FMGE 2026 Practice Questions

Q: A patient developed a complication after cataract surgery. On slit lamp examination, the following finding was observed. What is the diagnosis?

Lens subluxation. ***Lens subluxation*** - This occurs due to **zonular dehiscence** or weakness, leading to partial displacement of the lens from its normal position. - On slit-lamp examination, this typically manifests as **phacodonesis** (tremulousness of the lens) or an asymmetric anterior chamber depth. *Aphakia* - Refers to the complete absence of the crystalline lens from the eye, often resulting from surgical extraction without an **intraocular lens (IOL) implantation**. - Slit-lamp biomicroscopy would reveal an **absent lens** and often an **iridodonesis** (tremulousness of the iris) due to the lack of lens support. *Posterior capsular opacification* - This is the most common long-term complication of cataract surgery, often termed **after-cataract**. - It presents as a clouding of the posterior capsule caused by the **migration of lens epithelial cells** across the posterior capsule surface, significantly reducing visual acuity. *Endophthalmitis* - A devastating **intraocular inflammation** involving both the anterior and posterior segments, usually caused by a **bacterial or fungal infection**. - Clinical features include severe **pain, decreased vision, hypopyon, and vitreous haze**, rather than simple lens displacement.

Q: Best treatment for this corneal lesion is:

Topical acyclovir 3% with atropine. ***Topical acyclovir 3% with atropine*** - This regimen is the gold standard for treating **Herpes Simplex Keratitis**, specifically **dendritic ulcers**, to inhibit viral replication. - **Atropine** is added to prevent or manage secondary **uveitis** and provide pain relief by paralyzing the ciliary muscle. *Broad-spectrum topical antibiotics* - These are indicated for **bacterial keratitis**, presenting with dense **suppurative infiltrates** and mucopurulent discharge, not the characteristic dendritic pattern. - Using antibiotics for viral disease provides no therapeutic benefit and may cause ocular surface toxicity. *Topical steroids* - These are strictly **contraindicated** in active epithelial **Herpetic Keratitis** as they can cause rapid viral proliferation and **corneal melting**. - Steroids may only be considered under the coverage of antivirals for **stromal keratitis** (immune-mediated) or to manage severe **uveitis**, never for active epithelial disease. *Lubricating eye drops* - These are used for **dry eye syndrome** or mild surface irritation, which do not produce inflammatory corneal lesions. - They lack antimicrobial or antiviral properties and would be ineffective at treating an active **viral infection**.

Q: A patient presents with redness and pain in the eye. Examination findings are given below. What is the investigation of choice to diagnose this condition?

HLA-B27. ***HLA-B27*** - This genetic marker is strongly associated with **acute anterior uveitis**, the most common ocular manifestation of **seronegative spondyloarthropathies** like **ankylosing spondylitis**. - Testing for HLA-B27 is the diagnostic investigation of choice when a patient presents with **unilateral redness**, **photophobia**, and **pain**, particularly if they have associated spinal or back symptoms. *Anti-CCP antibodies* - This antibody is highly specific for the diagnosis of **rheumatoid arthritis**. - While rheumatoid arthritis can cause ocular issues like **scleritis** or **keratoconjunctivitis sicca**, it is not the primary diagnostic investigation for acute anterior uveitis. *ANA* - **Antinuclear antibodies (ANA)** are primarily used in the workup for **systemic lupus erythematosus (SLE)** and **juvenile idiopathic arthritis (JIA)**. - While JIA is a common cause of uveitis in children, HLA-B27 is the more relevant association for acute (often unilateral) anterior uveitis in adult populations. *X-ray chest* - An **X-ray of the chest** is typically indicated to screen for **sarcoidosis** or **tuberculosis**, which can cause **granulomatous uveitis**. - However, it is not the initial investigation of choice for standard acute anterior uveitis unless systemic features of these specific conditions are present.

Q: A patient has 6/6 vision in one eye and <6/60 in the other eye. A difference of 4D is present. On covering the normal eye, the deviated eye moves towards the centre. What is the diagnosis?

Strabismic amblyopia. ### ***Strabismic amblyopia*** - Occurs when the brain ignores input from one eye due to a constant squint (strabismus), leading to reduced visual acuity because of the **abnormal binocular interaction** or image degradation. - The observation that the **deviated eye moves towards the center** upon covering the fixating eye is a classic sign of **strabismus** (specifically tropia, where the eye is misaligned under binocular conditions), which is the underlying cause here. *Anisometropia* - Refers to a **significant refractive error difference** between the two eyes (e.g., >2.5D difference in sphere), causing one eye to be blurred while the other focuses clearly. - While the patient does have a 4D refractive difference, this describes the *cause* of refractive amblyopia, not the clinical presentation of the fixation movement described (which confirms structural misalignment/strabismus). *Esotropia* - This is merely a **descriptive term for inward deviation** of the eyes (inward squint), representing the misalignment itself. - It does not encapsulate the concept of reduced visual acuity (amblyopia) which is the primary pathology represented by the <6/60 vision in the affected eye. *Suppression scotoma* - This is an active **inhibitory process** in the visual cortex where the brain ignores the image from the misaligned eye to avoid binocular diplopia. - While suppression is a mechanism *within* strabismic amblyopia, it is an adaptive response and not the primary clinical diagnosis for the reduced visual acuity observed.

Q: This instrument is used for :

Refinement of cylindrical prescription. ***Cross-cylinder (Jackson Cross Cylinder)*** - This tool is specifically designed for the **refinement of axis and power** of the cylindrical component of a patient's refraction. - It consists of an **equal power minus and plus cylinder** mounted with their axes at 90 degrees to each other, allowing for rapid comparison during subjective refraction. *Measurement of corneal curvature* - This is performed using a **keratometer** (or ophthalmometer), which measures the reflection of light from the corneal surface. - It is crucial for **contact lens fitting** and calculating intraocular lens power, not for determining refractive cylinder. *Visual acuity testing* - This is conducted using **Snellen charts** or **LogMAR charts** to quantify the patient's clarity of vision. - While it establishes the need for correction, it does not refine the specific astigmatic prescription. *Measurement of intraocular pressure* - This task is accomplished using a **tonometer**, such as the Goldmann applanation tonometer or Non-Contact Tonometer (NCT). - Measuring ocular tension is a critical step in diagnosing **glaucoma** and is unrelated to refractive lens correction.

Q: A baby sustained blunt trauma to the eye with a ball. Finding seen in the picture is:

Hyphema. ***Hyphema*** Defined as the **accumulation of blood** in the **anterior chamber** of the eye, typically resulting from blunt trauma that causes a tear in the **ciliary body** or iris vasculature. Initial management involves **bed rest**, elevating the head to allow the blood to settle, and topical **corticosteroids** or cycloplegics to reduce inflammation and pain. *Hypopyon* This refers to the presence of **leukocytes** (pus) in the anterior chamber, representing an **inflammatory exudate** rather than hemorrhage. It is commonly associated with **infectious keratitis** or **endophthalmitis**, not trauma-induced bleeding. *Iridodialysis* This condition involves the **detachment of the iris** from the **scleral spur** at the root of the iris. While also caused by blunt trauma, it appears as a **D-shaped pupil** or a peripheral crescent-shaped defect, not blood pooling in the chamber. *Traumatic cataract* Characterized by opacification of the **crystalline lens** following trauma, often manifesting as a **rosette-shaped cataract**. The primary finding is a **lens opacity** affecting vision, which is distinct from the opaque, layered pooling of blood seen in hyphema.

Q: A patient has bilateral proptosis with restricted movements of the eye. What is the most common cause of such condition?

Thyroid eye disease. ***Thyroid eye disease*** - Also known as **Graves' ophthalmopathy**, it serves as the most frequent cause of **bilateral proptosis** in adults. - The underlying pathogenesis involves **autoimmune inflammation** leading to **extraocular muscle enlargement** (sparing tendons) and restricted eye motility. *Idiopathic orbital inflammation* - Formerly known as **orbital pseudotumor**, this condition typically presents with acute, painful orbital inflammation. - It is less common than thyroid eye disease and usually lacks the systemic features associated with **hyperthyroidism**. *Orbital cellulitis* - This is an **acute infection** of the orbital tissues, usually unilateral and accompanied by **fever**, eyelid edema, and signs of systemic toxicity. - It is a medical emergency that requires prompt diagnosis via **CT scan** rather than being a chronic cause of bilateral proptosis. *Cavernous hemangioma* - This is a benign, slow-growing **vascular tumor** that typically presents as a painless, progressive, **unilateral proptosis**. - It does not usually cause restricted eye movements until the mass is large enough to cause significant **mass effect** or compression.

Q: Identify the lesion.

Dermoid cyst. ***Dermoid cyst*** - These are **congenital, benign, choristomatous lesions** commonly located at the **upper temporal quadrant** of the orbit near the **frontozygomatic suture**. - They most frequently appear in early childhood as a **painless, firm, non-tender, slow-growing mass** that is **fixed to the underlying bone**. *Lipodermoid* - These are typically located in the **subconjunctival space** at the **superotemporal limbus** rather than deep in the orbital bone. - They appear as **soft, yellowish, mobile masses** containing fatty tissue and are not usually associated with bone fixation. *Hemangioma* - **Capillary hemangiomas** typically present as a **reddish-purple (strawberry-like)** mass that is compressible and prone to rapid growth. - **Cavernous hemangiomas** are adult-onset, deep, orbital space-occupying lesions that cause **proptosis** and are not fixed to the superficial orbital bone. *Lacrimal sac tumor* - These lesions are located in the **medial canthal region** (tear duct area) rather than the orbital rim. - They typically present with **epiphora (tearing)**, chronic dacryocystitis, or a **palpable mass** in the area of the medial canthus.

Q: Image-based question: Diagnosis is:

Vernal keratoconjunctivitis. ***Vernal keratoconjunctivitis*** - Commonly presents with **giant papillae** (cobblestone appearance) on the superior tarsal conjunctiva in young males, particularly in warm climates. - Key diagnostic features include intense **itching**, **stringy mucoid discharge**, and potential **shield ulcers** (corneal epithelial defects) due to mechanical trauma. *Trachoma* - Caused by **Chlamydia trachomatis** serotypes A-C, characterized by **Herbert pits** and conjunctival scarring. - Typically manifests with **follicular conjunctivitis** in the superior tarsal conjunctiva, often leading to **entropion** and **trichiasis** in chronic stages. *Allergic conjunctivitis* - Usually presents with bilateral **itching**, **redness**, and **watery discharge** triggered by environmental allergens like pollen. - Physical examination typically shows **diffuse papillary reaction** but lacks the characteristic **giant papillae** seen in more severe chronic forms. *Chronic follicular conjunctivitis* - Presents with numerous small **follicles** (lymphoid aggregates) rather than the large papillae characteristic of vernal disease. - Often secondary to viral infections (like **adenovirus**) or toxic reactions to topical medications, and lacks the seasonal recurrences typical of vernal keratoconjunctivitis.

Q: . A patient presented with sudden loss of vision with the retinal findings as shown in the image. What is the most probable diagnosis?

CRAO. ***CRAO*** - Central Retinal Artery Occlusion (CRAO) typically presents as **sudden, painless, monocular vision loss** due to an embolic or thrombotic blockage of the retinal arterial supply. - The characteristic **fundus appearance** includes **pale, edematous retina** (due to ischemia) with a pathognomonic **cherry-red spot** at the fovea, where the underlying choroidal circulation remains visible. *CRVO* - Central Retinal Vein Occlusion (CRVO) presents with a **'blood and thunder' fundus** characterized by widespread **retinal hemorrhages**, dilated and tortuous veins, and cotton wool spots. - Unlike CRAO, CRVO is caused by venous obstruction, leading to backup of blood rather than the ischemic whitening seen in arterial occlusion. *Retinal detachment* - Commonly presents with symptoms of **'flashes' (photopsia)**, **'floaters'**, and a **'curtain-like' visual field defect** rather than sudden total loss. - Funduscopy reveals a **gray, elevated retina** with folds, lacking the specific cherry-red spot morphology associated with CRAO. *Vitreous hemorrhage* - Presents with sudden vision loss that is often described as a **reddish haze** or loss of the **red reflex** during ophthalmoscopy. - The fundus details—such as the optic disc and vessels—become **obscured or invisible** due to the blood filling the vitreous cavity, which distinguishes it from the clear but pale view in CRAO.

Question 1

A patient developed a complication after cataract surgery. On slit lamp examination, the following finding was observed. What is the diagnosis?

Accepted Answer

Lens subluxation

Answer

Aphakia

Answer

Posterior capsular opacification

Answer

Endophthalmitis

Question 2

Best treatment for this corneal lesion is:

Accepted Answer

Topical acyclovir 3% with atropine

Answer

Broad-spectrum topical antibiotics

Answer

Topical steroids

Answer

Lubricating eye drops

Question 3

A patient presents with redness and pain in the eye. Examination findings are given below. What is the investigation of choice to diagnose this condition?

Accepted Answer

HLA-B27

Answer

Anti-CCP antibodies

Answer

ANA

Answer

X-ray chest

Question 4

A patient has 6/6 vision in one eye and <6/60 in the other eye. A difference of 4D is present. On covering the normal eye, the deviated eye moves towards the centre. What is the diagnosis?

Accepted Answer

Strabismic amblyopia

Answer

Anisometropia

Answer

Esotropia

Answer

Suppression scotoma

Question 5

This instrument is used for :

Accepted Answer

Refinement of cylindrical prescription

Answer

Measurement of corneal curvature

Answer

Visual acuity testing

Answer

Measurement of intraocular pressure

Question 6

A baby sustained blunt trauma to the eye with a ball. Finding seen in the picture is:

Accepted Answer

Hyphema

Answer

Hypopyon

Answer

Iridodialysis

Answer

Traumatic cataract

Question 7

A patient has bilateral proptosis with restricted movements of the eye. What is the most common cause of such condition?

Accepted Answer

Thyroid eye disease

Answer

Idiopathic orbital inflammation

Answer

Orbital cellulitis

Answer

Cavernous hemangioma

Question 8

Identify the lesion.

Accepted Answer

Dermoid cyst

Answer

Lipodermoid

Answer

Hemangioma

Answer

Lacrimal sac tumor

Question 9

Image-based question: Diagnosis is:

Accepted Answer

Vernal keratoconjunctivitis

Answer

Trachoma

Answer

Allergic conjunctivitis

Answer

Chronic follicular conjunctivitis

Question 10

. A patient presented with sudden loss of vision with the retinal findings as shown in the image. What is the most probable diagnosis?

Accepted Answer

CRAO

Answer

CRVO

Answer

Retinal detachment

Answer

Vitreous hemorrhage

FMGE 2026

Ophthalmology