Free NEET PG & INI-CET Ophthalmology MCQs

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Trachoma is caused by Chlamydia trachomatis serotypes A to C, leading to conjunctival scarring, entropion, trichiasis, and eventually corneal blindness. The WHO SAFE strategy — Surgery, Antibiotics, Facial cleanliness, Environmental improvement — targets it.

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A branching dendritic ulcer staining with fluorescein is characteristic of herpes simplex keratitis. Topical steroids are contraindicated as they worsen the infection; treatment is with topical or oral antivirals such as aciclovir.

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Gonococcal ophthalmia neonatorum presents within the first 1 to 2 days with hyperacute copious purulent discharge and can rapidly perforate the cornea. It is a medical emergency needing systemic antibiotics. Chlamydial conjunctivitis presents later, at 5 to 14 days.

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Keratoconus is progressive corneal thinning and conical protrusion causing irregular astigmatism and reduced vision. It shows Munson's sign and is associated with atopy and eye rubbing; treatment ranges from rigid contact lenses to corneal cross-linking or grafting.

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A pterygium is a wing-shaped fibrovascular conjunctival growth, most commonly encroaching from the nasal side onto the cornea. It is linked to ultraviolet and sunlight exposure; surgery is indicated if it threatens the visual axis or causes symptoms.

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Vitamin A deficiency causes xerophthalmia (dry eye), Bitot spots (foamy conjunctival patches), night blindness, and, if untreated, keratomalacia and blindness. It is a leading cause of preventable childhood blindness worldwide.

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Allergic conjunctivitis presents with bilateral itching, watering, stringy mucoid discharge, and a papillary reaction, often seasonal. Itching is the hallmark. Treatment includes antihistamine and mast-cell stabiliser drops.

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The Schirmer test measures aqueous tear production using a strip of filter paper in the lower fornix. Reduced wetting indicates dry eye. It is used, for example, in evaluating Sjogren syndrome.

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Immediate, copious irrigation with water or saline is the priority in chemical eye injury, before anything else, to dilute and remove the chemical. Alkali burns penetrate deeper and are more dangerous than acid burns. Irrigation should not be delayed for assessment.

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Age-related (senile) cataract is the most common cause of cataract and the leading cause of reversible blindness worldwide. It causes gradual, painless loss of vision and glare, and is treated by surgical lens extraction with intraocular lens implantation.

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Phacoemulsification uses ultrasound to emulsify and aspirate the lens through a small incision, followed by foldable intraocular lens implantation. It is the standard modern technique, offering faster recovery than older methods.

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Congenital rubella causes cataracts, often with a 'pearly' nuclear appearance, along with deafness and cardiac defects. Congenital cataract needs early surgery to prevent stimulus-deprivation amblyopia. Galactosaemia is another metabolic cause.

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Leukocoria, a white pupillary reflex, in a child is a red flag for retinoblastoma, the most common intraocular malignancy of childhood, and must be urgently investigated. Congenital cataract and Coats disease are other causes.

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In Marfan syndrome the lens typically dislocates upward, or superotemporally. In homocystinuria, by contrast, it dislocates downward. Recognising the direction helps distinguish these two connective-tissue disorders.

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Aphakia is the absence of the crystalline lens, for example after cataract extraction without an intraocular lens. It produces high hypermetropia. Pseudophakia refers to an eye with an implanted artificial lens.

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Cataract is the leading cause of reversible blindness globally, and cataract surgery is one of the most cost-effective interventions in medicine. Much of the world's blindness is avoidable, cataract and refractive error being major contributors.

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Acute angle-closure glaucoma presents with a sudden painful red eye, a fixed mid-dilated pupil, haloes around lights, a hazy cornea, and often nausea and vomiting. It is an emergency requiring urgent intraocular pressure reduction to save vision.

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Primary open-angle glaucoma is typically painless and gradual, first affecting the peripheral visual field with central vision preserved until late, so it may go unnoticed. It causes optic disc cupping and is a leading cause of irreversible blindness.

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Glaucoma causes progressive loss of optic nerve fibres, seen as an increased cup-to-disc ratio (disc cupping) and notching of the neuroretinal rim. Monitoring this, along with intraocular pressure and visual fields, guides management.

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Prostaglandin analogues such as latanoprost increase uveoscleral outflow of aqueous humour, effectively lowering intraocular pressure with once-daily dosing, and are commonly first-line. Beta-blockers such as timolol reduce aqueous production instead.

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Tonometry, such as Goldmann applanation, measures intraocular pressure, with the normal range about 10 to 21 mmHg. Gonioscopy assesses the drainage angle, and perimetry measures the visual field.

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Mydriatic and anticholinergic drugs, including atropine and drugs with anticholinergic effects, dilate the pupil and can precipitate acute angle closure in an eye with a narrow angle. Pilocarpine, a miotic, is used to treat angle closure by constricting the pupil.

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Central retinal artery occlusion causes sudden, painless, severe monocular vision loss with a pale retina and a cherry-red spot at the fovea, where the underlying choroid shows through. It is an ocular emergency, effectively a 'stroke of the eye'.

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Central retinal vein occlusion produces the classic 'blood and thunder' fundus — widespread flame haemorrhages in all quadrants, dilated tortuous veins, and disc swelling. Risk factors include hypertension, diabetes, and glaucoma.

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Retinal detachment classically presents with photopsia (flashes), a sudden increase in floaters, and a curtain or shadow progressing across the visual field. It is an emergency; rhegmatogenous detachment, from a retinal tear, needs prompt surgery.

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Neovascularisation, the growth of abnormal new vessels, defines proliferative diabetic retinopathy and risks vitreous haemorrhage and tractional retinal detachment. It is treated with pan-retinal laser photocoagulation and anti-VEGF therapy.

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Advanced hypertensive retinopathy shows papilloedema, flame haemorrhages, cotton-wool spots, hard exudates in a macular star, and arteriovenous nipping. It signals a hypertensive emergency requiring urgent blood pressure control.

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Age-related macular degeneration is a leading cause of central vision loss in the elderly, affecting the macula. The 'dry' form shows drusen; the 'wet' or neovascular form causes rapid loss and is treated with anti-VEGF injections.

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Retinopathy of prematurity is driven by prematurity, low birth weight, and unregulated supplemental oxygen, which causes abnormal retinal neovascularisation. Screening of at-risk preterm infants allows timely laser or anti-VEGF treatment.

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Anterior uveitis (iritis) causes a painful red eye with photophobia, blurred vision, a small or irregular pupil from synechiae, and cells and flare in the anterior chamber. It is associated with HLA-B27 conditions; treatment includes topical steroids and cycloplegics.

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Anterior uveitis is strongly associated with HLA-B27-related seronegative spondyloarthropathies such as ankylosing spondylitis, reactive arthritis, and inflammatory bowel disease, as well as sarcoidosis and Behcet disease.

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Retinoblastoma is the most common primary intraocular malignancy of childhood, arising from the retina via the RB1 gene. It presents with leukocoria and strabismus, and early diagnosis is vital for saving both sight and life.

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Sympathetic ophthalmia is a bilateral granulomatous uveitis occurring after penetrating injury or surgery to one eye, in which the uninjured 'sympathising' eye is also affected. Early enucleation of a blind injured eye and immunosuppression reduce the risk.

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In myopia the eye is too long, or too powerful, so light focuses in front of the retina, blurring distance vision. It is corrected with a concave (minus) lens. Hypermetropia is the opposite, corrected with a convex (plus) lens.

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In hypermetropia light focuses behind the retina, so a convex (converging, plus) lens is used to bring the focus onto the retina. Myopia, in contrast, is corrected with a concave (minus) lens.

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Astigmatism arises from unequal corneal, or lens, curvature in different meridians, and is corrected with a cylindrical lens that compensates for the differing refractive power. It commonly coexists with myopia or hypermetropia.

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Presbyopia is the age-related decline in the lens's ability to accommodate, typically from the 40s, causing difficulty with near vision. It is corrected with convex reading glasses or bifocals.

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Amblyopia is reduced vision in an eye that did not develop normal sight in childhood, from strabismus, refractive error, or deprivation. Treatment — correcting the cause and patching the good eye — is most effective in early childhood, before the visual system matures.

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The cover-uncover test detects manifest and latent squints by observing eye movement when each eye is covered and uncovered. The corneal light reflex (Hirschberg) test also helps assess ocular alignment.

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Optic neuritis causes subacute monocular vision loss with pain on eye movement, reduced colour (red) vision, and a relative afferent pupillary defect. It is strongly associated with multiple sclerosis, so an MRI is warranted.

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Papilloedema is bilateral optic disc swelling due to raised intracranial pressure, transmitted along the optic nerve sheath. It warrants urgent evaluation for a mass, hydrocephalus, or idiopathic intracranial hypertension.

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A third (oculomotor) nerve palsy causes ptosis and a 'down and out' eye. Pupil involvement — a fixed dilated pupil — suggests a compressive lesion such as a posterior communicating artery aneurysm, a warning sign needing urgent imaging.

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A bitemporal hemianopia results from compression of the optic chiasm, classically by a pituitary adenoma, affecting the crossing nasal retinal fibres. Lesions behind the chiasm cause homonymous field defects instead.

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Ishihara pseudoisochromatic plates screen for red-green colour deficiency. The Snellen chart tests visual acuity, and the Amsler grid detects macular distortion (metamorphopsia) in conditions such as macular degeneration.

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A hordeolum externum (stye) is an acute staphylococcal infection of an eyelash follicle and its associated glands, causing a painful lid-margin swelling. Warm compresses usually suffice; a chalazion, by contrast, is a painless chronic meibomian cyst.

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A chalazion is a painless, firm granulomatous swelling from a blocked meibomian gland. It is typically chronic and may need incision and curettage if it does not resolve, unlike the acute painful stye.

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Entropion is inward turning of the lid margin, so the lashes abrade the cornea (trichiasis), risking ulceration. Ectropion is outward turning of the lid, causing exposure and watering. Both are more common with age.

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Dacryocystitis is infection of the lacrimal (tear) sac, presenting with a painful swelling below the medial canthus and epiphora, or watering, often from nasolacrimal duct obstruction. Treatment is antibiotics, with dacryocystorhinostomy for recurrent cases.

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Orbital cellulitis involves structures behind the orbital septum, causing proptosis, painful and restricted eye movements, and reduced vision — features absent in preseptal cellulitis. It is an emergency requiring IV antibiotics and imaging, as it can spread intracranially.

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Thyroid eye disease (Graves ophthalmopathy) causes bilateral proptosis, lid retraction, lid lag, and restricted movements from enlargement of the extraocular muscles. It is the most common cause of both unilateral and bilateral proptosis in adults.