100 Free Ophthalmology MCQs With Explanations
This is a 100-question diagnostic drawn directly from the free MCQs currently available on OphthaMCQ. It covers anatomy, optics, cornea, lens, glaucoma and uveitis. It is revision material for postgraduate ophthalmology examinations—not patient-specific clinical advice.
The useful unit here is not a raw score. Do the questions in blocks of 20, choose an option before opening the answer, then write down the discriminator: the finding, mechanism, formula, anatomy relation or wording that separated the right answer from the most tempting wrong one. A guessed-right answer belongs in the same error log as a wrong answer.
How to use this set without turning it into passive reading
- Work without notes and record only the question numbers you missed or guessed.
- Reveal the answer and explanation after committing to an option.
- Label the error: recall, mechanism, confused pair, calculation, or careless read.
- Re-answer those concepts in a mixed set after two to three days; do not merely re-read the explanation.
- Use the free MCQ hub for further category practice. For a general mixed session, use general ophthalmology questions; use high-yield questions when you want a more selective revision block.
The wording, option sets, keyed answers and explanations below are reproduced from the on-site free-question-bank dataset as checked on 18 August 2026. If the interactive bank changes, use the live free MCQ hub as the current version.
Anatomy & Embryology: questions 1–15
1. Which extraocular muscle is innervated by the trochlear nerve (CN IV)?
A. Superior rectus B. Superior oblique C. Inferior oblique D. Lateral rectus E. Medial rectus
Answer and explanation
Answer: B. Superior oblique
The trochlear nerve solely innervates the superior oblique muscle. CN VI supplies lateral rectus; CN III supplies the rest.
2. The arterial supply to the optic nerve head is primarily from:
A. Central retinal artery B. Short posterior ciliary arteries C. Long posterior ciliary arteries D. Lacrimal artery E. Ophthalmic artery directly
Answer and explanation
Answer: B. Short posterior ciliary arteries
The short posterior ciliary arteries (via the circle of Zinn-Haller) supply the optic nerve head. The central retinal artery supplies inner retina only.
3. Which structure is derived from neural crest?
A. Lens B. Retina C. Corneal stroma D. Vitreous primary E. RPE
Answer and explanation
Answer: C. Corneal stroma
Corneal stroma, endothelium, sclera, choroidal stroma, and trabecular meshwork are neural crest derived. Lens and retina are surface ectoderm and neuroectoderm respectively.
4. The fovea centralis is approximately how many disc diameters temporal to the optic disc?
A. 1 DD B. 1.5 DD C. 2 DD D. 2.5 DD E. 4 DD
Answer and explanation
Answer: D. 2.5 DD
The fovea is ~2.5 disc diameters (4 mm) temporal and 0.8 mm inferior to the center of the optic disc.
5. Bruch’s membrane lies between:
A. NFL and ganglion cell layer B. RPE and choriocapillaris C. Photoreceptors and RPE D. Sclera and choroid E. ILM and NFL
Answer and explanation
Answer: B. RPE and choriocapillaris
Bruch’s membrane is the basement complex separating the RPE from the choriocapillaris. It thickens with age and is involved in AMD.
6. The blood supply of the iris is from:
A. Central retinal artery B. Major arterial circle (long posterior ciliary) C. Short posterior ciliary arteries D. Vortex veins E. Lacrimal artery
Answer and explanation
Answer: B. Major arterial circle (long posterior ciliary)
The iris is supplied by the major arterial circle formed by the two long posterior ciliary arteries and anterior ciliary arteries.
7. The lacrimal sac drains into the nasal cavity via the:
A. Superior meatus B. Middle meatus C. Inferior meatus D. Sphenoethmoidal recess E. Vestibule
Answer and explanation
Answer: C. Inferior meatus
The nasolacrimal duct opens into the inferior meatus beneath the inferior turbinate (valve of Hasner).
8. Which extraocular muscle does NOT originate from the annulus of Zinn?
A. Superior rectus B. Inferior rectus C. Inferior oblique D. Medial rectus E. Lateral rectus
Answer and explanation
Answer: C. Inferior oblique
The inferior oblique originates from the orbital plate of the maxilla near the lacrimal fossa, not from the annulus of Zinn.
9. The thinnest part of the sclera is at:
A. Limbus B. Equator C. Posterior pole D. Insertions of rectus muscles E. Lamina cribrosa
Answer and explanation
Answer: D. Insertions of rectus muscles
The sclera is thinnest (~0.3 mm) just posterior to the recti insertions, a high-risk zone for staphyloma and perforation.
10. Müller cells are:
A. Photoreceptors B. Bipolar interneurons C. Glial cells spanning all retinal layers D. Pigmented cells of the RPE E. Cells of the ciliary epithelium
Answer and explanation
Answer: C. Glial cells spanning all retinal layers
Müller cells are the principal glial cells of the retina, spanning from the ILM to the external limiting membrane.
11. The pupillary light reflex pathway synapses in the:
A. Lateral geniculate nucleus B. Pretectal nucleus and Edinger-Westphal nucleus C. Superior colliculus D. Cuneiform nucleus E. Red nucleus
Answer and explanation
Answer: B. Pretectal nucleus and Edinger-Westphal nucleus
Afferents from the optic tract bypass the LGN and synapse in the pretectal nucleus, which projects bilaterally to the Edinger-Westphal nucleus.
12. The cone-to-RPE cell ratio at the fovea is approximately:
A. 1:1 B. 5:1 C. 20:1 D. 100:1 E. 1:5
Answer and explanation
Answer: A. 1:1
At the fovea each cone has its own RPE cell (1:1 relationship), supporting high acuity.
13. Which structure crosses ABOVE the superior oblique tendon?
A. Superior rectus B. Inferior oblique C. Lateral rectus D. Medial rectus E. Levator palpebrae
Answer and explanation
Answer: A. Superior rectus
The superior oblique tendon passes BELOW the superior rectus to insert on the globe.
14. The hyaloid artery normally regresses by:
A. Birth B. Week 20 of gestation C. 6 months postnatal D. 1 year postnatal E. 2 years postnatal
Answer and explanation
Answer: A. Birth
The hyaloid artery regresses completely by birth. Persistence causes Mittendorf dot, Bergmeister papilla, or PFV.
15. The macula lutea owes its yellow color to:
A. Melanin B. Lipofuscin C. Xanthophyll (lutein/zeaxanthin) D. Hemosiderin E. Beta-carotene
Answer and explanation
Answer: C. Xanthophyll (lutein/zeaxanthin)
Xanthophyll pigments (lutein and zeaxanthin) accumulate in the macula and filter blue light, protecting against oxidative damage.
Optics & Refraction: questions 16–35
16. The total refractive power of the eye is approximately:
A. +20 D B. +43 D C. +60 D D. +100 D E. +15 D
Answer and explanation
Answer: C. +60 D
The total power of the schematic eye is ~+60 D, with the cornea contributing ~+43 D and the lens ~+17–20 D.
17. A patient with a refractive error of +3.00 DS has:
A. Myopia B. Hyperopia C. Mixed astigmatism D. Emmetropia E. Aphakia
Answer and explanation
Answer: B. Hyperopia
A positive sphere indicates hyperopia. Parallel light is focused behind the retina; convex lenses correct it.
18. In with-the-rule astigmatism, the steepest meridian is:
A. Horizontal (180°) B. Vertical (90°) C. Oblique (45°) D. Oblique (135°) E. No fixed orientation
Answer and explanation
Answer: B. Vertical (90°)
With-the-rule astigmatism has the steep meridian vertical (close to 90°). It is the commonest form in young patients.
19. The far point of an emmetropic eye is at:
A. 25 cm B. 6 metres C. Infinity D. 1 metre E. Anterior focal point of the cornea
Answer and explanation
Answer: C. Infinity
In emmetropia parallel rays (from infinity) focus on the retina with accommodation relaxed; thus far point = infinity.
20. Spherical equivalent of +2.00 / -1.00 × 90° is:
A. +1.00 D B. +1.50 D C. +2.50 D D. +2.00 D E. +3.00 D
Answer and explanation
Answer: B. +1.50 D
Spherical equivalent = sphere + (cylinder/2) = +2.00 + (-1.00/2) = +1.50 D.
21. Best test for evaluating distortion in epiretinal membrane is:
A. Snellen acuity B. Amsler grid C. Ishihara plates D. Pelli-Robson chart E. Goldmann perimetry
Answer and explanation
Answer: B. Amsler grid
The Amsler grid is sensitive for metamorphopsia and central scotomas associated with macular pathology including ERM.
22. A myope reads comfortably without glasses at 25 cm. What is the approximate refractive error?
A. -1.00 D B. -2.00 D C. -4.00 D D. -6.00 D E. -8.00 D
Answer and explanation
Answer: C. -4.00 D
A myope whose far point is at 25 cm has a refractive error of 1/0.25 = -4.00 D.
23. IOL power calculation in eyes with prior LASIK is most accurately performed using:
A. SRK II B. Hoffer Q C. Haigis-L or Barrett True-K D. Holladay 1 E. Regression formula
Answer and explanation
Answer: C. Haigis-L or Barrett True-K
Post-refractive surgery eyes require dedicated formulas such as Haigis-L or Barrett True-K (or the ASCRS post-refractive calculator).
24. A “Jackson cross cylinder” is used to refine:
A. Sphere only B. Cylinder power and axis C. Add for presbyopia D. Prism prescription E. Pupil size
Answer and explanation
Answer: B. Cylinder power and axis
The JCC refines both the power and axis of the cylindrical correction during subjective refraction.
25. The accommodative amplitude in a 40-year-old is approximately (Hofstetter’s average):
A. 10 D B. 6 D C. 4.5 D D. 2 D E. 1 D
Answer and explanation
Answer: C. 4.5 D
Hofstetter’s average: 18.5 − 0.3 × age = 18.5 − 12 = 6.5 D; minimum amplitude = 15 − 0.25 × age ≈ 5 D at 40. ~4.5 D is the expected minimum/average range for this option set.
26. Image formed on the retina in a normal eye is:
A. Real, erect, diminished B. Real, inverted, diminished C. Virtual, erect, magnified D. Real, inverted, magnified E. Virtual, inverted, diminished
Answer and explanation
Answer: B. Real, inverted, diminished
A convex lens system (eye) forms a real, inverted, and diminished image of distant objects on the retina.
27. In keratoconus, the earliest refractive change is typically:
A. Hyperopic shift B. Increasing oblique/irregular astigmatism C. Decreasing astigmatism D. Anisocoria E. Loss of color vision
Answer and explanation
Answer: B. Increasing oblique/irregular astigmatism
Progressive irregular astigmatism (often oblique) with steepening on topography is the earliest sign of keratoconus.
28. The vergence of light from an object at 50 cm is:
A. +2 D B. -2 D C. +0.5 D D. -0.5 D E. +1 D
Answer and explanation
Answer: B. -2 D
Vergence = 1/distance in metres with appropriate sign. A real object at 50 cm gives -2.00 D (diverging) at the lens.
29. A patient sees better through a pinhole. The most likely cause is:
A. Cortical cataract B. Refractive error or media irregularity C. Optic neuritis D. Macular hole E. Amblyopia
Answer and explanation
Answer: B. Refractive error or media irregularity
Pinhole improves acuity by reducing the effect of refractive error and irregular media; little improvement in macular/neural causes.
30. The Knapp’s rule states that for axial ametropia, the image size is unchanged if:
A. Glasses worn at corneal plane B. Glasses worn at the anterior focal point of the eye C. Contact lens is used D. IOL is implanted E. Aphakic spectacles are used
Answer and explanation
Answer: B. Glasses worn at the anterior focal point of the eye
Knapp’s rule: in axial ametropia, correcting with a lens placed at the anterior focal point of the eye (~15.7 mm in front of the cornea) produces no change in retinal image size.
31. The principal action of cycloplegic agents in refraction is:
A. Pupil dilation only B. Paralysis of accommodation C. Lowering IOP D. Improving fundus view E. Producing miosis
Answer and explanation
Answer: B. Paralysis of accommodation
Cycloplegics paralyse the ciliary muscle, suspending accommodation so latent hyperopia can be measured accurately.
32. A +10 D lens has a focal length of:
A. 1 cm B. 10 cm C. 100 cm D. 0.1 cm E. 20 cm
Answer and explanation
Answer: B. 10 cm
Focal length (m) = 1/power (D); 1/10 = 0.1 m = 10 cm.
33. Anisometropia of how many dioptres typically risks amblyopia in children?
A. ≥0.25 D B. ≥1.5 D C. ≥4 D D. ≥6 D E. ≥10 D
Answer and explanation
Answer: B. ≥1.5 D
Anisometropia of ~1.5 D (or 1 D hyperopic, 3 D myopic, 1.5 D astigmatic) is generally regarded as amblyogenic.
34. In presbyopia the principal physiologic change is decreased:
A. Axial length B. Lens elasticity C. Ciliary muscle strength D. Pupil diameter E. Vitreous viscosity
Answer and explanation
Answer: B. Lens elasticity
Presbyopia is mainly due to lens stiffening (loss of elasticity) leading to a progressive decline in accommodative amplitude.
35. A duochrome (red-green) test uses the principle of:
A. Color blindness B. Chromatic aberration of the eye C. Polarisation D. Stereoscopy E. Phase difference
Answer and explanation
Answer: B. Chromatic aberration of the eye
The duochrome test exploits longitudinal chromatic aberration: red focuses behind, green in front of the retina. Equal clarity = correct sphere.
Cornea & External Disease: questions 36–55
36. A dendritic ulcer staining with fluorescein in a young adult is most likely caused by:
A. Bacterial keratitis B. Herpes simplex epithelial keratitis C. Herpes zoster ophthalmicus D. Acanthamoeba E. Pseudomonas
Answer and explanation
Answer: B. Herpes simplex epithelial keratitis
A true branching dendrite with terminal bulbs and ulcerated centre is pathognomonic of HSV epithelial keratitis. HZO produces pseudodendrites without true ulceration.
37. The earliest topographic sign of keratoconus is:
A. Diffuse flattening B. Inferior steepening with skewed radial axes (SRAX) C. Central island D. Pellucid pattern E. Symmetric bowtie
Answer and explanation
Answer: B. Inferior steepening with skewed radial axes (SRAX)
Asymmetric inferior steepening with skewed radial axes (loss of bowtie symmetry) is the earliest topographic sign.
38. Munson’s sign is associated with:
A. Keratoconjunctivitis sicca B. Keratoconus C. Pterygium D. Acanthamoeba keratitis E. Trachoma
Answer and explanation
Answer: B. Keratoconus
Munson’s sign is V-shaped indentation of the lower eyelid on downgaze due to corneal protrusion in advanced keratoconus.
39. Endothelial cell density below which decompensation risk significantly rises:
A. 2500/mm² B. 2000/mm² C. 1500/mm² D. 500/mm² E. 3000/mm²
Answer and explanation
Answer: D. 500/mm²
Below ~500 cells/mm² the endothelial pump fails and corneal oedema is likely. Cataract surgery is risky <1000.
40. The most common cause of bacterial keratitis in contact lens wearers is:
A. Staph aureus B. Strep pneumoniae C. Pseudomonas aeruginosa D. Moraxella E. Acanthamoeba
Answer and explanation
Answer: C. Pseudomonas aeruginosa
Pseudomonas aeruginosa is the commonest organism in contact-lens related bacterial keratitis due to its biofilm formation.
41. Acanthamoeba keratitis classically presents with:
A. Painless ulcer with hypopyon B. Severe pain out of proportion to signs, ring infiltrate, radial keratoneuritis C. Dendritic ulcer D. Hypopyon and posterior synechiae E. Mucopurulent discharge only
Answer and explanation
Answer: B. Severe pain out of proportion to signs, ring infiltrate, radial keratoneuritis
Acanthamoeba causes severe pain disproportionate to slit-lamp findings, with a characteristic ring infiltrate and radial perineural infiltrates.
42. A child with bilateral mucopurulent conjunctivitis and follicles on the lower tarsus may have:
A. Allergic conjunctivitis B. Chlamydial trachoma C. Viral conjunctivitis D. Vernal keratoconjunctivitis E. Floppy eyelid syndrome
Answer and explanation
Answer: B. Chlamydial trachoma
Trachoma (Chlamydia trachomatis serovars A-C) classically begins with mucopurulent discharge and follicles on the superior tarsus in endemic regions.
43. The most specific corneal dystrophy associated with TGFBI gene mutation is:
A. Fuchs endothelial B. Lattice (LCD1) C. Posterior polymorphous D. Meesmann E. Schnyder
Answer and explanation
Answer: B. Lattice (LCD1)
TGFBI mutations cause Lattice (type 1), Granular, Avellino, and Reis-Bückler dystrophies. Lattice type 2 (Meretoja) involves the gelsolin gene.
44. Kayser-Fleischer ring is found in:
A. Hemochromatosis B. Wilson’s disease C. Lowe syndrome D. Cystinosis E. Marfan syndrome
Answer and explanation
Answer: B. Wilson’s disease
Kayser-Fleischer ring is a copper deposition in Descemet’s membrane (Wilson’s disease) and is best seen on gonioscopy.
45. Most appropriate first-line treatment for herpes simplex epithelial dendritic keratitis is:
A. Topical corticosteroid B. Topical ganciclovir 0.15% gel or trifluridine C. Oral cephalexin D. Topical NSAID E. Bandage contact lens alone
Answer and explanation
Answer: B. Topical ganciclovir 0.15% gel or trifluridine
Topical antiviral (ganciclovir 0.15% gel, trifluridine 1%) ± oral acyclovir/valacyclovir is first line. Steroids worsen epithelial disease.
46. Vernal keratoconjunctivitis is best characterised by:
A. Bulbar follicles B. Giant papillae on upper tarsus + Horner-Trantas dots C. Marginal infiltrates D. Mucopurulent discharge E. Pre-auricular lymphadenopathy
Answer and explanation
Answer: B. Giant papillae on upper tarsus + Horner-Trantas dots
VKC presents in young atopic patients with cobblestone papillae on the upper tarsus and limbal Horner-Trantas dots.
47. Hudson-Stähli line is:
A. Iron deposition in corneal epithelium at the lower one-third B. Hemosiderin in stroma C. Calcium in Bowman layer D. Copper in Descemet E. Cholesterol in stroma
Answer and explanation
Answer: A. Iron deposition in corneal epithelium at the lower one-third
A horizontal brown line of iron deposition in the inferior corneal epithelium, increasing with age. Other iron lines: Fleischer (keratoconus), Stocker (pterygium), Ferry (filtering bleb).
48. Recommended preferred treatment for moderate-severe Fuchs endothelial dystrophy with cataract:
A. Phacoemulsification only B. PKP alone C. Combined phaco + DMEK / DSAEK D. Conservative management with hypertonic saline E. Laser photocoagulation
Answer and explanation
Answer: C. Combined phaco + DMEK / DSAEK
When stromal oedema is present, combined phaco with DMEK (preferred) or DSAEK gives best functional results.
49. Schirmer’s test with anaesthesia measuring <5 mm in 5 minutes indicates:
A. Normal tear secretion B. Mild dry eye C. Severe aqueous deficient dry eye D. Mucin deficiency E. Reflex tearing
Answer and explanation
Answer: C. Severe aqueous deficient dry eye
Schirmer I with anaesthesia <5 mm/5 min indicates severe aqueous-deficient dry eye (basal secretion measurement).
50. Most common cause of fungal keratitis in tropical/agricultural settings is:
A. Candida albicans B. Fusarium spp. C. Aspergillus D. Cryptococcus E. Rhizopus
Answer and explanation
Answer: B. Fusarium spp.
Fusarium is the commonest filamentous fungus in tropical regions (often after vegetative trauma); Aspergillus is next. Candida predominates in compromised hosts.
51. The corneal layer most resistant to bending forces and contributing most to mechanical strength is:
A. Epithelium B. Bowman layer C. Stroma D. Descemet membrane E. Endothelium
Answer and explanation
Answer: C. Stroma
The stroma accounts for ~90 % of corneal thickness and provides most of the cornea’s tensile strength via collagen lamellae.
52. Cogan microcystic epithelial dystrophy (EBMD) is characterised by:
A. Maps, dots, fingerprints in epithelium B. Endothelial guttata C. Stromal lattice lines D. Subepithelial calcification E. Iron deposition
Answer and explanation
Answer: A. Maps, dots, fingerprints in epithelium
EBMD shows map-dot-fingerprint changes from abnormal epithelial basement membrane, commonly causing recurrent erosions.
53. Pseudomembranes are typical of which conjunctivitis:
A. Allergic B. Viral (adenoviral) and severe bacterial (e.g. diphtheria) C. Toxic D. Chemical splash E. Chronic blepharitis
Answer and explanation
Answer: B. Viral (adenoviral) and severe bacterial (e.g. diphtheria)
Pseudomembranes and true membranes occur in severe adenoviral conjunctivitis, gonococcal, diphtheric, and Stevens-Johnson conjunctivitis.
54. In suspected ocular surface chemical injury, the first intervention is:
A. Apply antibiotic ointment B. Immediate copious irrigation C. Refer to ophthalmology D. Pressure patch E. Topical steroid
Answer and explanation
Answer: B. Immediate copious irrigation
Immediate prolonged irrigation with saline/Ringer’s lactate (or water) for at least 15-30 minutes is the single most important step; check pH after.
55. Pterygium classically grows:
A. Superiorly from the cornea B. From temporal limbus C. From nasal limbus toward visual axis D. Around the entire limbus E. Only on the inferior conjunctiva
Answer and explanation
Answer: C. From nasal limbus toward visual axis
Pterygium is a triangular fibrovascular growth typically arising from the nasal interpalpebral conjunctiva and encroaching onto the cornea.
Lens & Cataract: questions 56–70
56. Posterior subcapsular cataract is MOST classically associated with:
A. Diabetes only B. Chronic corticosteroid use C. Galactosemia D. Hypocalcemia E. Hyperthyroidism
Answer and explanation
Answer: B. Chronic corticosteroid use
PSC is the hallmark of chronic systemic or topical steroid therapy; it also occurs with radiation, uveitis, and high myopia.
57. “Christmas tree” cataract is characteristic of:
A. Diabetes B. Myotonic dystrophy C. Atopic dermatitis D. Wilson disease E. Galactosemia
Answer and explanation
Answer: B. Myotonic dystrophy
Polychromatic iridescent crystals in the cortex (“Christmas tree” cataract) are characteristic of myotonic dystrophy.
58. In sunflower cataract, the deposited substance is:
A. Copper B. Iron C. Silver D. Calcium E. Mercury
Answer and explanation
Answer: A. Copper
Sunflower cataract is copper deposition under the anterior lens capsule in Wilson’s disease or chalcosis.
59. Phacoanaphylactic uveitis is caused by:
A. Type I hypersensitivity to lens proteins B. Granulomatous reaction to retained lens material C. Bacterial endophthalmitis D. Sympathetic ophthalmia E. Allergy to viscoelastic
Answer and explanation
Answer: B. Granulomatous reaction to retained lens material
Phacoanaphylactic (lens-induced granulomatous) uveitis is a zonal granulomatous reaction to lens proteins after capsule disruption.
60. Most common indication for YAG capsulotomy:
A. Vitreous opacities B. Posterior capsular opacification C. Pupillary block D. IOL repositioning E. Cyclodialysis cleft
Answer and explanation
Answer: B. Posterior capsular opacification
YAG laser capsulotomy is performed for visually significant posterior capsular opacification (PCO) after cataract surgery.
61. Risk factor LEAST associated with intra-operative floppy iris syndrome (IFIS):
A. Tamsulosin B. Other α-1A antagonists C. Topical pilocarpine pre-op D. Finasteride alone E. Saw palmetto extract
Answer and explanation
Answer: D. Finasteride alone
IFIS is strongly associated with α-1A antagonists (notably tamsulosin); finasteride (5α-reductase inhibitor) alone is not a recognised cause.
62. Soemmering ring describes:
A. Subluxated lens B. Doughnut-shaped peripheral residual lens cortex after rupture/surgery C. Pigment ring on lens D. Anterior capsule fibrosis E. Ciliary body cyst
Answer and explanation
Answer: B. Doughnut-shaped peripheral residual lens cortex after rupture/surgery
Soemmering ring is residual peripheral cortex sandwiched between the anterior and posterior capsules after rupture or extracapsular extraction.
63. In congenital cataract surgery the recommended optical timing for visually significant unilateral cataract is:
A. Within 6 weeks of birth B. Around 6 months C. At 1 year D. At 2 years E. Defer to age 3
Answer and explanation
Answer: A. Within 6 weeks of birth
Dense unilateral congenital cataract should be removed before 6 weeks of age to prevent dense deprivational amblyopia.
64. Phacoemulsification using ultrasound at 28 kHz works by:
A. Heating tissue to vaporise it B. Mechanical jackhammer and cavitation C. Direct laser ablation D. Cryocoagulation E. Chemical dissolution
Answer and explanation
Answer: B. Mechanical jackhammer and cavitation
Phaco needles oscillate at ~28-40 kHz, producing mechanical impact and cavitation that emulsify the lens nucleus.
65. In ectopia lentis associated with Marfan syndrome, displacement is classically:
A. Infero-nasal B. Supero-temporal C. Posterior D. Anterior chamber E. No fixed pattern
Answer and explanation
Answer: B. Supero-temporal
Marfan: supero-temporal displacement. Homocystinuria: infero-nasal. Weill-Marchesani: microspherophakia with subluxation.
66. Refractive shift in nuclear sclerosis is typically:
A. Hyperopic B. Myopic (“second sight”) C. Astigmatic only D. No change E. Aniseikonia
Answer and explanation
Answer: B. Myopic (“second sight”)
Increased refractive index of nuclear sclerotic lens causes a myopic shift, sometimes letting presbyopes read without glasses (“second sight”).
67. Most common cause of late IOL dislocation 10+ years after uneventful phaco:
A. Trauma B. Pseudoexfoliation C. Capsular block D. PCO contraction alone E. High myopia alone
Answer and explanation
Answer: B. Pseudoexfoliation
Pseudoexfoliation syndrome with progressive zonular weakness is the commonest cause of late spontaneous IOL-bag dislocation.
68. Best treatment for postoperative cystoid macular oedema (Irvine-Gass):
A. Observation only B. Topical NSAID + steroid combination C. Anti-VEGF first line D. Pars plana vitrectomy E. Subconjunctival 5-FU
Answer and explanation
Answer: B. Topical NSAID + steroid combination
First-line therapy for Irvine-Gass CME is topical NSAIDs combined with topical corticosteroids; refractory cases may need intravitreal steroid or anti-VEGF.
69. A lens-induced glaucoma with hypermature cataract leaking proteins is termed:
A. Phacomorphic glaucoma B. Phacolytic glaucoma C. Phacoanaphylactic glaucoma D. Phacoantigenic uveitis E. Phacoblock
Answer and explanation
Answer: B. Phacolytic glaucoma
Phacolytic glaucoma is open-angle glaucoma due to leakage of high-molecular-weight lens proteins through an intact capsule of a hypermature lens.
70. In intraoperative posterior capsule rupture without vitreous loss, the most important next step is:
A. Convert to extracapsular extraction B. Inject viscoelastic to tamponade and carefully remove residual cortex C. Suture incision and refer D. Abort surgery E. Aggressive irrigation to remove cortex
Answer and explanation
Answer: B. Inject viscoelastic to tamponade and carefully remove residual cortex
Injecting dispersive viscoelastic to tamponade vitreous and stabilise the rupture allows controlled cortex removal; avoid aggressive irrigation/aspiration over a tear.
Glaucoma: questions 71–90
71. In primary open-angle glaucoma the most reliable structural test for early damage is:
A. Gonioscopy B. Optical coherence tomography of RNFL/GCC C. Tonometry D. Specular microscopy E. Pachymetry
Answer and explanation
Answer: B. Optical coherence tomography of RNFL/GCC
OCT of the peripapillary RNFL and macular ganglion cell complex detects structural loss earlier than visual field defects in POAG.
72. Classic visual field defect in glaucoma:
A. Central scotoma B. Bitemporal hemianopia C. Arcuate scotoma respecting horizontal meridian D. Junctional scotoma E. Altitudinal defect
Answer and explanation
Answer: C. Arcuate scotoma respecting horizontal meridian
Glaucomatous field loss follows the arcuate nerve fibre pattern and respects the horizontal meridian (nasal step, arcuate, Bjerrum scotoma).
73. First-line medical therapy for primary open-angle glaucoma:
A. Topical beta-blocker B. Topical prostaglandin analogue C. Oral acetazolamide D. Pilocarpine E. Brimonidine
Answer and explanation
Answer: B. Topical prostaglandin analogue
Prostaglandin analogues (latanoprost, travoprost, bimatoprost, tafluprost) are first-line for POAG: best IOP lowering, once-daily dosing, few systemic effects.
74. A central corneal thickness of 480 μm in a glaucoma suspect implies:
A. Underestimation of true IOP B. Overestimation of true IOP C. No effect on IOP reading D. Always indicates keratoconus E. Requires immediate trabeculectomy
Answer and explanation
Answer: A. Underestimation of true IOP
Thin corneas (<555 μm) lead to underestimation of true IOP with Goldmann and are an independent risk factor for glaucoma progression (OHTS).
75. Acute primary angle closure crisis: emergency treatment of choice:
A. Immediate trabeculectomy B. Topical pilocarpine 2% + IOP-lowering medical Rx + later laser PI C. Laser trabeculoplasty D. Cyclophotocoagulation E. Topical steroid only
Answer and explanation
Answer: B. Topical pilocarpine 2% + IOP-lowering medical Rx + later laser PI
Initial treatment is medical IOP lowering (timolol, brimonidine, acetazolamide, hyperosmotic) plus pilocarpine after pressure drops, then laser PI once cornea clears.
76. Pigment dispersion syndrome classically affects:
A. Elderly hyperopes B. Young myopic males C. Postmenopausal women D. Diabetics E. Children
Answer and explanation
Answer: B. Young myopic males
PDS classically occurs in young (20-40 y) myopic males with Krukenberg spindle, mid-peripheral iris transillumination and pigment in the trabecular meshwork.
77. Pseudoexfoliation material is best seen on:
A. Anterior lens capsule and pupillary margin B. Posterior capsule C. Iris stroma surface D. Cornea endothelium E. Optic disc
Answer and explanation
Answer: A. Anterior lens capsule and pupillary margin
PXF deposits classically appear on the anterior lens capsule (central disc, peripheral band, clear intermediate zone) and at the pupillary margin.
78. In neovascular glaucoma the rate-limiting management step is:
A. Cyclodestruction first B. Treat underlying ischemia (PRP ± anti-VEGF) C. Trabeculectomy with MMC immediately D. Topical β-blockers only E. Iridotomy
Answer and explanation
Answer: B. Treat underlying ischemia (PRP ± anti-VEGF)
NVG must be treated by addressing the underlying retinal ischemia (PRP) and acutely with anti-VEGF; IOP-lowering surgery is needed only after vascularisation is regressed.
79. Trabeculectomy with mitomycin C primarily acts to:
A. Increase uveoscleral outflow B. Prevent subconjunctival fibrosis improving bleb survival C. Inhibit aqueous formation D. Promote angle widening E. Strengthen the trabecular meshwork
Answer and explanation
Answer: B. Prevent subconjunctival fibrosis improving bleb survival
Intraoperative MMC inhibits fibroblast proliferation, reducing scarring at the bleb site and improving long-term IOP control.
80. The most accurate office method to assess angle structures is:
A. Penlight Van Herick test B. Goldmann gonioscopy / anterior segment OCT C. Slit lamp without contact D. Fundoscopy E. Ultrasonography B-scan
Answer and explanation
Answer: B. Goldmann gonioscopy / anterior segment OCT
Gonioscopy (Goldmann or Posner) is the gold standard for angle assessment; anterior-segment OCT and UBM are useful adjuncts.
81. Aqueous humour is produced by:
A. Pigmented ciliary epithelium B. Non-pigmented ciliary epithelium C. Trabecular meshwork D. Endothelium E. Iris stroma
Answer and explanation
Answer: B. Non-pigmented ciliary epithelium
Non-pigmented ciliary epithelium of the pars plicata produces aqueous via active secretion involving Na⁺/K⁺-ATPase and carbonic anhydrase.
82. The drug class that lowers IOP by reducing aqueous production AND increasing uveoscleral outflow:
A. Beta-blocker B. Alpha-2 agonist (e.g. brimonidine) C. Prostaglandin analogue D. Pilocarpine E. Carbonic anhydrase inhibitor
Answer and explanation
Answer: B. Alpha-2 agonist (e.g. brimonidine)
Alpha-2 agonists like brimonidine both reduce aqueous formation and enhance uveoscleral outflow.
83. A patient with optic-disc cupping 0.9, IOP 14, normal visual field, family history of POAG. Likely diagnosis:
A. Normal-tension glaucoma B. Physiologic cupping C. Optic neuropathy D. Pseudoexfoliative glaucoma E. Steroid-induced glaucoma
Answer and explanation
Answer: A. Normal-tension glaucoma
Normal-tension glaucoma: glaucomatous optic neuropathy with IOP consistently ≤21 mmHg; family history and disc haemorrhages are risk factors.
84. Acetazolamide acts by inhibiting carbonic anhydrase isoenzyme:
A. CA-I B. CA-II C. CA-IV D. CA-IX E. CA-XII
Answer and explanation
Answer: B. CA-II
CA-II in the ciliary epithelium is the major isoenzyme inhibited to reduce bicarbonate (and hence aqueous) secretion.
85. Plateau iris configuration features:
A. Pupillary block as main mechanism B. Anteriorly positioned ciliary processes causing peripheral iris bunching C. Dense iris pigmentation D. Subluxated lens E. Iris atrophy
Answer and explanation
Answer: B. Anteriorly positioned ciliary processes causing peripheral iris bunching
Plateau iris is caused by anteriorly positioned ciliary processes that push the peripheral iris forward despite a patent iridotomy; treated with argon laser iridoplasty.
86. Most common cause of secondary open-angle glaucoma worldwide:
A. Pigment dispersion B. Pseudoexfoliation C. Inflammatory D. Steroid response E. Phacolytic
Answer and explanation
Answer: B. Pseudoexfoliation
Pseudoexfoliation is the commonest identifiable cause of secondary open-angle glaucoma worldwide, with higher IOP fluctuations and faster progression.
87. Selective laser trabeculoplasty (SLT) targets:
A. Schlemm canal B. Pigmented trabecular meshwork cells (selective melanin absorption) C. Ciliary body D. Iris stroma E. Sclera
Answer and explanation
Answer: B. Pigmented trabecular meshwork cells (selective melanin absorption)
SLT uses a frequency-doubled Q-switched Nd:YAG (532 nm) selectively absorbed by pigmented TM cells without collateral thermal damage.
88. Optic disc haemorrhage (Drance) is most ominous because it:
A. Indicates active inflammation B. Predicts future field progression in glaucoma C. Suggests papilloedema D. Is benign and self-resolving E. Indicates BRVO
Answer and explanation
Answer: B. Predicts future field progression in glaucoma
A Drance haemorrhage at the disc margin is a strong independent predictor of progressive glaucomatous damage.
89. Primary congenital glaucoma classic triad:
A. Photophobia, epiphora, blepharospasm B. Leukocoria, strabismus, nystagmus C. Cataract, glaucoma, deafness D. Buphthalmos, microcornea, cataract E. Heterochromia, ptosis, miosis
Answer and explanation
Answer: A. Photophobia, epiphora, blepharospasm
Primary congenital glaucoma presents with photophobia, epiphora and blepharospasm; signs include corneal oedema, Haab striae, buphthalmos.
90. Most common type of glaucoma in Asians:
A. Primary open-angle B. Primary angle-closure C. Pseudoexfoliative D. Neovascular E. Pigmentary
Answer and explanation
Answer: B. Primary angle-closure
In East and South Asian populations primary angle-closure disease accounts for a major share of glaucoma blindness due to anatomically narrower anterior chambers.
Uveitis: questions 91–100
91. Hypopyon uveitis is characteristic of:
A. Toxoplasmosis B. HLA-B27 associated anterior uveitis and Behçet disease C. Sarcoidosis D. Fuchs heterochromic uveitis E. CMV retinitis
Answer and explanation
Answer: B. HLA-B27 associated anterior uveitis and Behçet disease
Hypopyon is classically seen in HLA-B27 acute anterior uveitis and Behçet disease; rarely in infections and endophthalmitis.
92. Fuchs heterochromic iridocyclitis is characterised by:
A. Granulomatous uveitis with posterior synechiae B. Mild chronic anterior uveitis WITHOUT synechiae, heterochromia, secondary cataract C. Acute hypopyon uveitis D. Necrotising retinitis E. Vasculitis
Answer and explanation
Answer: B. Mild chronic anterior uveitis WITHOUT synechiae, heterochromia, secondary cataract
Fuchs is a low-grade chronic anterior uveitis classically with heterochromia, fine stellate KPs, absence of posterior synechiae, cataract and secondary glaucoma.
93. Mutton-fat keratic precipitates indicate:
A. Non-granulomatous uveitis B. Granulomatous uveitis (e.g. sarcoid, TB, syphilis, VKH) C. Infectious endophthalmitis D. Pigment dispersion E. Iridoschisis
Answer and explanation
Answer: B. Granulomatous uveitis (e.g. sarcoid, TB, syphilis, VKH)
Large greasy mutton-fat KPs (made of epithelioid cells) signify granulomatous inflammation – sarcoidosis, TB, syphilis, VKH, sympathetic ophthalmia.
94. Vogt-Koyanagi-Harada syndrome classically involves:
A. Vasculitic retinitis only B. Bilateral panuveitis with serous retinal detachments, meningism, vitiligo, poliosis C. Granulomatous keratitis D. Anterior segment only E. Endophthalmitis
Answer and explanation
Answer: B. Bilateral panuveitis with serous retinal detachments, meningism, vitiligo, poliosis
VKH is an autoimmune disease against melanocytes causing bilateral granulomatous panuveitis with exudative RDs, plus auditory, meningeal, integumentary signs.
95. Posterior synechiae predispose to:
A. Hyphema B. Iris bombe and angle closure C. Choroidal effusion D. Macular hole E. Vitreous haemorrhage
Answer and explanation
Answer: B. Iris bombe and angle closure
Posterior synechiae block aqueous flow through the pupil leading to iris bombe and secondary angle closure.
96. Most common cause of posterior uveitis worldwide:
A. Sarcoidosis B. Toxoplasmosis C. Behçet disease D. CMV E. Syphilis
Answer and explanation
Answer: B. Toxoplasmosis
Toxoplasma chorioretinitis is the leading cause of posterior uveitis worldwide; classic appearance is a focal necrotising retinitis adjacent to an old pigmented scar.
97. CMV retinitis typically occurs when CD4 count drops below:
A. 500 B. 350 C. 200 D. 50 E. 1000
Answer and explanation
Answer: D. 50
CMV retinitis is an AIDS-defining illness usually occurring with CD4 < 50/μL.
98. Acute retinal necrosis (ARN) is most commonly caused by:
A. Toxoplasma B. Herpes simplex / varicella zoster virus C. CMV D. Tuberculosis E. Treponema
Answer and explanation
Answer: B. Herpes simplex / varicella zoster virus
ARN is typically due to VZV or HSV, presenting with peripheral necrotising retinitis, retinal vasculitis, vitritis and a high rate of detachment.
99. Sympathetic ophthalmia is:
A. Hereditary uveitis B. Bilateral granulomatous panuveitis after penetrating trauma/surgery to one eye C. Photosensitive dermatitis D. Drug reaction E. Tumour related
Answer and explanation
Answer: B. Bilateral granulomatous panuveitis after penetrating trauma/surgery to one eye
Sympathetic ophthalmia is a delayed bilateral granulomatous panuveitis following penetrating injury or intraocular surgery to a fellow (“exciting”) eye.
100. First-line steroid-sparing agent for chronic non-infectious uveitis:
A. Cyclophosphamide B. Methotrexate C. Mycophenolate or azathioprine D. IVIG E. Rituximab
Answer and explanation
Answer: C. Mycophenolate or azathioprine
Methotrexate, mycophenolate mofetil and azathioprine are common first-line steroid-sparing immunomodulators in non-infectious uveitis.
Turn the score into a revision plan
A pattern matters more than the total. If errors cluster in optics, isolate formulae and sign conventions before another mixed set. If they cluster in cornea, glaucoma or uveitis, state the distinguishing sign and mechanism aloud before returning to options. A question bank can show a gap; it cannot replace a current standard reference, guideline or supervisor when clinical decisions are involved.
For topic-led revision, the ophthalmology topics hub is a useful next stop. The glossary can help when a missed item is terminology rather than a concept. Keep the live free MCQ hub for fresh practice rather than repeating this fixed diagnostic immediately.
Sources
- OphthaMCQ free MCQ hub — public destination for the free question-bank experience; checked 18 August 2026. The 100 records in this article were matched to the on-site dataset, including every option, keyed answer and supplied explanation.
- Karpicke and Roediger, repeated retrieval during learning — used only for the retrieval-practice approach described above; accessed 18 August 2026.
- Cepeda et al., distributed practice review — used only for the spacing/retest suggestion; accessed 18 August 2026.
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