TOS:

Topic MCQs SEQs

Anatomy 2 0
Physiology 2 0
Ocular Therapeutics 2 0
Orbit 2 0.5
Lacrimal system 1 0.5
Conjunctiva 4 0.5
Cornea 4 1
Uvea 3 1
Glaucoma 4 1
Lens 4 1
Vitreo-retina 6 1
Neuro ophthalmology 2 0.5
Squint 3 0.5
Refraction 2 0.5
Trauma 2 0.5
Lids & adnexa 2 0.5

Classified Opthalmology Page 1

MCQs:

ANATOMY:

1. Avascular coat of the eye is:

a. Sclera
b. Cornea
c. Retina
d. Choroid
e. Iris

2. Structures derived from embryonic mesoderm include.

a. Lens capsule
b. Ciliary muscle
c. Retinal pigment epithelium
d. Levator palpebrae superioris
e. Corneal endothelium

3. The facial nerve.

a. Exits the skull through the stylomastoid foramen
b. Crosses the tempore-mandibular joint
c. Passes between the 2 lobes of the parotid gland
d. Transmits the parasympathetic supply to the lacrimal gland via its first branch, the greater superficial petrosal nerve
e. Supplies tensor tympani

4. The following structures pass through the superior orbital fissure.

a. Ophthalmic artery
b. Lacrimal branch of the trigeminal nerve
c. Abducens nerve
d. Superior ophthalmic vein
e. Sympathetic supply to the eye

5. In each optic nerve.

a. There are 1 million nerve fibers
b. 50% of the nerve fibers are derived from the macular region of the retina
c. Myelination is virtually complete at birth
d. Pial vessels are the major blood supply throughout most of its course
e. Are axons of the retinal bipolar cells

6. The left oculomotor uncleus.

a. Supplies the left inferior oblique muscle
b. Supplies the left inferior rectus muscle
c. Supplies the right superior rectus muscle
d. Lies close to the left red nucleus
e. Is connected to the right abducens nerve nucleus via the right medial longitudinal fasciculus

7. Levator palpebrae superioris.

a. Arises from the lesser wing of the sphenoid bone
b. Separates the trochlear and frontal nerves from the roof of the orbit
c. Attaches to the superior conjunctival fornix, and the medial and lateral palpebral ligaments
d. Lies superior to Whitnall’s ligament
e. Passes through the orbicularis oculi to insert into the skin of the upper eyelid

8. The inferior orbital fissure.

a. Connects the orbit to the pterygo-palatine fossa
b. Transmits the zygomatic nerve
c. Transmits the inferior ophthalmic vein
d. Transmits the main lymphatic drainage of the orbit
e. Is separated from the superior orbital fissure by the sphenoid strut

9. The anterior orbital rim.

a. Includes the anterior lacrimal crest
b. Forms part of the trochlear fossa
c. Is crossed by the external nasal branch of the naso-ciliary nerve
d. Is the site of attachment of the orbital septum
e. Is commonly involved in a blow-out fracture

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10. The crystalline lens.
a. Is derived from neural crest ectoderm
b. Consists of 35% protein
c. Is suspended by the zonule which contains the protein fibrillin
d. The anterior capsule is responsible for the formation of new lens bibres
e. Is fully developed at birth

11. The meibomian glands.

a. Are suderiferous gland
b. Communicate with the eyelash follicles
c. Open anterior to the gray line
d. Contribute secretions to the deepest layer of the tear film
e. Number approximately 25 in each eyelid

12. Bruch’s membrane.

a. Its inner layer lies next to the basement membrane of the retinal pigment epithelium
b. Terminates at the anterior border of the choroid
c. Is separated from the choroid by the suprachoroidal space
d. Is continuous with the internal non-pigmented layer of the ciliary body
e. Has a central collagenous layer

13. The vitreous.

a. Consists of about 50% water
b. Does not contain any collagen
c. Is firmly attached throughout life to the ciliary epithelium
d. Includes the hyaloid canal (Cloquet’s canal) which is present throughout life
e. Comprises 2/3 of the volume of the globe

14. The middle cerebral artery.

a. May supply the anterior portion of the visual cortex
b. Supplies the optic tract
c. Supplies Broca’s area
d. Supplies the third nerve nucleus
e. Enters the skull through the foramen spinosum

PHYSIOLOGY: (intermixed w/others)

OCULAR THERAPEUTICS: (intermixed w/others)

15. Topical steroids are contraindicated in:
a. Uveitis
b. Dendritic ulcer
c. Glaucoma
d. Myopia
e. Hypermetropia

16. Following drug is contraindicated in viral ulcer:

a. Aciclovir
b. Steroids
c. Antibiotics
d. NSAIDs

17. Local anaesthetic drop are used in all except:

a. Removal of sutures
b. Removal of corneal foreign body
c. Treatment of corneal ulcer
d. Applantation tonometry
e. Gonioscopy

18. Ciprofloxacin is:

a. Antiglaucoma drug
b. Antibiotic
c. Mydriatic
d. Antifungal
e. None of the above

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 ORBIT:
19. Exopthalmos occurs due to:
a. Blow out fracture of the orbit
b. Thyrotoxicosis
c. Hypotony
d. Phthisis bulbi
e. Micro opthalmos

20. Thyroid dysfunction is associated with all except:

a. Exopthalmos
b. Limitation of ocular movements
c. Cataract
d. Glaucoma
e. Periorbital swelling

21. All are a cause of exopthalmos except:

a. Arteriovenous aeurysms
b. Neurofibromatosis
c. Optic nerve glioma
d. Hemangioma
e. Coloboma iris

22. Exopthalmos is seen in:

a. Orbital tumors
b. Orbital hemorrhage
c. Myopia
d. Orbital cellulitis
e. Fracture of floor of orbit

23. Exopthalmos is a term denoting:

a. Absent eye ball
b. Absent adnexa
c. Small eye ball
d. Sunken eye ball
e. Protruding eye ball

24. The bony orbit is made of:

a. 3 bones
b. 5 bones
c. 6 bones
d. 7 bones
e. 8 bones

25. Basal cell carcinoma is most common in:

a. Asians
b. Blacks
c. Whites
d. Orientals
e. Hispanics

26. Exopthalmos can occur due to all of the given causes except:
a. Blow out fracture of the orbit
b. Thyrotoxicosis
c. Hypotony
d. Phthisis bulbi
e. Micropthalmos

27. The organism most commonly responsible for orbital cellulitis in adults is:
a. Proteus mirabalis
b. Staphylococcus aureus
c. Pseudomonas aeroginosa
d. Escherichia coli

28. Most commonly the first muscle involved in the thyroid opthalmyopathy is:
a. Inferior rectus
b. Medial rectus
c. Lateral rectus
d. Superior rectus
e. Levator palpebrae superioris

LIDS AND ADENEXA:

29. Following is not true regarding basal cell carcinoma:

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29. Following is not true regarding basal cell carcinoma:
a. It occurs in fair skin people
b. Chronic exposure to sunlight is a risk factor
c. It is very rare lid tumor
d. Majority arises from lower eye lid
e. It is a slow growing tumor

30. Accessory lacrimal glands are called:

a. Zeis gland
b. Krause's gland
c. Molls gland
d. Orbital gland
e. Lacrimal gland

31. Paralytic ectropion is caused by:

a. Third CN palsy
b. Fourth CN Palsy
c. Fifth CN Palsy
d. Sixth CN palsy
e. Seventh CN palsy

32. Stye is the:

a. Suppurative inflammation of the Molls glands
b. Suppurative inflammation of the Zeis's glands
c. Allergic inflammation of the entire lid
d. Bacterial infection of the lid margin
e. Viral Infection of the lid margin

33. Treatment of trichiasis does not consist of:

a. Antibiotics
b. Epilation
c. Electrolysis
d. Cryotherapy
e. Argon laser ablation

34. Blepharitis leads to the following complications except:

a. Trichiasis
b. Madrosis
c. Ulceration and bleeding
d. Poliosis
e. Dry eye

35. Exogenous allergens can give rise to:

a. Angular conjunctivitis
b. Spring catarrh
c. Opthalmia neonatorum
d. Cicatrizing conjunctivitis
e. Follicular conjunctivitis

36. Regarding distichiasis:

a. Is treated with steroid and antibiotic combination
b. Is a common condition
c. Partial or complete row of lashes emerge at or behind mebomian gland orifices
d. Is posterior misdirection of eye lashes
e. Can lead to dacryocystitis

37. Chalazion is treated by:

a. Tetracycline
b. Topical steroids
c. Oral steroids
d. Surgery
e. Cryotherapy

38. Regarding pterygium all are true except:

a. It is a triangular fibrovascular subepithelial growth
b. It is prevalent in hot climate
c. It may be caused by UV exposure
d. It may be caused by UV rays
e. Chronic dryness may cause it

39. Treatment of blephiritis does not consist of:

a. Antibiotics
b. Miotics
c. Lid hygiene

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 c. Lid hygiene
d. Topical steroids
e. Tear substitute

40. When small white scales accumulate near the roots of lashes the condition is called:
a. Madarosis
b. Blepherophimosis
c. Blepharoptosis
d. Blepharitis
e. Blepharochalasis

41. Commonest cause of cicatricial entropion is:

a. Pemphigus
b. Systemic lupus
c. Trachoma
d. Acid/alkali burns
e. Trauma

42. Moll's glands situated in the lid are:

a. Sebaceous glands
b. Sweat glands
c. Modified meibomian glands
d. Modified lacrimal glands
e. Mucus glands

43. Involvement of which muscle causes ptosis?

a. Levator palpebrae superioris
b. Orbicularis oculi
c. Superior rectus
d. Superior oblique
e. Inferior oblique

44. Ptosis may be classified as following except:

a. Neurogenic
b. Myogenic
c. Aponeurotic
d. Cicatricial
e. Mechanical

45. Following is not true regarding distichiasis:

a. It may be congenital
b. It may be acquired
c. There is partial and complete second row of lashes
d. Treatment consists of cryotherapy and lamellar eye lid division
e. It may cause madarosis

46. Trichiasis is:

a. Inverison of eyelid
b. Inward turning of puncta
c. Misdirection of eyelash
d. Caused by pterygium
e. Can only be treated with cryotherapy

47. Regarding chalazion following is not true:

a. It is acute sterile non-granulomatous inflammatory lesion
b. Histology shows lipogranulomatous inflammatory reaction
c. Multinucleated giant cells and epitheloid cells are present
d. It is a nontender roundish nodule in tarsal plate
e. Eversion of lid may show polypoidal granuloma

48. Treatment of trachoma include all except:

a. Antibiotics
b. Face washing
c. Miotics
d. Trachoma trichiasis surgery
e. Environmental improvement

49. Chalazion is due to the granulomatous inflammation of:

a. Glands of Moll
b. Glands of Zeis
c. Meibomian gland
d. Sebaceous gland
e. Sweat gland

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 LACRIMAL SYSTEM:
50. All except one are contraindications to dacryocystorhinostomy:
a. Atrophic rhinitis
b. Lepromatous dacryocyctitis
c. Malignancy of the sac
d. Rhinoliths

51. In darcocytorhinostomy (DCR) osteum communicates into:

a. Spheno-ethmoidal recess
b. Superior meatus
c. Middle meatus
d. Inferior meatus
e. Nasopharynx

52. Lacrimal sac opens into:

a. Ethmoid bone
b. Sphenoid bone
c. Inferior meatus
d. Frontal bone
e. Zygomatic bone

53. Management of acute dacryocystitis is:

a. Dacrocystostomy
b. Dacrocystectomy
c. Dacryocystorhinostomy
d. Canalicular intubation
e. Medical management

54. Tear film is composed of:

a. One layer
b. Two layers
c. Three layers
d. Four layers
e. Five layers

55. Which of the following is not cause of red eye:

a. Acute congestive glaucoma
b. Acute iritis
c. Corneal ulcer
d. Allergic conjunctivitis
e. Macular hole

56. Watering from the eye of an infant occurs in all of the following except:
a. Congenital dacryocystitis
b. Bupthalmos
c. Corneal ulcer
d. Corneal foreign body
e. Congenital cataract

57. The nasolacrimal duct opens in the:

a. Middle meatus
b. Inferior meatus
c. Spheno-ethmoidal recess
d. Vestibule of mouth
e. Superior meatus

58. The direction of nasolacrimal duct is:

a. Downwards, inward and medially
b. Downwards, laterally and forwards
c. Downwards, laterally and backwards
d. Upwards and internally
e. Upwards and externally

59. Xeropthalmia is caused by:

a. Deficiency of vitamin B
b. Deficiency of vitamin C
c. Deficiency of vitamin A
d. Deficiency of vitamin E
e. Deficiency of vitamin D

60. Occlusion of the canaliculus may result from:

a. Foreign body

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 a. Foreign body
b. Inflammation
c. Eyelash
d. All of the above
e. None of the above

61. In babies the most common abnormality of the lacrimal passage is an obstruction at the:
a. Nasolacrimal duct
b. Common canaliculi
c. Canaliculus
d. Punctum
e. Lacrimal sac

62. Swelling in relation to lacrimal sac is usually:

a. Below the medial palpebral ligament
b. Above the medial palpebral ligament
c. Medial to palpebral ligament
d. Lateral to palpebral ligament
e. Superior to lateral palpebral ligament

63. Inner most layer of tear film is:

a. Lipid layer
b. Aqueous layer
c. Collagenous layer
d. Mucin layer
e. None of the above

CONJUNCTIVA:
64. In gonococcal opthalmia neonatorum all are false except:
a. Symptoms usually appear after the 1st week of life
b. Treated with systemic antibiotics
c. Corneal ulceration is unlikely
d. Spontaneous resolution is the rule
e. Maternal infection is rare

65. Goblet cells of conjunctiva are numerous in:

a. Inter-marginal strip
b. Fornix conjunctiva
c. Tarsal conjunctiva
d. Bulbar conjunctiva
e. Palpebral conjunctiva

66. Epithelial xerosis is seen in:

a. Conjunctivitis
b. Pterygium
c. Arcus senilis
d. Vitamin A deficiency
e. Band keratopathy

67. Conjunctiva shows 'cobblestone' appearance in:

a. Mucopurulent conjunctivitis
b. Trachoma
c. Spring catarrh
d. Acute conjunctivitis
e. Membranous conjunctivitis

68. Treatment of bacterial conjunctivits does not include:

a. Chloramphenicol
b. Ciprofloxacin
c. Metronidazole
d. Gentamicin
e. Tetracycline

69. In vernal keratoconjunctivitis, the discharge is:

a. Watery
b. Mucoid (ropy)
c. Mucopurulent
d. Purulent
e. Sanguionous (bloody)

70. Ingrowth of the subconjunctival fibrovascular tissue to the cornea is:

a. Symblepharon

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 a. Symblepharon
b. Pingecula
c. Pterygium
d. Dermoid
e. Ankyloblepharon

71. Histologically conjunctiva consists of:

a. Epithelium
b. Epithelium and stroma
c. Epithelium and endothelium
d. Stroma and endothelium
e. Stroma

72. Regarding giant papillary conjunctivitis:

a. Is a cause of glaucoma
b. Is caused by glaucoma
c. Is caused by soft contact lens use
d. Is cured by timolol
e. Caused by trachoma

73. Following is not the conjunctival reaction:

a. Chemosis
b. Membrane
c. Follicles
d. Papillary reaction
e. Punctal stenosis

74. A red fleshy mass in the nasal conjunctival area is usually:

a. Penguicula
b. Concretions
c. Naevus
d. Pterygium
e. Squamous cell carcinoma

75. In keratoconus all occur except:

a. Central or para central stromal thinning
b. Apical protrusion
c. Hypermetropia
d. Myopia
e. Astigmatism

76. Treatment of VKC does not consist of:

a. Mast cell stabilizers
b. Antihistamines
c. Topical steroids
d. Miotics
e. Oral steroids

77. In VKC, the discharge is:

a. Watery
b. Mucoid (thready)
c. Mucopurulent
d. Purulent
e. Sanguinous

78. Regarding opthalmicus neonatorum all are true except:

a. It develops within 2 weeks
b. It is caused by bacteria
c. It may be caused by virus
d. Fungi are responsible
e. C trachomatis is one of the major cause

79. Regarding VKC:

a. It is more common in elderly
b. It is a unilateral disease
c. More common in winters
d. More common in young adults
e. More common in non-atopic subjects

80. Following is not the signs of VKC

a. Diffuse papillary hypertrophy
b. Trantas dots
c. Punctate epithelial erosions
d. Giant papillae

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 d. Giant papillae
e. Madarosis

81. Following is not the sign of adenoviral conjunctivitis:

a. Eyelid edema
b. Follicular conjunctivitis
c. Papillary conjunctivitis
d. Pseudomembrane
e. Keratitis

82. Treatment of adenoviral conjunctivitis consist of:

a. Pilocarpine
b. Atropine
c. Antibiotic
d. Cold compresses
e. Acetazolamide

83. Reagrding adenoviral conjunctivitis following is not true:

a. Its incubation period is 4 to 10 days
b. It is transmitted through hand to eye contact
c. Droplet infection is not the cause
d. It may cause epidemic
e. It is highly contagious virus

84. Following is not true to trachoma:

a. It is chronic conjunctival inflammation
b. It Is caused by C trachomatis
c. It is caused due to oor hygiene
d. Fly is an important vector
e. It is spread by mosquito

85. In VKC, all are present except:

a. Cobblestone appearance
b. Corneal ulcer
c. Conjunctival follicles
d. Limbitis
e. Tranta's dots

86. Complications of trachoma include all except:

a. Trichiasis
b. Cicatricial entropion
c. Corneal opacification
d. Ptosis
e. Corneal vascularization

87. The dry eye syndrome:

a. Is more common in warm season
b. Is characterized by keratoconjunctivitis sicca
c. Is usually due to excessive drainage of tears
d. Should always be treated with local steroids
e. Should raise the suspicion of a systemic disease

88. Bacteria responsible for all conjunctivitis are all except:

a. Treponema pallidum
b. N gonorrhea
c. S aureus
d. H influenza
e. S pneumoniae

89. Trachoma is characterized by all except:

a. Mixed follicular/papillary conjunctivitis
b. Trantus dots
c. Herbet pits
d. Arlt lines
e. Pannus formation

90. Treatment of trachoma include all except:

a. Antibiotics
b. Face washing
c. Miotics
d. Trachoma trichiasis surgery
e. Environmental improvement

91. Following is not symptoms of conjunctivits:

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 91. Following is not symptoms of conjunctivits:
a. Lacrimation
b. Headache
c. Stinging sensation
d. Irritation
e. Itching

92. Following is not the drug of choice in treating bacterial conjunctivitis:

a. Gentamicin
b. Chloramphenicol
c. Oflaxacin
d. Fusidic acid
e. Penicillin

93. All are clinical features of bacterial conjunctivits except:

a. Circum corneal injection
b. Papillary reaction
c. Mucopurulent discharge
d. Superficial corneal punctuate erosion
e. Sticking together of eyelids

94. Following is not the conjunctival reaction:

a. Chemosis
b. Membrane
c. Follicles
d. Papillary reaction
e. Punctal stenosis

95. Giant papillary conjunctivitis:

a. Is a cause of glaucoma
b. Is caused by soft contact lens use
c. Is cured by timolol
d. Often shows corneal involvement
e. Can mimic trachoma

96. Periauricular lymph nodes are enlarged in:

a. Bacterial conjunctivitis
b. Viral conjunctivitis
c. Allergic conjunctivitis
d. Chlamydial conjunctivitis
e. Toxic conjunctivitis

97. Conjunctival discharge consists of all except:

a. Watery
b. Hemorrhagic
c. Mucoid
d. Mucopurulent
e. Purulent

98. All statements regarding pterygium are correct except:

a. Elastatic degeneration is underlying pathology
b. Treated by conjunctival autograft
c. It is carcinoma in situ
d. UV radiation is one of the causative agent
e. Usually present on nasal aspect of cornea

99. Epithelium of conjunctiva does not consist of:

a. Non-keratinizing epithelium
b. Five cell layer thick epithelium
c. Cuboidal basal cells
d. Columnar basal cells
e. Goblet cells

100. Regarding conjunctiva all are true except

a. It is a transparent mucous membrane
b. It lines the inner surface of eyelid and globe up to the limbus
c. It has no lymphatic supply
d. It forms a defensive barrier against infection
e. It contains accessory lacrimal glands

101. Regarding pterygium all are true except:

a. It is triangular fibrovascular subepithelial in growth
b. It is prevalent in hot climates
c. It may be caused by UV exposure

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 c. It may be caused by UV exposure
d. It may be caused by infrared rays
e. Chronic dryness may cause it

102. All of the following can assess keratoconus except:

a. Keratometry
b. Corneal topography
c. Flourescein angiography
d. Direct opthalmoscope
e. Slit lamp biomicroscopy

103. Signs of keratoconus include all except:

a. Oil droplet reflex on distant direct opthalmoscope
b. Scissor reflex on retinoscope
c. Haab striae
d. Progressive corneal thinning
e. Munson's sign

CORNEA:
104. Corneal involvement is most commonly seen in:
a. Viral conjunctivitis
b. Bacterial conjunctivitis
c. Mucopurulent conjunctivitis
d. Angular conjunctivitis
e. Opthalmia neonatorum

105. Following is not the signs of vernal keratoconjunctivitis:

a. Diffuse papillary hypertrophy
b. Tranta's dots
c. Punctate epithelial erosions
d. Giant papillae
e. Poliosis

106. In vernal keratoconjunctivitis (VKC) all are present except:

a. Cobblestone papillae
b. Corneal ulcer
c. Conjunctival follicles
d. Limbitis
e. Tranta's dots

107. In a patient with corneal trauma which test is appropriate:

a. Schirmer test
b. Tear film break up time
c. Fluorescein staining of the cornea
d. Applanation tonometry
e. Fluroscein dye disappearance

108. Regarding herpes zoster opthalmicus all are true except:

a. It is caused by varicella zoster virus
b. It is caused by herpes simplex virus
c. It is more severe in immunocompromised people
d. It commonly occur in 6th and 7th decades
e. Post herpetic neuralgia may occur

109. Applantation tonometer is used to measure:

a. Curvature of anterior corneal surface
b. Curvature of posterior corneal surface
c. Intraocular pressure
d. Axial length of the eye
e. Corneal thickness

110. Band shaped keratopathy is deposition of which salt in the anterior corneal layers:
• Calcium

111. Corneal sensations are decreased in which type of corneal infection:

a. Viral keratitis
b. Bacterial conjuctivitis
c. Acanthamoeba keratitis
d. Fungal keratitis
e. Bacterial keratitis

112. A 20 years old female presents with progressive decrease in vision in both eyes for the last one year. She has myopia with
irregular astigmatism. Distant Direct opthalmoscopy shows oil droplet reflex in both eyes with central stromal thinning. She is

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 irregular astigmatism. Distant Direct opthalmoscopy shows oil droplet reflex in both eyes with central stromal thinning. She is
most likely having:
a. Band keratopathy
b. Keratoconus
c. Arcus senilis
d. Pellucid marginal degeneration
e. Stromal dystrophy

113. The most important risk factor for bacterial keratitis is:
a. Contact lens wear
b. Dry eyes
c. Topical steroids
d. Vitamin A deficiency

114. Which of the most uncommon risk factor for bacterial keratitis:
a. Contact lens wear
b. Uncontrolled diabetes mellitus
c. Systemic immunosuppression
d. Trauma with metal object
e. Use of topical steroids

115. Following is not an indication of keratoplasty:

a. Bacterial keratitis
b. Arcus senilis
c. Trichiasis
d. Band keratopathy
e. Keratoconus

116. Following is not true about corneal dystrophies:

a. They are progressive disorders
b. They are hereditary disorders
c. They are usually unilateral
d. They show no signs of inflammation
e. They have no associated systemic diseases

117. Which one of these organisms cannot penetrate through intact corneal epithelum
a. N gonorrhea
b. N meningitides
c. P aeroginosa
d. C diphtheria
e. H influenza

118. Treatment of herpes simplex keratitis include all except:

a. Topical steroids
b. Debridement
c. Mydriatric
d. Keratoplasty
e. Hard contact lenses

119. Ocular signs of herpes zoster opthalmicus include all except:

a. Papilledema
b. Epithelial keratitis
c. Disciform keratitis
d. Stromal keratitis
e. Scleritis

120. Following is not the symptom of bacterial corneal ulcer:

a. Fever
b. Pain
c. Photophobia
d. Discharge
e. Blurred vision

121. Following is not the treatment of bacterial corneal ulcer:

a. Topical antibiotics
b. Oral antibiotics
c. Subconjunctival antibiotics
d. Atropine
e. Acyclovir

122. Promotion of corneal ulcer healing is done by all except:

a. Eyelid closure
b. Conjunctival flap
c. Injection streptokinase

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 c. Injection streptokinase
d. Bandage soft contact lens
e. Amniotic membrane grafting

123. Herpes simplex ulcer presents as:

a. Epithelial defect
b. Stains with fluoroscein
c. Decreased sensitivity
d. Posterior synechiae
e. Dendritic pattern of lesion

Following is not the complication of bacterial corneal ulcer:

a. Posterior synechiae
b. Cotton wool spots on retina
c. Uveitis
d. Complicated cataract
e. Perforation

124. Signs of bacterial corneal ulcer include all except

a. Epithelial defects
b. Infiltrate around the margins
c. Trichiasis
d. Hypopyon
e. Exudates

125. Dendritic ulcer is a characteristic of:

a. Fungal
b. Bacterial
c. Parasitic
d. Viral

126. Risk factors of corneal ulcer include all except:

a. Contact lens wear
b. Trauma
c. Trichiasis
d. Cataract
e. Vit A deficiency

127. Management of bacterial corneal ulcer include all except:

a. Debridement
b. Culture and sensitivity of corneal scrapping
c. Steroids
d. Cycloplegics
e. Antibiotics

128. All are layers of cornea except:

a. Epithelium
b. Trabecular meshwork
c. Bowman's membrane
d. Descements membrane
e. Endothelium

129. Corneal transparency is maintained by all except:

a. Regular arrangement of corneal lamellae
b. Avascularity
c. Relative state of dehydration
d. Increased number of keratocytes
e. Decreased number of keratocytes

130. Risk of ocular involvement in herpes zoster opthalmicus increase in all except:
a. Old age
b. Immunodeficiency
c. Malignancy
d. Involvement of external nasal nerve
e. Involvement of mandibular nerve

131. Initial clinical feature of herpes zoster opthalmicus

a. Dendritic corneal ulcer
b. Excessive blinking
c. Tender pre-auricular lymph nodes
d. Hyphaema
e. Vesicular eruption along opthalmic branch of 5th nerve

UVEA:

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 UVEA:
132. The most important first step in the management of acute bacterial endopthalmitis is:
a. Use of topical antibiotics
b. Intra-vitreal antibiotics
c. Vitreous and aqueous tap
d. Intra vitreal steroids
e. Oral antibiotics

133. The angle of anterior chamber can be visualized by:

a. Distant direct opthalmoscopy
b. Indirect gonioscopy
c. Specular microscopy
d. Applantation tonometry
e. Corneal topography

134. Generally, which clinical sign is not an indication for initiation of treatment in cases of anterior uveitis
a. Aqueous cells
b. Aqueous flare
c. Mutton fat KPs
d. Bosaca nodules
e. Hypopyon

135. Which of the following is true in Acute Anterior Uveitis in a patient suffering from Ankylosing Spondylitis
a. The uveitis is non-granulomatous
b. It is a disease of old age
c. The uveitis usually precedes arthritis
d. It is associated with positive rheumatoid factor
e. Involvement of non axial skeleton

136. In a case of Posterior Uveitis, on Funduscopy - Perivenous exudates referred to as ‘candlewax drippings’ in the retina are seen in
a. Syphilis
b. Toxocariasis
c. Tuberculosis
d. Sarcoidosis
e. Toxoplasmosis

137. On Slit lamp examination of the cornea, Mutton Fat KP’s on the corneal endothelium are seen in
a. Granulomatous Iridocyclitis
b. Posterior Uveitis
c. Non- Granulomatous Iridocyclitis
d. Vitreous Hemorrhage
e. Keratitis

138. Koeppe nodules are seen in

a. Choroiditis
b. Pars planitis
c. Vitritis
d. Non granulomatous uveitis
e. Granulomatous uveitis

139. Rubeosis Iridis (new vessels on the iris) is seen in all except
a. Diabetes Mellitus
b. Neovascular glaucoma
c. Central venous occlusion
d. Acute uveitis
e. None of the above

140. Special investigations of uveitis are not indicated in which condition

a. Granulomatous uveitis
b. Recurrent uveitis
c. Bilateral disease
d. Unilateral acute anterior uveitis
e. Uveitis associated with systemic manifestations.

141. The most common side effect of topical steroids when used long term in uveitis is
a. Fungal infections
b. Corneal melting
c. Raised intra-ocular pressure
d. Serous retinal detachment
e. Optic neuropathy.

142. Hypopyon may be seen in:

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142. Hypopyon may be seen in:
a. Endopthalmitis
b. Behcet's disease
c. Fungal corneal ulcer
d. Retinoblastoma
e. Horner's syndrome

143. Hypopyon is
a. Blood in anterior chamber
b. Exudates on cornea
c. Sterile pus in anterior chamber
d. Pus in vitreous
e. Exudates on retina

144. Hyphaema is
a. Blood in anterior chamber
b. Blood in vitreous
c. Blood staining of cornea
d. Hemorrhages on retina
e. New blood vessels on retina

GLAUCOMA:
145. The therapy of choice for the fellow of acute angle closure glaucoma is:
a. Pilocarpine eye drops
b. Goniotomy
c. Peripheral Laser Iridotomy
d. Mydriatrics/Cycloplegics
e. Trabeculectomy

146. A patient having normal intraocular pressure with glaucomatous disc change and field defects is a patient of:
a. Primary open angle glaucoma
b. Angle closure glaucoma
c. Normal tension glaucoma
d. Ocular hypertension
e. Secondary open angle glaucoma

LENS:
147. What is extracapsular cataract formation?
a. Lens removed leaving posterior capsule behind
b. Total removal of lens and capsule
c. Removal of lens by ultrasonic tip
d. Removal of lens by cryoprobe
e. Lens removed leaving anterior capsule behind

148. Most vision threatening intra-operative complication of extra-capsular cataract surgery is:
a. Retinal detachment
b. Opacification of posterior capsule
c. Endopthalmitis
d. Suprachoroidal hemorrhage

149. The most common type of intraocular lens used after cataract extraction is:
a. Anterior chamber lens
b. Posterior chamber lens
c. Iris claw lens
d. Phakic lens
e. Soft contact lens

150. A 35 year old man complains of visual blurring. On slit lamp examination the iris is slightly displaced
And the margin of the lens is visible through the pupil. This condition is not seen in which of the following
Cases:
a. Trauma
b. Marfan Syndrome
c. Homocysteinuria

151. The most common cause of reversible painless visual loss in elderly population worldwide is:
a. Age related macular degeneration
b. Senile cataract
c. Diabetic nephropathy
d. Open angle glaucoma
e. Refractive errors

152. Four years after cataract surgery, a patient comes with decreased vision in the operated eye, on slit lamp
Examination there is a white opacity in the pupillary area behind the lens. What is the most probable diagnosis?

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 Examination there is a white opacity in the pupillary area behind the lens. What is the most probable diagnosis?
a. Iris prolapse
b. Residual lens matter
c. Bacterial endopthalmitis
d. Hyphema
e. Posterior capsule opacification

153. On the first post op day after a difficult cataract surgery a patient has congested and red eye with some brown tissue that the
protruding through the wound. Most likely diagnosis?
a. Broken stitch
b. Lens subluxation
c. Iris prolapse
d. Pigmented cornea
e. Melanoma

154. Cataract is known to occur with topical use of the following medicine:
a. Timolol
b. Lignocaine
c. Corticosteroids
d. Ciprofloxacin
e. Flavinoids

155. Ectopia lentis with lens displacement superiorly is typical of:

a. Homocysteinuria
b. Sturge weber syndrome
c. Bournevill's disease
d. Marfan's syndrome
e. Von recklinghausen's disease

VITREO-RETINA:
156. Oedema and necrosis of the axons of ganglion cells in nerve fiber layer within the retina is called
a. Hard exudates
b. Flame shaped hemorrhages
c. Cotton wool spots
d. Cystoid macular edema
e. Diabetic maculopathy

157. Proliferative diabetic retinopathy is diagnosed by the presence of

a. Cotton wool spot
b. Flame shaped hemorrhages
c. NVDs and NVEs
d. Hard exudates
e. Dot and blot haemorrhages

158. 50 years old male patient of hypertension comes with sudden severe visual loss in left eye from last 3 days. Examination showed
RAPD and extensive flame shaped hemorrhages. Most likely cause is
a. Ischemic CRVO
b. Proliferative diabetic retinopathy
c. Central retinal artery occlusion
d. Retinopathy of prematurity
e. Age related macular degeneration

159. High myope comes to eye clinic with complaints of flashes of light, floaters and visual field defect in right eye. . He describes the
pattern of visual loss as if a curtain has come in front of his eye. Fundus examination will most likely show
a. Exudative RD with shifting fluid
b. Retinal break with Rhegmatogenous RD
c. Tractional RD at macula
d. Macular hole
e. Vitreous hemorrhage.

160. 50 yrs old aphakic patient comes to clinic with sudden painless loss of vision in right eye. He has RAPD on pupil examination. The
examination of eye revealed low intra-ocular pressure, mild iritis and tobacco dust of anterior vitreous. The most likely diagnosis
of this patient is
a. Exudative retinal detachment
b. Anterior uveitis
c. Vitreous hemorrhage
d. Tractional retinal detachment
e. Rhegmatogenous retinal detachment

161. An obese male smoker of 55yrs is complaining of sudden and severe loss of vision in one eye. 02 days ago he had an attack of
painless transient visual loss with complete recovery in the same eye. He has amaurotic pupil. Most likely retinal finding is
a. Extensive retinal hemorrhages
b. Cherry red spot with pale retina

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 b. Cherry red spot with pale retina
c. Retinal detachment with tears
d. Retinal edema with hard exudates
e. Swollen optic nerve.

162. Bilateral asymmetrical impairment of vision in which retinal examination shows macular drusens and sharply circumscribed area
of RPE atrophy and window defect on FFA in old patient of 75yrs point towards the diagnosis of
a. Myopic degeneration
b. Dry age related macular degeneration
c. Age related macular hole
d. Diabetic macular edema
e. Central serous chorioretinopathy

163. The treatment of central retinal artery (CRA) include the following except
a. Vigorous massage of the globe
b. Paracentasis
c. Retrobulbar steroids
d. Inhalation of CO2
e. Acetazoleamide

164. In central retinal vein occlusion there is a risk of secondary glaucoma which occurs in
a. 15 days
b. 30 days
c. 90 days
d. 6 months
e. 12 months

165. The principle of Argon laser in the treatment of diabetic retinopathy involves
a. Direct destruction of abnormal vasculature
b. Ablation of ischemic areas of retina .
c. Making holes in retina for new vessel to grow
d. Liquifying vitreous so nutrients can easily reach retina
e. Direct destruction of abnormal tissue

166. The earliest sign of diabetic retinopathy is

a. Microaneurysm
b. Soft exudates
c. Hard exudates
d. Deep hemorrhages
e. Flame shaped hemorrhages

167. The patients of retinitis pigmentosa come with the symptom of

a. Night blindness and diminished visual acuity
b. Decreased visual acuity and redness
c. Acute and chronic pain in eye
d. Persistent discharge and decreased vision
e. Color blindness

168. A retinal detachment is a separation of

a. Retina from choroid
b. Retina and choroid from sclera
c. Neurosensory retina from retinal pigment epithelium
d. Internal separation of retina at external plexiform layer
e. Internal separation of retina at internal plexiform layer.

169. Treatment of exudative retinal detachment is

a. Treat with cryo, buckle, and drainage
b. Steroids and treat basic disease
c. Vitrectomy
d. Antibiotic therapy
e. Drainage of subretinal fluid

170. A flash of light (photopsia) is due to

a. Haemorrhage into vitreous
b. Traction of vitreous on optic disc
c. Traction of vitreous on retina
d. Subluxation of lens
e. Corneal irregularity

171. A rhegmatogenous retinal detachment means

a. A retinal detachment without hole

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 a. A retinal detachment without hole
b. A retinal detachment with exudates
c. A retinal detachment with traction
d. A retinal detachment with retinal hole
e. A retinal detachment with inflammation.

172. In the presence of opaque media the posterior segment pathology can be demonstrated by
a. Indirect ophathalmoscopy
b. B scan Ultrasonography
c. Three mirror examination
d. Fundus photography
e. Direct ophthalmoscope

173. Commonest ocular tumor of first decade is:

a. Lemia
b. Retinoblastoma
c. Rhadbomyosarcoma
d. Meningioma
e. Dermoid

NEURO-OPTHALMOLOGY:
174. Opthalmic artery is a branch of:
a. Ciliary artery
b. Temporal artery
c. Internal carotid artery
d. Frontal artery
e. Central retinal artery

175. Marcus Gunn-jaw winking syndrome is caused by misdirection of:

a. Mandibular division of 5th CN
b. Opthalmic division of 5th CN
c. Maxillary division of 5th CN
d. 3rd CN
e. 7th CN

176. The clinical investigations of measuring the visual field for assessing nerve damage is called:
a. Tonometry
b. Perimetry
c. Keratoplasty
d. Topography
e. B scan ultrasonography

177. Photophobia is aversion to:

a. Photography
b. Bright light
c. Yellow light
d. Water
e. Darkness

REFRACTION:

178. The maximum contribution to total refractive power of eye is made by:
a. Cornea
b. Lens
c. Tear film
d. Ciliary muscle
e. Iris

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ORBIT

A young girl is presented to the emergency room with fever, swelling and pain in the right eye since 4 days. She has been
suffering from sinusitis for the last 6 months. On examination she had severe right peri-orbital edema, conjunctival congestion
and chemosis. Her ocular movements in right eye were restricted, pupil non-reacting and vision was 6/24.
a. What is the most probable diagnosis?
○ Orbital cellulitis
b. How will you investigate this patient?
○ Complete blood count (CBC) - Leukocytosis greater than 15,000
○ Purulent material assessment - staining and culture
○ CT scanning with contrast infusion
○ MRI
c. What is the management of this disease?
○ Hospital admission:
ENT assessment and frequent ophthalmic review
○ Antibiotic therapy:
Intravenous ceftazidime, oral metronidazole (anaerobes)
Vancomycin in case of penicillin allergy
Antibiotic therapy continued till patient is apyrexial for 4 days
○ Monitoring of optic nerve function
Every 4 hours-- pupillary reactions, VA, colour vision, light brightness
Investigations:
□ White cell count
□ Blood culture
□ CT orbit, sinuses and brain (exclude a subperiosteal abscess)
□ Lumbar puncture if meningeal or cerebral signs develop
○ Surgical intervention Infected sinuses and orbital collections are drained when:
Lack of response to antibiotics
Subperiosteal or intracranial abscess
Atypical picture, which may merit a biopsy

Note on management of thyroid eye disease?

• Control of hyperthyroidism
• Management of ocular manifestations
Five main clinical manifestations of thyroid eye disease are:
i. Soft Tissue Involvement
□ Topical
Lubricants (artificial tears & ointment)
□ Elevating the head end of bed during sleep
Decreases periorbital edema
Diuretics given at night
□ Taping of eyelids at night
For mild exposure keratopathy
ii. Lid Retraction
□ Mild
No treatment
50 % improve spontaneously
□ Treatment of hyperthyroidism may improve retraction
□ Surgical correction of lid abnormalities only after orbital or extraocular muscle surgery because
these operations change lid position
iii. Proptosis (Exophthalmos)
□ Medical
Lubricants
Stop smoking
Systemic steroids: reduce inflammation
◊ Oral Prednisolone 60-80 mg/day
◊ IV Prednisolone 0.5 g in 200 ml N/Saline over 30 min (Reserved for compressive
optic neuropathy)
Low dose radiotherapy
□ Surgical
Surgical decompression
◊ Removed one or more orbital walls to increase space
◊ Extreme cases: four walls removed
Squint surgery
Lid surgery (last)
iv. Restrictive Myopathy
□ Surgery:
Diplopia in primary gaze/reading position
Diplopia stable for 6 months
Aim : Binocular vision in primary position and good cosmesis
v. Optic Neuropathy
□ Initially, systemic steroids and/or radiotherapy
□ Orbital decompression

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LACRIMAL SYSTEM
A 30 years old patient presents to the eye department with 3 days history of redness and pain in the right eye. On examination
of right eye there is purulent discharge, conjunctival congestion and tender swelling near the medial canthus of right eye.
a. What is the diagnosis?
○ Acute dacrocystitis
b. How will you proceed with the management of the case?
○ Treatment:
Initial
□ Local warmth
□ Oral antibiotics (penicillins)
Incision and drainage
□ Considered if pus points or abscess is about to drain spontaneously
Dacrocystorhinostomy
□ After acute infection has been controlled

Tear film structure and functions?

Tear film has 3 layers:
1. Lipid layer secreted by meibomian glands
○ Functions:
Prevent evaporation of aqueous layer
Act as surfactant for spread of tear film
2. Aqueous layer secreted by lacrimal gland
○ Functions:
Provide atmospheric oxygen to corneal epithelium
Antibacterial function
Wash away debris and noxious stimuli and allow passage of leukocytes after injury
Provide smooth optical surface
3. Mucin layer secreted by conjunctival goblet cells
○ Function:
Convert corneal epithelium from hydrophobic to hydrophilic
Lubrication

Classify dry eyes. Write the tests to confirm dry eyes?

Classification Tests to confirm dry eyes:

• Aqueous layer deficiency i. Tear film break up time

○ Sjögren syndrome ii. Schirmer test
○ Non Sjögren iii. Ocular surface staining
Primary age related hypo-secretion ( most common) ○ Flourescein
Lacrimal gland destruction ○ Rose bengal
□ Tumors iv. Fluorescein clearance test
□ Inflammation v. Lactoferrin
Absence or reduction of lacrimal gland tissue vi. Phenol red thread test
□ Surgical removal vii. Tear meniscometry
□ Congenital absence viii. Tear osmolarity
Conjunctival scarring with obstruction of lacrimal gland ductules ix. Impression cytology
□ Chemical burns
□ Cicatrizing conjuctival inflammations
□ Trachoma
□ Steven Johnson syndrome
□ Cicaticial pemphigoid
Neurological diseases with sensory or motor reflex loss
□ Refractive surgery and contact lens use.
Vitamin A deficiency
• Evaporative
○ Meibomian gland dysfunction
Posterior blepharitis
Atopic keratoconjunctivitis
Congenital absence
○ Lagophthalmos/Exposure
Proptosis
Facial nerve palsy
Eyelid scarring
Following surgery ( blepharoplasty)
○ Contact lens associated
○ Environmental factors
Air conditioning

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CONJUNCTIVA
A 20 years old patient came to the eye department with 3 days of history of redness, foreign body sensation and watering right
eye. He also complains of cough and sore throat. His brother is having similar complaints for last 2 weeks.
a. What is the likely diagnosis?
○ Adenoviral conjunctivitis
b. Enumerate the various conditions presenting as 'red eye'?
D/Ds of red eye:
○ Conjunctivitis
○ Keratitis
○ Acute congestive glaucoma
○ Anterior uveitis
○ Entropion
○ Ectropion
○ Posterior blepharitis
○ Trachoma
○ Scleritis
○ Episcleritis

A 16 year old boy presents with severe itching and redness for the last four years which occurs during summers.
OR
A 10 years old boy presented in the eye OPD with severe itching in both eyes that exacerbated in spring season. On examination
cobble stone papillae are seen.
a. What is the most likely diagnosis?
○ Vernal ketaroconjunctivitis
b. Enumerate other clinical findings?
○ Symptoms
Itching
Photophobia
Lacrimation
Burning
Foreign body sensation
Thick mucoid discharge
○ Signs
Palpebral disease
□ Diffuse papillary hypertrophy
□ Macropapillae (cobble-stone appearance)
□ Mucus deposition between papillae
Limbal disease
□ Gelatinous papillae on limbal conjunctiva with trantas dots at apices
Keratopathy
□ Punctate epithelial erosions
□ Epithelial micro-erosions
□ Shield ulcers and plaques
□ Psuedogerontoxon
□ Peripheral superficial vascularization (pannus)
□ Sub-epithelial scarring
c. How will you treat this case?
MEDICAL: 4. Systemic
1. Prophylaxis with beta radiation and disodium • Immunosuppressive agents
chromoglycate + desensitization • Oral antihistamines
2. Topical 5. Follow up (counseling and wash)
Mast cell stabilizer
Antihistamines SURGICAL:
Weak steroids i. Superficial keratectomy
Acetylcysteine ii. Amniotic membrane overlay graft
Cyclosporin
3. Supratarsal steroid injection

Name types of Allergic conjunctivitis.

1. Vernal Keratoconjunctivitis
2. Acute allergic Rhinoconjunctivitis
3. Atopic Keratoconjunctivitis
4. Giant Papillary Conjunctivitis

Write short essay on Pterygium.

It is a fibrovascular connective tissue over growth upon the cornea from the conjunctiva in the interpalpebral region. There is
degenerative and hyperplastic condition of conjunctiva.

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degenerative and hyperplastic condition of conjunctiva.
• Etiology
○ In hot climate there is drying of interpalpebral tear film and damage by UV radiations. Radiation causing damage
to corneal epithelium and stroma, subconjunctival tissue undergo elastic degeneration and proliferative and
vascularized granulation tissue encroaches the cornea.
• Types
• Progressive • Regressive
Thick, fleshy, vascular infiltration at the Thin, atrophic, decreased vascularization
anterior edge called cap No infiltration at anterior edge
• Clinical features
○ A cup (avascular halo-like zone at the advancing stage), head and body
○ A deposit of iron (Stocker line) may be seen in the corneal epithelium
○ Intermittent inflammation
○ Lesion can interfere with pre-corneal tear film and induce astigmatism
• Treatment
○ Medical
Tear substitutes
Weak topical steroids
Sunglasses
○ Surgical
Simple excision
Conjunctival autograph or amniotic membrane
Mitomycin C and radiation as adjunct
Peripheral lamellar keratoplasty

Write a note on Subconjunctival hemorrhage.

• Subconjunctival hemorrhage, also known as subconjunctival haemorrhage and hyposphagma, is bleeding underneath the
conjunctiva.
• Causes
○ Mask squeeze from diving and not equalizing mask pressure during descent
○ Eye trauma
○ Coagulation disorder (congenital or acquired)
○ Head injury
○ Whooping cough or other extreme sneezing or coughing
○ Severe hypertension
○ LASIK
○ Acute hemorrhagic conjunctivitis
• Management
○ A subconjunctival hemorrhage is typically a self-limiting condition that requires no treatment in the absence of
infection or significant trauma.
○ Artificial tears may be applied

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CORNEA
A 25 years old contact lens wear user is having pain, redness, photophobia, and discharge in right eye. Her cornea shows a
central corneal ulcer.
a. What are the other risk factors for this disease?
○ Trauma
○ Ocular surface disease:
Herpetic keratitis
Bullous keratopathy
Dry eyes
Chronic blepharitis
Trichiasis
Entropion
Exposure
Allergic disease
Corneal anesthesia
○ Others:
Local or systemic immune-suppression
Diabetes
Vitamin A deficiency.
b. What are the clinical features of this disease?
○ Symptoms:
Pain
Photophobia
Blurred vision
Muco-purulent or purulent discharge.
○ Signs:
Epithelial defect ass with larger infiltrate.
Stromal edema, folds in DM, mild anterior uveitis
Chemosis and eyelid swelling
Infiltrate progression with hypoyon.
Descematocoele and perforation
Endophthalmitis
Scarring, vascularization and opacification.
b. How will you manage such a case?
○ Investigations:
Corneal scrapping
□ With a disposable scalpel blade, sterile spatula or bent tip of a hypodermic needle.
□ Delay off treatment for 12 hours if antibiotics previously started.
□ Margins and base of lesion are scraped.
Gram staining
Culture / sensitivity
Routinely, blood, chocolate and Sabouraud media
○ Treatment
Local therapy.
□ Initially instillation is hourly for 24-48 hrs.
□ Antibiotic monotherapy
Fluoroquinolone
□ Antibiotic duotherapy
Combination of two fortified antibiotics, typically a cephalosporin and aminoglycoside
Subconjunctival antibiotics
Mydriatics / cycloplegics
□ for prevention of posterior synechiae and
□ to reduce pain.
Systemic antibiotics
□ Potential for systemic involvement
□ Severe corneal thinning or perforation
□ Scleral involvement

Write short note on Clinical features of Keratoconus?

• A progressive disorder in which the cornea assumes a conical shape secondary to stromal thinning and protrusion.
○ Both eyes in almost all cases.
• Symptoms:
○ During puberty, unilateral impairment of vision due to progressive myopia and astigmatism.
• Signs:
i. Central or paracentral stromal thinning, apical protrusion and irregular astigmatism
ii. Distant direct Ophthalmoscopy shows oil droplet reflex
iii. Retinoscopy shows irregular scissoring reflex.
iv. Very fine vertical deep stromal lines ( Vogt striae)
v. Epithelial iron deposits may surround the base of cone ( Fleischer ring) .
vi. Bulging of lower lid in down-gaze ( Munson Sign)

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 vi. Bulging of lower lid in down-gaze ( Munson Sign)
vii. Acute hydrops may occur following breaks in Descemet membrane. Heals in 6-10 weeks.
viii. Apical stromal scarring. Some improvement of vision if following acute hydrops.
ix. Corneal topography shows irregular astigmatism.

Describe briefly clinical features and management of Herpetic Keratitis? (5) Marks
Clinical features:
• Epithelial keratitis
○ Epithelial (dendritic or geographic) keratitis is associated with active virus replication.
○ Presentation:
At any age
Mild discomfort
Redness
Photophobia
Watering
Blurred vision
○ Signs:
Swollen epithelial cells in punctuate or satellite pattern.
Linear branching (dendritic) ulcer, centrally.
Ends of dendrite have terminal buds and the bed stains with fluorescein.
Corneal sensations are reduced.
Enlargement of ulcer to geographical or amoeboid configuration.
Elevated IOP
Mild sub-epithelial scarring on healing.
○ Treatment:
Topical
□ Acyclovir 3% ointment 5 times daily.
□ Usually resolves in 2 weeks.
Debridement
Oral anti-viral therapy in immune-deficient.
IOP control
• Disciform keratitis (Endothelitis)
○ Etiology is controversial.
○ May be active infection or hypersensitivity to viral antigens in cornea.
○ Clinical features:
Symptoms:
□ Gradual onset of blurred vision
□ Haloes around lights
□ Discomfort and redness common but milder
Signs:
□ Central zone of stromal edema with overlying epithelial edema.
□ KPs underlying edema.
□ Folds in descemets membrane.
□ Wessely immune ring of stromal haze
□ IOP elevated
□ Reduced corneal sensations.
□ Faint ring of stromal and sub-epithelial opacification
○ Treatment:
Topical steroids with anti-viral cover, both q.i.d.
Tapered in 4 weeks.
• Necrotizing stromal keratitis:
○ Rare condition result of active viral replication in stroma.
○ Signs:
Stromal necrosis and melting
Anterior uveitis with KPs
Epithelial defect may be present
Scarring, vascularization and lipid deposition
○ Treatment
As of disciform keratitis but with oral anti-virals
• Neurotrophic ulceration:
○ Failure of re-epithelization due to corneal anesthesia.
○ Signs:
Non-healing epithelial defect.
Gray, opaque and thin stroma.
○ Treatment:
Promote epithelial healing
Topical steroids stopped or kept to minimum.

Enlist various factors responsible for transparency of cornea.

i. Non pigmented
ii. Non keratinized
iii. Relatively acellular

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 iii. Relatively acellular
iv. Avascular
v. Relatively dehydrated
vi. Helical arrangement of stromal fibers
vii. Unmyelinated nerve fibres

Define corneal dystropies.

• A group of progressive, usually bilateral, mostly genetically determined, non inflammatory opacifying disorders.
Enlist various types of corneal dystrophies.
1. Epithelial dystrophies 2. Bowman layer dystrophies
• Cogan epithelial basement membrane dystrophy • Reis-buckler's dystrophy
• Meesman epithelial dystrophy • Theil-Behnke dystrophy
• Lisch epithelial dystrophy • Schnyder central crystalline dystrophy
3. Stromal dystrophies 4. Endothelial dystrophies
• Lattice dystrophy • Fuchs endothelial dystrophy
• Granular corneal dystrophy • Posterior polymorphous dystrophy
• Macular dystrophy • Congenital hereditary endothelial dystrophy

Write short note on Arcus Juvenelis

• An opaque ring about the periphery of the cornea similar to arcus senilis but occurring in the young.
• It may be due to hypercholesterolemia, corneal irritation or inflammation, or a congenital anomaly.

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UVEA

Define uveitis. Write down 3 classifications of uveitis?

Inflammation of the uveal tract which includes iris, ciliary body and choroid
ANATOMICAL CLASSIFICATION CLINICAL CLASSIFICATION AETIOLOGICAL CLASSIFICATION
• Anterior uveitis • Acute uveitis • Systemic disease
○ Iritis ○ Sudden ○ Juvenile arthritis
○ Iridocyclitis ○ Persists for upto 3 ○ Sarcoidosis
• Intermediate uveitis months ○ Behcet’s disease
○ Pars planitis • Chronic uveitis • Traumatic
• Posterior uveitis ○ Insidious ○ Lens induced uveitis
○ Choroiditis ○ May be asymptomatic Phacoanaphylactic
○ Retinitis ○ Persists longer than 3 Phacogenic
○ Vasculitis months ○ Sympathetic uveitis
• Panuveitis • Recurrent • Infestations
○ Entire uveal tract ○ Repeated episodes, ○ Toxoplasmosis
• Endophthalmitis separated by periods of ○ Toxocariasis
○ All intraocular inactivity without • Idiopathic
structures except sclera treatment lasting at ○ Specific
• Panophthalmitis least 3 months ○ Nonspecific uveitis entities
○ Entire globe • Remission • Infections
○ Inactive disease for at ○ Viral
least 3 months after Varicella zoster
discontinuation of Herpes simplex
treatment Influenza virus
• Resistant Measles virus
Rubella virus
○ Bacterial
Syphilis
Tuberculosis
Leprosy
○ Fungal
Histoplasmosis
Candidiasis
Aspergillosis

What are the clinical features of anterior uveitis?

Clinical features of anterior uveitis include:

• Symptoms:
Sudden onset
Duration - 3 months or less
Unilateral pain
Photophobia, redness
VA: Usually good
• Signs:
Circumcorneal injection
Miosis
Endothelial dusting
Mutton fat KPs
Iris nodules
Aqueous cells
Aqueous flare: Protein due to blood–aqueous barrier breakdown
Hypopyon
Cells settle in the AC
Posterior synechiae
Intraocular Pressure
Low (reduced secretion)
Elevated (hypertensive uveitis)
Fundus
Normal
Exclude ‘spillover’ anterior uveitis (toxoplasmosis)
Duration
Resolution - 5–6 weeks

Medicines used to treat uveitis short note?

1. Mydriatics 4. Intraocular Steroids

Indications 5. Systemic steroids
Promote comfort, relieve spasm of ciliary Indications
muscle and pupillary sphincter Intermediate uveitis unresponsive to
Break down recently formed posterior posterior sub-Tenon injections

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 Break down recently formed posterior posterior sub-Tenon injections
synechiae Sight-threatening posterior / panuveitis
Prevent formation of posterior synechiae Resistant anterior uveitis
2. Topical Steroids 6. Antimetabolites
Indications Indications
AAU Sight-threatening uveitis
□ Hourly or more according to severity □ Bilateral, non-infectious, reversible,
□ Tapered, 2-hrly, 3-hrly, 4 times/ day, no response steroids
reduce by 1drop/week Steroid-sparing therapy
□ Discontinue by 5–6 weeks □ Intolerable side-effects from
CAU steroids
□ Long-term therapy □ Chronic relapsing disease
□ Risk of complications □ Treatment - 6–24 months, taper,
3. Periocular Steroid Injection discontinue in 3–12 months
Advantages over topical Side-effects
Therapeutic concentrations behind lens Bone marrow suppression, hepatotoxicity
Water-soluble drugs, incapable of penetrating and nausea
cornea topically
Prolonged effect with ‘depot’ preparation 7. Calcineurin Inhibitors
Indications Ciclosporin
Unilateral/asymmetrical intermediate or Tacrolimus
posterior uveitis
Bilateral posterior uveitis 8. Biological blockers
Poor compliance Interleukin receptor antagonists
Daclizumab and Anakinra
Tumour necrosis factor alpha antagonists
Infliximab and Adalimumab

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GLAUCOMA
A 60 years hypermetropic female comes with a sudden severe pain in the right eye, headache, nausea, and vomiting from the
last 3 hours. She sees halos around lights and vision is reduced. The eye is red and the pupil does not react to light.
a. What is the most likely diagnosis?
• Acute congestive glaucoma
b. What is the pathogenesis of this disease in this case?
Contraction of dilator pupillae
↓
Apposition between iris and lens
↓
Pupillary block
↓
Increased pressure of posterior chamber
↓
Peripheral iris bows anteriorly (Iris bombe)
↓
Peripheral iris touches the posterior corneal surface obstructing the angle
↓
Elevation of IOP
c. What is the emergency treatment in this case?
• Initial medical treatment
○ Assume supine position.
○ Tab Acetazolamide (250mg x 2).
○ IV 20% Mannitol 1-2g/kg over 30-60 min.
○ Topical beta blocker: Timolol- eye drops .
○ Once pressure is below 35mm Hg : Topical 2% Pilocarpine – every 30 min until pupil constricts.
○ Prednisolone eye drops 1 % / Dexamethasone 0.1% every 30-60 min to reduce inflammation.
○ Anti emetic
○ Analgesic
• If these measures fail
○ Central corneal indentation with squint hook or indentation gonio-lens.
○ Corneal oedema cleared with topical 50% glycerol to improve visualization.
○ Laser iridotomy or iridoplasty after cornea clears.
○ Lens extraction, goniosynechialysis, trabeculectomy.

List the signs and symptoms of Chronic Open Angle Glaucoma.

• SYMPTOMS • SIGNS
○ Asymptomatic ○ VA is likely to be normal.
○ Bilateral ○ Pupils : RAPD
○ Asymmetrical ○ Colour vision assessment to R/O other
○ Visual field loss forms of optic neuropathy.
○ In Advanced Disease ○ Slit lamp examination to R/O secondary
Decreased vision causes.
Variety of visual problems, such as night glare ○ Tonometry for Elevated IOP
Fluctuating vision with reading or close work, and while ○ Diurnal fluctuations in IOP (more than 5
going from brightly lit place to dim environment mm Hg).
Frequent Change in reading glasses ○ Gonioscopy
○ Optic disc examination.
○ Perimetry
○ Optic disc or peri-papillary RNFL
imaging

Name the different groups of medicines available for treatment of glaucoma? What is the mechanism of action of each group?

Group Mechanism of action

1. Beta-blockers: • Reduce IOP by decreasing aqueous secretion.
2. Alpha 2 agonists: • Decrease aqueous production and enhance uveo-scleral out flow.
3. Prostaglandin analogues: • Promoting out flow through uveo-scleral route.
4. Topical carbonic anhydrase inhibitors: • Chemically related to sulphonamides.
• Lower IOP by inhibition of aqueous secretion.
5. Miotics: • Parasympathomimetic medicines act by stimulating muscarinic receptors in
sphincter papillae and ciliary body.
• In POAG , increase outflow from the trabecular meshwork by contracting ciliary
muscles.
• In PACG, pull peripheral iris away from angle.
6. Osmotic agents: • Osmotic agents remain intravenous.

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6. Osmotic agents: • Osmotic agents remain intravenous.
• Create an osmotic gradient between blood and vitreous so that water is drawn
out of the vitreous.

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LENS
What are the steps in pre-operative assessment of a patient of cataract? Name the various cataract surgery procedures?
PREOPERATIVE ASSESSMENT OF PATIENT OF CATARACT: CATARACT SURGERIES:
• Visual acuity
• Cover test • Intra-capsular cataract extraction (ICCE)
• Pupillary responses • Extra-capsular cataract extraction (ECCE)
• Ocular adnexa • Extra-capsular cataract extraction with IOL
• Cornea • Phacoemulsification
• Anterior segment
• Lens
• Fundus
• Biometry
○ A-scan ultrasonic biometry
○ Zeiss IOLMaster
○ IOL power calculation formulae
○ Personalized A-constant
• Routine preoperative medical examination
A 70 years old male underwent phacoemulsification. On 3rd post-op day, he comes with severe pain in the operated eye. On slit
lamp examination there is corneal edema, folds in the Descement's membrane, hypopyon and fundus is not clearly visible.
OR
A patient comes to eye clinic 3rd day after cataract surgery; Left eye with complaints of severe pain, lacrimation, redness and
decrease vision. On examination, cornea is hazy and hypopyon is observed in anterior chamber.
a. What is the most probable diagnosis?
○ Acute post operative endophthalmitis
b. What investigations should be carried out?
i. B-scan ultrasound
ii. Aqueous samples
0.1 or 0.2ml of aqueous
iii. Vitreous samples
23G needle
0.2 to 0.4ml from mid vitreous cavity
iv. Microbiology/cultures
Specimens should be sent to lab immediately
c. How will you treat this case?
○ Medical:
i. Intra-vitreous antibiotics
□ Immediately after culture specimens are obtained
Ceftazidime (2mg in 0.1ml) and vancomycin (2mg in 0.1ml)
Amikacin (0.4mg in 0.1ml) as alternate to ceftazidime
ii. Topical antibiotics
iii. Oral antibiotics
iv. Oral steroids
v. Peri-ocular steroids
vi. Topical steroids
vii. Intra-vitreal steroids
viii. Cycloplegics
○ Surgical:
Pars plana vitrectomy

D/Ds of leukocoria
• Anterior chamber or lens abnormalities • Infection
○ Cataract ○ Toxocara
○ Corneal opacity • Inflammation
Glaucoma ○ Endophthalmitis
Hypopyon (i.e. white blood cells ○ Uveitis
accumulating in the anterior chamber) • Neoplasia
• Congenital abnormalities ○ Retinoblastoma
○ Coloboma of retina, choroid or optic nerve ○ Medulloepithelioma
○ Incontinentia pigmenti • Trauma
○ Myelinated nerve fibers ○ Foreign body
○ Myopia, high ○ Retinal detachment
○ Norrie disease ○ Retinal fibrosis
○ Persistent hyperplastic primary vitreous ○ Vitreous hemorrhage that is organizing
○ Retinal detachment • Vascular abnormalities
○ Retinalfold ○ Choroidal hemangioma
○ X-linked retinoschisis ○ Coats’ disease

Differential diagnosis of Leucocoria

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Anterior chamber or lens abnormalities
○ Cataract
○ Corneal opacity
Glaucoma
Hypopyon (i.e. white blood cells accumulating in the anterior chamber)
Congenital abnormalities
○ Coloboma of retina, choroid or optic nerve
○ Incontinentia pigmenti
○ Myelinated nerve fibers
○ Myopia, high
○ Norrie disease
○ Persistent hyperplastic primary vitreous
○ Retinal detachment
○ Retinalfold
○ X-linked retinoschisis
Infection
○ Toxocara
Inflammation
○ Endophthalmitis
○ Uveitis
Neoplasia
○ Retinoblastoma
○ Medulloepithelioma
Trauma
○ Foreign body
○ Retinal detachment
○ Retinal fibrosis
○ Vitreous hemorrhage that is organizing
Vascular abnormalities
○ Choroidal hemangioma
○ Coats’disease

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VITREO-RETINA
A 36 years old insulin dependant diabetic presents in eye OPD with the complaints of blurring of vision in both eyes for the
last 6 weeks. Fundus examination revealed proliferative diabetic retinopathy (PDR) in both eyes.
(a) What are the clinical signs suggestive of PDR?
1. Micro-aneurysms
2. Retinal hemorrhages
a. Retinal nerve fiber layer hemorrhage
b. Intra-retinal hemorrhage
c. Deeper dark round hemorrhage
3. Exudates
4. Diabetic macular edema
5. Focal maculopathy
6. Diffuse maculopathy
7. Ischemic maculopathy
8. Cotton wool spots - accumulation of necrotic debris within nerve fiber layer
9. Venous changes

(b) Enlist the effects of diabetes on the eye?

1. Orbit 6. Lens
• Orbital cellulitis • Cataract
2. Eyelid • Myopic shift
• Recurrent stye 7. Iris
• Ptosis • Rubeosis iridis
3. Conjunctiva 8. Vitreous
• Conjunctivitis • Vitreous hemorrhage
• Dry eyes 9. Retina
4. Cornea • Hemorrhage
• Bacterial keratitis • Ischemia
• Fungal keratitis • Retinal detachment
• Neurotropic ulceration 10. Macula
• Exposure keratitis • Macular edema
5. Irido-corneal angle 11. Optic nerve
• Neovascular glaucoma • Papilloedema

A high myope comes to eye clinic with complaints of flashes of light, floaters and visual field defect in the right eye. He
describes the pattern of visual loss as if a curtain has come in front of his eye.
a. What is the most likely cause of such painless visual loss in this myopic patient?
• Rhegmatogenous retinal detachment
b. What is the significance of myopia in the pathogenesis of this disease?
Myopes 10% of general population , over 40% of all RD occur in myopic eyes because of increased anterio-posterior
diameter of myopic eyes as compared to that of the normal.
Lattice degeneration
Snail tract degeneration
Diffuse chorioretinal atrophy
Macular holes
Vitreous degeneration and early PVD
Vitreous loss during cataract surgery
Posterior capsulotomy

Retinal detachment:
a. List the types of Retinal Detachments and define Rhegmatogenous retinal detachment.
Types:
• Rhegmatogenous retinal detachment
• Non-rhegmatogenous retinal detachment

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 • Non-rhegmatogenous retinal detachment
Tractional RD
Exudative RD

Rhegmatogenous RD:
The separation of the neuro-sensory retina (NSR) from the retinal pigment epithelium (RPE) due to accumulation of sub-retinal
fluid (SRF) in the potential space between the NSR and RPE secondary to a full thickness defect in NSR, which permits fluid from
liquefied vitreous to sub-retinal space.

Write short note on Retinitis pigmentosa?

Definition:
Clinically and genetically diverse group of diffuse retinal dystrophies initially affecting the rod photoreceptor cells with
subsequent degeneration of cones.
Diagnosis:
Bilateral involvement, with loss of peripheral and night vision.
Classical triad is
• Arteriolar attenuation
• Retinal bone spicule pigmentation
• Waxy disc pallor
Symptoms:
• Nyctalopia often during the 2nd -3rd decade.
Signs:
• Mid peripheral RPE atrophy with arteriolar narrowing , and mid-peripheral intra-retinal perivascular bone spicule
pigmentary changes.
• Tessellated fundus due to unmasking of large Choroidal vessels and RPE atrophy.
• Gliotic waxy disc pallor.
• Macular atrophy, epi-retinal membrane, and CMO
Investigations:
• ERG
• EOG
• DA
• Perimetry
Ocular associations:
• Posterior sub-capsular cataract
• Open angle glaucoma
• Myopia
• Keratoconus
• Vitreous changes (PVD , intermediate uveitis)
• Optic disc drusens

A 70yrs old hypertensive male is complaining of blurred vision and distorted images in his left eye from last 4 days.
His hypertension is inadequately controlled and his serum lipid levels are also raised. He has Flame shaped and dot
blot hemorrhages, cotton wool spots and retinal edema involving inferior half of the macula. Occluded vessel is
visible in the involved area.
a. What is the most likely diagnosis in this case?
• Retinal venous occlusive disease
b. What clinical investigations will help you to manage this case?
Investigations:
All patients Selected patients with conditions
• Blood pressure Chest X-ray (TB, sarcoidosis)
• ESR / plasma polarity CRP
• Full blood count Auto-antibodies (anti DNA antibody)
• Random blood glucose Serum ACE
• Random total and HDL cholesterol VDRL
• Plasma protein electrophoresis ANA
• Urea, electrolysis, creatinine Carotid duplex imaging
• TFTs
• ECG
c. What are the treatment options available?
Macular edema Neovascularization
• Grid laser photocoagulation • Usually not treated
• Intranasal triamcinolone
• Periocular steroid • If appropriate, scatter laser
• Intravitreal anti VEGF photocoagulation is performed
• A/V sheathotomy

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NEURO-OPHTHALMOLOGY
Note on 6th Nerve Palsy (2.5)
1. Lesions in and around 6th N nucleus cause
Ipsilateral weakness of abduction.
Failure of horizontal gaze towards the side
of lesion.( horizontal gaze centre in PPRF)
Ipsilateral LMN facial nerve palsy
2. Foville’s Syndrome: (Involves fasciculus as it passes
PPRF)
Ipsilateral 6th nerve palsy
Horizontal Gaze palsy
Ipsilateral 5th nerve involvement
Ipsilateral deafness
Ipsilateral 7th nerve palsy
Central Horner’s syndrome
3. Millard- Gubler Syndrome: (Involves fasciculus as it
pass pyramidal tract)
Ipsilateral 6th nerve palsy
Ipsilateral 7th nerve palsy
Contralateral hemi-plegia
• Signs:
○ Left 6th N palsy
Left esotropia
Marked limitation of left abduction.
Compensatory head turn into the field of action of paralyzed muscle
4. Raised intra-cranial pressure:
Downward displacement of brain stem resulting in
stretching of sixth nerve over the tip of petrous bone.
Bilateral 6th nerve palsies.
False localizing sign.
5. Acoustic neuroma:
May damage it at ponto-medullary jn.
First symptom is hearing loss
First sign is loss of corneal sensations.
6. Gradenigo’s syndrome:
6th nerve palsy
Ipsilateral decreased hearing
Ipsilateral facial weakness
Caused by mastoiditis or acute petrositis
7. Petrous bone/ base of skull fracture:
5th, 6th, 7th and 8th nerve involvement
8. Cavernous Sinus Syndrome

A 40 years old obese female is complaining of generalized headache aggravating with head movements, projectile vomiting and
transient visual obscurations lasting few seconds in both eyes from the last two weeks. Her vision is 6/6 in both eyes. Fundus
examination shows bilateral disc hyperemia, moderate disc elevation with indistinct margins and peri-papillary hemorrhages.
Lumber puncture shows opening pressure of >250mmHg with no inflammatory cells and normal CSF glucose and proteins.
• Diagnosis:
Papilledema
• D/Ds
○ Idiopathic intracranial hypertension
○ Anterior ischemic optic neuropathy
○ Adult optic neuritis
○ CRVO
○ Compressive optic neuropathy
○ Hypertension
○ Pseudopapilledema
○ Thyroid ophthalmopathy
○ Scleritis
○ Acute complication of sarcoidosis
○ Toxic optic neuropathy

Note on Papilledema
• Papilledema is swelling of optic nerve head secondary to raised intracranial pressure.
• Usually bilateral and may be asymmetrical
• Clinical features
○ Headache :
early in the morning,
gets progressively worse,
generalized or localized,
intensify with head movements,
very rarely may be absent.
○ Sudden nausea and vomiting:
projectile ,
may partially relieve headache
Deterioration of consciousness
○ Visual:
transient obscurations,
horizontal diplopia,
decreased vision.
• Stages
○ Early papilloedema
○ Established papilloedema (acute)
○ Longstanding papilloedema (chronic)
○ Atrophic papilloedema (secondary optic atrophy)

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 ○ Atrophic papilloedema (secondary optic atrophy)
• Investigations
○ MRI/ CT scan
○ B scan

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SQUINT
Classify squint. Briefly discuss its principle of management? (5) Marks
• Phorias (latent squint)
○ Esophoria
○ Exophoria
○ Hyperphoria
○ Hypophoria
• Tropias (manifest squint)
○ Esotropia
○ Exotropia
○ Hypertropia
○ Hypotropia
OR
• Concomitant or non paralytic
• Nonconcomitant or paralytic
OR
• Intermittent or constant
OR
• Unilateral or alternating

MANAGEMENT
• Clinical evaluation of a patient of strabismus • MOTOR EXAMINATION OF SQUINT
• HISTORY • HIRSCHBERG TEST
○ Age of onset ○ Objective estimation of the angle
○ Intermittent or constant squint of squint
○ Unilateral or alternating squint • COVER TEST- UNCOVER TEST;
○ General health ○ To differentiate tropias from
○ Birth history phorias
○ Family history ○ To assess the control of the
• SENSORY EXAMINATION OF SQUINT deviation and preference of
• VISUAL ACUITY; fixation
○ The ability to distinguish separate elements of a • ALTERNATE COVER TEST;
target and identify them as a whole ○ To assess the total squint ; phoria
○ Minimum angle of separation between two plus tropia
objects that allows them to be perceived as • PRISM COVER TEST;
separate ○ to accurately measure
• REFRACTIVE STATUS the squint
○ Commonest refractive error is hypermetropia • EXTRAOCULAR MUSCLE MOVEMENT;
○ Cycloplegic refraction is to be done after ○ To check the weak muscle or the
paralysing the ciliary muscle and hence paralysed muscle
abolishing the accomodation • FUSIONAL AMPLITUDES;
○ Hypermetropia is usually associated with ○ to assess the binocularity of vision
esotropia
○ Myopia is usually associated with exotropia
• FUNDOSCOPY
○ To assess any underlying pathology like macular
scarring or optic disc hypoplasia
• Tests for sensory anomalies of squint
○ Worth four test

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REFRACTION
Write short notes on:
a. Myopia?
• Refractive error of eye in which parallel rays of light focus in front of retina. It is also called near sightedness
• Etiology:
○ Increased refractive power of eye
○ Increased length of eyeball
• Types
○ Axial myopia (large eyeball)
○ Index myopia (lens globular)
○ Curvatural myopia (defective cornea)
• Clinical features
○ Decreased distant vision
○ Convergence insufficiency
○ Headaches, asthenopia
○ Exophoria/ exotropia
• Treatment:
1. Concave lens used - divergence of rays, point of focus is pushed back till it falls on retina
2. Contact lenses
3. Surgical
i. Radial keratotomy
ii. Photorefractive keratotomy
iii. LASIK
iv. Phakic intraocular implants
b. Presbyopia
• Impaired vision for near work due to old age
• Decrease in accommodative power due to loss of elasticity of lens
• Age:
○ 40-45 years
• Treatment
○ Convex lenses
c. Hypermetropia?
• Refractive error of eye in which parallel rays of light focus behind the retina when accomodation is relaxed. It is also call ed
far sightedness
• Etiology:
○ Decreased refractive power of eye
○ Decreased length of eyeball
• Types
○ Axial hypermetropia (small eyeball)
○ Index hypermetropia (lens less globular)
○ Curvatural hypermetropia (defective cornea)
• Clinical features
○ Decreased near vision
○ Headaches
○ Eye strain
○ Esophoria/ esotropia
○ Decrease axial length
○ Dislocation/Absence of lens(Aphkia)
○ Psuedo-papilloedema
• Complications:
○ Squint
○ Amblyopia
○ Hypermetropic eyes are small , more prone to angle closure glaucoma
• Treatment
○ Convex lens
○ Surgical
○ LASIK
○ EXCIMER LASER

Write short notes on Pinhole test.

○ The pinhole testing device can determine if a problem with acuity is the result of refractive error (and thus correctable
with glasses) or due to another process.
○ The pinholes only allow the passage of light which is perpendicular to the lens, and thus does not need to be bent prior to
being focused onto the retina.
○ The patient is instructed to view the Snellen chart without the pinholes and then again with them in position
○ If the deficit corrects with the pinholes in place, the acuity issue is related to a refractive problem.

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TRAUMA
A player was hit with tennis ball in the evening. Next day he presented in the OPD with swelling and numbness on cheek,
narrowed palpebral fissure, double diplopia and hypotonia.
a. What is the most probable diagnosis in this case?
• Blow out orbital floor fracture
b. What other clinical signs do you expect in blunt trauma to the eye?
OR
A patient comes to eye clinic with trauma to Right eye with Tennis ball and complains of Diplopia. What further clinical features
you expect in this patient?
OR
Enumerate the effects of CONTUSION to the orbit and eye
• Orbit • Lens
○ Blow out fracture ○ Cataract
○ Orbital hematoma ○ Sublaxation
○ Carotid-Cavernous fistula ○ Rupture of capsule
• Eyelids • Sclera
○ Hematoma ○ Rupture ( at limbus or behind the insertion of
○ Avulsion of lower lid. recti)
• Conjunctiva • Vitreous
○ Subconjunctival Hemorrhage ○ Hemorrhage
• Cornea • Choroid
○ Corneal abrasion ○ Choroidal rupture
○ Acute corneal oedema ○ Supra-choroidal Hg
○ Tears in DM • Retina
• Anterior uvea ○ Retinal or sub-retinal Hg
○ Hyphaema ○ Retinal oedema ( commotion retinae)
○ Tear of iris sphincter ○ Retinal dialysis
○ Iridodialysis ○ Macular hole or oedema
○ Angle recession • Optic nerve
○ ON avulsion
○ Hemorrhage of ON sheath

Write short essay on chemical injury? (5) Marks

• Range from trivial to potentially blinding.
• Occur due to accidental or assault.
• Severity of chemical injury is related to
○ Properties of chemical
○ Area of affected ocular surface
○ Duration of exposure
○ Related effects like thermal injury etc.
• Pathophysiology:
○ Damage by severe chemical injury occur in following order
○ Necrosis of conjunctiva and corneal epithelium with disruption and occlusion of the limbal vasculature.
○ Loss of limbal stem cells result in conjunctivalization of corneal surface and persisting epithelial defects.
○ Corneal ulceration and perforation.
○ Ocular surface wetting disorders, symblephron formation and cicatricial entropion.
○ Corneal stromal opacities
○ AC penetration-iritis and lens damage.
○ Ciliary epithelial damage- impaired secretion of ascorbats required for corneal repair.
○ Hypotony and phthisis bulbi.
• Management:
○ Copious irrigation.
○ Normal saline or Ringer lactate for 15-30 min or neutral.
○ Double aversion of upper eye lid for removal of retained particulate matter
○ Debridement of necrotic areas
○ Admission for severe injuries

Write a short note on:

a. Siderosis Bulbi
○ An intraocular ferrous foreign body undergoes dissociation resulting in deposition of iron in the intraocular
epithelial structures. This condition is known as siderosis bulbi
○ Commonly involves lens epithelium, iris, ciliary body epithelium and sensory retina
○ Deposited iron exerts a toxic effect on cellular enzyme system resulting in cell death
○ Signs:
Anterior capsular cataract
Reddish brown staining of iris - heterochromia iridis
○ Complications:
Secondary glaucoma
Pigmentary retinopathy

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 Pigmentary retinopathy
b. Chalcosis
○ Chalcosis occurs when an intraocular copper-containing foreign body deposits copper in Descemet’s membrane,
the anterior lens capsule, or other intraocular basement membranes
○ Signs:
Kayser Fleischer ring
Anterior sun-flower cataract
Retinal deposition resulting in golden plaques

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LIDS AND ADNEXA

A 70 years old patient presents to the eye OPD with redness and foreign body sensation in the right eye. On examination of the
right eye the inferior bulbar conjuctiva is hyperemic and the right lower eyelid margin is turned inwards.
a. What is the diagnosis?
○ Entropion
b. What are the various types of this disease?
There are 4 types of entropion
1. Involutional/senile entropion
2. Cicatricial entropion
3. Spastic entropion
4. Congenital entropion

c. What are the treatment options?

1. For involutional entropion
Horizontal lid laxity
Vertical lid instability
Over-riding
2. For cicatricial entropion
Medical
□ Bandage contact lenses
Surgical
□ Transverse tarsotomy with anterior rotation of lid margin
□ Grafting
3. For spastic entropion
Surgery performed to create ridge of fibrous tissue in front of orbicularis to prevent over-riding of
orbicularis
4. For congenital entropion
Hotz procedure

Classify Ptosis. Name different surgical procedures to correct Ptosis? (5) Marks
Classification: Surgical procedures:
• Neurogenic
○ Third nerve palsy
○ Horner syndrome 1. CONJUNCTIVAL MULLER RESECTION
○ Marcus Gunn jaw – winking syndrome 2. LEVATOR RESECTION
○ Third nerve misdirection 3. FRONTALIS SUSPENSION
• Myogenic 4. APONEUROTIC STRENGTHENING
○ Myasthenia gravis 5. Fasanella-Servat for mild to moderate ptosis
○ Myotonic dystrophy
○ Ocular myopathy
○ Simple congenital
○ Blepharophimosis
• Aponeurotic
○ Involutional / senile
○ Postoperative
• Mechanical
○ Dermatochalasis
○ Tumors
○ Edema
○ Anterior orbital lesions
○ Scarring

Note on
a. Trichiasis? b. Chalazion
• Posterior misdirection of lashes • Chronic inflammatory granuloma of mebomian gland
• COMPLICATIONS • Single or multiple
○ Corneal epithelium trauma • Also known as tarsal or mebomian cyst
○ Corneal ulceration • Blockage of gland orifices and stagnation of secretions
○ Pannus formation (vascularization of • Patients with mebomian gland disease or Rosacea at
cornea) increased risk
• CAUSES • HISTOLOGY
○ Entropion -- any cause ○ Lipogranulamotous inflammatory sterile
○ Scarring of conjunctiva--chemical burns, reaction containing epitheloid and
Stevens-Johnson syndrome multinucleated giant cells
• Symptoms: • SYMPTOMS
○ Irritation ○ Gradually enlarging nodule
○ Lacrimation ○ Diplopia

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 ○ Lacrimation ○ Diplopia
○ FB sensation ○ Blurred vision
○ Photophobia and redness. • SIGNS
• Sign ○ Presentation - any age
○ Reflex blephrospasm ○ May cause astigmatism
○ Later superficial punctate erosions ○ Non-tender, roundish, nodule within tarsal plate
○ Corneal opacities ○ Eversion of lid may show an associated
○ Vascularization of cornea conjunctival granuloma
• Treatment: ○ May be secondarily infected (Hordeolum
○ Epilation Internum)
○ Electrolysis • TREATMENT
○ Cryosurgery ○ Observe for 8-10 weeks as 1/3 of chalazia
○ Entropion correction resolve spontaneously
○ Argon laser ablation ○ Lid hygiene and warm fomentation
○ Surgery ○ Surgery
Incision & Curettage – vertical incision
○ Steroid injection
0.1-0.2 ml Triamcinalone (Kanacort)
○ Systemic tetracycline
As prophylaxis in recurrent chalazia

A mother brought her child to OPD with complaints of crusts on eye lid margins and matted eye lashes. Bleeding from lid
margins occurs when crusts are removed.
Anterior blepharitis
Treatment?
• LID HYGIENE
○ Warm compresses
○ Remove crusts
○ General cleanliness
○ Daily cleaning with baby shampoo
• ANTIBIOTICS
○ Topical
○ Oral
• WEAK TOPICAL STERIOD
• TEAR SUBSTITUTES

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