NEET-PG 2025 — Ophthalmology

Q: A 15-year-old female presents with a painless, gradually increasing mass located at the superotemporal orbital rim (upper outer quadrant of the orbit), present for the past 10 years. On examination, the mass is non-tender and slowly progressive. What is the most likely diagnosis?

Dermoid cyst. ***Dermoid cyst*** - This diagnosis is strongly suggested by the classic presentation of a **painless**, **slowly progressive** mass in a young patient, located near the **superotemporal orbital rim** (lateral to the lateral canthus). - Dermoid cysts are **congenital choristomas** formed by sequestration of ectoderm along embryonic lines of closure, often presenting fixed to the periosteum. *Capillary hemangioma* - These tumors typically present in infancy and exhibit characteristic rapid growth followed by **spontaneous involution** (not slow progression over 10 years). - They are usually soft, compressible, and display color changes (red/blue), unlike the description of a firm, non-tender mass. *Lacrimal gland tumor* - Primary lacrimal gland epithelial tumors are rare in children and primarily occur in **adults** (40-60 years). - They typically cause axial proptosis and globe displacement (inferonasal) due to growth within the **lacrimal fossa**, usually presenting with symptoms related to pressure or pain if malignant. *Epidermoid cyst* - While also slow-growing and painless, epidermoid cysts are less likely than dermoid cysts to be found in the deep subcutaneous tissue fixed to the periosteum near the lateral canthus. - Epidermoid cysts contain only stratified squamous epithelium and keratin, while **dermoid cysts** also contain skin appendages (hair follicles, sebaceous glands). [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient presents with guttate lesions in one eye and bullous keratopathy in the other eye. What is the most likely diagnosis?

Fuchs' endothelial dystrophy. ***Fuchs' endothelial dystrophy*** - This condition involves progressive loss of corneal endothelial cells and deposition of abnormal basement membrane material (**guttae**). The presence of **guttate lesions** represents early disease. - As the disease progresses and the remaining endothelial cells fail to pump fluid effectively, the cornea swells, leading to epithelial and stromal edema, clinically described as **bullous keratopathy**. *Interstitial keratitis* - This is non-ulcerative inflammation predominantly affecting the **corneal stroma**, often associated with systemic infections like **congenital syphilis** or Cogan's syndrome. - It typically causes stromal clouding and deep **neovascularization** (ghost vessels) but does not primarily involve guttate lesions or asymmetric endothelial failure. *Viral corneal ulcer* - Viral ulcers (like those caused by **HSV**) present acutely with epithelial defects, often in a dendritic or geographic pattern, and cause significant inflammation. - They are acute processes characterized by surface epithelial involvement, not characterized by the slowly progressive, **endothelial-based changes** (guttae and bullae) seen in Fuchs' dystrophy. *Keratoconjunctivitis* - This is a general term for inflammation affecting both the cornea and conjunctiva, commonly seen in **adenoviral infections** or severe dry eye (**KCS**). - The primary findings are typically conjunctival injection and punctate epithelial erosions, not the specific endothelial deposits (**guttae**) or resulting severe edema (**bullous keratopathy**) characteristic of Fuchs' dystrophy. [Practice more Ophthalmology PYQs on OnCourse]

Q: An elderly patient presents with white, dandruff-like deposits on the anterior lens surface, seen during slit-lamp examination. What is the most likely diagnosis?

Pseudoexfoliation syndrome. ***Pseudoexfoliation syndrome*** - The pathognomonic finding of **white, dandruff-like material** deposited on the **anterior lens capsule** (often forming a characteristic clear central zone and peripheral zone separated by a clear space) is indicative of Pseudoexfoliation syndrome. - This material is an **abnormal fibrillar glycoprotein** that can block the trabecular meshwork, elevating intraocular pressure and predisposing the patient to **pseudoexfoliation glaucoma**. *Iris cyst* - An iris cyst appears as a localized, non-transilluminating mass or elevation within the iris stroma or attached to the pupil margin. - It does not present as diffuse **dandruff-like material** covering the lens surface, which is the hallmark of pseudoexfoliation. *Persistent pupillary membrane* - This is a **congenital anomaly** where remnants of the embryonic **tunica vasculosa lentis** persist, appearing as fine strands bridging the pupil or extending from the iris collar to the lens. - They are typically dark, thread-like structures, and are not the widespread **white deposits** usually seen in elderly patients with PEX. *Pigment dispersion syndrome* - This condition involves the dispersion of **iris pigment**, which classically manifests as a **Krukenberg spindle** (vertical pigment line on the corneal endothelium) and dense pigment deposits in the trabecular meshwork. - The deposits are visually **brown/black (pigmentary)**, not white/gray as described in PEX, and they primarily affect the corneal endothelium and trabecular meshwork. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which condition is treated using an Intacs ring, as shown in the image?

Keratoconus. ***Keratoconus*** - The image displays **Intacs**, which are intracorneal ring segments specifically designed to treat **keratoconus** by flattening the steep cornea. - This procedure provides structural support to the weakened, cone-shaped cornea, thereby improving uncorrected and best-corrected visual acuity by reducing **myopia** and **astigmatism**. *Cataract* - Cataract treatment involves the surgical removal of the opacified natural lens, typically through **phacoemulsification**. - An **intraocular lens (IOL)** is implanted in place of the natural lens, not a ring within the corneal stroma as shown. *Corneal ulcer* - A corneal ulcer is an active infection of the cornea and is treated primarily with intensive **topical antimicrobial** therapy (antibiotics, antifungals, or antivirals). - Placing a foreign body like an Intacs ring is contraindicated in an active infection and would worsen the condition. *Glaucoma* - The goal of glaucoma treatment is to lower **intraocular pressure (IOP)** to prevent optic nerve damage. - This is managed with medications (eye drops), **laser procedures** (e.g., trabeculoplasty), or **filtration surgery** (e.g., trabeculectomy), none of which involve corneal ring implants. [Practice more Ophthalmology PYQs on OnCourse]

Q: The essential foundational components of binocular single vision are:

a. SMP b. Fusion. ***a. SMP b. Fusion*** - **Simultaneous Macular Perception (SMP)** is the foundational first grade of Binocular Single Vision (BSV), where both eyes perceive images simultaneously on corresponding retinal points. - **Fusion** is the second essential grade, where the brain actively merges these two simultaneously perceived images into a single unified percept. - These two components form the **essential foundation** for BSV. Stereopsis (Grade 3) is a higher function that depends on intact SMP and Fusion. - Together, SMP and Fusion represent the core sensory and motor mechanisms that enable binocular vision. *a. Stereopsis b. Fusion* - This option omits **SMP**, which is the primary prerequisite for all binocular functions. - Without SMP, the brain cannot perceive images from both eyes simultaneously, making fusion impossible. - Stereopsis cannot develop without the foundational presence of SMP. *a. SMP b. Stereopsis* - This option skips **Fusion** (Grade 2), which is the critical intermediate step between SMP and stereopsis. - Fusion is essential for merging the two images before depth perception (stereopsis) can occur. - The progression must follow: SMP → Fusion → Stereopsis. *a. Fusion b. SMP* - While containing the correct components, this reverses the physiological sequence. - **SMP must occur first** before fusion can take place—you cannot fuse images that aren't simultaneously perceived. - The correct hierarchy is SMP (Grade 1) followed by Fusion (Grade 2). [Practice more Ophthalmology PYQs on OnCourse]

6 Previous Year Questions with Answers & Explanations

Questions

A 15-year-old female presents with a painless, gradually increasing mass located at the superotemporal orbital rim (upper outer quadrant of the orbit), present for the past 10 years. On examination, the mass is non-tender and slowly progressive. What is the most likely diagnosis?

A patient presents with guttate lesions in one eye and bullous keratopathy in the other eye. What is the most likely diagnosis?

An elderly patient presents with white, dandruff-like deposits on the anterior lens surface, seen during slit-lamp examination. What is the most likely diagnosis?

Which condition is treated using an Intacs ring, as shown in the image?

The essential foundational components of binocular single vision are:

Which of the following is true about orbital cellulitis?

NEET-PG 2025 - Ophthalmology NEET-PG Practice Questions and MCQs

Question 1: A 15-year-old female presents with a painless, gradually increasing mass located at the superotemporal orbital rim (upper outer quadrant of the orbit), present for the past 10 years. On examination, the mass is non-tender and slowly progressive. What is the most likely diagnosis?

A. Epidermoid cyst
B. Dermoid cyst (Correct Answer)
C. Capillary hemangioma
D. Lacrimal gland tumor

Explanation: ***Dermoid cyst*** - This diagnosis is strongly suggested by the classic presentation of a **painless**, **slowly progressive** mass in a young patient, located near the **superotemporal orbital rim** (lateral to the lateral canthus). - Dermoid cysts are **congenital choristomas** formed by sequestration of ectoderm along embryonic lines of closure, often presenting fixed to the periosteum. *Capillary hemangioma* - These tumors typically present in infancy and exhibit characteristic rapid growth followed by **spontaneous involution** (not slow progression over 10 years). - They are usually soft, compressible, and display color changes (red/blue), unlike the description of a firm, non-tender mass. *Lacrimal gland tumor* - Primary lacrimal gland epithelial tumors are rare in children and primarily occur in **adults** (40-60 years). - They typically cause axial proptosis and globe displacement (inferonasal) due to growth within the **lacrimal fossa**, usually presenting with symptoms related to pressure or pain if malignant. *Epidermoid cyst* - While also slow-growing and painless, epidermoid cysts are less likely than dermoid cysts to be found in the deep subcutaneous tissue fixed to the periosteum near the lateral canthus. - Epidermoid cysts contain only stratified squamous epithelium and keratin, while **dermoid cysts** also contain skin appendages (hair follicles, sebaceous glands).

Question 2: A patient presents with guttate lesions in one eye and bullous keratopathy in the other eye. What is the most likely diagnosis?

A. Keratoconjunctivitis
B. Fuchs' endothelial dystrophy (Correct Answer)
C. Interstitial keratitis
D. Viral corneal ulcer

Explanation: ***Fuchs' endothelial dystrophy*** - This condition involves progressive loss of corneal endothelial cells and deposition of abnormal basement membrane material (**guttae**). The presence of **guttate lesions** represents early disease. - As the disease progresses and the remaining endothelial cells fail to pump fluid effectively, the cornea swells, leading to epithelial and stromal edema, clinically described as **bullous keratopathy**. *Interstitial keratitis* - This is non-ulcerative inflammation predominantly affecting the **corneal stroma**, often associated with systemic infections like **congenital syphilis** or Cogan's syndrome. - It typically causes stromal clouding and deep **neovascularization** (ghost vessels) but does not primarily involve guttate lesions or asymmetric endothelial failure. *Viral corneal ulcer* - Viral ulcers (like those caused by **HSV**) present acutely with epithelial defects, often in a dendritic or geographic pattern, and cause significant inflammation. - They are acute processes characterized by surface epithelial involvement, not characterized by the slowly progressive, **endothelial-based changes** (guttae and bullae) seen in Fuchs' dystrophy. *Keratoconjunctivitis* - This is a general term for inflammation affecting both the cornea and conjunctiva, commonly seen in **adenoviral infections** or severe dry eye (**KCS**). - The primary findings are typically conjunctival injection and punctate epithelial erosions, not the specific endothelial deposits (**guttae**) or resulting severe edema (**bullous keratopathy**) characteristic of Fuchs' dystrophy.

Question 3: An elderly patient presents with white, dandruff-like deposits on the anterior lens surface, seen during slit-lamp examination. What is the most likely diagnosis?

A. Iris cyst
B. Persistent pupillary membrane
C. Pigment dispersion syndrome
D. Pseudoexfoliation syndrome (Correct Answer)

Explanation: ***Pseudoexfoliation syndrome*** - The pathognomonic finding of **white, dandruff-like material** deposited on the **anterior lens capsule** (often forming a characteristic clear central zone and peripheral zone separated by a clear space) is indicative of Pseudoexfoliation syndrome. - This material is an **abnormal fibrillar glycoprotein** that can block the trabecular meshwork, elevating intraocular pressure and predisposing the patient to **pseudoexfoliation glaucoma**. *Iris cyst* - An iris cyst appears as a localized, non-transilluminating mass or elevation within the iris stroma or attached to the pupil margin. - It does not present as diffuse **dandruff-like material** covering the lens surface, which is the hallmark of pseudoexfoliation. *Persistent pupillary membrane* - This is a **congenital anomaly** where remnants of the embryonic **tunica vasculosa lentis** persist, appearing as fine strands bridging the pupil or extending from the iris collar to the lens. - They are typically dark, thread-like structures, and are not the widespread **white deposits** usually seen in elderly patients with PEX. *Pigment dispersion syndrome* - This condition involves the dispersion of **iris pigment**, which classically manifests as a **Krukenberg spindle** (vertical pigment line on the corneal endothelium) and dense pigment deposits in the trabecular meshwork. - The deposits are visually **brown/black (pigmentary)**, not white/gray as described in PEX, and they primarily affect the corneal endothelium and trabecular meshwork.

Question 4: Which condition is treated using an Intacs ring, as shown in the image?

A. Keratoconus (Correct Answer)
B. Glaucoma
C. Cataract
D. Corneal ulcer

Explanation: ***Keratoconus*** - The image displays **Intacs**, which are intracorneal ring segments specifically designed to treat **keratoconus** by flattening the steep cornea. - This procedure provides structural support to the weakened, cone-shaped cornea, thereby improving uncorrected and best-corrected visual acuity by reducing **myopia** and **astigmatism**. *Cataract* - Cataract treatment involves the surgical removal of the opacified natural lens, typically through **phacoemulsification**. - An **intraocular lens (IOL)** is implanted in place of the natural lens, not a ring within the corneal stroma as shown. *Corneal ulcer* - A corneal ulcer is an active infection of the cornea and is treated primarily with intensive **topical antimicrobial** therapy (antibiotics, antifungals, or antivirals). - Placing a foreign body like an Intacs ring is contraindicated in an active infection and would worsen the condition. *Glaucoma* - The goal of glaucoma treatment is to lower **intraocular pressure (IOP)** to prevent optic nerve damage. - This is managed with medications (eye drops), **laser procedures** (e.g., trabeculoplasty), or **filtration surgery** (e.g., trabeculectomy), none of which involve corneal ring implants.

Question 5: The essential foundational components of binocular single vision are:

A. a. Stereopsis b. Fusion
B. a. SMP b. Stereopsis
C. a. SMP b. Fusion (Correct Answer)
D. a. Fusion b. SMP

Explanation: ***a. SMP b. Fusion*** - **Simultaneous Macular Perception (SMP)** is the foundational first grade of Binocular Single Vision (BSV), where both eyes perceive images simultaneously on corresponding retinal points. - **Fusion** is the second essential grade, where the brain actively merges these two simultaneously perceived images into a single unified percept. - These two components form the **essential foundation** for BSV. Stereopsis (Grade 3) is a higher function that depends on intact SMP and Fusion. - Together, SMP and Fusion represent the core sensory and motor mechanisms that enable binocular vision. *a. Stereopsis b. Fusion* - This option omits **SMP**, which is the primary prerequisite for all binocular functions. - Without SMP, the brain cannot perceive images from both eyes simultaneously, making fusion impossible. - Stereopsis cannot develop without the foundational presence of SMP. *a. SMP b. Stereopsis* - This option skips **Fusion** (Grade 2), which is the critical intermediate step between SMP and stereopsis. - Fusion is essential for merging the two images before depth perception (stereopsis) can occur. - The progression must follow: SMP → Fusion → Stereopsis. *a. Fusion b. SMP* - While containing the correct components, this reverses the physiological sequence. - **SMP must occur first** before fusion can take place—you cannot fuse images that aren't simultaneously perceived. - The correct hierarchy is SMP (Grade 1) followed by Fusion (Grade 2).

Question 6: Which of the following is true about orbital cellulitis?

A. Treated effectively with topical antibiotics
B. Ethmoid sinusitis is the most common etiology (Correct Answer)
C. It is present anterior to the orbital septum
D. Presents with proptosis, orbital swelling, normal pupil, and extraocular movements

Explanation: ***Ethmoid sinusitis is the most common etiology*** - Orbital cellulitis most frequently results from the spread of infection from adjacent structures, with the **ethmoid sinus** being the most common source due to the thin **lamina papyracea** separating it from the orbit. - It is almost always a serious complication of **acute bacterial sinusitis**, necessitating urgent aggressive management. *It is present anterior to the orbital septum* - Cellulitis **anterior to the orbital septum** is termed **preseptal** or **periorbital cellulitis**, which is a less severe condition. - Orbital cellulitis is characterized by infection and inflammation extending **posterior to the orbital septum**, affecting the deep orbital soft tissues. *Treated effectively with topical antibiotics* - Topical antibiotics are wholly inadequate for managing such a severe, deep-seated infection with risk of intracranial spread. - Treatment for orbital cellulitis requires immediate initiation of **systemic broad-spectrum intravenous antibiotics**. *Presents with proptosis, orbital swelling, normal pupil, and extraocular movements* - Orbital cellulitis typically causes severe pain, **proptosis**, **chemosis**, and crucially, **restricted and painful extraocular movements** (ophthalmoplegia). - The presence of restricted Extraocular Movements (EOM) and often an **Afferent Pupillary Defect (APD)** differentiates orbital cellulitis from preseptal cellulitis.