FMGE 2026 - Ophthalmology PYQs Practice Questions

Q: A patient presents with a history of chemical injury to the eye. Based on the image shown, what is the most likely diagnosis?

Symblepharon. ***Symblepharon*** - This condition represents a **fibrous adhesion** between the bulbar conjunctiva and the palpebral conjunctiva, often occurring as a long-term complication of severe **chemical burns**. - It results from the inflammatory destruction of the **conjunctival epithelium**, causing raw surfaces to adhere during the healing process. *Ankyloblepharon* - This refers to the **abnormal fusion** of the upper and lower eyelid margins, often occurring congenitally or following severe trauma. - It is distinct from symblepharon because it involves the closure of the **palpebral fissure** itself, rather than adhesion between the eyeball and eyelid. *Entropion* - Characterized by the **inward turning** of the eyelid margin, causing eyelashes to rub against the cornea. - While chemical injuries can cause scarring leading to cicatricial entropion, it describes the **malposition** of the lid margin rather than a direct adhesion between the conjunctival layers. *Trichiasis* - This describes the **misdirection** of eyelashes toward the eyeball, which often rubs against the cornea and causes irritation. - It is a common secondary consequence of eyelid inflammation or scarring, but it defines the **aberrant growth angle** of individual cilia rather than a symblepharon adhesion. [Practice more Ophthalmology PYQs on OnCourse]

Q: Festooned (irregular) pupil is most commonly seen in which type of glaucoma?

Acute uveitic glaucoma. ***Acute uveitic glaucoma*** - Festooned pupils occur due to the formation of **posterior synechiae**, which are adhesions between the iris and the lens capsule, commonly seen in **anterior uveitis**. - When the pupil is dilated (e.g., in a darkened room or with drops), the iris adheres to the lens at certain points, preventing uniform dilation and resulting in an irregular, or "festooned," pupil shape. *Primary angle-closure glaucoma* - This condition typically presents with a **mid-dilated, non-reactive pupil** due to iris ischemia, not a festooned shape. - The primary mechanism involves **pupillary block**, which increases intraocular pressure rather than causing synechial iris deformation. *Open-angle glaucoma* - This is characterized by a pathologically **open drainage angle** and leads to progressive optic nerve damage without acute anatomical changes to the pupil. - Patients typically exhibit no acute iris changes, and the pupil remains round and reactive unless secondary pathologies are present. *Pseudoexfoliation glaucoma* - This condition is characterized by the accumulation of **fibrillar, eosinophilic material** on the lens capsule, iris margin, and trabecular meshwork. - While iris atrophy can occur, the hallmark feature is **exfoliative material deposition**, rather than the inflammatory synechiae that specifically define a festooned pupil. [Practice more Ophthalmology PYQs on OnCourse]

Q: A young patient presents with this sign. Diagnosis is best made by:

Corneal topography. ***Corneal topography*** - This is the **gold standard** diagnostic tool for detecting early and subclinical forms of **keratoconus**, as it provides a detailed map of the corneal curvature. - It identifies characteristic patterns like **inferior steepening** and **asymmetric bowtie** appearance which precede clinical signs visible on slit-lamp examination. *Keratometry* - Keratometry measures the **corneal power** at two principal meridians but is unable to map the entire corneal surface. - It is generally insufficient for the early diagnosis of keratoconus as it only provides averaged readings of the **central cornea**. *Pachymetry* - While pachymetry measures **corneal thickness** and may show localized thinning, it is not a diagnostic tool for mapping the surface curvature. - It is an adjunctive test; thinning is a structural change, but topography provides the functional assessment of the **corneal shape** necessary for diagnosis. *A-scan* - A-scan ultrasonography is primarily used to measure the **axial length** of the eye, typically for **intraocular lens (IOL) power calculations**. - It offers no diagnostic utility in assessing the **topographical curvature** or surface irregularities characteristic of corneal ectasias. [Practice more Ophthalmology PYQs on OnCourse]

Q: Best treatment for a small boy with itching in summers and Horner-Trantas spots:

Topical mast cell stabilizers + steroids. ***Topical mast cell stabilizers + steroids*** - **Horner-Trantas spots** (limbal white dots) combined with seasonal itching in a young boy is pathognomonic for **Vernal Keratoconjunctivitis (VKC)**, a chronic allergic ocular condition. - First-line management involves **topical mast cell stabilizers** (such as sodium cromoglycate) for maintenance and **topical corticosteroids** for acute exacerbations to rapidly control severe inflammation. *Oral antihistaminics* - These are typically reserved for **systemic allergic reactions** or when allergic rhinitis is present as a comorbidity. - They are generally ineffective as monotherapy for severe, localized **allergic conjunctivitis** compared to topical agents. *Antibiotics* - **Antibiotics** are strictly indicated for **bacterial conjunctivitis**, which presents with mucopurulent discharge and conjunctival injection rather than intense itching. - Their use in this scenario is inappropriate as it does not address the underlying **type I hypersensitivity reaction** causing the disease. *Surgery* - **Surgery** (such as excision of giant papillae) is reserved only for rare, refractory cases with significant **mechanical keratopathy** or visual impairment unresponsive to medical therapy. - It is never the first-line treatment for the management of the inflammatory component of **Vernal Keratoconjunctivitis**. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

A patient presents with a history of chemical injury to the eye. Based on the image shown, what is the most likely diagnosis?

Accepted Answer

Symblepharon

Answer

Ankyloblepharon

Answer

Entropion

Answer

Trichiasis

Question 2

Festooned (irregular) pupil is most commonly seen in which type of glaucoma?

Accepted Answer

Acute uveitic glaucoma

Answer

Primary angle-closure glaucoma

Answer

Open-angle glaucoma

Answer

Pseudoexfoliation glaucoma

Question 3

Absolute contraindication for LASIK is:

Accepted Answer

Central corneal thickness < 480 µm

Answer

Age < 13 years

Answer

Myopia of −4 D

Answer

Stable refraction for 1 year

Question 4

A young patient presents with this sign. Diagnosis is best made by:

Accepted Answer

Corneal topography

Answer

Keratometry

Answer

Pachymetry

Answer

A-scan

Question 5

Best treatment for a small boy with itching in summers and Horner-Trantas spots:

Accepted Answer

Topical mast cell stabilizers + steroids

Answer

Oral antihistaminics

Answer

Antibiotics

Answer

Surgery

Question 6

A patient came with redness and pain, and you dilated the pupil to break the synechiae. Which drug was used, looking at this picture?

Accepted Answer

Atropine

Answer

Phenylephrine

Answer

Scopolamine

Answer

Miotics

Question 7

A 52-year-old male outdoor worker presents with a fleshy growth in his left eye associated with foreign body sensation and redness for 3 years. On examination, a triangular fibrovascular tissue is seen arising from the nasal conjunctiva and encroaching 3 mm onto the cornea, crossing the pupillary axis. Best-corrected visual acuity is reduced to 6/18, and keratometry reveals significant with-the-rule astigmatism. There is no evidence of active inflammation. What is the most appropriate management for this patient?

Accepted Answer

Excision with conjunctival autograft

Answer

Simple excision

Answer

Topical corticosteroids and sunglasses

Answer

Observation with lubricating eye drops

Question 8

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 9

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 10

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

FMGE 2026 — Ophthalmology