1
Q
Astroid Hyalosis
A
Calcium deposition - starry sky appearance
2
Q
Synchysis Scintillans
A
Cholesterol Deposition
3
Q
What are the layers of the cornea from anterior to posterior?
A
Epithelium (Non-keratinized SSq) → Bowman’s membrane → Stroma → Dua’s layer → Descemet’s membrane → Endothelium
4
Q
Which corneal layer is the STRONGEST? Which does NOT regenerate?
A
Strongest = Dua’s layer
Does NOT regenerate = Bowman’s membrane
5
Q
Which corneal layer is most metabolically active and contributes maximally to transparency?
A
Endothelium — has Na⁺-K⁺-ATPase pump; maintains corneal dehydration = transparency
6
Q
GAG in corneal stroma? Copper deposits in which corneal layer?
A
GAG = Keratan sulfate
Cu deposits in Descemet’s membrane → Wilson’s disease (KF rings)
7
Q
Corneal blink reflex: afferent and efferent limbs?
A
Afferent: V1 (ophthalmic)
Efferent: VII (bilateral)
8
Q
Causes of corneal anesthesia?
A
HSV-1
Leprosy
Diabetes mellitus
β-blockers
9
Q
Cogan’s syndrome = ?
A
Interstitial Keratitis (IK) + Sensorineural Hearing Loss (SNHL)
10
Q
Hutchinson’s Triad (Congenital Syphilis)?
A
- Interstitial Keratitis
- SNHL
- Peg-shaped (Hutchinson’s) incisors
11
Q
Corneal opacity grading: Nebula vs Macula vs Leukoma?
A
Nebula: pupillary margin ✓, iris ✓
Macula: pupillary ✓, iris ✗
Leukoma: most severe, both ✗
12
Q
Corneal dystrophy characteristics?
A
NON-inflammatory, progressive, bilateral, inherited (mostly AD)
Exceptions: Lisch = XLR; Congenital & posterior endothelial = AR
13
Q
Most common corneal dystrophy? Its appearance?
A
Cogan’s epithelial dystrophy (MC) → ‘Fingerprint’ defects
14
Q
Lattice vs Granular stromal dystrophy: deposits?
A
Lattice = Amyloid
Granular = Hyaline (‘Bread crumb appearance’)
15
Q
Specular microscopy: normal endothelial count? When does bullous keratopathy occur?
A
Normal = 2500–3000 cells/mm²
Bullous keratopathy when < 500 cells/mm²
16
Q
Pachymetry vs Keratometry vs Placido disc?
A
Pachymetry = corneal thickness
Keratometry = corneal curvature (contributes 45D of 60D total)
Placido disc = corneal surface
17
Q
Contact lens → corneal ulcer: organism? Perforates in how many hours?
A
Pseudomonas aeruginosa → perforates within 48 hours
18
Q
Acanthamoeba keratitis: hallmark sign + DOC?
A
Ring abscess; H/o contact lens misuse; severe pain;
DOC = PHMB (Polyhexamethylene Biguanide)
19
Q
Hypopyon: sterile & mobile vs fixed & immobile?
A
Sterile & mobile = Bacterial ulcer
Fixed & immobile = Fungal ulcer
20
Q
HSV keratitis: dendritic ulcer treatment? What is contraindicated?
A
Dendritic ulcer → Acyclovir ✓
Steroids CONTRAINDICATED (cause metaherpetic keratitis)
SPK → steroids allowed
21
Q
Fluorescein stain vs Rose Bengal/Lissamine Green in corneal ulcer?
A
Fluorescein = stains floor of ulcer (cobalt blue filter)
Rose Bengal/Lissamine Green = stain margins
22
Q
Siedel test: positive result means?
A
Aqueous humor leak → indicates corneal perforation
23
Q
Signs of Keratoconus?
A
Munson sign
Vogt’s striae (vertical)
Fleischer ring (Fe in epithelium)
Rizzuti sign
Oil droplet (ophthalmoscopy)
Scissoring (retinoscopy)
24
Q
Keratoconus treatment?
A
INTACS (implantable rings)
C3R = Collagen Cross-linking with Riboflavin (arrests progression)
25
KF rings: deposit, layer, disease?
Copper (Cu) deposits in Descemet's membrane → Wilson's disease
50% hepatic, 90% neurological involvement
26
Types of keratoplasty?
PK = all layers
DALK = down to mid-stroma
DSEK = endothelial replacement (stroma not disturbed)
27
Keratoplasty graft: storage medium, time from cadaver, suture?
McCarey-Kauffman medium
Within 6 hours
Nylon sutures
28
Signs of corneal graft rejection?
Kaye's dots (subepithelial)
Khodadoust line
Keratic precipitates (KP)
29
Visual field defect at optic chiasma?
Bitemporal hemianopia (bilateral temporal field loss)
30
Visual field defect at optic tract? Associated pupil sign?
Contralateral homonymous hemianopia + Wernicke's hemianopic pupil
31
Meyer's loop vs Baum's loop visual field defect?
Meyer's (temporal) = Superior quadrantanopia 'Pie in the sky'
Baum's (parietal) = Inferior quadrantanopia 'Pie on the floor'
32
Visual cortex (PCA infarct) defect? Syndrome?
Macular sparing homonymous hemianopia
Anton syndrome = denial of blindness (PCA infarct)
33
Argyll Robertson pupil: light reflex vs accommodation reflex?
Light reflex: ABSENT
Accommodation reflex: PRESENT ('Prostitute's pupil — accommodates but doesn't react')
34
Marcus Gunn pupil: hallmark of? Test used?
Hallmark of Optic Neuritis (RAPD)
Swinging flashlight test
Always rule out Multiple Sclerosis
35
Adie's tonic pupil: accommodation? Response to 0.125% pilocarpine?
Accommodation: intact
0.125% pilocarpine → miosis (denervation supersensitivity)
Pharmacological (atropine) → no response
36
Layers of retina from inside out (mnemonic)?
ILM → NFL → GCL (3° neuron) → IPL → INL (2° Bipolar/Amacrine/Müller) → OPL → ONL → Photoreceptors (1° neuron) → RPE → Choroid (Bruch's)
37
Retinal detachment occurs at which layer? Between which layers?
Between photoreceptor layer and RPE (Retinal Pigment Epithelium)
38
ERG: a-wave vs b-wave? EOG: Arden's ratio — normal value and decreased in?
a-wave = photoreceptors
b-wave = bipolar cells
Arden's ratio normal >1.85; decreased in Best's disease
39
Blood supply: outer 4 retinal layers vs inner 6?
Outer 4 = Short Posterior Ciliary Artery
Inner 6 = Central Retinal Artery
40
Direct vs Indirect ophthalmoscopy comparison?
Direct: 14× magnification, 2DD field, upright image, no stereopsis
Indirect (+20 lens): 3× magnification, 9DD field, inverted/reversed image, stereopsis present
41
Central Serous Retinopathy (CSR): risk factors, FFA appearance, treatment?
Risk factors: steroids, Type A personality
FFA: Ink blot/Umbrella pattern
Rx: Photodynamic Therapy (PDT) with Verteporfin
42
Cystoid Macular Edema (CME): layer involved, FFA appearance, associations?
Layer: Outer Plexiform Layer (OPL)
FFA: Petalloid appearance
Associated with: Irvine-Gass, DR, CRVO, uveitis, PG analogues
43
Outer blood-retinal barrier vs Inner blood-retinal barrier?
Outer BRB = RPE (disrupted in CSR)
Inner BRB = Capillary permeability (disrupted in CME)
44
Dry ARMD: deposits, location, treatment formula?
Drusen = Lipofuscin deposits between RPE and Bruch's membrane
AREDS2 = Vit C + E + Zinc + Copper + Lutein + Zeaxanthin
45
Best's disease (vitelliform macular dystrophy): appearance and diagnostic test?
Egg-yolk appearance on fundus
EOG Arden's ratio DECREASED (normal >1.85)
46
Earliest feature of diabetic retinopathy? Which layer?
Microaneurysm — located in Inner Nuclear Layer (INL)
47
Retinal layers: dot-blot hemorrhages vs hard exudates vs flame-shaped hemorrhage vs cotton wool spots?
Dot-blot & hard exudates = OPL
Flame-shaped hemorrhage = NFL
Cotton wool spots = NFL
48
Severe NPDR: 4-2-1 rule?
>20 intraretinal hemorrhages in 4 quadrants
Venous beading in 2 quadrants
Prominent IRMA in 1 quadrant — any ONE qualifies
49
PDR treatment: laser type and wavelength?
Panretinal Photocoagulation (PRP)
Nd:YAG double frequency laser
532 nm
50
Anti-VEGF agents used in diabetic retinopathy/ARMD?
Bevacizumab
Ranibizumab
Brolucizumab
Aflibercept
Pegaptanib
Intravitreal injection: 4mm above limbus (temporal quadrant)
51
DR screening: Type 1 vs Type 2 DM?
Type 1: screen after 5 years of diagnosis
Type 2: screen immediately at diagnosis
DR ∝ Duration > Glycemic control
52
Normal AV ratio vs hypertensive AV ratio?
Normal = 2:3
Hypertension = 1:3
53
Salus, Gunn, Bonnet signs in hypertensive retinopathy?
Salus = S-shaped deflection of vein
Gunn = tapering of vein at either end
Bonnet = dilatation of vein at AV junction
54
Keith-Wagner grading of hypertensive retinopathy?
Grade 1: mild arteriolar narrowing
Grade 2: AV nipping
Grade 3: hemorrhages + exudates + cotton wool spots
Grade 4: Grade 3 + papilledema
55
CRAO: fundus appearance + D/D for cherry red spot?
Cherry red spot at fovea
D/D: Berlin's edema (trauma), Tay-Sachs, Niemann-Pick disease
56
CRVO: fundus appearance and late complication?
Splashed tomato appearance
100-day glaucoma (neovascular glaucoma from neovascularisation)
57
CMV retinitis: appearance, CD4 count, DOC?
Pizza-pie appearance
HIV/AIDS with CD4 < 50 cells/μL
DOC: Ganciclovir
58
Toxoplasmosis retinitis: appearance and pathognomonic feature?
Headlight in fog appearance
Macular scar
Old inactive lesion with active satellite
59
Retinitis Pigmentosa: features, which receptor affected first, associated syndrome?
Bony spicules, waxy pale disc, arteriolar attenuation
Rods > Cones
Night blindness first → Ring scotoma → Tunnel vision
Usher syndrome = RP + SNHL
60
Stargardt's disease: gene, fundus appearance, which receptor?
ABCA4 gene mutation
Fish flecks/Copper-beaten appearance
Silent choroid
Cone > Rod affected
61
3 types of retinal detachment and mechanism?
Rhegmatogenous = retinal break (trauma/myopia) — 'curtain falling'
Exudative = tumor/pus — dome-shaped, fluid shifts
Tractional = fibrous bands — tent-shaped RD
62
Management of rhegmatogenous RD?
Scleral buckling
Pneumatic retinopexy (SF6 gas)
Identify horseshoe break
63
Retinoblastoma: MC presentation, IOC, hallmark on CT?
MC = Leukokoria (age 1–5 yrs) > Esotropia
IOC = CE-MRI
CT hallmark = calcification
64
Retinoblastoma genetics?
Sporadic 60%
Hereditary 40% (familial 7%, non-familial 33%)
Gene = RB1, Chromosome 13
AD inheritance
Trilateral RB = Pinealoblastoma
MC associated cancer = Osteosarcoma
65
3 types of rosettes in retinoblastoma histopathology?
Flexner-Wintersteiner = TRUE rosette (empty center) = Retinoblastoma
Homer Wright = Neuropil center (RB, Medulloblastoma, Ewing's)
Perivascular = BV in center = Ependymoma
66
PHPV: what is it? D/D for leukokoria?
Persistent Hyperplastic Primary Vitreous | Retrolental triangular opacity | Hyaloid artery remnant in Cloquet's canal
67
Anterior vs Intermediate vs Posterior uveitis: symptoms?
Anterior = painful red eye + loss of vision | Intermediate = snowball/snowbank (pars plana) | Posterior = painless loss of vision + floaters
68
Mutton fat KP vs Fine granular KP vs Stellate KP?
Mutton fat = Granulomatous (TB, Sarcoid, Leprosy, Syphilis) | Fine granular = Non-granulomatous lymphocytic (AS, Reiter's, Behcet's) | Stellate = HSV, Toxoplasma, FHI
69
Fuch's Heterochromic Iridocyclitis (FHI): features?
Unilateral | Heterochromia (affected eye lighter) | Iris atrophy | Stellate KP | Posterior subcapsular cataract | Painless, no redness | Amsler sign = bleeding on paracentesis
70
VKH syndrome: type of uveitis and features?
Granulomatous Panuveitis | Perilimbal vitiligo (Sugiura sign) | Sunset glow fundus | Bilateral
71
Sympathetic ophthalmitis: cause, timing, treatment, prevention?
Penetrating trauma to uvea/ciliary body | Occurs >2 weeks after injury | Granulomatous panuveitis with Dalen-Fuchs nodules | Prevention = Enucleation | Rx = Steroids
72
Normal IOP? Abnormal C:D ratio?
Normal IOP = 10–21 mmHg | Abnormal C:D ratio > 0.3 | Vertical C:D enlargement earliest in glaucoma
73
Goldmann applanation tonometer: gold standard? Principle?
Gold standard for IOP measurement | Imbert-Fick's Law: P = F/A | Variable force, fixed area
74
Visual field defect progression in glaucoma (earliest to latest)?
Isopter contracture → Paracentral scotoma → Seidel's scotoma → Bjerrum/arcuate scotoma → Ring scotoma → Loss of central vision → Temporal crescent (LAST)
75
ACG (Angle Closure Glaucoma): triad of Vogt + management?
Glaucomflecken + Iris atrophy + Pigment on endothelium | Mx: Acetazolamide + Mannitol + Pilocarpine + Peripheral Iridotomy
76
Anti-glaucoma drugs: decrease aqueous production?
Beta-blockers: Timolol (non-selective), Betaxolol (selective β1) | Alpha-2 agonists: Apraclonidine (lid retraction), Brimonidine (NOT in children — apnea) | CAIs: Acetazolamide, Dorzolamide, Brinzolamide
77
PGF2α analogues: drugs, mechanism, side effects?
Latanoprost, Bimatoprost | Increase uveoscleral outflow | DOC for glaucoma | S/E: Heterochromia iridis, hypertrichosis (eyelash), CME, uveitis reactivation
78
Pilocarpine mechanism and side effects?
Cholinomimetic → increases trabecular outflow | S/E: Miosis, NLD stenosis
79
Netarsudil mechanism and unique side effect?
Rho kinase inhibitor → increases trabecular outflow | S/E: Vortex keratopathy (Cornea verticillata) — also seen in Fabry's, Chloroquine, Amiodarone, Tamoxifen
80
Types of cataracts and associations?
Snowflake = DM (sorbitol)
Sunflower = Wilson's/Chalcosis (Cu)
Christmas tree = Myotonic dystrophy
Blue dot = MC congenital (Down's)
Lamellar/Zonular = MC causing visual impairment (Rubella, Vit D deficiency)
81
Phacomorphic vs Phacolytic vs Phacotoxic glaucoma?
Phacomorphic = intumescent lens → shallow AC → pupil block
Phacolytic = hypermature lens → leaked denatured proteins → deep AC
Phacotoxic/Phacoanaphylactic = lens particles with ruptured capsule
82
PCO (Posterior Capsule Opacification): MC chronic complication, Rx?
MC chronic complication of cataract surgery
Rx: Nd:YAG laser 1064nm (photodisruption)
Appearance: Elschnig pearls, Sömmerring ring
83
Phacoemulsification incision size and mechanism?
Clear corneal incision 3–3.5mm
40 kHz ultrasound
Piezoelectric mechanism
Photodisruption of lens particles
84
Endophthalmitis after cataract surgery: early vs late organism?
Early onset = CONS (Coagulase-negative Staphylococcus)
Late onset = Propionibacterium acnes
85
Ptosis + dilated pupil vs ptosis + miotic pupil vs ptosis + normal reflex?
Dilated pupil = 3rd CN palsy (LPS + mydriasis)
Miotic pupil = Horner's syndrome (Müller's muscle + miosis) Normal reflex = Myasthenia Gravis
86
Laws of ocular motility: Herring's vs Sherrington's?
Herring's = Yoke muscles receive equal simultaneous innervation
Sherrington's = Reciprocal inhibition of antagonist muscle
87
Paralytic vs non-paralytic squint: how to differentiate?
Paralytic: Primary deviation ≠ Secondary deviation (2° > 1°)
Non-paralytic: Primary = Secondary deviation
88
Worth 4 Dot Test: findings?
4 spots = fusion
2 red = Left eye suppression
3 green = Right eye suppression
5 spots = Diplopia (Uncrossed/ESO or Crossed/EXO)
89
Myopia vs Hypermetropia: axial length, AC depth, squint tendency?
Myopia: ↑ axial length, deeper AC, exotropia
Hypermetropia: ↓ axial length, shallow AC, esotropia
90
LASIK contraindications?
Age <18 yrs
Unstable refraction
Corneal thickness <450 μm
Progressive keratoconus
91
Types of myopia by cause?
Axial = ↑ axial length
Curvature = Keratoconus
Index = Nuclear cataract (2nd sight)
Positional = Weil-Marchesani syndrome
92
Siderosis bulbi: cause, IOC, contraindication?
Iron-containing intraocular foreign body
IOC = NCCT orbit
MRI CONTRAINDICATED
93
Enucleation vs Evisceration vs Exenteration?
Enucleation = globe + optic nerve removed (RB, sympathetic ophthalmitis)
Evisceration = sclera left (endophthalmitis)
Exenteration = all orbital contents removed (mucormycosis, metastasis)
94
Orbital Apex syndrome vs Cavernous Sinus Thrombosis?
Orbital apex: CN II+III+IV+VI+V1, unilateral, gradual, vision loss ✓
CST: starts with VI then III/IV/V1/V2, bilateral, sudden, NO vision loss, severe chemosis/proptosis
95
MC orbital tumors: child vs adult (benign & malignant)?
Child: Benign = Dermoid cyst
Malignant = Rhabdomyosarcoma
Adult: Benign = Hemangioma
Malignant = NHL
Orbital mets: Child = Neuroblastoma, Adult = Breast Ca
96
VKC (Vernal Keratoconjunctivitis): hallmark signs + DOC?
Cobblestone papillae
Horner-Tranta dots
Pseudogerontoxon
Shield ulcer
Ropy discharge
DOC = Olopatadine + Steroids
97
Neonatal conjunctivitis: onset and treatment by type?
Chemical: <24 hrs → lubricants
Gonococcal: 2–5 days → Ceftriaxone
Chlamydial: 5–14 days → Oral Erythromycin
98
Trachoma: causative agent, staging, SAFE strategy?
Chlamydia trachomatis serotypes A–C
WHO FISTO staging: TF (sago grain follicles), TI, TS, TT, CO
SAFE = Surgery + Antibiotics + Facial cleanliness + Environmental change
Eliminated from India: October 2024
99
3 layers of tear film and associated deficiency?
Inner mucous = Goblet cells → Vit A deficiency
Middle aqueous = Lacrimal gland → KCS (Keratoconjunctivitis Sicca)
Outer lipid = Meibomian gland → Contact lens users
100
Schirmer's test: filter paper, normal value, time?
Whatmann filter paper No. 41
Normal >15 mm wetting
Duration: 5 minutes
101
TBUT (Tear Break-Up Time): normal value and what deficiency it reflects?
Normal >10 seconds
Reduced TBUT = Mucin deficiency (goblet cell dysfunction)
102
Congenital dacryocystitis: MCC and management steps?
MCC = Obstruction at valve of Hasner (NLD)
Mx: Massage + topical ABs → Syringing & probing → DCR (>4 yrs, into middle meatus)
103
Iron deposition lines: Hudson-Stahli, Stocker's, Ferry's, Fleischer's?
Hudson-Stahli = normal aging/siderosis
Stocker's = around pterygium
Ferry's = around filtering bleb
Fleischer's = keratoconus (basal epithelium)
104
Laser types in ophthalmology: Photocoagulation vs Photoablation vs Photodisruption?
Photocoagulation = Nd:YAG double freq 532nm → PRP, trabeculoplasty
Photoablation = Excimer 193nm → LASIK
Photodisruption = Nd:YAG 1064nm → Peripheral iridotomy, PCO
FLACS = Nd Glass 1053nm
105
Ectopia lentis: Marfan's vs Homocystinuria vs Weil-Marchesani?
Marfan's = Superotemporal dislocation
Homocystinuria = Inferonasal
Weil-Marchesani = Microspherophakia (positional myopia)
106
Anterior lenticonus vs Posterior lenticonus: associated syndromes?
Anterior lenticonus = Alport syndrome (nephritis + SNHL)
Posterior lenticonus = Lowe syndrome (Oculo-Cerebro-Renal)
107
Congenital glaucoma triad + corneal findings?
BLP = Blepharospasm + Lacrimation + Photophobia
Haab's striae (horizontal)
Corneal diameter >13 mm
108
Topical steroids → ? | Systemic steroids → ?
Topical steroids → Glaucoma (POAG)
Systemic steroids → Posterior subcapsular Cataract
109
Symblepheron vs Ankyloblepheron?
Symblepheron = bulbar + palpebral conjunctiva fused
Ankyloblepheron = superior + inferior eyelids fused
110
EOM: nerve supply of SR, IR, SO, IO, MR, LR?
MR = CN3 (adduction)
LR = CN6 (abduction)
SR = CN3 (elevation, intorsion, adduction)
IR = CN3 (depression, extorsion, adduction)
SO = CN4 (intorsion, depression, abduction)
IO = CN3 (extorsion, elevation, abduction)
SIN: Superior = Intorsion;
RAD: Rectus = Adduction
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