FMGE 2025 — Ophthalmology
23 Previous Year Questions with Answers & Explanations
A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Visual acuity is normal in both eyes with correction, and fundus examination reveals normal retinal findings. What is the most likely diagnosis?
Which of the following is NOT a feature of Horner's Syndrome?
Which of the following statements is correct regarding indirect ophthalmoscopy?
A patient presents with right-sided field defects in both eyes, but central vision remains unaffected. What is the most likely diagnosis?
A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?
A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?
A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?
A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?
The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?
A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?
FMGE 2025 - Ophthalmology FMGE Practice Questions and MCQs
Question 1: A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Visual acuity is normal in both eyes with correction, and fundus examination reveals normal retinal findings. What is the most likely diagnosis?
- A. Myopia
- B. Amblyopia
- C. Hyperopia
- D. Anisometropia (Correct Answer)
Explanation: ***Anisometropia*** - This diagnosis refers to the condition where the two eyes have significantly **unequal refractive powers**, usually a difference of 2 diopters or more, as seen in this case (-2D vs +1D = 3 diopters). - Anisometropia is critical because the brain suppresses the blurred image from the eye with the greater refractive error, making it the most important cause of **refractive amblyopia** in children. *Myopia* - Myopia (nearsightedness) refers to the refractive error where light focuses in front of the retina, characteristic only of the **right eye** (-2D). - This term fails to describe the overall condition, which involves two different types of errors (**myopia and hyperopia**) in the same patient. *Hyperopia* - Hyperopia (farsightedness) refers to the refractive error where light focuses behind the retina, characteristic only of the **left eye** (+1D). - Applying this term alone ignores the presence of myopia in the right eye and the crucial **disparity in focus** between the two eyes. *Amblyopia* - Amblyopia (lazy eye) is reduced vision in an eye uncorrectable with lenses, often due to conditions like anisometropia that cause visual deprivation during the critical period. - The key differentiating factor here is that the patient is noted to have **normal visual acuity** despite the refractive disparity, meaning amblyopia has not yet developed (though the patient is at high risk).
Question 2: Which of the following is NOT a feature of Horner's Syndrome?
- A. Miosis
- B. Exophthalmos (Correct Answer)
- C. Ptosis
- D. Anhidrosis
Explanation: ***Exophthalmos*** - **Exophthalmos** (bulging of the eyeball) is caused by hyperactivity of the sympathetic system (e.g., in *hyperthyroidism*) or orbital mass effects, making it *NOT* a feature of sympathetic paralysis. - Horner's Syndrome, due to paralysis of the **Müller's muscle** in the orbit, actually causes the opposite effect: apparent **enophthalmos** (sinking of the eyeball). *Anhidrosis* - **Anhidrosis** (lack of sweating) on the ipsilateral face and neck is a crucial component of Horner's syndrome, particularly if the lesion is located preganglionic or centrally. - This occurs because the sympathetic fibers supplying the **sweat glands** are disrupted along the pathway. *Miosis* - **Miosis** (constricted pupil) is a hallmark feature resulting from the unopposed action of the parasympathetic system's **sphincter pupillae muscle**. - The sympathetic nerves responsible for innervating the **dilator pupillae muscle** are paralyzed, leading to relative pupil constriction that is more pronounced in dim light (*anisocoria*). *Ptosis* - **Ptosis** (droopy eyelid) is a characteristic symptom caused by the paralysis of the sympathetically innervated **Müller's muscle** (superior tarsal muscle). - This results in a mild degree of eyelid drooping (partial ptosis), often less severe than the ptosis seen with **Oculomotor Nerve (CN III) palsy**.
Question 3: Which of the following statements is correct regarding indirect ophthalmoscopy?
- A. It provides 3-5x magnification. (Correct Answer)
- B. The image is erect and real.
- C. The condenser lens needs to be kept close to the eye.
- D. It provides 15x magnification.
Explanation: ***It provides 3-5x magnification.*** - Indirect ophthalmoscopy typically provides a lower magnification, ranging from **3x to 5x**, which is essential for yielding a much **wider field of view** - The wide field of view allows the examiner to visualize large areas of the **peripheral retina**, facilitating screening for detachments or tears - This lower magnification is a trade-off for the **stereoscopic viewing** and **broader illuminated area** *The image is erect and real.* - The image formed by indirect ophthalmoscopy is **real** but **inverted** (upside down), not erect - The examiner must mentally reorient the inverted image during examination - An **erect (upright)** and **virtual** image is characteristic of **direct ophthalmoscopy** *The condenser lens needs to be kept close to the eye.* - The **condenser lens** is held at **arm's length**, at its **focal distance** from the patient's eye (not close to the examiner's eye) - Typically held at about 10-15 cm from the patient's cornea - If held too close or too far, the examiner will lose the **red reflex** or clear retinal details *It provides 15x magnification.* - A magnification of approximately **15x** is characteristic of **direct ophthalmoscopy**, not indirect - Direct ophthalmoscopy is used for fine detail work near the macula and optic disc - Indirect ophthalmoscopy sacrifices magnification for a **broader field of view** and **stereoscopic depth perception**
Question 4: A patient presents with right-sided field defects in both eyes, but central vision remains unaffected. What is the most likely diagnosis?
- A. Optic Tract Lesion
- B. Homonymous Hemianopia with Macular Sparing (Correct Answer)
- C. Heteronymous Hemianopia with Central Sparing
- D. Optic Chiasm Lesion
Explanation: ***Homonymous Hemianopia with Macular Sparing*** - **Homonymous hemianopia** refers to a visual field defect on the same side in both eyes (in this case, the right side), which precisely matches the patient's presentation. - **Macular sparing** occurs because the occipital pole, which processes central vision, often has a dual blood supply from both the **posterior cerebral artery (PCA)** and the **middle cerebral artery (MCA)**, protecting it during a stroke affecting one vessel. *Heteronymous Hemianopia with Central Sparing* - **Heteronymous hemianopia** involves defects on opposite sides of the visual field in each eye (e.g., loss of both temporal fields), which is inconsistent with the patient's right-sided defect in both eyes. - This type of defect is classically caused by a lesion at the **optic chiasm**, such as a pituitary adenoma, leading to **bitemporal hemianopia**. *Optic Chiasm Lesion* - A lesion compressing the optic chiasm, where the nasal retinal fibers cross, typically causes **bitemporal hemianopia** (loss of peripheral vision in both eyes). - This results in a **heteronymous** defect, not a **homonymous** one as described in the question. *Optic Tract Lesion* - A lesion in the optic tract (posterior to the chiasm) does cause a contralateral **homonymous hemianopia**. - However, lesions in the optic tract typically do not spare the macula, as the fibers from the macula are intermingled with other fibers at this point. Macular sparing points towards a more posterior lesion in the **visual cortex**.
Question 5: A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?
- A. Iridodialysis (Correct Answer)
- B. Vossius Ring
- C. Cycloiriditis
- D. Ankyloblepharon
Explanation: ***Iridodialysis*** - This condition involves the tearing of the **iris root** from its attachment to the **ciliary body**, which is a known complication of significant **blunt ocular trauma**. - The separation creates a secondary pupillary opening, leading to symptoms like **monocular diplopia**, **glare**, and blurred vision, consistent with the patient's presentation and the image showing a detached iris segment. *Ankyloblepharon* - Ankyloblepharon refers to the partial or complete **fusion of the eyelids**, which is a condition affecting the external adnexa, not the internal structures of the eye like the iris. - It is typically **congenital** or can result from severe chemical burns or trauma to the eyelids themselves, and does not match the clinical image. *Vossius Ring* - A Vossius ring is a circular deposit of **pigment** on the anterior surface of the **lens capsule** that occurs after blunt trauma presses the iris against the lens. - While it is an indicator of past trauma, it is a finding on the lens and is not the structural iris damage seen here. It doesn't typically cause chronic blurring of vision on its own. *Cycloiriditis* - Cycloiriditis, or **iridocyclitis**, is an **inflammatory** condition of the iris and ciliary body, presenting with pain, redness, and photophobia. - This is an inflammatory process, not a structural tear. Examination would show signs of **anterior uveitis** (cells and flare), not a physical separation of the iris tissue.
Question 6: A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?
- A. Myasthenia Gravis
- B. 3rd CN palsy
- C. Marcus Gunn Jaw-Winking Syndrome (Correct Answer)
- D. Lagophthalmos
Explanation: ***Marcus Gunn Jaw-Winking Syndrome***- This classic presentation involves **trigemino-oculomotor synkinesis**, where activation of the mandibular division of the **trigeminal nerve (V3)** during sucking or chewing causes involuntary co-contraction of the levator palpebrae superioris muscle (innervated by CN III).- The resulting unilateral ptosis is temporarily relieved (eyelid elevates or 'winks') only during jaw movement, confirming the mechanical synkinetic link.*Lagophthalmos*- This condition describes the **inability to close the eyelids completely**, leading to risk of corneal exposure and drying.- It is usually caused by **facial nerve palsy (CN VII)**, severe proptosis, or scarring, and does not involve intermittent, movement-related eyelid retraction.*Myasthenia Gravis*- Myasthenia gravis causes **fatigable ptosis** and diplopia that typically worsens with sustained muscle use or activity (e.g., end of the day or prolonged crying/sucking), distinguishing it from synkinesis.- Congenital myasthenia involves poor sucking effort and generalized or ocular muscle weakness, but the trigger mechanism is *fatigue*, not specific jaw movement.*3rd CN palsy*- A complete third cranial nerve palsy results in **severe ptosis** (paralysis of the levator palpebrae superioris) and limitations in eye movement (superior, inferior, medial recti, inferior oblique).- Although ptosis occurs, CN III palsy does not explain the *intermittent* and *synkinetic* nature of the eyelid movement linked specifically to mandibular division (V3) activity.
Question 7: A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?
- A. Glass
- B. Iron (Correct Answer)
- C. Aluminum
- D. Wood
Explanation: ***Iron*** - A metallic flying foreign body (often iron-containing) retained in the eye causes **siderosis bulbi**, a condition characterized by toxic **iron deposition** in ocular structures. - Iron ions diffuse from the retained foreign body and deposit in the cornea, lens, iris, and retina, leading to **progressive visual loss** and characteristic findings like rust-brown discoloration of the anterior lens capsule, heterochromia iridis, and retinal toxicity. - Siderosis bulbi is a serious complication requiring urgent removal of the iron-containing foreign body. *Aluminum* - Aluminum foreign bodies can cause **chalcosis** when copper-containing, but pure aluminum is relatively **inert** in the eye. - Aluminum does not cause the same toxic deposition syndrome as iron and is not associated with siderosis bulbi. *Wood* - Wood is an **organic foreign body** that primarily causes severe **inflammatory reactions** and carries a high risk of **endophthalmitis** (intraocular infection). - Wood does not cause metallic ion deposition or the specific toxicity pattern seen in siderosis bulbi. *Glass* - Glass foreign bodies are generally **inert** and well-tolerated in the eye, causing primarily mechanical trauma. - Glass does not leach metallic ions and does not cause toxic chemical deposition like siderosis bulbi.
Question 8: A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?
- A. Central Serous Retinopathy
- B. Irvine-Gass Syndrome (Correct Answer)
- C. Posner-Schlossman Syndrome
- D. Elschnig Pearls
Explanation: ***Irvine-Gass Syndrome*** - This syndrome is defined as the development of **cystoid macular edema (CME)** after intraocular surgery, most commonly **cataract surgery**, which matches the patient's history. - The Optical Coherence Tomography (OCT) image clearly shows characteristic **intraretinal fluid-filled cysts** and thickening in the macular region, which are hallmark signs of CME. *Posner-Schlossman Syndrome* - This condition, also known as glaucomatocyclitic crisis, involves recurrent episodes of **acute unilateral uveitis** and **high intraocular pressure**. - While inflammation can cause CME, it is not the primary feature, and the diagnosis relies on signs of anterior chamber inflammation and pressure spikes, not postoperative macular changes. *Central Serous Retinopathy* - This condition is characterized by the accumulation of **subretinal fluid**, creating a serous detachment of the neurosensory retina, which appears as a large fluid-filled space under the retina on OCT. - The provided OCT shows **intraretinal cysts**, not subretinal fluid, which is the key differentiating feature from CSR. *Elschnig Pearls* - These are a type of **posterior capsule opacification (PCO)**, a common complication of cataract surgery where residual lens epithelial cells proliferate on the posterior capsule. - PCO causes blurry vision by obstructing the visual axis but is a condition of the lens capsule, not the retina, and would not produce the macular edema seen on this OCT.
Question 9: The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?
- A. Lateral Nystagmus
- B. Manifest Squint
- C. Latent Squint
- D. Amblyopia (Correct Answer)
Explanation: ***Amblyopia*** - Amblyopia, often called a "lazy eye," is a neurodevelopmental disorder characterized by reduced **visual acuity** in one eye, which is not correctable by refractive means alone. - It is diagnosed by assessing vision with tools like a **Snellen chart**, whereas the cover-uncover test is designed to evaluate **ocular alignment** and motor fusion, not sensory function like visual acuity. *Latent Squint* - A latent squint, or **heterophoria**, is a tendency for the eyes to misalign when binocular vision is interrupted, such as when one eye is covered. - The **uncover** portion of the test reveals a phoria, as the eye that was covered will move to re-establish fixation once the occluder is removed. *Manifest Squint* - A manifest squint, or **heterotropia**, is a constant, observable misalignment of one eye. - The **cover test** component identifies a tropia by observing the movement of the uncovered eye; if it moves to take up fixation when the other eye is covered, a manifest squint is present. *Lateral Nystagmus* - **Nystagmus** is an involuntary, rhythmic movement of the eyes. Certain types, like latent nystagmus, become apparent or worsen when one eye is occluded. - The cover-uncover test, by breaking binocular fusion, can elicit or accentuate **latent nystagmus**, making it observable to the examiner.
Question 10: A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?
- A. External Dacryocystorhinostomy (DCR)
- B. Endonasal Dacryocystorhinostomy (DCR)
- C. Dacryocystectomy
- D. Conjunctivodacryocystorhinostomy (CDCR) (Correct Answer)
Explanation: ***Conjunctivodacryocystorhinostomy (CDCR) / Jones Tube*** - A **soft block** on probing indicates an obstruction within the **canalicular system**, as the probe meets a spongy resistance and cannot enter the lacrimal sac. - **Conjunctivodacryocystorhinostomy (CDCR)**, also known as conjunctival DCR or Jones tube placement, is the surgical procedure that bypasses the obstructed canaliculi by creating a new passage from the conjunctival sac to the nasal cavity with a Jones tube. - In this case, the soft block at 7 mm suggests canalicular obstruction, which cannot be addressed by standard DCR procedures that target nasolacrimal duct obstruction. *Endonasal Dacryocystorhinostomy (DCR)* - This procedure is the treatment of choice for **nasolacrimal duct (NLD) obstruction**, not canalicular obstruction. - NLD obstruction is identified by a **hard stop** during probing, where the probe passes through the canaliculi and contacts the bony lacrimal fossa wall. *External Dacryocystorhinostomy (DCR)* - Like the endonasal approach, external DCR is indicated for **NLD obstruction** (a **hard stop**), which is not the finding in this case. - It involves creating a fistula between the lacrimal sac and nasal mucosa through an external skin incision. *Dacryocystectomy* - This procedure involves the complete removal of the lacrimal sac and is reserved for conditions like **lacrimal sac tumors** or intractable chronic dacryocystitis. - It is a destructive procedure that eliminates the sac as a source of infection but does not resolve the **epiphora** (tearing).