Cornea MCQs & Guide
450+ questions with detailed explanations. Master cornea for FRCOphth, ICO, FAICO, DNB and NEET-SS.
Cornea overview
Cornea covers a broad clinical territory — from common infections and dry eye through complex dystrophies and surgical transplantation. The cornea is the eye’s primary refractive element and a transparent immune-privileged window.
Clinical & exam importance
Cornea question density is 12–15% of most exams. Microbial keratitis and corneal dystrophy patterns appear in every cycle. FAICO cornea sub-specialty candidates are tested on transplant decision-making and refractive surgery.
At a glance
- MCQ bank
- 450+
- Glossary terms
- 14+
- Free sample MCQs
- 20
- Matched products
- 2
Core anatomy & physiology refresher
The foundations you need before tackling clinical and surgical MCQs.
- Cornea has five layers: epithelium, Bowman, stroma, Descemet, endothelium. Pre-Descemet (Dua) layer described in 2013.
- Central thickness 520–540 µm, peripheral 650 µm; horizontal diameter 11.7 mm.
- Refractive power of the cornea is ~43 D — two-thirds of the eye’s total refractive power.
- Innervation by ophthalmic division of CN V (long ciliary nerves).
- Endothelial cell density falls ~0.6% per year; <500 cells/mm² leads to decompensation.
High-yield cornea facts for MCQs
The facts that appear most often in real exam stems. Learn them cold.
- 1Bacterial keratitis: most common organisms — Pseudomonas, Staphylococcus, Streptococcus.
- 2Pseudomonas keratitis: rapidly progressive ring infiltrate with hypopyon; common in contact lens wearers.
- 3Fungal keratitis: feathery margins, satellite lesions, slow course; common after vegetative trauma.
- 4Acanthamoeba keratitis: severe pain out of proportion to signs, ring infiltrate, contact lens wear with water exposure.
- 5HSV epithelial keratitis: dendritic ulcer with terminal bulbs, treat with topical aciclovir.
- 6Corneal dystrophies: epithelial (Meesmann, EBMD), Bowman (Reis-Bücklers, Thiel-Behnke), stromal (granular, macular, lattice), endothelial (Fuchs, posterior polymorphous, CHED).
- 7Granular: TGFBI gene, autosomal dominant, breadcrumb opacities. Macular: AR, GAGs accumulation, stains with Alcian blue.
- 8Keratoconus: progressive corneal thinning and ectasia; Vogt striae, Fleischer ring, Munson sign.
- 9Cross-linking (CXL) halts keratoconus progression in eyes with documented progression and adequate corneal thickness.
- 10Fuchs endothelial dystrophy: guttae, stromal oedema, AM blur improving through the day.
- 11PK vs DSAEK vs DMEK: DMEK gives the best visual outcome for endothelial disease; PK reserved for full-thickness pathology.
- 12Dry eye: aqueous-deficient (Sjögren) vs evaporative (MGD). Schirmer test, TBUT and ocular staining quantify it.
- 13Refractive surgery: LASIK, SMILE, PRK. Contraindicated in keratoconus, thin corneas, severe dry eye.
- 14Arcus senilis under age 50 raises suspicion of dyslipidaemia.
- 15Limbal stem cell deficiency: conjunctivalisation, persistent epithelial defects; treat with SLET or CLET.
Related cornea glossary terms
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Last 10 years of ICO/FICO past papers with full explanations and answer keys.
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- ✓Cornea
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Oculoplastics and eyelid disorders for your PG and fellowship exams.
What's Included
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- ✓Concise explanations
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- ✓Cornea
- ✓Glaucoma
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Suggested study sequence
Six phases used by recent passers. Spread across 4–8 weeks per subspecialty.
- 1
1. Anatomy and physiology
Layers, innervation, endothelial function, transparency mechanisms.
- 2
2. Infectious keratitis
Bacterial, fungal, viral, acanthamoeba — clinical pattern recognition and treatment.
- 3
3. Dystrophies and degenerations
IC3D classification, genetics, exam appearance.
- 4
4. Ectasia and refractive surgery
Keratoconus, post-LASIK ectasia, CXL, refractive procedures.
- 5
5. Ocular surface disease
Dry eye, MGD, limbal stem cell disease, ocular surface tumours.
- 6
6. Keratoplasty
PK, DALK, DSAEK, DMEK; indications and complications.
20 free cornea MCQs with explanations
Exam-pattern stems with the correct option marked and the reasoning spelled out. Open a question to check your answer.
Q1.A dendritic ulcer staining with fluorescein in a young adult is most likely caused by:
Explanation: A true branching dendrite with terminal bulbs and ulcerated centre is pathognomonic of HSV epithelial keratitis. HZO produces pseudodendrites without true ulceration.
Q2.The earliest topographic sign of keratoconus is:
Explanation: Asymmetric inferior steepening with skewed radial axes (loss of bowtie symmetry) is the earliest topographic sign.
Q3.Munson's sign is associated with:
Explanation: Munson's sign is V-shaped indentation of the lower eyelid on downgaze due to corneal protrusion in advanced keratoconus.
Q4.Endothelial cell density below which decompensation risk significantly rises:
Explanation: Below ~500 cells/mm² the endothelial pump fails and corneal oedema is likely. Cataract surgery is risky <1000.
Q5.The most common cause of bacterial keratitis in contact lens wearers is:
Explanation: Pseudomonas aeruginosa is the commonest organism in contact-lens related bacterial keratitis due to its biofilm formation.
Q6.Acanthamoeba keratitis classically presents with:
Explanation: Acanthamoeba causes severe pain disproportionate to slit-lamp findings, with a characteristic ring infiltrate and radial perineural infiltrates.
Q7.A child with bilateral mucopurulent conjunctivitis and follicles on the lower tarsus may have:
Explanation: Trachoma (Chlamydia trachomatis serovars A-C) classically begins with mucopurulent discharge and follicles on the superior tarsus in endemic regions.
Q8.The most specific corneal dystrophy associated with TGFBI gene mutation is:
Explanation: TGFBI mutations cause Lattice (type 1), Granular, Avellino, and Reis-Bückler dystrophies. Lattice type 2 (Meretoja) involves the gelsolin gene.
Q9.Kayser-Fleischer ring is found in:
Explanation: Kayser-Fleischer ring is a copper deposition in Descemet's membrane (Wilson's disease) and is best seen on gonioscopy.
Q10.Most appropriate first-line treatment for herpes simplex epithelial dendritic keratitis is:
Explanation: Topical antiviral (ganciclovir 0.15% gel, trifluridine 1%) ± oral acyclovir/valacyclovir is first line. Steroids worsen epithelial disease.
Q11.Vernal keratoconjunctivitis is best characterised by:
Explanation: VKC presents in young atopic patients with cobblestone papillae on the upper tarsus and limbal Horner-Trantas dots.
Q12.Hudson-Stähli line is:
Explanation: A horizontal brown line of iron deposition in the inferior corneal epithelium, increasing with age. Other iron lines: Fleischer (keratoconus), Stocker (pterygium), Ferry (filtering bleb).
Q13.Recommended preferred treatment for moderate-severe Fuchs endothelial dystrophy with cataract:
Explanation: When stromal oedema is present, combined phaco with DMEK (preferred) or DSAEK gives best functional results.
Q14.Schirmer's test with anaesthesia measuring <5 mm in 5 minutes indicates:
Explanation: Schirmer I with anaesthesia <5 mm/5 min indicates severe aqueous-deficient dry eye (basal secretion measurement).
Q15.Most common cause of fungal keratitis in tropical/agricultural settings is:
Explanation: Fusarium is the commonest filamentous fungus in tropical regions (often after vegetative trauma); Aspergillus is next. Candida predominates in compromised hosts.
Q16.The corneal layer most resistant to bending forces and contributing most to mechanical strength is:
Explanation: The stroma accounts for ~90 % of corneal thickness and provides most of the cornea's tensile strength via collagen lamellae.
Q17.Cogan microcystic epithelial dystrophy (EBMD) is characterised by:
Explanation: EBMD shows map-dot-fingerprint changes from abnormal epithelial basement membrane, commonly causing recurrent erosions.
Q18.Pseudomembranes are typical of which conjunctivitis:
Explanation: Pseudomembranes and true membranes occur in severe adenoviral conjunctivitis, gonococcal, diphtheric, and Stevens-Johnson conjunctivitis.
Q19.In suspected ocular surface chemical injury, the first intervention is:
Explanation: Immediate prolonged irrigation with saline/Ringer's lactate (or water) for at least 15-30 minutes is the single most important step; check pH after.
Q20.Pterygium classically grows:
Explanation: Pterygium is a triangular fibrovascular growth typically arising from the nasal interpalpebral conjunctiva and encroaching onto the cornea.
Cornea FAQ
Answers to the questions residents ask most about this topic.
What is the most common bacterial cause of contact lens keratitis?
When is corneal cross-linking indicated?
Best technique for endothelial keratoplasty?
How do I distinguish granular from macular dystrophy?
Best book for cornea preparation?
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