applanation Tonometry?

    • A3.06 mm
    • B3.16 mm
    • C3.10 mm
    • D3.01 mm
    Show answer and explanationHide answer

    Answer: A — 3.06 mm

    At 3.06 mm, corneal rigidity and tear-film surface tension cancel each other.

40. 40

    Medication Causing Most Dermatitis?

    • ALatanoprost
    • BBrimonidine
    • CDorzolamide
    • DApraclonidine
    Show answer and explanationHide answer

    Answer: D — Apraclonidine

    Apraclonidine: allergic dermatitis ≈ 40%, limits chronic use.

41. 41

    Herpetic Keratitis and Glaucoma Therapy?

    • ALatanoprost
    • BTimolol
    • CBrimonidine
    • DMethazolamide
    Show answer and explanationHide answer

    Answer: A — Latanoprost

    Prostaglandin analogs may reactivate HSV keratitis, uveitis, CME. Avoid in these settings.

42. 42

    Visual Field Artifact and Pupil Size?

    • A1.5 mm
    • B2.5 mm
    • C3.5 mm
    • D4.5 mm
    Show answer and explanationHide answer

    Answer: B — 2.5 mm

    Pupil <2.5 mm → generalized depression artifact on Humphrey VF.

43. 43

    Substance That Lowers IOP?

    • AAlcohol
    • BLSD
    • CCaffeine
    • DKetamine
    Show answer and explanationHide answer

    Answer: A — Alcohol

    ↓ IOP: Alcohol, Cannabis, Heroin; ↑ IOP: Ketamine, LSD

44. 44

    Image Question: Gray-White Lens Deposits?

    • AAcute angle-closure glaucoma
    • BChronic angle closure glaucoma
    • CUveitic glaucoma
    • DPseudoexfoliation glaucoma
    Show answer and explanationHide answer

    Answer: A — Acute angle-closure glaucoma

    Glaukomflecken = anterior subcapsular lens epithelial necrosis caused by a previous acute angle-closure attack.

45. 45

    Closed-loop Anterior Chamber IOL with Corneal Edema?

    • ACorneal pachymetry
    • BGonioscopy
    • CSpecular microscopy
    • DCorneal topography
    Show answer and explanationHide answer

    Answer: D — Corneal topography

    In pseudophakic bullous keratopathy:; Pachymetry → corneal thickness; Specular microscopy → endothelial count; Gonioscopy → haptic position; Topography → least useful

46. 46

    Shallow AC During Phaco with Intact Posterior Capsule?

    • AEmpty infusion bottle
    • BChoroidal hemorrhage
    • CMisdirection syndrome
    • DPatient maneuver
    Show answer and explanationHide answer

    Answer: C — Misdirection syndrome

    Fluid passes through zonules behind capsule → posterior pressure → shallow AC.

47. 47

    Prevention of Postoperative Endophthalmitis?

    • A5% povidone-iodine preparation
    • BTreat blepharitis preoperatively
    • CAdd gentamicin to irrigating solution
    • DAdhesive drape isolating lashes
    Show answer and explanationHide answer

    Answer: C — Add gentamicin to irrigating solution

    Best proven prevention = povidone iodine.

48. 48

    Long-Term Sequela of Flat/Shallow AC?

    • AGlaucomatous cupping
    • BVitreous hemorrhage
    • CCapsular block syndrome
    • DCorneal decompensation
    Show answer and explanationHide answer

    Answer: D — Corneal decompensation

49. 49

    Risk Factor for Postoperative Corneal Edema?

    • AAMD
    • BTopical steroids
    • CPosterior chamber phacoemulsification
    • DFuchs dystrophy
    Show answer and explanationHide answer

    Answer: D — Fuchs dystrophy

    Fuchs = endothelial failure → postop edema.

50. 50

    Contraindication to Topical Anesthesia?

    • AMonocular patient
    • BNystagmus
    • CDementia
    • DLong axial length
    Show answer and explanationHide answer

    Answer: B — Nystagmus

    Continuous eye movement makes surgery unsafe under topical anesthesia.

51. 51

    Triple Procedure (PK + Cataract Surgery)?

    • ADecreased polymegathism
    • BCorneal pachymetry >640 μm
    • CDecreased pleomorphism
    • DEndothelial count >1000/mm²
    Show answer and explanationHide answer

    Answer: B — Corneal pachymetry >640 μm

    Fuchs dystrophy: pachymetry >640 μm → likely need corneal transplant.

52. 52

    Ideal Continuous Curvilinear Capsulorrhexis (CCC)?

    • ADetermined by staining zonules
    • BFit within scotopic pupil
    • CExpose all optic in multifocal IOL
    • DOverlap anterior optic edge while allowing cataract removal
    Show answer and explanationHide answer

    Answer: D — Overlap anterior optic edge while allowing cataract removal

    Ideal CCC: centered, covers optic edge 360°, prevents PCO.

53. 53

    Intumescent Cataract?

    • AIris prolapse
    • BChoroidal effusion
    • CCorneal wound burn
    • DCapsular radial tear
    Show answer and explanationHide answer

    Answer: D — Capsular radial tear

    "Argentinian flag sign."

54. 54

    Viscoelastic Material?

    • ASodium hyaluronate
    • BKeratan sulfate
    • CHydroxypropyl methylcellulose
    • DChondroitin sulfate
    Show answer and explanationHide answer

    Answer: B — Keratan sulfate

    Sodium hyaluronate; Chondroitin sulfate; Hydroxypropyl methylcellulose

55. 55

    Retrobulbar Hemorrhage?

    • AVitreous aspiration
    • BLateral canthotomy ± paracentesis
    • CGlobe massage
    • DTarsorrhaphy
    Show answer and explanationHide answer

    Answer: B — Lateral canthotomy ± paracentesis

    Emergency Pearl: Retrobulbar hemorrhage + rock-hard eye = immediate lateral canthotomy/cantholysis.

56. 56

    Posterior Capsular Rupture with Vitreous Loss?

    • AConvert to ECCE if needed
    • BAutomated vitrectomy
    • CInject viscoelastic under nucleus
    • DContinue gentle phaco because phaco cuts vitreous
    Show answer and explanationHide answer

    Answer: D — Continue gentle phaco because phaco cuts vitreous

    Never continue routine phaco in vitreous loss.

57. 57

    Highly Myopic Eyes?

    • ADeep and constant
    • BDeep and fluctuating
    • CShallow and constant
    • DShallow and fluctuating
    Show answer and explanationHide answer

    Answer: B — Deep and fluctuating

    High myopes: deep AC, marked fluctuations during phaco.

58. 58

    Refractive Surgery in a 54-Year-Old Engineer (-6.5 D)?

    • AFull emmetropia LASIK
    • BCorrect all but 1 D of myopia in each eye
    • CMonovision
    • DFull emmetropia PRK
    Show answer and explanationHide answer

    Answer: B — Correct all but 1 D of myopia in each eye

    Presbyopic patient wanting computer vision → leave mild residual myopia (~1 D).

59. 59

    Use of Iris Hooks?

    • APhacolytic glaucoma
    • BExfoliation syndrome
    • CDislocated crystalline lens
    • DPositive vitreous pressure
    Show answer and explanationHide answer

    Answer: B — Exfoliation syndrome

    Pseudoexfoliation: poor dilation, weak zonules, iris hooks frequently needed.

60. 60

    Retinal Flap Tear Before Cataract Surgery?

    • ALaser demarcation before cataract surgery
    • BCataract surgery + intra-op laser
    • CLaser after cataract surgery
    • DCareful cataract surgery
    Show answer and explanationHide answer

    Answer: A — Laser demarcation before cataract surgery

    Symptomatic retinal tear = treat first, cataract later.

61. 61

    IOL Formula for High Axial Hyperopia (Short Eye)?

    • ASRK II
    • BColenbrander
    • CHoffer Q
    • DSRK
    Show answer and explanationHide answer

    Answer: C — Hoffer Q

    Formula Pearls:; Short eyes (<22 mm) → Hoffer Q; Average eyes → SRK/T; Long eyes → Holladay 2, Barrett, Haigis

62. 62

    Cataract Surgery in With-the-Rule Astigmatism?

    • ASuperior scleral incision + LRIs at 180°
    • BSuperior frown incision
    • CToric IOL axis 180°
    • DTemporal clear corneal incision + paired LRIs at 90°
    Show answer and explanationHide answer

    Answer: D — Temporal clear corneal incision + paired LRIs at 90°

    With-the-rule astigmatism: steepen 180°, flatten 90°. LRIs placed in steep meridian (90°).

63. 63

    Diffusely Distributed Keratic Precipitates?

    • AFuchs heterochromic iridocyclitis
    • BSarcoidosis
    • CVogt–Koyanagi–Harada syndrome
    • DSyphilis
    Show answer and explanationHide answer

    Answer: C — Vogt–Koyanagi–Harada syndrome

    Diffuse KPs → Fuchs, Sarcoidosis, Syphilis, Keratouveitis. VKH usually has inferior KPs.

64. 64

    HLA-B27 Associated Disease?

    • ABehçet disease
    • BPsoriatic arthritis
    • CCrohn disease
    • DReactive arthritis
    Show answer and explanationHide answer

    Answer: A — Behçet disease

    Behçet → HLA-B5 (Bw51), not HLA-B27.

65. 65

    Band Keratopathy in JIA?

    • ACalcium carbonate at Descemet membrane
    • BCalcium hydroxyapatite at Descemet membrane
    • CCalcium carbonate at Bowman membrane
    • DCalcium hydroxyapatite at Bowman membrane
    Show answer and explanationHide answer

    Answer: D — Calcium hydroxyapatite at Bowman membrane

    Band keratopathy = calcium hydroxyapatite deposition in Bowman layer.

66. 66

    HLA-B27 Counseling?

    • AAlmost 10% will develop AAU
    • B8% of population is HLA-B27 positive, but only 0.012% develop AAU
    • CTwo-thirds of HLA-B27 positives develop AAU
    • DHLA-B27 is not associated with AAU
    Show answer and explanationHide answer

    Answer: B — 8% of population is HLA-B27 positive, but only 0.012% develop AAU

    Only about 1 in 667 HLA-B27 positive individuals develop AAU.

67. 67

    HLA-DR4 Association?

    • AAcute anterior uveitis
    • BBehçet disease
    • CBirdshot chorioretinopathy
    • DSympathetic ophthalmia
    Show answer and explanationHide answer

    Answer: D — Sympathetic ophthalmia

    HLA-DR4 ↔ Sympathetic ophthalmia and VKH.

68. 68

    JIA Chronic Anterior Uveitis?

    • ABand keratopathy
    • BFibrinous AC reaction
    • CHypopyon
    • DVitritis
    Show answer and explanationHide answer

    Answer: A — Band keratopathy

    JIA uveitis is chronic, silent, destructive → band keratopathy, cataract, posterior synechiae.

69. 69

    SUN Classification of Recurrent Uveitis?

    • ARecurrence <3 months after stopping treatment
    • BRecurrence >3 months after treatment discontinued
    • CRecurrence irrespective of treatment status
    • DResolves in <3 months
    Show answer and explanationHide answer

    Answer: B — Recurrence >3 months after treatment discontinued

    Acute: <3 months; Chronic: relapse <3 months after stopping therapy; Recurrent: relapse after >3 months of inactivity off treatment

70. 70

    Intermediate Uveitis with Multiple Sclerosis?

    • ASC adalimumab
    • BIV infliximab
    • CIV methylprednisolone
    • DSC etanercept
    Show answer and explanationHide answer

    Answer: C — IV methylprednisolone

    Anti-TNF agents may worsen demyelinating disease.

71. 71

    Drug Causing Human Anti-Chimeric Antibodies?

    • AAbatacept
    • BInfliximab
    • CInterferon alfa-2a/2b
    • DTacrolimus
    Show answer and explanationHide answer

    Answer: B — Infliximab

72. 72

    HLA-B27 Uveitis with Ankylosing Spondylitis?

    • AUrinalysis
    • BPathergy test
    • CAqueous tap PCR
    • DChest X-ray and cardiac echogram
    Show answer and explanationHide answer

    Answer: D — Chest X-ray and cardiac echogram

    AS may be associated with pulmonary apical fibrosis and aortic regurgitation.

73. 73

    Scleritis and BRAO?

    • AANA
    • BLumbar puncture
    • CUrinalysis
    • DTemporal artery biopsy
    Show answer and explanationHide answer

    Answer: C — Urinalysis

    Scleritis with tracheomalacia suggests relapsing polychondritis or systemic vasculitis. Urinalysis assesses renal involvement.

74. 74

    Ocular vs Generalized Myasthenia?

    • AMore commonly associated with Graves' disease
    • BMore responsive to anticholinesterase drugs
    • CMore responsive to steroids
    • DCompletely localized to ocular or bulbar involvement
    Show answer and explanationHide answer

    Answer: D — Completely localized to ocular or bulbar involvement

    Ocular myasthenia is restricted to extraocular, levator, and orbicularis oculi muscles (± bulbar). It is less responsive to anticholinesterases than generalized disease and is not specifically linked to Graves' disease.

75. 75

    Drug-Induced Myasthenia?

    • AWarfarin
    • BD-penicillamine
    • CDiltiazem
    • DRanitidine
    Show answer and explanationHide answer

    Answer: B — D-penicillamine

    D-penicillamine is the classic drug causing an autoimmune myasthenic syndrome. Other reported agents include aminoglycosides, macrolides, fluoroquinolones, statins, and beta-blockers.

76. 76

    Migraine with Homonymous Hemianopia?

    • ACerebral MRI
    • BDiscontinue oral contraceptives
    • CSumatriptan (Imitrex)
    • DTangent screen
    Show answer and explanationHide answer

    Answer: A — Cerebral MRI

    A new, persistent homonymous hemianopia in a migraine patient requires neuroimaging to rule out a posterior visual pathway lesion (stroke, mass, AVM). Aura is transient; persistent deficit is not typical aura.

77. 77

    Indications for Treating Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)?

    • A1, 2, 3
    • B1 and 3
    • C2 and 4
    • D4 only
    • E1, 2, 3, 4
    Show answer and explanationHide answer

    Answer: C — 2 and 4

    Treatment of IIH is indicated for debilitating headache and any visual field loss/threat to vision. Asymptomatic papilledema alone may be observed; obesity is a risk factor managed but is not itself an indication for acute IIH therapy.

78. 78

    Permanent Visual Loss in Cavernous Sinus-Dural Fistula?

    • ANeovascular glaucoma
    • BCorneal exposure
    • COpen-angle glaucoma
    • DChoroidal effusions
    • EStrabismus
    Show answer and explanationHide answer

    Answer: C — Open-angle glaucoma

    Carotid-cavernous/dural fistulas can cause elevated episcleral venous pressure → impaired aqueous outflow → secondary open-angle glaucoma. This is the leading cause of permanent vision loss.

79. 79

    Antidote for Edrophonium Overdose?

    • AAtropine
    • BDantrolene
    • CEpinephrine
    • DVerapamil
    Show answer and explanationHide answer

    Answer: A — Atropine

    Edrophonium is a short-acting acetylcholinesterase inhibitor. Overdose causes cholinergic excess (bradycardia, bronchospasm, sweating, salivation). Atropine blocks muscarinic effects and is the antidote.

80. 80

    Feature NOT Seen in Adie's Pupil?

    • AVermiform movement of iris border
    • BHypersensitivity to parasympathomimetic drugs
    • CLight-near dissociation
    • DAnisocoria greater in the dark
    Show answer and explanationHide answer

    Answer: D — Anisocoria greater in the dark

    Adie's tonic pupil is larger than the fellow eye and shows light-near dissociation, segmental iris sphincter palsy (vermiform movements), and denervation supersensitivity to dilute pilocarpine. The anisocoria is typically greater in bright light (the Adie's pupil dilates poorly and constricts poorly).

81. 81

    Bilateral Optic Neuritis with Poor Recovery?

    • AMultiple sclerosis
    • BNeuromyelitis optica (NMO)
    • CGiant cell arteritis
    • DFingolimod adverse effect
    Show answer and explanationHide answer

    Answer: B — Neuromyelitis optica (NMO)

    Bilateral, severe optic neuritis with poor visual recovery is classic for NMO (AQP4-IgG) rather than MS. MS-related optic neuritis is usually unilateral and has better recovery.

82. 82

    Post-Traumatic Headache, Ptosis, and Amaurosis Fugax?

    • ACT brain and orbits
    • BBilateral carotid Doppler study
    • COrbital ultrasound
    • DCT angiography (CTA) of the neck
    Show answer and explanationHide answer

    Answer: D — CT angiography (CTA) of the neck

    The triad of post-traumatic headache, partial Horner syndrome (mild ipsilateral ptosis + miosis), and transient monocular vision loss is highly suggestive of carotid artery dissection. CTA/MRA of the neck is the investigation of choice.

83. 83

    Most Common Cause of Third Nerve Palsy in Children?

    • ACongenital
    • BTraumatic
    • CInflammatory
    • DTumor
    Show answer and explanationHide answer

    Answer: A — Congenital

    In children, isolated third nerve palsy is most often congenital. Adults most commonly have microvascular ischemic palsies.

84. 84

    Most Common Cause of Third Nerve Palsy in Adults?

    • AMicrovascular
    • BTraumatic
    • CAneurysm
    • DTumor
    Show answer and explanationHide answer

    Answer: A — Microvascular

    Microvascular ischemia (diabetes, hypertension) is the leading cause of isolated CN III palsy in adults. Aneurysm must be excluded if pupil is involved.

85. 85

    Timing of Strabismus Surgery in Graves' Ophthalmopathy?

    • AOrbital decompression
    • BOrbital radiation
    • CTarsorrhaphy
    • DEyelid surgery
    Show answer and explanationHide answer

    Answer: D — Eyelid surgery

    Surgical sequence in thyroid eye disease: orbital decompression (if needed) → strabismus surgery → eyelid surgery. Strabismus surgery changes eyelid position; therefore eyelid surgery is last.

86. 86

    Hyphema Without Trauma in an Infant?

    • AJuvenile xanthogranuloma (JXG)
    • BHerpes simplex uveitis
    • CLymphoma
    • DRetinoblastoma
    Show answer and explanationHide answer

    Answer: C — Lymphoma

    Non-traumatic hyphema in infants raises concern for JXG (iris lesions bleed), retinoblastoma (iris neovascularization), trauma (abuse), or viral uveitis. Lymphoma is rare in this age group.

87. 87

    Periorbital Ecchymosis in a 2-Year-Old?

    • ANeuroblastoma
    • BLeukemia
    • CLymphangioma
    • DDermoid cyst
    Show answer and explanationHide answer

    Answer: D — Dermoid cyst

    Periorbital ecchymosis ("raccoon eyes") can result from metastatic neuroblastoma, leukemia, orbital lymphangioma, or trauma. Dermoid cyst typically presents as a painless superotemporal mass and does not cause ecchymosis.

88. 88

    Neuroblastoma Characteristics?

    • AMetastasis from adrenal gland
    • BPossible spontaneous regression
    • CPoor prognosis if diagnosed before 1 year of age
    • DPeriorbital ecchymosis
    Show answer and explanationHide answer

    Answer: C — Poor prognosis if diagnosed before 1 year of age

    Neuroblastoma has a better prognosis in infants (<1 year) and can spontaneously regress. Metastasis to the orbit causes periorbital ecchymosis and proptosis.

89. 89

    Type 2 Duane Retraction Syndrome?

    • APoor adduction and exotropia
    • BPoor abduction and esotropia
    • CPoor abduction and adduction
    • DPoor abduction and exotropia
    Show answer and explanationHide answer

    Answer: A — Poor adduction and exotropia

    Duane type 2 = limited adduction with exotropia in primary gaze. Type 1 = limited abduction + esotropia (most common). Type 3 = limitation of both abduction and adduction.

90. 90

    Best Use of Botulinum Toxin Type A in Strabismus?

    • ASmall-angle esotropia
    • BLarge-angle exotropia
    • CA-pattern esotropia
    • DChronic sixth nerve palsy
    Show answer and explanationHide answer

    Answer: A — Small-angle esotropia

    Botulinum toxin is most effective for small-angle, comitant deviations (especially small-angle esotropia and sixth nerve palsy acutely). Large-angle or complex incomitant deviations respond less well.

91. 91

    Overcorrection After Bilateral Medial Rectus Recession?

    • AExtraocular movement examination
    • BStereopsis measurement
    • CVertical deviation measurement
    • DSlit lamp examination
    Show answer and explanationHide answer

    Answer: A — Extraocular movement examination

    Early overcorrection after strabismus surgery requires assessment of ductions to detect a slipped or lost muscle before considering further intervention.

92. 92

    Spasmus Nutans vs Serious Pathology?

    • AOptic nerve meningioma
    • BParasellar glioma
    • CPontine glioma
    • DCerebellar astrocytoma
    Show answer and explanationHide answer

    Answer: B — Parasellar glioma

    Spasmus nutans (nystagmus, head nodding, torticollis) is usually benign. It must be distinguished from optic pathway/chiasmal glioma, which can present similarly and requires neuroimaging.

93. 93

    Nystagmus Null Point and Prism Correction?

    • ABase down both eyes
    • BBase in both eyes
    • CBase in OD and Base out OS
    • DBase out OD and Base in OS
    Show answer and explanationHide answer

    Answer: C — Base in OD and Base out OS

    Prisms shift the image toward the null point, reducing the head turn. Null point in right gaze with left head turn → use BO-OD / BI-OS (prism base direction opposite to head turn) to shift images rightward.

94. 94

    Initial Management of Accommodative Esotropia with Amblyopia?

    • ABimedial recession
    • BBilateral resection
    • CHyperopic correction with bifocals
    • DHyperopic correction + patching of good eye
    Show answer and explanationHide answer

    Answer: D — Hyperopic correction + patching of good eye

    First-line treatment for accommodative esotropia is full cycloplegic hyperopic correction. If amblyopia is present, occlusion therapy of the better-seeing eye is started. Surgery is reserved for non-responders.

95. 95

    Axenfeld-Rieger Syndrome?

    • A50% develop glaucoma
    • BAssociated with PITX2 and FOXC1 mutations
    • CSystemic abnormalities may occur
    • DAutosomal recessive inheritance is most common
    Show answer and explanationHide answer

    Answer: D — Autosomal recessive inheritance is most common

    Axenfeld-Rieger syndrome is autosomal dominant, caused most often by PITX2 or FOXC1 mutations. ~50% develop glaucoma; systemic features include dental, facial, and umbilical anomalies.

96. 96

    Causes of Heterochromia?

    • AHorner syndrome
    • BAlbinism
    • CJuvenile xanthogranuloma
    • DWaardenburg syndrome
    Show answer and explanationHide answer

    Answer: B — Albinism

    Heterochromia can be congenital (Waardenburg, Horner due to sympathetic denervation) or acquired (iris melanoma, JXG, Fuchs heterochromic iridocyclitis, siderosis). Albinism causes reduced iris pigment but not heterochromia.

97. 97

    Most Common Ocular Manifestation of Abusive Head Trauma?

    • ACorneal abrasion
    • BHyphema
    • CSubconjunctival hemorrhage
    • DRetinal hemorrhage
    Show answer and explanationHide answer

    Answer: D — Retinal hemorrhage

    Retinal hemorrhages (often multilayered, posterior pole, and bilateral) are the most characteristic ocular finding in shaken baby syndrome/abusive head trauma.

98. 98

    High Crossing Fibers at the Optic Chiasm?

    • AOcular albinism
    • BOptic nerve hypoplasia
    • CAchromatopsia
    • DMorning glory disc anomaly
    Show answer and explanationHide answer

    Answer: A — Ocular albinism

    Ocular albinism is associated with misrouting of optic nerve fibers at the chiasm — excessive fibers cross to the contralateral hemisphere. Diagnosed with VEP asymmetry.

99. 99

    Best Visual Acuity Test for Preliterate Children?

    • AHOTV
    • BTumbling E
    • CAllen Figures
    • DLighthouse Chart
    Show answer and explanationHide answer

    Answer: A — HOTV

    HOTV matching or recognition is the preferred standardized test for preschool/preliterate children. Allen figures are less uniform and not as well calibrated.

100. 100

     Comitant Deviation?

     • ANasal wall fracture
     • BInfantile esotropia
     • CThyroid orbitopathy
     • DSixth nerve palsy
     Show answer and explanationHide answer

     Answer: B — Infantile esotropia

     Comitant strabismus = deviation is the same in all gazes (e.g., infantile esotropia). Incomitant deviations vary with gaze (restrictive, paralytic, orbital disease, cranial nerve palsy).

101. 101

     Strabismus Notation?

     • AIntermittent
     • BConstant
     • CInward
     • DOutward
     Show answer and explanationHide answer

     Answer: A — Intermittent

     In clinical notation, "T" = tropia (manifest, constant) and "(T)" or "phoria" indicates intermittent. Often "(T)" denotes intermittent tropia.

102. 102

     Lateral Muscular Branch of Ophthalmic Artery?

     • ASuperior rectus
     • BMedial rectus
     • CInferior rectus
     • DInferior oblique
     Show answer and explanationHide answer

     Answer: A — Superior rectus

     The lateral muscular branch supplies the superior rectus, levator palpebrae superioris, and superior oblique. The inferior muscular branch supplies the medial rectus, inferior rectus, and inferior oblique.

103. 103

     Surgery for Exotropia with Dense Amblyopia?

     • A−1.50 D overminus lenses
     • BBase-in prism
     • CBilateral rectus recession
     • DLeft lateral rectus recession + left medial rectus resection
     Show answer and explanationHide answer

     Answer: D — Left lateral rectus recession + left medial rectus resection

     In unilateral or strongly asymmetric exotropia with one poorly seeing amblyopic eye, surgery on the amblyopic eye alone (unilateral recess-resect) is preferred to preserve the good eye.

104. 104

     Predictor of Postoperative Diplopia?

     • AAge
     • BSize of deviation
     • CPreoperative prism adaptation testing
     • DRefraction
     Show answer and explanationHide answer

     Answer: C — Preoperative prism adaptation testing

     Prism adaptation testing (using Fresnel prisms to preoperatively simulate alignment) helps identify patients at risk for postoperative diplopia and can improve surgical planning.

105. 105

     Canthal Tendon Avulsion After Periorbital Trauma?

     • APulling the eyelid and palpating the insertions of the tendon
     • BObserving the contour of the eyelids and the position of the puncta
     • CReviewing the medical history and the mechanism of the trauma
     • DProbing and irrigating the lacrimal outflow
     Show answer and explanationHide answer

     Answer: A — Pulling the eyelid and palpating the insertions of the tendon

     Physical examination with gentle traction on the eyelid and palpation over the normal insertion sites is the best bedside test for canthal tendon avulsion. Laxity or absence of a firm stop suggests avulsion.

106. 106

     Ptosis with Lid Lag in Downgaze?

     • ACongenital ptosis
     • BSuperior orbital mass
     • COcular myasthenia
     • DDehiscence of the aponeurosis
     Show answer and explanationHide answer

     Answer: A — Congenital ptosis

     Congenital ptosis is characterized by decreased levator function and lid lag in downgaze (the ptotic lid remains higher or fails to descend normally). Aponeurotic ptosis typically worsens in downgaze.

107. 107

     Ptosis with Dysphagia and Respiratory Symptoms?

     • AExternal levator resection
     • BElectromyography and edrophonium (Tensilon) testing
     • CInternal ptosis repair
     • DAnti-acetylcholine receptor antibody testing
     Show answer and explanationHide answer

     Answer: B — Electromyography and edrophonium (Tensilon) testing

     Fluctuating ptosis with systemic bulbar/respiratory symptoms suggests myasthenia gravis. EMG with repetitive nerve stimulation and edrophonium/Tensilon test are key diagnostic steps. Surgery is contraindicated before diagnosis.

108. 108

     Imaging After Blunt Orbital Trauma?

     • ACT scan with contrast
     • BMRI
     • CCT scan without contrast
     • DMRI with contrast
     Show answer and explanationHide answer

     Answer: C — CT scan without contrast

     Non-contrast CT is the first-line imaging for orbital trauma because it best demonstrates bony fractures, orbital wall displacement, and intraorbital hemorrhage. MRI is reserved for soft-tissue/optic nerve evaluation.

109. 109

     Dermolipoma Excision and Dry Eye?

     • ALacrimal gland ductules
     • BMeibomian glands
     • CGlands of Zeis
     • DGlands of Wolfring
     Show answer and explanationHide answer

     Answer: A — Lacrimal gland ductules

     Dermolipomas arise in the superotemporal fornix, close to the palpebral lobe of the lacrimal gland and its ductules. Over-aggressive excision can damage ductules → severe aqueous deficiency dry eye.

110. 110

     New-Onset Thyroid Eye Disease?

     • AEyelid retraction repair
     • BOrbital decompression
     • CThyroid lab testing
     • DStrabismus surgery
     Show answer and explanationHide answer

     Answer: C — Thyroid lab testing

     New-onset thyroid-associated orbitopathy requires biochemical confirmation (TSH, free T4, T3, TSH receptor antibodies) and assessment of disease activity before any surgical intervention.

111. 111

     Upper Lid Blepharoplasty Landmark?

     • AOrbital septum
     • BMüller muscle
     • CLevator aponeurosis
     • DConjunctiva
     Show answer and explanationHide answer

     Answer: B — Müller muscle

     The peripheral arterial arcade runs along the anterior surface of Müller muscle. Encountering it during upper lid surgery indicates the dissection plane is at or just anterior to Müller muscle.

112. 112

     SOOF Equivalent?

     • AOrbital fat
     • BSubcutaneous fat
     • CRetro-orbicularis oculi fat (ROOF)
     • DTemporal fat pad
     Show answer and explanationHide answer

     Answer: C — Retro-orbicularis oculi fat (ROOF)

     SOOF is the inferior (midface) counterpart of ROOF in the upper eyelid/forehead region. Both lie deep to the orbicularis oculi muscle.

113. 113

     Acute Painful Proptosis in a Child?

     • ACavernous hemangioma
     • BSinusitis with orbital abscess
     • CTraumatic retrobulbar hemorrhage
     • DOrbital lymphangioma
     Show answer and explanationHide answer

     Answer: A — Cavernous hemangioma

     Cavernous hemangioma is a slow-growing, painless, adult-onset benign tumor. It does not present with acute painful proptosis. The other options are classic causes of acute pediatric orbital presentation.

114. 114

     Acute Ecchymosis with Cystic Orbital Lesion?

     • ARhabdomyosarcoma
     • BCapillary hemangioma
     • COrbital abscess
     • DLymphangioma
     Show answer and explanationHide answer

     Answer: D — Lymphangioma

     Orbital lymphangioma (lymphatic malformation) is characterized by cystic spaces that undergo spontaneous hemorrhage, producing acute proptosis and ecchymosis. Fluid-fluid levels on MRI are typical.

115. 115

     Most Common Primary Orbital Malignancy in Children?

     • ANeuroblastoma
     • BRhabdomyosarcoma
     • CEwing sarcoma
     • DNone of the above
     Show answer and explanationHide answer

     Answer: B — Rhabdomyosarcoma

     Rhabdomyosarcoma is the most common primary malignant orbital tumor in children, usually arising from undifferentiated mesenchymal cells. It presents with rapid-onset proptosis.

116. 116

     Painless Lacrimal Gland Swelling in Older Adult?

     • APrimary lacrimal gland lymphoma
     • BPleomorphic adenoma
     • CAdenoid cystic carcinoma
     • DMalignant pleomorphic adenoma
     Show answer and explanationHide answer

     Answer: A — Primary lacrimal gland lymphoma

     Painless lacrimal gland enlargement in older adults with molding of bone on CT strongly suggests lymphoma. Pleomorphic adenoma typically shows smooth bony remodeling, while carcinomas are more destructive.

117. 117

     Enophthalmos Without Trauma?

     • ACavernous hemangioma
     • BMetastatic breast carcinoma in a woman
     • COrbital cellulitis
     • DAll of the above
     Show answer and explanationHide answer

     Answer: B — Metastatic breast carcinoma in a woman

     Scirrhous metastatic breast carcinoma can cause enophthalmos due to orbital fibrosis and contraction. Cavernous hemangioma and cellulitis typically cause proptosis, not enophthalmos.

118. 118

     Most Common Cause of Bilateral Adult Exophthalmos?

     • ACavernous hemangioma
     • BPseudotumor
     • CThyroid-related orbitopathy
     • DMetastatic disease
     Show answer and explanationHide answer

     Answer: C — Thyroid-related orbitopathy

     Thyroid eye disease is the most common cause of bilateral proptosis in adults, especially women. It is also the leading cause of unilateral or asymmetric exophthalmos.

119. 119

     Most Common Cause of Unilateral Childhood Exophthalmos?

     • ACapillary hemangioma
     • BThyroid-related orbitopathy
     • COrbital hemorrhage
     • DOrbital cellulitis
     Show answer and explanationHide answer

     Answer: D — Orbital cellulitis

     Orbital cellulitis, often secondary to paranasal sinusitis, is the most common cause of unilateral proptosis in children and requires urgent treatment to prevent vision loss and intracranial spread.

120. 120

     Predisposing Conditions for Mucormycosis?

     • ADiabetes
     • BRenal disease
     • CDehydration
     • DAll of the above
     Show answer and explanationHide answer

     Answer: D — All of the above

     Mucormycosis is an aggressive fungal infection seen in immunocompromised and metabolically deranged patients. Risk factors include uncontrolled diabetes (especially diabetic ketoacidosis), renal disease, dehydration, immunosuppression, and iron overload.

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