Topic Study Guide

Glaucoma MCQs & Guide

500+ questions with detailed explanations. Master glaucoma for FRCOphth, ICO, FAICO, DNB and NEET-SS.

Glaucoma overview

Glaucoma is a group of optic neuropathies characterised by progressive retinal ganglion cell loss, optic disc cupping and visual field defects, usually but not always associated with raised intraocular pressure (IOP). It is the second leading cause of irreversible blindness worldwide.

Clinical & exam importance

Glaucoma carries the highest weighting after retina across most ophthalmology exams — typically 12–18% of MCQs. Surgical decision-making (trabeculectomy vs tube vs MIGS) and field interpretation dominate viva questions in FAICO and DNB practicals.

At a glance

MCQ bank
500+
Glossary terms
14+
Free sample MCQs
3
Matched products
2
Practice Glaucoma MCQs

Core anatomy & physiology refresher

The foundations you need before tackling clinical and surgical MCQs.

  • Aqueous humour is secreted by the non-pigmented ciliary epithelium (pars plicata) at 2–3 µL/min.
  • Drainage: 80–90% via the trabecular meshwork into Schlemm canal, 10–20% via the uveoscleral pathway.
  • Trabecular meshwork has three layers: uveal, corneoscleral and juxtacanalicular (greatest outflow resistance).
  • Normal IOP range is 10–21 mmHg with diurnal variation up to 4–5 mmHg.
  • Optic nerve head has ~1.2 million axons converging through the lamina cribrosa.

High-yield glaucoma facts for MCQs

The facts that appear most often in real exam stems. Learn them cold.

  • 1
    Primary open angle glaucoma (POAG) is the most common adult glaucoma worldwide.
  • 2
    First-line medical therapy is a prostaglandin analogue (latanoprost, travoprost, bimatoprost).
  • 3
    Risk factors for POAG: raised IOP, family history, African ancestry, age, thin central cornea, myopia.
  • 4
    CCT correction: thin cornea underestimates true IOP; thick cornea overestimates.
  • 5
    Angle closure: pupillary block (most common), plateau iris, phacomorphic, malignant glaucoma.
  • 6
    Acute angle closure attack: pain, headache, nausea, halos, mid-dilated fixed pupil, IOP often 40–80 mmHg.
  • 7
    Acute treatment: IV acetazolamide, topical beta-blocker, alpha agonist and pilocarpine after IOP drops, then YAG PI.
  • 8
    Normal tension glaucoma: progressive optic neuropathy with IOP consistently <21 mmHg; consider migraine and vasospasm.
  • 9
    Pseudoexfoliation: dandruff-like material on lens; high IOP spikes; often unilateral or asymmetric.
  • 10
    Pigmentary glaucoma: Krukenberg spindle, mid-peripheral iris transillumination, young myopic men.
  • 11
    Congenital glaucoma triad: epiphora, photophobia, blepharospasm. Buphthalmos and Haab striae on exam.
  • 12
    Surgical ladder: SLT → MIGS (iStent, Hydrus, XEN) → trabeculectomy → tube shunt → cyclodestruction.
  • 13
    Trabeculectomy complications: hypotony, choroidal effusion, bleb leak, blebitis, endophthalmitis.
  • 14
    Visual field defects progress: paracentral scotoma → nasal step → arcuate scotoma → tunnel vision.
  • 15
    OCT RNFL is most sensitive in early glaucoma; macular GCC adds value in advanced disease.

Related glaucoma glossary terms

Exam-ready definitions filtered by subspecialty.

Browse full 316-term glossary
Angle Closure
Apposition of the peripheral iris to the trabecular meshwork blocking aqueous outflow, raising IOP.
Buphthalmos
Enlargement of the globe in congenital glaucoma due to scleral stretching before age 3.
Cup-to-Disc Ratio
Vertical ratio of the optic cup to disc; values above 0.6 or marked asymmetry suggest glaucoma.
Ghost Cell Glaucoma
Open-angle glaucoma caused by degenerated red cells (khaki ghost cells) obstructing the trabecular meshwork after vitreous haemorrhage.
Glaucoma (POAG)
Chronic progressive optic neuropathy with characteristic optic disc cupping and visual field loss in the presence of an open angle.
Gonioscopy
Contact-lens examination of the anterior chamber angle; the gold standard for differentiating open from closed angles.
Intraocular Pressure (IOP)
Pressure exerted by aqueous humour; mean ~15.5 mmHg, upper normal ~21 mmHg.
Iridotomy (Laser)
Nd:YAG laser opening in the peripheral iris that equalises pressure between anterior and posterior chambers, treating pupillary block.
Neovascular Glaucoma
Secondary glaucoma due to new vessels on iris/angle, typically following ischaemic retinal disease such as PDR or CRVO.
Ocular Hypertension
IOP >21 mmHg without glaucomatous optic nerve or visual-field changes; managed based on individual risk assessment.
Open-Angle Glaucoma
Glaucoma with a gonioscopically open anterior chamber angle, the most common worldwide form.
Optic Disc Cupping
Excavation of the optic disc reflecting loss of neuroretinal rim; vertical elongation and notching are characteristic glaucomatous features.
Pseudoexfoliation Syndrome
Systemic disorder with dandruff-like material on lens capsule and pupil margin; commonest identifiable cause of secondary open-angle glaucoma.
Scheie Stripe / Sampaolesi Line
Pigment line anterior to Schwalbe’s line seen on gonioscopy in pigment dispersion and pseudoexfoliation syndromes.

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Suggested study sequence

Six phases used by recent passers. Spread across 4–8 weeks per subspecialty.

  1. 1

    1. Aqueous physiology and IOP control

    Lock in production, drainage and IOP measurement. Foundations for every glaucoma question.

  2. 2

    2. Angle assessment and gonioscopy

    Open vs closed, Shaffer grading, plateau iris vs pupillary block.

  3. 3

    3. Optic nerve and field assessment

    Disc photography, RNFL OCT, Humphrey 24-2 interpretation patterns.

  4. 4

    4. Medical management

    Drug classes, mechanisms, side effects and combinations.

  5. 5

    5. Laser and surgical ladders

    SLT, YAG PI, trabeculectomy steps, tube shunts and MIGS.

  6. 6

    6. Special situations

    Congenital glaucoma, neovascular glaucoma, post-surgical management.

Free glaucoma sample MCQs

A taste of the exam-style stems from the full bank.

Q1.In primary open-angle glaucoma the most reliable structural test for early damage is:
A. Gonioscopy
B. Optical coherence tomography of RNFL/GCC
C. Tonometry
D. Specular microscopy
E. Pachymetry

Explanation: OCT of the peripapillary RNFL and macular ganglion cell complex detects structural loss earlier than visual field defects in POAG.

Q2.Classic visual field defect in glaucoma:
A. Central scotoma
B. Bitemporal hemianopia
C. Arcuate scotoma respecting horizontal meridian
D. Junctional scotoma
E. Altitudinal defect

Explanation: Glaucomatous field loss follows the arcuate nerve fibre pattern and respects the horizontal meridian (nasal step, arcuate, Bjerrum scotoma).

Q3.First-line medical therapy for primary open-angle glaucoma:
A. Topical beta-blocker
B. Topical prostaglandin analogue
C. Oral acetazolamide
D. Pilocarpine
E. Brimonidine

Explanation: Prostaglandin analogues (latanoprost, travoprost, bimatoprost, tafluprost) are first-line for POAG: best IOP lowering, once-daily dosing, few systemic effects.

Glaucoma FAQ

Answers to the questions residents ask most about this topic.

What is the first-line treatment for primary open-angle glaucoma?
Topical prostaglandin analogues (latanoprost, travoprost, bimatoprost) are first-line in most settings due to efficacy and once-daily dosing.
When should SLT be offered before drops?
SLT is increasingly offered as first-line based on the LiGHT trial, particularly for newly diagnosed POAG and ocular hypertension.
How do I differentiate POAG from normal tension glaucoma?
NTG has consistent IOP under 21 mmHg with progressive optic neuropathy and field loss. Diurnal IOP monitoring, vascular assessment and disc haemorrhages help.
What is the most common cause of acute angle closure?
Pupillary block in a hypermetropic eye with a shallow anterior chamber.
Does OphthaMCQ cover MIGS?
Yes — the glaucoma question bank and notes cover iStent, Hydrus, XEN gel stent, Kahook dual blade and goniotomy.

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