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Osama’s

Ophthalmology Notes
In my second attempt of FCPS part 1 ophthalmology, I made one-liner notes from
each and every MCQ of ophthalmology I read in the huge compilation of past
paper files by Dr. Omar HanifJanjua, Dr. Khalid Khan and few other members.
Recently, I studied new past paper files of ophthalmology from year 2015 and
2016 compiled by respectable candidates, added March 2017 eye MCQs which I
compiled myself and Dr. Faisal Mitru and Dr. SohailBukhari made the effort in
correcting its keys (sadly I couldn’t pass this one either) and also studied ‘eye’ and
‘vision’ MCQs from Rabia Ali 4th edition, ophthalmology papers given in
Chandkians 6th edition, 550 Apple and Rabb ocular pathology MCQs, high yield
embryology eye chapter, all eye related points from Tanveer’s Notes 3rd edition
and Golden 1 points in SK pearls, and finally added all this additional stuff to those
existing notes and arranged them categorically. In September 2017, Dr. Arqam
Shariq Syed also contributed updating this file with May 2017 and September
2017 papers. The November 2017 paper and some additions were done by Dr.
Mehrunnisa. March 2018 edition was updated by Dr. Nida. Editions of May and
September 2018 was updated by Dr. Muhammad Raihan. November 2018 edition
was updated by Dr. Anum Yousaf.
In my opinion, these notes represent more than 95% of all ophthalmology MCQs
present in MCQ books and eye past paper files (because I read all those files in my
2nd attempt while making these notes for the first time and read all 2015-2016
files in 4thattempt). So after reading through these notes I am sure that you DON'T
need to go through those files separately which contain many repetitions of same
MCQs again and again, and hence they look like a huge pile to complete in a very
small time while actually most of them contain same MCQs repeatedly.
Obviously, some of these one-liners may contain mistakes too (because some
MCQs were answered differently by different members). But we tried to correct

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as many points as possible by repeated discussions on controversial MCQs on
Facebook group www.facebook.com/groups/1574550492865498/
Also you can join WhatsApp Ophthalmology group for Part I.
https://chat.whatsapp.com/HQ1wlan5dcEKtdoU6K1fgN
These notes are best for repeated quick revisions in last weeks before appearing
in ophthalmology exam. In my last attempt, I read them once daily in last 7 days
and you can see the March 2017 eye paper file to see that many MCQs related to
eye were repeated from these.
MOST IMPORTANTLY, if you think a point contains a mistake, please tell me about
it with authentic reference so correction can be made.
=======================================
Please note that:
- These notes are made mostly from MCQs of eye past papers, points added by
me are very few.
- Not even a single MCQ related to ophthalmology in past papers files was
skipped. Every MCQ I read (which was related to eye in anyway) is converted to a
one-liner and added here. Even MCQs with the word 'except' are converted to a
sentence with 'not/no' in it.
- I excluded all general MCQs from the papers and included only eye and eye-
related neuroanatomy MCQs in these notes.
Still if you want all the ophthalmology past paper files I collected, these are all
present on this link : http://bit.ly/fcpsbox
Here is the story of my own struggle through Part 1 :
https://www.facebook.com/groups/102979646495000/permalink/1235324066
593880/
========================================
The only thing I ask in return is to remember me in your prayers and help others
where and when you can. May ALLAH help us all. Aameen.

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Development:
 Optic vesicles appear from walls of diencephalon (forebrain) on day 22 (High Yield Embryology).
 Closure of choroid fissure at 7th week of gestation (High Yield Embryology) (6th week according to
Apple and Rabb MCQS)
 Failure of closure of choroid fissure results in coloboma. Most commonly affected structure is IRIS
(Nov 2017)
 Hyaloid artery regresses 6 weeks before birth (Snell), hyaloid artery and hyaloid vein become central
artery and vein of retina.
 Ganglion cells are first retinal cells to be recognized.
 Rods and cones are visible at the end of first trimester.
 Corneal nerves appear at 5th month.
 Pupillary membrane disappears at 8th month. (September 2018)
 Anterior chamber forms by splitting of mesoderm.
 Frontal sinus forms after birth.
 No psychogenic tear production until 3 months of age.
 Optic nerve is not completely myelinated until 3 months after birth (High Yield Embryology).
 Intraretinal space is obliterated in adults but it is a weakened area prone to retinal detachment (High
Yield Embryology).
 Ganglion cells cover the fovea at birth. (Nov 2017)

Sphincter and dilator pupillae muscle derived from ectoderm of optic cup. (March 2018)
Eyelids derived from both ectoderm and mesoderm(Nov 2018)
Neurosensory retina derived from neuroectoderm (Nov 2018)

DERIVATIVES:

Neural Crest Cells Ciliary ganglion, Corneal and choroidal stroma,


Uveal melanocytes, Trabecular meshwork,
Tendons of extraocular muscles, Optic nerve
sheath, Medial and inferior orbital bones
Neuro-ectoderm Sphincter (Sept 2018)/Dilator pupillae, Pigmented
iris epithelium, Ciliary epithelium, Sensory retina,
RPE (March + May 2018) , Optic nerve, LGB,
Posterior pituitary gland
Surface Ectoderm Lens(Nov 2017, March + May 2018), Lens
zonules, Lacrimal gland(Nov 2017), Nasolacrimal
duct, Glands of Moll, Corneal and conjunctival
epithelium
Mesoderm Sclera, Choroid, Lower 4 corneal layers,

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Extraocular muscles, Ciliary muscles, Iris and
ciliary body stroma, Orbital vessels endothelium,
Central retinal artery, Connective tissue
Mixed Eyelids (Ectoderm+Mesoderm) (Sep + Nov 2017)
(May 2018)
Ciliary Body (Neuroectoderm+Mesoderm) (T.N
3rd ed page 96)(May 2017)
Vitreous (In High Yield Embryology, it is from
mesoderm)
Telencephalon Cerebrum (Lateral ventricles)

Diencephalon Hypothalamus, Thalamus. (3rd Ventricle)

Mesencephalon Midbrain (Cerebral Aqueduct)

Metencephalon Pons, Cerebellum (4th ventricle upper part)

Myelencephalon Medulla (4th ventricle lower part)

Cornea:
1. Cornea is 1/6th of globe.
2. Diameter = 12 mm horizontal and 11 mm vertical
3. Thickness = 0.5 mm (Thinner at center =0.5-0.6mm, thicker at periphery=0.7mm)
4. Radius of curvature of anterior surface = 7.7 mm. Radius of curvature of posterior surface= 6.9mm
(less in myopic eye) (Snell Clinical Anatomy of Eye 2nd ed pg. 143)
5. Refractive index = 1.37
6. Anterior surface of the cornea is maximum contributor (43D) to refractive power of the eye (59D)
(T.N 3rdedpage 140)
7. Corneal reflex afferent is by ophthalmic branch of trigeminal nerve. (Sep 2017, March + May 2018)
8. Corneal reflex pathway goes through Trigeminal ganglion to sensory cortex.
9. Corneal reflex is infrequent in infants.
10. Sensory Nerve supply of cornea is Nasociliary nerve (trigeminal > ophthalmic (V1) > nasociliary >
long ciliary) (May 2018)
11. Corneal layers:
12. Epithelium = Stratified squamous non-keratinized (T.N 3rdedpage 121 and 171) (May 2018)
13. Corneal Epithelium produces MMP-9.
14. Corneal Epithelium lies on the Bowman’s membrane. (May 2017)

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15. Bowman’s membrane= Cannot regenerate. (Continuous with trabecular meshwork)
16. Stroma = Collagen Type 1 held by GAGs. Stroma forms 90% of total
thickness of cornea not 70%.(Nov 2018) Descemet’s membrane= Can regenerate, it is
basement membrane for endothelium, contains type 4 collagen (Sep 2017), Fetal Descemet’s
membrane has banding pattern, It ends abruptly at Schwalbe’s line.
Descement membrane is basement membrane of endothelial cells (Nov 2018)
17. Endothelium = Corneal transparency is DUE TO lattice arrangement of collagen fibrils and
MAINTAINED BY endothelial pump, it has 5000 cells per mm2 at birth, 3000 at 40 years of age and
less than 500 cause corneal edema. (Both points asked in 2 different questions in Nov 2017)
Corneal transparency is maintained by intact endothelium (Nov 2018)
18. Cornea is insensitive to warm.
19. Cornea gets oxygen from ATMOSPHERE.
20. Tears contain more potassium than plasma. (Chandkians 6th ed page 569) (September 2018)
21. Tear film has outer lipid layer which is thinnest, middle aqueous layer which is THICKEST and inner
mucin layer.
22. Lipid layer prevents underlying aqueous layer from evaporating and it also lubricates the conjuctiva.
23. Mucin is secreted by Goblet cells in the lamina propria of conjunctiva.
24. Bulbar conjunctiva and sclera attached strongly at Tenon’s capsule at bulbar limbus. (Snell 2nd ed pg.
109)
25. Surgical limbus width is 2 mm.
26. Palisades of Vogt are the sites for corneal regeneration because they contain stem cells.
27. Corneal source of energy pathway is glycolysis. (Sep 2017, March 2018)
28. There are unmyelinated nerve fibers in the cornea.
29. Source of oxygen for cornea in a 1-year-old child is atmosphere. (atmosphere˃tear film˃corneal
epithelium) (March and September 2018)
30. Fuch’s dystrophy occurs in Endothelium
31. Regarding Cornea, it has 523 to 530 microns (about 0.5mm) (May 2018)
32. Regarding central Cornea, it has 565 to 580 microns (about 0.5mm to 0.6mm) (September 2018)

Eyelids:

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1. While performing surgery on eyelids, an ophthalmologist must know the correct arrangement of
structures within the eyelids which is skin>aponeurosis>orbital septum>Muller muscle>conjunctiva.
(Nov 2017)
2. Blink rate = 12-20 times per minute
3. Infants blink less frequently
4. Lacrimal sac capacity = 30 ul
5. Meibomian glands open posteriorly to eyelashes.
6. Glands of Zeis opens through follicle. (May 2018)
7. Meibomian glands are located within Tarsus. (Apple and Rabb MCQs)
8. In upper eyelid, levator aponeurosis is analogous to capsulopalpebral fascia of the lower eyelid, both
retract the Tarsus. (T.N 3rded page 88)
9. Levator aponeurosis is attached with ‘Whitnal’s tubercle’.(November 2018)
10. Muscle of Riolan is part of orbicularis oculi and it is situated near lid margin. (Apple and Rabb
MCQs)
11. Lateral parts of both eyelids drain into preauricular lymph nodes.
12. Meibomian gland DUCT epithelium = Stratified squamous epithelium (Sep 2017)
13. Meibomian gland epithelium = Simple columnar epithelium (May 2017)
14. Lacrimal canaliculi = Stratified squamous epithelium
15. Lacrimal gland = Simple columnar epithelium with myoepithelial cells
16. Lacrimal sac = stratified columnar epithelium with goblet cells (Snell 2nd ed pg. 120)
17. Nasolacrimal duct = stratified ciliated columnar epithelium
18. Palpebral conjunctiva = Non-keratinized stratified squamous epithelium
19. Bulbar conjunctiva = Stratified columnar epithelium (September 2018)
20. Number of cells layers in Conjunctival epithelium = 4-6 layers (Sep 2017)
21. Goblets cells in conjunctiva are majorly distributed INFERIO-MEDIALLY. (Snells Eye Anatomy Pg.
110) (Sep 2017)
22. Glands of Moll are apocrine.
23. In eyelids, tarsal (Meibomian) glands are modified sebaceous glands. (Snell 2nd ed pg. 99) (May
2017)
24. Accessory lacrimal gland of Krause is in upper fornix. They produce basal tears to keep cornea moist,
Main lacrimal gland only takes part in psychogenic or irritable tear generation.
25. Basal tear production is mainly from Glands of Krause. (May 2018)
26. Grey line at the end of the eyelid is formed by mucocutaneous junction.

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27. Orbicularis oculi also helps in lacrimal drainage; its contraction causes pressure on lacrimal sac which
causes its emptying. This is why it is important part of lacrimal pump.
28. Facial nerve palsy leads to paralysis of orbicularis oculi and sagging of lower eyelid, both factors lead
to epiphora.
29. Lacrimal gland is Serous. (May 2018)
30. Tear film is drained in Superior and Inferior Puncta. (May 2018)
31. Patient comes with infection of outer eyelid, lateral part of eyelid drains into Pre auricular nodes.
(May 2018) 32.Tear film drains via Lacrimal punctum into canaliculus which leads
to lacrimal sac (Nov 2018)

Anterior Chamber:
1. Volume of aqueous humor = 0.25 - 0.30 ml (Nov 2017, May 2018)
2. Depth of anterior chamber = 3 mm
3. Normal IOP = 10 - 20 mmHg
4. PaO2 of aqueous humor is 55 mmHg.
5. pH of aqueous humor = 7.2
6. Refractive index of aqueous humor is 1.33, same as vitreous. (Sep 2017)
7. Highest resistance to outflow of aqueous is at juxtacanalicular trabecular meshwork.
8. Trabecular meshwork is LEAST RESISTANT at the UVEAL PART (Sep 2017)
9. Schlemm’s canal drains into aqueous veins.
10. Aqueous veins cannot be seen on gonioscopy.
11. Schwalbe’s line is anterior to trabecular meshwork. (Apple and Rabb MCQs) (May 2018)
12. Schlemm’s canal is anterior to scleral spur.
13. From central to peripheral the angle structures are: Schwalbe’s line -> Non-pigmented trabecular
meshwork -> Pigmented trabecular meshwork -> Scleral spur ->Ciliary body band
14. Aqueous humor has carbonic anhydrase, lysozyme and hyaluronidase at functioning levels.
15. Aqueous humor has more ascorbic acid/Vitamin C than plasma.
16. Aqueous flow rate is 2.3 ul/min
17. Aqueous contains IgG and IgM. And IgE
18. Aqueous humor is secreted by ciliary processes.(Nov 2018)
19. Aqueous humor production is majorly by Active transport. (May and September 2018)
20. Valsalva maneuver raises IOP.
21. Trabecular meshwork more dilated at uveoscleral region. (March 2018)

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22. Aqueous contains Ascorbate more than plasma (September 2018) 23.
Aqueous humor fills anterior and posterior chamber of eye.

Lens:
1. Diameter = 9-10 mm (8 to 10 mm) (May 2018)
2. Thickness = 4-5 mm
3. Refractive index = 1.39 (overall), 1.42 (nucleus), 1.38 (cortex)
4. Anterior radius of curvature = 10 mm
5. Posterior radius of curvature = 6 mm
6. Lens refractive power depends on its curvature.
7. Lens is thinnest at EQUATOR. (May 2017)
8. Lens capsule thinnest at POSTERIOR POLE. (May 2018)
9. Taxon specific crystalline present in lens absorbs ultraviolet light.
10. Alpha crystalline = Largest lens crystalline
11. Beta crystalline = Abundant lens crystalline
12. Lens has no sensory innervation. (May 2017, March , May 2018 & Nov 2018)
13. Lens is Avascular. (May 2018)
14. Lens cannot regenerate (T.N 3rded page 62)
15. Lens need continuous supply of glucose. (May , Nov 2017 And Nov 2018)
16. Lens metabolism is by anaerobic pathway.
17. Most mitotically active lens epithelial cells are at equator.
18. Crystalline lens epithelium is mitotically active throughout its span. (Sep 2017)
19. Lens epithelium is simple cuboidal located beneath the capsule only on the anterior surface. (High
Yield Embrology)
20. Most common congenital anomaly of lens is LENS COLOBOMA. (March 2018) (May 2018)
(ANOMALY = COLOBOMA, DEFORMITY = ECTOPIA LENTIS)
21. Most common congenital ABNORMALITY of lens is ECTOPIA LENTIS. (May 2018)
22. Lens accommodation at 70 years is 2 Diopters. (May and September 2018)

Sclera:
1. Maximum thickness = 1mm

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2. Mostly avascular
3. 65-70% water
4. Weakest at lamina cribrosa (according to Snell’s ocular anatomy) , at posterior to recti insertion
(according to Apple and Rabb MCQs)
5. Sclera Thinnest at posterior to recti insertion. (May & Nov 2017) This is where sclera starts
developing.
6. Sclera can be bluish in newborns and in patients of Marfan’s syndrome and osteogenesis imperfecta.
7. Sclera is continuous with dura mater (High Yield Embryology).

Choroid:
1. Choroid is continuous with pia and arachnoid mater (High Yield Embryology).
2. Choroidal vessels cause metastasis of malignancy.
3. Choroidal vessels are most fenestrated at submacular region(Chandkians 6thed page 571)
4. Choroidal capillaries diameter is maximum at macula (Snell 2nd ed pg 157)
5. Damage to the choroidal vessels will cause INTER-RETINAL HEMORRHAGE. (May 2017)
6. Bruch’s membrane separates choroid from retina. (September 2018 & Nov 2018)
7. Bruch membrane lies between RPE and Choroid. (May 2017)
8. Choroidal capillaries are not part of Bruch’s Membrane.
9. Bruch’s membrane is also called vitreous lamina because of glassy appearance.
10. Sub-macular fluid leaks from Choriocapillaries. (September 2018) 11.Submacular
fluid leaks from choroid (choriocapillaries was not in options) (Nov 2018)

Retina:
1. Outer nuclear layer (4th layer) = Nuclei of rods and cones (September 2018)
2. Outer plexiform layer = Bipolar and horizontal cells
3. Inner nuclear layer = Nuclei of bipolar and horizontal cells, Amacrine cells, Muller cells
4. Central retinal artery supply retina upto inner nuclear layer, retina behind it is supplied by choroidal
vessels.
5. Sequence of connection: BIPOLAR CELLS>>INNER PLEXIFORM LAYER>>GANGLION
CELLS.
6. Optic disc is a blind spot.
7. Optic disc diameter = 1.5 mm (March 2018)

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8. 3 mm infratemporal to optic disc is fovea/macula. (Nov 2017)
9. Macula is represented at large posterior part of occipital lobe/visual cortex .
10. Macula diameter= 5mm (Snell 2nd ed pg 186)
11. Fovea diameter is 1.5 mm (Snell 2nd ed pg 186)
12. Foveola diameter is 0.3 mm
13. Fovea has more cones.
14. Visual acuity is increased by foveal cones (Rabia Ali 4thed page 211)
15. Rods to cones ratio in retina is 20: 1
16. Rods have higher sensitivity. Rods work best in low light situations.
17. Cones detect white light or colours.
18. Rods and cones both have glutamate as neurotransmitter.
19. Light adaptation takes 5 minutes.
20. Dark adaptation takes 20-30 minutes.
21. Dark adaptation involves regeneration of lumirhodopsin from metarhodopsin or opsin and retinine.
(Nov 2017)
22. Person comes into a dark room from bright sunlight, what changes will occur mostly in dark
adaptation? Regeneration of rhodopsin. (May 2018)
23. Dark adaptation is avoided by red goggles (Chandkians 6thed page 573)
24. Workers should wear RED GOGGLES to avoid dark adaptation. (September 2018)
25. Sensory retina is thickest at perpapillary region.(Nov 2018)
26. Retina is thickest at posterior pole BELOW the optic disc. (inferior > superior > nasal > temporal)
27. Retina is thinnest at foveola.
28. Retinal detachment occurs mostly at retinal pigment epithelium.
29. Retinal pigment epithelium is the outermost layer of retina. It covers the outer surfaces of rods and
cones.
30. Retinal pigment epithelium is supplied by choroidal vessels.
31. Retinal pigment epithelium is simple cuboidal anteriorly and simple columnar posteriorly.
32. Retina becomes white after death.
33. Visual pigment is filled between the discs of rods and cones.
34. Chromophore for all visual pigments is 11-cis-retinaldehyde.
35. 11-cis-retinal converts to all-trans-retinal in presence of light.
36. Rhodopsin is deactivated by Rhodopsin kinase and Arrestin.
37. Amacrine cells and horizontal cells perform lateral inhibition. (horizontal > amacrine)
38. Lateral inhibition in retina done by Horizontal cells (September 2018)

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39. Horizontal cells secrete GABA (Chandkians 6thed page 576)
40. GAGs and +ve hydrophobic forces keep sensory and neural retina together. (March 2018)
41. Astrocytes give structural support to optic disc and retina.
42. 15% people have cilioretinal artery contributing to macular circulation which protects the macula in
case of CRAO. (Similar question in May and September 2017)
43. Regarding cilio-retinal artery, most appropriate is Good prognosis in CRAO. (September 2018)
44. Nuclei of horizontal cells are in inner nuclear layer (Chandkians 6thed page 572)
45. Bodies of photoreceptors are in layer 4 (outer nuclear layer).
46. Respiratory rate of retina is twice as that of brain.
47. Photoreceptors of retina carry Docosahexaenoic acid. (March 2018)
48. Outermost layer of retina is pigmented epithelial layer. (March 2018)
49. Pigment epithelial layer and sensory retina are kept intact by GAGs. (March 2018)
50. RPE and sensory retina are bound together because of GAGs. (September 2018)
51. Pars optica retina has a nervous component. (March 2018)
52. Retinal pigment epithelium derived from neuroectoderm. (March 2018) (May 2018)
53. Transmitter cells of eye are bipolar cells. (March 2018)
54. Ganglion cells have the property to self-generate action potential. (May 2018)
55. Hyperpolarization of photoreceptors, = Na channel is blocked. (September 2018) 56.
Macula is 3mm lateral to optic disc (Nov 2018) 57. Distance between fovea centralis
(Not macula) and Optic disc is about 6.5mm (macula is 5mm and fovea is 1.5mm if u calculate
distance by using this information it comes about about 6.5mm which was not in options )

Iris and ciliary body:


1. Bilateral granulomatous inflammation of uvea alongwith loss of visual acuity following blunt trauma
to one eye is the result of T cell activation due to release of sequestered antigens (of uvea) (Nov 2017)
2. When the colour of one iris is different from the other, it is called Heterochromia Iridum. It is a
hereditary condition.
3. In sphincter pupillae, group of smooth muscle cells are 8 in number.
4. Innermost muscles in ciliary body are circular. (Nov 2017) (September 2018)
5. Aqueous is secreted by active transport mainly (May 2018), also by diffusion, ultrafiltration and
carbonic anhydrase 2 activity. (Nov 2017)
6. Aqueous production decreases in exercise.

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7. Ciliary body has 2 layers of CUBICAL epithelia, outer pigmented and inner non-pigmented. (snell 2nd
ed pg 161)
8. Both epithelia secrete aqueous according to new research, previously it was considered that only inner
non-pigmented epithelium secretes aqueous.
9. Outer pigmented ciliary epithelium is continuos with RPE.
10. Iris has also bilayered columnar epithelia, both are pigmented here.
11. Iris dilator muscles arise from anterior iris epithelium.
12. Anterior ciliary vein drains iris and ciliary body.
13. LigamentumPectinatum attaches ciliary body with lens.(May 2017)
14. Ligament (forming some meshwork) present between sclera and ciliary body is
LigamentumPectinatum. (Sep 2017)
15. Firm uveoscleral attachment at optic nerve, vortex veins and scleral spur.
16. On looking close, ciliary muscle contraction causes lens to be more globular.
17. On looking far, ciliary muscle relaxation causes lens to be more flatter. Beta-2 receptor activation
causes relaxation of ciliary muscles.
18. Alpha-adrenergic receptor activation causes contraction of radial muscles of iris, leading to mydriasis.
(T.N page 212)(Sep , Nov 2017 & Nov 2018)
19. Ora serrata is 8.5 mm away from limbus, on nasal side it is 7.5 mm away.
20. Distance of ora serrata from limbus nasally is: 7.5mm (ref Snell ocular anatomy)
21. True about ciliary body is pigment epithelium of retina is continuous with pigment epithelium of
ciliary body. (Sep 2017)
22. Nerve supply of sphincter pupillae muscle is parasympathetic from Edinger-Westphal nucleus.
(March 2018)
23. Iris muscle has alpha adrenergic supply. (March 2018)
24. Nerve supply of ciliary muscle is short ciliary nerve. (March 2018)
25. Type of receptor on constrictor pupillae muscle is muscarinic type 3. (March 2018)
26. Receptor activated in ciliary muscle during accommodation is muscarinic. (March 2018)
27. True statement about ciliary body is that it is covered by double epithelium. (May 2018)

Vitreous:
1. Volume of vitreous = 4 ml (Nov 2017) (May 2018)
2. Transparent, contains 99% water.

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3. Vitreous main content is Water. (September 2018)
4. Contains collagen type 2 (90% of all collagen of vitreous), type 5, type 9 and type 11. No collagen
type 4.
5. Refractive index of vitreous is 1.33, same as aqueous humor.
6. Hyaluronic acid is the major GAG of vitreous.
7. Hyaloid canal contains hyaloid artery. (September 2018) before birth which regresses almost 6 weeks
before birth.
8. Strongest vitreous attachment is with ora serreta.
9. Ligament of Wiegert connects vitreous with posterior surface of lens.

Extraocular Muscles:
1. Superior rectus = longest RECTUS (Receives crossed innervation from contralateral brainstem
subnucleus)
2. Lateral rectus = longest tendon among recti (Receives only 1 artery from anterior ciliary artery, rest of
recti by 2)
3. Medial rectus = Largest extraocular muscle, with shortest tendon (Minimum distance from limbus)
4. Inferior rectus = Shortest rectus (Supplied by 3 arteries)
5. Inferior oblique = Shortest extraocular muscle (No tendon)
6. Superior oblique= longest tendon and belly among all extraocular muscles
7. Superior oblique is lastly affected by local anesthesia. Prime depressor of eyeball when eye is
medially rotated.
8. Long and thin extraocular muscle= superior oblique (Sep 2017)
9. Both obliques pass inferiorly to recti.
10. Superior and inferior oblique do not originate mechanically from orbital apex.
11. Inferior oblique does not originate from orbital apex either mechanically or anatomically.
12. Common tendonous ring is Also called Annulus of Zinn.
13. Superior oblique supplied by CN4/Trochlear, lateral rectus supplied by CN6/Abducent (March 2018)
and rest of extraocular muscles are supplied by CN3/Oculomotor [ RememberLR6(SO4)3 ]
14. Superior oblique depresses and abducts the eye.
15. Inferior oblique elevates and abducts the eye.
16. (Both superiors __ intorters) (Both inferiors __ extorters)

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17. Primary depressor of eye when aBDucted at 23degrees is inferior rectus. (March 2018)
18. Elevator of eye in primary position (looking straight) is Superior rectus. (March 2018)
19. To CHECK superior rectus instruct the patient to look above and laterally. (March 2018)
20. Muscle attached closest to limbus is Medial Rectus. (May 2018)
21. Levator palpebrae superioris helps in opening the eye. (May and September 2018)
22. Inferior oblique is the Extorsion muscle. (May 2018 &Nov 2018)
23. LEVATOR PALPABRAE SUPERIORIS has autonomic and somatic nerve supply. (September
2018) 24.Patient is having diplopia on looking lateral with right eye : Right
abducent palsy (Nov 2018)

Orbit:
1. Medial wall = Thinnest (0.5 cm) Formed majorly by ethmoid bone which is also called lamina
paperecia.
2. Inferior wall = Weakest (especially at medial aspect) It is the site of blow-out fractures of
orbit.Formed by Maxilla and Zygomatic bones. Presents as diplopia and there may be anesthesia of
the cheek due to involvement of infraorbital nerve. (Nov 2017)
3. Lateral wall = Strongest (Greater wing of Sphenoid is also a part of it, mostly it is formed by
Zygomatic bone)
4. Superior orbital fissure lies between greater and lesser wings of sphenoid bone.
5. Greater wing of sphenoid is a part of lateral orbital wall.
6. Palatine bone is NOT a part of medial orbital wall.
7. Eye in orbit is near to roof and lateral wall.
8. Volume of orbit = 30 ml
9. iVolume of eyeball = 6.5 ml
10. Anteroposterior diameter of eyeball is 22-24 mm. (May 2018)
11. Lacrimal gland lies in lacrimal gland fossa formed by anterolateral part of frontal bone.(Nov 2018)
12. Lacrimal gland lies in lacrimal fossa in superior orbital wall. (May 2017)
13. Lacrimal gland lies in the roof of the orbit. (Sep 2017)
14. Lacrimal gland fossa formed by 1 bone, lacrimal sac fossa formed by two bones.
15. Lacrimal gland is primarily serous. (Nov 2017) (May 2018)
16. Main lacrimal gland only takes part in psychogenic or irritationaltearing, otherwise eye is kept moist
by accessory lacrimal glands.
17. Corneal surface is kept moistened by GREATER PETROSAL NERVE. (Sep 2017)
18. Cornea dry, nerve damage is in Greater petrosal nerve. (September 2018)

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19. No HIV is present in tears.
20. Tears are 30% aqueous, rest is mucin and lipid.
21. Lockwood ligament is the suspensory ligament of globe.
22. Orbital septum is attached to anterior lacrimal crest and posterior lacrimal crest.
23. Orbital septum is attached to posterior lacrimal crest of . (May 2017) It should be noted that anterior
lacrimal crest is formed by maxilla while posterior by lacrimal bone. (Nov 2018)
24. Inferior ophthalmic vein spreads infection (like orbital cellulitis) to cavernous sinus (T.N 3rded page
93). Infection is spread to cavernous sinus via Inferior ophthalmic vein (May 2018)
25. Superior ophthalmic vein spreads thrombosis to cavernous sinus (T.N 3rd edition) (Nov 2018)
26. Sign of cavernous sinus thrombosis is abducent nerve palsy.
27. Orbicularis oculi is attached to lateral raphe.
28. Glabella is part of frontal bone.
29. Two long posterior ciliary arteries enter sclera at 3 and 9 o’ clock to optic nerve.
30. No lymphatics are present in orbit.
31. There are 2 venous systems in eye, whole uvea including iris is drained by vorticose vein, one vortex
vein drains each quadrant.
32. Supply to fovea/macula is by choriocapillaries which arise from short posterior ciliary arteries.
33. Choriocapillaries network is most dense at the SUB-MACULAR region. (May 2017)
34. Choriocapillaries are branches of Short Posterior Ciliary arteries. (Sep 2017 and September 2018)
35. Choriocapillaries provide nutrition to outer 1/3rd of retina. (Nov 2017)
36.Nerve passing through cavernous sinus is abducent nerve.(Nov 2018) 37.Optic canal
is formed by sphenoid bone.(Nov 2018) 38. Inferior and anterior relation of pituitary gland
is sphenoid air sinus.(Nov 2018)

Nerves and Tracts:


1. Optic nerve fibers contain SPECIAL SOMATIC AFFERENT (SSA) fibers. (Sep 2017)
2. Lacrimal,frontal and trochlear nerves pass outside Annulus of Zinn.
3. Abducent nerve passes through superior orbital fissure within the annulus of zinn. [mnemonic =
LFTS(ONA)] (May 2018)
4. Nerve supply to medial canthus and lacrimal sac is by infratrochlear nerve (Chandkians 6thed page
570)
5. Medial inferior orbit supply = Infratrochlear nerve

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6. Medial superior orbit supply = Supratrochlear nerve (it also supplies medial forehead and upper
eyelid)
7. Lacrimal gland is supplied by greater petrosal nerve through pterygopalatine ganglion.
8. Lacrimal nerve arises from origin of lateral rectus, it has sensory, sympathetic and parasympathetic
components.
9. Longest portion of optic nerve is intraorbital = 25 mm
10. Smallest portion of optic nerve is intraocular = 1 mm (out of it only retrolaminar is myelinated)
11. Each optic nerve has 1.2 million axons. (May 2017)
12. Short ciliary nerve (parasympathetic to iris) and nerve to inferior oblique travel below optic nerve.
Nerve to inferior oblique passes 12 mm behind globe below optic nerve.
13. Short ciliary nerve is parasympathetic to sphincter pupillae (causes miosis), Its post ganglionic
parasympathetic fibres synapse in ciliary ganglion. Therefore injury of ciliary ganglion causes loss of
miosis and pupil gets dilated (Adies pupil). Its preganglionic parasympathetic fibreslie in Edinger-
Westphal nucleus (Rabia Ali 4thed page 212) Lesion of Edinger-Westphal nucleus causes absent light
reflex and absent accomodation.
14. Long ciliary nerve is sympathetic to dilator pupillae (causes mydriasis).
15. Long ciliarynerve is also the sensory supply to the cornea and therefore a part of corneal reflex
pathway (it is a branch of ophthalmic nerve).
16. Afferent component of corneal reflex is by nasociliary nerve (Rabia Ali 4thed page 96).
17. Corneal reflex afferent is present in trigeminal nerve. (TRIGEMINAL> OPHTHALMIC DIV >
NASOCILIARY> LONG CILIARY NERVES) (Nov 2017) (May 2018)
18. Cornea is supplied by nasociliary nerve. (Nov 2017) (May 2018)
19. Y-type ganglion cells (for fast vision) end on layer 1 and 2 (magnocellular) in lateral geniculate body.
(September 2018)
20. Parvocellular pathway is most sensitive for the stimulus of colour contrast (Rabia Ali 4thed page 212).
21. In oculosympathetic pathway, 3rd order neurons are in superior cervical ganglia.
22. Optic nerve in cranium is medial to internal carotid artery and inferior to anterior cerebral artery.
23. Optic nerve is special somatic afferent.
24. Oligodendrocytes form myelin sheath of optic nerve (just like they do in CNS).
25. Myelination of optic nerve is from posterior to anterior.
26. Subarachnoid space extends upto retina.
27. Ganglion cells are 2nd order neurons in visual pathway.
28. Pupillomotor fibres of oculomotor nerve runs peripheral in nerve in inferior division.
29. Infraorbital nerve and nerve from pterygopalatine ganglion pass through inferior orbital fissure.

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30. In cavernous sinus, Trochlear nerve lies between Oculomotor above and ophthalmic divison of
Trigeminal nerve below.
31. Orbicularis oculi (it closes the eye) is supplied by Zygomatic branch of Facial nerve (Rabia Ali 4thed
page 96).
32. In Facial nerve lesion, patient can’t close the eye (T.N 3rded page 185).
33. A patient has difficulty closing his eye alongwith sagging of lower eyelid. This is due to involvement
of ORBICUALRIS OCULI. (Nov 2017)
34. Levator palpebrae superioris(it opens the eye). is supplied by superior division of Oculomotor nerve
(supratrochlear nerve) and its nucleus is shared by both Oculomotor nerve nuclei.(Sep 2017)
35. Levator palpebrae superioris OPENS THE EYE. (May 2017) (May 2018)
36. Orbicularis oculi CLOSES THE EYE.
37. In oculomotor nerve lesion, patient can’t open the eye (T.N 3rded page 185).
38. If patients tilts his head to avoid diplopia, lesion is in trochlear nerve or superior oblique.
39. Oculomotornerver lesion leads to diplopia in primary position along with ptosis and deviation of eye
infrolaterally.
40. Nerve involved in ptosis is Oculomotor nerve. (May 2018)
41. Optic tract lesion causes contralateral homonymous hemianopia. (May 2017)
42. Right homonymous hemianopia is due to lesion of left optic tract. (Nov 2017 & Nov 2018)
43. Bilateral peripheral loss of vision after trauma to back of head is due to lesion of PCA. (Nov 2017 &
Nov 2018)
44. (Remember that BITEMPORAL HETERONYMOUS HEMIANOPIA or simply BITEMPORAL
HEMIANOPIA is due to the lesion at Optic chiasm)( Nov 2018)
45. Berry aneurysm of anterior communicating artery compresses optic chiasma anteriorly to posteriorly.
46. Posterior communicating artery passes above oculomotor nerve and it joins PCA to ICA.
47. Tip of nose is supplied by ophthalmic nerve.
48. Light reflex is by optic (afferent) and oculomotor (efferent) nerves (T.N 3rded page 93).
49. Trigeminal ganglion is like a posterior root ganglion of spinal cord (T.N 3rded page 140).
50. Maxillary nerve is in pterygoid fossa.
51. Central retinal artery lies inside optic nerve.
52. Central retinal artery emerges from optic disc within the optic nerve. (September 2018)
53. Superior colliculus receives visual sensations (T.N 3rdedpage 198) and it is concerned with visual-
body reflex.

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54. A patient can see the distant objects easily and can move the eye normally in all directions but can’t
focus on near objects. This is due to dysfuction of short ciliary nerves and ciliary ganglion. (Nov
2017)
55. Optic canal related to medial cranial fossa. (May 2018)
56. Blood supply of optic radiations is by Middle cerebral artery (MCA) (May 2018)
57. Nucleus ambiguous nerves are CN 9, 10 and 11. (May 2018)
58. Nerve passing within the cavernous sinus is Abducent nerve. (May 2018 & Nov 2018)
59. Posterior part of posterior limb of internal capsule related to Optic radiation. (September 2018)
60. Climbing fibers originate from Inferior olivary nucleus.(Nov 2018) 61.Route of
olivary and pontine fibers : Ipsilateral cotex to ipsilateral inferior olivary nucleus or pontine nucleus
to Contralateral cerebellum. Ref is snell neuroanatomy. (Nov 2018)
62.PNS : Cranial nerves plus spinal nerves. (Nov 2018) 63.Neurotransmitter of
Striatopallidal fibers is GABA (Nov 2018) 64. Prosopagnosia : inability to
recongnize face (Nov 2018) 65.Most common posterior cranial fossa tumor in children is
pilocytic astrocytoma. (Nov 2018) 66.CSF is secreted by ependymal cells.(
Nov 2018) 67.Alpha feto protein is decreased in Down syndrom.(Nov 2018)
66.Acteycholine is released at two sites in sympathetic nervous system. One is at postganglionic
cholinergic ending of salivary glands other at Blood vessels of skeletal muscle.(Nov 2018)
67.Babinski sign is absent in LMN lesion. (Nov 2018)
68.Microphthalmia,Microcephaly,cataract,coloboma is patau syndrom (Nov 2018)

Cortex:
1. In lateral geniculate body, Magnocellular lamina = Area 1 & 2, Parvocellular lamina = Area 3 TO 6
2. Y type Ganglion cells end in Layer 1 and 2 of lateral geniculate body. (Sep 2017)
3. Fibres from LGB to visual cortex are called geniculooccipital fibres or geniculocalcarine tract. (May
2017)
4. Fibres from LGB go to Superior Colliculus. (May 2017)
5. Optic tract fibers end at LGB. (May & Sep 2017)
6. Site of fusion of binocular vision is visual cortex.
7. Primary visual cortex is called Striate cortex (Brodmann Area 17) and it has 6 layers. (May 2017)
8. Secondary visual area or visual association areas are area 18 and 19. It is present in left angular gyrus.
Lesion of these areas leads to loss of ability to recognize objects and interpret what he see and gradual

Page 18 of 43
visual loss. (T.N 3rded page 90 and page 102). This kind of blindness is also called Anton’s
syndrome/Denial of blindness or cortical blindness (T.N 3rded page 96)
9. In central loss of vision, lesion is at the level of the calcarine sulcus. (Sep 2017)
10. Conjugate/Scanning/Horizontal eye movements are controlled by frontal eye fields.
11. Pursuit eye movements are carried by occipital eye field.
12. Saccadic movement is controlled by Cerebrum (frontal eye field) (Sep 2017 and 2018)
13. Visual cortex is supplied by posterior cerebral arteries. (March 2018)
14. Optic tract is supplied by middle cerebral arteries.
15. Frontal eyefield is supplied by anterior cerebral arteries.
16. Circadian rhythm is controlled by suprachiasmatic nucleus
17. Fibers,for circadian rhythm,leave the optic tract and synapse in the suprachiasmatic nucleus.(Nov
2017)
18. Light reflex only involves midbrain, NOT cortex.
19. Pupillary reflex and consensual light reflex does NOT involve cerebral cortex. (May 2018)
20. Accomodation involves midbrain and cortex.
21. Closed eyes = alpha waves on EEG
22. Open eyes or REM sleep = beta waves
23. Stage 1 of NREM sleep = theta waves
24. Oculomotor nerve and pretectal area is at the level of superior colliculus. (May 2017)
25. Pretectal area is anterior to superior colliculus and posterior to thalamus.
26. Upper retinal fibers end at cuneate gyrus and lower retinal fibres end at lingual gyrus in the visual
cortex, calcarine sulcus separate these gyri(Kaplan anatomy)
27. Visual cortex receives fiber from the Meyer’s loop. (May 2017)
28. Visual and auditory areas combine at Wernicke’s area (T.N 3rded page 90). 30. Right
Homonymous hemianopsia involving only inferior quadrants : lesion of Left parietal lobe .(Nov
2018)

Head and Neck:


1. Cavernous sinus contains abducent nerve and internal carotid artery. (May 2017) But at the level of
pituitary fossa, they do not travel in the wall of cavernous sinus.
2. Superior orbital fissure is anterior to cavernous sinus. It lies between the greater and lesser wings of
sphenoid.

Page 19 of 43
3. Ophthalmic artery is the first branch of internal carotid artery after emergence from cavernous sinus.
4. Ophthalmic artery lies lateral and inferior to optic nerve in optic canal, on entering orbit it crosses
superiorly and comes to medial side of nerve.
5. Central retinal artery is the first branch of ophthalmic artery. Central retinal artery do not pass through
optic canal, it emerges after ophthalmic artery enters the orbit. Central retinal artery is an end artery
(T.N 3rded page 158).
6. Optic canal is present in sphenoid bone (T.N 3rd ed page 139).
7. Optic canal opens in middle cranial fossa. (May 2018)
8. Supraorbital artery is a branch of ophthalmic artery. (May, Sep & Nov 2017)
9. Infratemporal fossa is also known as parapharyngeal space. (T.N 4th ed) (Nov 2017)
10. Infraorbital artery is a branch of maxillary artery (T.N 3rded page 134).
11. Ciliary ganglion is 1 cm posterior to globe on the lateral side of optic nerve, it has three roots.
12. Anterio-posterior diameter of eyeball is longest (22-26 mm).24 mm at average. (May and September
2018)
13. Abducent nerve is most inferior motor nerve of eye. It passes through superior orbital fissure and
Annulus of Zinn. (May 2018)
14. Trochlear nerve has longest intracranial course???, it does NOT pass through Annulus of Zinn and it
has common congenital lesions. It enters the orbit through superior orbital fissure.
15. Trauma to head with bleeding from ears and dilatation of pupil means oculomotor nerve injury.
16. Greater wing of sphenoid and petrous part of temporal bone forms floor of middle cranial fossa.
17. Nasolacrimal duct is directed inferiorly, posteriorly and laterally and it opens in inferior meatus
(below inferior concha)
18. Foramen of Monroe connects lateral ventricles with 3rd ventricle.
19. Septum pellucidum seperates lateral ventricles.
20. CSF is produced by choroid plexus (daily 500 ml) (Nov 2017)
21. CSF absorbed in arachnoid granulations.
22. CSF enters venous blood through arachanoid villi. (Nov 2017)
23. All important cerebral vessels are in subarachnoid space.
24. Trigeminal ganglion is covered by only dura mater. ???
25. Emissory veins connect extracranial veins to intracranial veins (T.N 3rded page 201).
26. Mandibular nerve passes through foramen ovale.
27. Patient unable to abduct his eye, lesion is present at the level of Facial colliculus. (Sep & Nov 2017)
28. Middle meningeal artey gives anterior branch at pterion. (Sep 2017)
29. Lateral rectus palsy causes medial squint/convergent squint/esotropia. (Nov 2017)

Page 20 of 43
30. In the endonasal surgery of Posterior Ethmoidal sinus, there is danger of injury to Optic nerve (Sep
2017) 31. CSF is present in sub-arachnoid space. (Nov 2018) 32.Dilatation of Unilateral
lateral ventricle site of obstruction is foramen of monro.(Nov 2018) 33.Bills bar
separates superior vestibular nerve from facial nerve in internal acoustic meatus. (Nov 2018)

Vision and Optics:


1. First step when light strikes on eye is conversion of cisretinene to transretinene.
2. In Snellen’s chart, each letter subtends an angle of 5 minutes of arc and each component part is
seperated by 1 minute of arc.
3. In Snellen’s chart, the angle which is subtended by each letter is most likely: 5 minutes of arc.
(September 2018)
4. Ishihara chart is a pseudoisochromatic chart.
5. Telescope lens is used for chromatic aberration correction.???
6. Calculation of IOL power is called biometry.
7. Retinoscopy is done for checking refractive power of eye. It is no informative value in a patient of
sudden visual loss.
8. Keratometer calculates the power of front of cornea.
9. Direct ophthalmoscopy is done for examination of central retina.
10. Binocularity, retinal correspondance, angle of deviation, degree and range of fusion is measured by
synaptophore.
11. There is high astigmatism in keratoconus.
12. Contact lenses are best for treating regular astigmatism. Astigmatism means irregular corneal
curvature.
13. Refractive errors are msot common cause of reduced vision worldwide.
14. Trachoma is most common cause of blindness worldwide.
15. According to W.H.O, a person is blind when vision in better eye is less than 3/60 and/or visual field is
less than 10 degrees with best possible correction.
16. For color vision, most important is CONES in CENTRAL RETINA. (May 2017)
17. S-cones are for blue and yellow wavelengths (genes are on chromosome 7)
18. L-cones are for red wavelength (genes are on X-chromosome)
19. M-cones are for green wavelength (genes are on X-chromosome)
20. Color blindness is more common in males due to X-linked recessive. (May 2017)

Page 21 of 43
21. In myopia, there is decrease in collagen and hyaluronic acid concentration in vitreous and also the
corneal radius of posterior curvature is decreased.
22. In old age, decrease in near vision is due to DECREASE in CURVATURE of the LENS. (May 2017)
23. An old man with complaint of difficulty in near vision is due to DECREASE ACCOMODATION
POWER OF THE LENS. (Presbyopia) (May 2017)
24. In myopia (near sightedness), image is formed in front of retina, it is corrected with biconcave lens.
25. In hypermetropia or hyperopia (far sightedness), image is formed behind the retina, it is corrected
with convex lens.(Nov 2018)
26. In hyperopia patient is unable to see near object but can see the far objects due to sustained use of
accomodation for far vision (Snell 2nd ed pg 204) (Sep 2017)
27. In a 70 years old, diagnosis for reduced far vision is axial myopia (axial myopia means increase in AP
diameter of eye) (Chandkians 6thed page 547)
28. A child cannot see what’s written on blackboard. Most likely condition he has is Axial myopia.
(September 2018)
29. In a young adult with high blood sugar, diagnosis for reduced far vision is index myopia (Chandkians
6thed page 547)
30. Anterior staphyloma is NOT a myopic retinal change.
31. Myopic eye focuses for red.
32. Emmetropic eye focuses for yellowgreen.
33. Hypermetropic eye focuses for blue.
34. (To remember this Mnemonic = MEH ~ RGB)
35. Near point of convergence is 6-10 cm (irrespective of age)
36. Near point of accomodationis :

7 cm at 10 years

10 cm at 20 years

13 cm at 30 years

20 cm at 40 years

45 cm at 50 years

90 cm at 60 years

(REMEMBER 7+3+3+7+25+45)

37. In accomodation reflex, pupils constrict, eyes converge, ciliary muscle contracts and lens become
more globular.

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38. Accomodation reflex is the function of Midbrain. (May 2018)
39. Accomodation by 5 years old leads to 14D increase in lens power.
40. Accomodation by young adult leads to 8D increase in lens power.
41. Range of accomodation = Far point – near point
42. If near point is 12.5 cm and range is 5D, error will be -3 (September 2018)

(Power = 1/0.125 = 8D, therefore Error = 5D – 8D = -3D )

43. Miosis increases the depth of focus.


44. Virtual image forms behind the lens and inverted (SK pearls 2nded golden 1 page 234)
45. Refractive index = 1 / Refractive power
46. If the Refractive Power is 0.75 Diopters, Refractive Index = 1/0.75 = 1.33 (May 2017)

Power = 1 / focal length (in meters)

47. If the focal length is 75 cm (0.75 meters), Power = 1/0.75 = 1.33


48. When a person looks near, visual field is decreased.
49. Light rays enter parallel into eyes if at a distance of 6 meters. (May ,Nov 2017 & Nov 2018)
50. High myopic, far point without correction is 25 cm. Corrected accommodation is 8D with -2DS lens.
Near point will be 10 cm (Sep 2017)

1/f= 1/p+ 1/q

Where p= power (8-2=6) f= far point, q= near point

1/q= 1/f-1/p

1/q= 1/25 – 1/6

1/q = -0.1m

Convertion>> q= 10cm

OR

1/ (2+8) (power of specs added to the amplitude of accomodation)

1/10= 0.1 m

10 cm

Page 23 of 43
51. Visual evoked potential(VEP) is used for evaluation of visual pathways in infants. (Nov 2017)
52. In near accomodation mechanism of lens there is contraction of ciliary muscle. (May 2018)
53. In a 50 years old man with gradual loss of vision, near vision is reduced due to: Decreased curvature
of lens. (September 2018) 54.Focal length is 0.25m , power would be 4D.(Nov
2018).

Pharmacology:
1. Ethambutol (anti-tuberculosis drug) can cause optic neuritis.
2. Morphine and Heroin poisoning presenst with miosis.
3. Cocaine poisoning presents with mydriasis.
4. Mechanism of action of local anesthetics is by binding to Sodium channels in ionized from.
5. Mechanism of action of local anesthetics is by closure of Sodium channels. (Sep 2017 & Nov 2018)
6. Cocaine is most potent vasoconstrictor local anesthetic.
7. Dose of Lignocaine is 2 mg/kg.
8. 2% lignocaine in 4ml contains 80mg. (May 2018)
9. First side effect of Lignocaine is light headedness. (Nov 2017)
10. Sign of Lignocaine overdose is perioral peristhesia. Seizures can also occur. (Medscape)
11. Sign of Bupivacaine overdose is tinnitus.
12. Bupivacaine is most toxic local anesthetic (Maximum adult dose is 150 mg).
13. Bupivacaine has highest protein binding affinity. Procaine has lowest.
14. Bupivacaine is longest acting local anesthetic. (Sep 2017)
15. Primary determinant of local anesthetic activity is protein binding affinity which also depends on
lipid solubility of the drug. (Nov 2017 & Nov 2018)
16. Adding epinephrine to local anesthetics increases their effect.
17. Beta-adrenergic agonists increase both production and outflow of aqueous.
18. Ketamine raises ICP and IOP. (May 2017 & Nov 2018)
19. Trifluridine and acyclovir is given in herpes simplex keratitis (T.N 3rded page 102) (Trifluridine >
acyclovir) (May 2017) (September 2018)
20. Acyclovir (Acycloguanosine) mechanism of action is by inhibiting DNA Polymerase and leading to
Chain Termination. (May,Sep & Nov 2017)
21. Timolol (beta-blocker) is used to treat glaucoma.
22. Latanoprost is superior in efficacy to Timolol.

Page 24 of 43
23. Latanoprost (PGF2) increases uveoscleral outflow and decreases aqueous production by 30%, hence
it can be used in glaucoma.
24. Latanoprost route is through uveal tract.
25. Latanoprost causes changes in color of IRIS. (Sep 2017)
26. Adrenaline decreases aqueous production.
27. Pilocarpine, Prostaglandins and Morphine causes miosis, hence they can be used in glaucoma.
Pilocarpine is used in emergency.
28. Pilocarpine is used to treat POAG in an old hypertensive patient who is suffering from bronchitis and
also taking anti-depressants.
29. Prostaglandins lower IOP in low doses but raise IOP in high doses. In low doses, they promote
uveoscleral outflow.
30. Topical prostaglandins do not cause bradycardia.
31. 20% Mannitol infusion quickly lowers IOP in emergency, it decreases the secretion of aqueous, not
production. It is excreted mainly through kidneys.
32. Atropine (anti-muscarinic) and Phenylephrine (alpha-1 adrenergic agonist) causes mydriasis, hence
they are contraindicated in glaucoma. Atropine intoxication can cause glaucoma in elderly.
33. Phenyephrine is mydriatic but not cycloplegic.(Nov 2018) Cyclopentolate and Atropine causes both
mydriasis and cycloplegia. (Sep 2017)
34. Atropine can be used in neovascular glaucoma.
35. SCOPOLAMINE has Atropine like effect. (May 2017)
36. Mechanism of action of Atropine = Competitive antagonist of the muscarinic Acetyl Choline
Receptors classified as anti-cholinergic drug (parasympatholytic). (May 2017)
37. Dipivalyl Epinephrine converts to Epinephrine in cornea.
38. Avoid Epinephrine in a patient taking Amitriptyline.
39. Carbonic anhydrase inhibitors are least effective in glaucoma.
40. Drug of choice in endophthalmitis is Amikacin because it is most resistant to bacterial
inactivation.(Sep 2017)
41. Intravitreal antibiotic that causes retinal toxicity is Gentamycin. (Sep 2017, March 2018)
42. Quinolone drops inhibit DNA-gyrase and cell proliferation.
43. Treatment of uveitis is betamethasone.
44. Glucocorticoids promote epithelial healing and decrease Prostaglandins synthesis.
45. Indirectly acting miotics increase sensitivity to Tetracaine and depolarizing paralytic agents.
46. No known drug can induce REM sleep.
47. Neuromuscular junction blocker = Tubocurarine(Snell Eye Anatomy Pg. 262) (May 2017)

Page 25 of 43
48. Edrophonium can be used in the diagnosis of Myasthenia Gravis.
49. Ptosis in the evening, confirmatory test to be is done is EMG for Myasthenia Gravis. (May 2017)
50. Neostigmine can be used in treatment of Myasthenia Gravis because it increases Acetylcholine at
motor end plate.
51. Drug used orally for myasthenia gravis is neostigmine. (Nov 2017)
52. Neostigmine is used for long term use in Myasthenia Gravis. (May 2018)
53. Patient of Myasthenia Gravis improve on giving Anticholinesterase (ACE inhibitors) (May 2018)
54. Physostigmine has an advantage over Neostigmine, that Physostigmine can be used in glaucoma.
(Nov 2017)
55. Chlorpromazine causes lens opacity.
56. Chloroquine can cause bull’s eye retinopathy and corneal opacity. (Nov 2017)
57. Phenothiazides cause corneal opacity (Rabia Ali 4thed page 450).
58. Chloramphenicol causes bone marrow suppression.
59. Apraclonidine causes lid retraction.
60. Brimonidine causes follicular conjuctivitis. (Nov 2017)
61. Brimonidine is Alpha-2 agonist.
62. Cyclopentolate is used for pupil dilatation in children.
63. ATROPINE used to treat accomodative spasm in children.
64. A child came with accommodative spasm. Treatment is Atropine > cyclopentolate (September 2018)
65. Thioflavin-T stain is used for lamellar keratopathy.
66. Prussian blue dye is used for staining iron foriegn body (Apple and Rabb MCQs).
67. Prussian blue dye is also used in diagnosis of ocular sidrosis.
68. Ranibizumab is used to treat diabetic macular edema (Rabia Ali 4thed page 465).
69. Large dose of Digoxin may cause irreversible change in blue-yellow axis of colour vision.
70. Increasing eye drops viscosity increases conjuctival contact time.
71. Higher or lower pH of the drug causes reflex tearing which decreases corneal penetration of drug.
72. If oculocardiac reflex (mostly happen in strabismus surgery) is triggered, first step is to stop the
stimulus and then I.V atropine is given (T.N 3rded page 105 and 158).
73. Rubella causes congenital cataracts, risk can be prevented by vaccination of all women of child-
bearing age (T.N 3rded page 175). (Nov 2017)
74. In thyroid ophthalmopathy, drugs blocking T-lymphocytes are given.
75. Phenlyephrine dilates the eye but doesNOT produce cycloplegia. (March 2018)
76. Pain and redness in eyes associated with decreased vision by instilling Atropine eyedrops. (March
2018)

Page 26 of 43
77. Drug causing inotropic effect on heart and pupil dilatation is Atropine. (March 2018)
78. Neuromuscular blockade is by Tubocurarine. (March 2018)
79. MOA of Itraconazole = Fungal Cell wall inhibitor [it inhibits enzyme cytochrome p450 14 alpha
demethylase which convertes lanosterol to ergosterol (it is required in fungal cell wall synthesis)]
(May 2018 & Nov 2018)
80. Corneal opacity is caused by Chloroquine. (May 2018)
81. Young patient went to eye specialist. He instilled some drops to check him. Next day, he couldn’t
read anything. Doctor put Homatropine in the eyes (atropine was not in options) (September 2018)
82. Effect of pilocarpine on sphincter pupillae is analogous to effect of Epinephrine on dilator pupillae?
(September 2018) 83. MOA penicillin:cell wall synthesis inhibitor.
(Nov 2018) 84.Drug which causes mydriasis,Inc TPR and bradycardia is PHENYLEPHRINE (rabia
ali bcq)..(Nov 2018) 85. Side-Effect of anticholinergic is DRY MOUTH and Dry
eyes. (Nov 2018) 86. Echothiophate : Has same mechanism of action as
organophosphorous compounds. (Nov 2018)

Pathology:
HYPERTENSIVE RETINOPATHY DIABETIC RETINOPATHY
Dry retina Wet retina

Rare edema Extensive edema

Rare exudates Multiple exudates

Many cotton wool spots Few cotton wool spots

Many flame shaped hemorrhages Rare flame shaped hemorrhages

Arterial involvement Venous and capillary involvement

1. Sudden painless visual loss = Central retinal vein occlusion (May 2017)
2. Sudden painless visual loss with no fundal glow = Vitreous hemorrhage
3. Sudden painless vision loss in a young patient with no systemic problems also happens in Eales
disease.
4. Sudden painless vision loss in a 25 week pregnant lady could be due to exudative retinal detachment.
5. B-scan is used to see retina when there is no fundal view.

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6. Comma floaters are seen in vitreous hemorrhage, posterior vitreous detachment and diabetic
retinopathy. In young myopes, they could be due to retinal detachment.
7. High myopic with complaint of comma shaped floaters, corrected vision is 6/6, IOP is normal –
Posterior Vitreous detachment (Sep 2017)
8. Fluffy margins on fundus of young diabetic patient show CRVO.
9. First sign of diabetic retinopathy is retinal vessels dilatation.
10. Most probable cause of loss of vision in a chronic diabetic patient having non-proliferative diabetic
retinopathy is cystoid macular edema.
11. Cystoid macular edema is due to RPE changes and macular edema related to diabetes is due to leaky
capillaries (AAO.org) (May 2017)
12. First effect of hypertension intraocularly is arteriosclerosis. (May 2017 & Nov 2018)
13. A patient presents with hazy vision in one eye. On fundoscopy,yellow white fluffy margins are seen
around the chorioiretinal scar. The cause for this lesion is TOXOPLASMOSIS. (Nov 2017)
14. Hypertensive retinopathy causes arteriovenous nipping, this retinopathy commonly involves
arterioles. (May 2017)
15. Hypertension in Retina causes Retinopathy? Dot and Blot Hemorrhages?CRAO?CRVO?
16. Hypertension effect on retina is HEMORRHAGE. (Sep 2017)
17. Silver and Copper wire appearance is seen on fundoscopy in HYPERTENSIVE Retinopathy.
18. Cotton wool spots are associated with diabetic, hypertensive, HIV and lupus retinopathies.
19. Retinal ischemia leads to neovascularization in diabetic retinopathy. Proliferative diabetic retinopathy
also leads to retinal neovascularization.
20. Soft exudates show ischemia, hard exudates show leakage.
21. Drusens form between RPE and inner collagenous layer of Bruch membrane. (September 2018) Hard
exudates form between RPE and external limiting membrane.
22. Soft exudates, vitreous hemorrhage or macular edema are NOT the features of background
retinopathy.
23. Retinal detachment is a likely feature of premature retinopathy.
24. Cryotherapy is beneficial in premature retinopathy.
25. Infrared light causes eclipse burns.
26. Most common lens deformity = Ectopia Lentis (May 2018)
27. Most common congenital lens anamoly = Coloboma (Rare ones are Lenticlonus, Lentiglobus,
Microspherophakia)
28. Iris coloboma is due to failure of closure of choroidal fissure.
29. There is NO foreign body sensation in cataract.

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30. There is NO sudden visual loss in cataract.
31. Loss of contrast sensitivity is also a symptom of cataract.
32. There is NO other treatment of cataract besides surgery, therefore it is an economical burden.
33. The shortest duration of surgery resulting in photic maculopathy is 55 minutes.
34. Commonest cataract is senile cataract.
35. Juvenile diabetes causes snowflake cataract (Apple and Rabb MCQs, March 2018). (September 2018
& Nov 2018)
36. Rubella causes dense nuclear cataract.
37. Smoking causes nuclear cataract.
38. Steroids causes posterior subcapsular cataract (Apple and Rabb MCQs). It could happen in patients of
rheumatoid arthritis who are on long term steroid therapy.
39. Young boy having severe asthma is treated by inhaled steroids, he might be at the risk of developing
CUSHING SYMDROME (not cataract)
40. Diabetes causes posterior subcapsular and cortical cataract.
41. Ultraviolet light causes cortical cataract. (September 2018)
42. Nuclear sclerosis cataract occurs due to Protein degeneration in lens. (September 2018)
43. Lower educational level causes nuclear, posterior subcapsular and cortical cataracts.
44. Lens subluxation causes iridodonesis. (iridodonesis is VIBRATION of IRIS with EYE MOVEMENT
– occurs due to lens subluxation or aphakia)
45. Smoking causes choroidal neovascularization.
46. In ARMD, smoking is strongly associated with choroidal neovascularization.
47. Xeroderma pigmentosa is caused by damage to DNA repair gene, corneal opacity is also a symptom
of this disease.
48. Raised ICP + Bradycardia + Hypertension = Cushing’s Triad
49. Ophthalmoplagia + Ataxia + Confusion = Wernicke’s Triad
50. Ocular anomalies + Corneal defect + Lens prolapse = Potter syndrome (T.N 3rded page 93)
51. Urethritis + Arthritis + Conjuctivitis = Reiter’s syndrome associated with HLA-B27 (May 2017)
52. Similar symptoms as above along with recurrent oral aphthous ulcers and Uveitis = Behcet syndrome
53. HLA B5 is associated with Behcet disease. (Nov 2017)
54. Hyphema is blood in anterior chamber,hypopyon is pus in anterior chamber.
55. Head trauma leading to loss of vision which becomes normal after a day is due to subtotal
hyphema.(Nov 2018)
56. Circulus Iridis Major is the source of hyphema in blunt trauma.
57. 75% of enucleations are due to trauma (Apple and Rabb MCQs).

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58. Vossius rings form on anterior lens after trauma.
59. In blunt trauma, the cataract formed is Rosette shaped, treatment is phacoemulsification with foldable
IOL.
60. Foldable IOL has low incidence of complications during and after surgery (Apple and Rabb MCQs).
61. Phacoemulsification is not done in dislocated lens.
62. Best outcome of phacoemulsification when done by temporal scleral tunnel operation (Apple and
Rabb MCQs).
63. Most common cataract surgery is intracapsular extraction with aphakic spectacles (Apple and Rabb
MCQs).
64. IOL is contraindicated in cataract due to juvenile rheumatoid arthritis.
65. YAG laser is used for treatment of postsurgical thickening of posterior capsule.
66. Treatment of choice in Elschnig’s pearls is Nd–YAG capsulotomy.
67. Best vision in moderate myopia is achieved by laser vision correction procedure.
68. Common complication of photorefractive keratectomy is undercorrection(Apple and Rabb MCQs).
69. Central corneal thickness is decreased in photorefractive keratectomy.
70. Polarity of laser least likely to influence the result of therapy (Chandkians 6thed page 572)
71. Anterior calcarine sulcus lesion leads to contralateral temporal crescent defect.
72. Flame shaped hemorrhages occur in superficial nerve fiber layer.
73. Posterior staphyloma seen in degenerative myopia.
74. Earliest visual field defect in POAG is isolated paracentral nasal scotoma (Apple and Rabb MCQs).
75. In chronic simple glaucoma, there is damage to optic nerve head.
76. Superior and inferior polar cup notching is the specific sign of glaucomatous damage.
77. Layer of retina most affected by glaucoma is nerve fiber layer.
78. In congenital glaucoma, anterior chamber volume is greatest (Apple and Rabb MCQs). Buphthalmos
is a sign of congenital glaucoma.
79. Primary congenital glaucoma is autosomal recessive.
80. Primary open angle glaucoma is commonly autosomal dominant (Apple and Rabb MCQs).
81. No disc edema in open angle glaucoma.
82. Hypermetropia is not a risk factor for POAG.
83. In acute angle closure glaucoma, the signs and symptoms are red eye, decreased visual acuity, raised
IOP and shallow anterior chamber.
84. Eyes prone to angle closure usually have shallow anterior chambers, thick corneas, anteriorly placed
lens and are hypermetropic.
85. Vogt’s triad is seen in post attack of acute angle closure glaucoma.

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86. In phacolytic glaucoma, cause of blockage is protein laden macrophages.Patient presents with raised
IOP, deep anterior chamber, some cells and flare, hypermature cataract, and is diabetic.
87. Pigment dispersion in anterior chamber can lead to open angle glaucoma.
88. Neovascular glaucoma is NOT a cause of sudden painless visual loss.
89. There is NO ptosis in exophthalmos.
90. Thyroid ophthalmopathy is most common cause of bilateral proptosis.
91. Commonest muscle to get involved in thyroid related ophthalmopathy is inferior rectus.
92. Exophthalmos in thyroid eye disease is due to accumulation of GAGs. (and EOM
edema,accumulation of fats)
93. Exophthalmos due to increase in hormone TRH. (May 2018)
94. Optic nerve compression causes decrease visual acuity and visual field defects in thyrotoxicosis (T.N
3rded page 54)
95. Hassal-Henle warts are normal aging phenomenon (Apple and Rabb MCQs).
96. In congenital glaucoma, horizontal lines (Habbstriae) are present on cornea due to disruption of
Descemet’s membrane (High Yield Embryology).
97. Anterior cleavage syndrome causes abnormal anterior chamber development.
98. Retrolental fibroplasia is oxygen induced retinopathy in premature babies (High Yield Embryology).
99. Retinocele is herniation of retina into sclera (High Yield Embryology).
100. Maternal vaginal Gonococcus infection causes ophthalmia wwneonatorum in newborn. Baby
presents with pus discharge from eyes.
101. Maternal vaginal Chlamydia infection causes inclusion conjuctivitis in newborn (Rabia Ali 4thed
page 438)
102. Cytomegalovirus causes chorioretinitis in AIDS patient (T.N 3rded page 83).
103. Chorio retinitis is NOT caused by Onchocerciasis.
104. Microaneurysms are formed in HIV and diabetic retinopathy.
105. Herpes Zoster ophthalmicus in a 25 years old patient is an indication forELISA for HIV.
106. In watering and photophobia, flouriscine staining test is appropriate.
107. HSV causes dendritic corneal ulcers, which can be seen by flouriscine staining.
108. HSV1 is most common cause of viral corneal ulcer.
109. Adenovirus type 8 causes epidemic keratoconjuctivitis(Apple and Rabb MCQs).
110. In vernal keratoconjuctivitis, there are papillae on conjuctiva.
111. Trantas dots is also a sign of vernal keratoconjuctivitis.
112. Acute purulent conjuctivitis is NOT associated with HLA.

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113. In retinitis pigmentosa, there is degeneration of rods and gun-barrel vision (High Yield
Embryology).
114. Retinitis pigmentosa is usually bilateral and symmetrical, night blindness/nyctalopia is usually the
first symptom (Apple and Rabb MCQs).
115. First SYMPTOM of Vitamin A deficiency is night blindness/nyctalopia.
116. First SIGN of vitamin A deficiency is conjunctival xerosis.
117. Toxoplasmosis causes choroidoretinitis.
118. In iridocyclitis, ‘water-logging’ causes increased water in iris stroma and release of
prostaglandins causes miosis.
119. In acute anterior uveitis, pupil is miosed, irregular and poorly reactive. Also, there is conjuctival
congestion due to release of Prostaglandins.
120. Anophthalmia = no eye
121. Cyclopia = one orbit and one eye (High Yield Embryology).
122. Microphthalmia = Small socket and small eye
123. Nanophthalmia = Distinguished from microphthalmia on the basis of no organic abnormality and
no anatomical alteration. It does not present as cystic palpebral bulge.
124. Maxillary bone fracture leads to dished-in face and diplopia.
125. Cheif symptom in blow-out fracture is unilateral diplopia (Chandkians 6thed page 549)
126. Colourblindness is X-linked recessive, but blue-yellow blindness is related to chromosome 7
(genes for S-cones)
127. Protanomaly = Red blindness
128. Deutranomaly = Green blindness (most common)
129. Tritanomaly = Blue blindness (rare)
130. Limbaldermoid, dermoid cyst, orbital cyst and chalazion are benign.
131. Chalazion is a common painless lid swelling.
132. Bleeding after few hours of chalazion surgery is from palpebral arcade.(Nov 2018)
133. Distichiasis is accessory row of eyelashes.
134. In a diabetic patient, ptosis and intact miosis (pupil sparing 3rd nerve palsy) means oculomotor
nerve lesion. (Snell 2nd ed. Pg. 309)
135. A diabetic and chronic smoker presents with PARTIAL PTOSIS and MIOSIS – Involvement of
cervical sympathetic (Sep 2017) (Nov 2018)
136. Ptosis and infrolateral deviation in primary position means oculomotor nerve palsy.
137. In facial nerve falsy, epiphora is due to lacrimal pump failure &/or lower lid ectropion.
138. Optic nerve colobomas are usually inferonasal. (Kanski 7th ed pg 805)

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139. Other congenital colobomas (like iris coloboma) are inferionasal.
140. In albinism, there is photophobia, strabismus and nystagmus.
141. Iris vessels are visible in albinism.
142. In congenital tilted disc, there is myotic astigmatism.
143. Eye findings in Turner syndrome (XO) are prominent epicanthal folds, ptosis, blue sclera and
high incidence of dyschromatopsia.
144. In Patau syndrome (Trisomy 13), intraocular cartilage with ciliary body colobomas are
found.(Nov 2018)
145. In Edward syndrome (Trisomy 18), Glaucoma is common.
146. In Down syndrome (Trisomy 21), cataracts and keratoconus are common.
147. Faulty dextroversion (right gaze) and normal convergence is right PPRF problem.
148. MLF lesion = PPRF Median
149. Pie in the sky is the sign of lesion of Meyer’s loop.
150. Most severe papilladema is in posterior cranial fossa tumors (Apple and Rabb MCQs).
151. In lesion of anterior calcarine sulcus, there is contralateral temporal crescent defect.
152. K-F rings form in Wilson’s disease by the deposition of Copper, check serum ceruloplasmin for
diagnosis (T.N 3rded page 103).
153. Sunflower cataract forms in Wilson’s disease.
154. Craniopharyngioma = Bitemporal inferior quadranopia
155. Pituitary adenoma = Bitemporal superior quadranopia (May 2017 & Nov 2018)
156. Pituitary adenoma/Acidophilic adenoma causes bitemporal hemianopia.
157. Bitemporal hemianopia is due to lesion of upper part of optic -chiasma (T.N 3rded page 121)
158. 40 years old with gradual loss of vision in 3 years. VA is counting finger, IOP 10 mmHg
bitemporal heteronymous hemianopia and tunnel vision. Lesion will be in Optic Chiasma. (May
2018)
159. In a Right handed man with left lower quadranopia, the lesion is in the RIGHT PARIETAL
LOBE. (May 2017)
160. Right homonymous superior quadrantanopia is due to lesion of LEFT TEMPORAL LOBE. (Nov
2017)
161. Deletion of short arm of chromosome 11 leads to aniridia and Wilms tumor.
162. In newly diagnosed aniridia, family members should also be examined.
163. In all causes of aniridia, gene affected isPAX-6 (American Academy Fundamentals 2011-2012
Pg. 166) (May 2017)

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164. Alkali burns are more destructive than acidic burns, neutralization of pH by irrigation is first step
of management (Apple and Rabb MCQs).
165. Hypotony and irregular anterior chamber means ruptured globe.
166. Liver transplant can lead to disseminated opputunistic fungal infection including endophthalmitis.
167. Liver abcess can lead to endogenous bacterial endophthalmitis.
168. There is no scleral involvement in endophthalmitis(Apple and Rabb MCQs).
169. 5% of diabetics have asymmetric retinopathy.
170. Newly diagnosed type 1 diabetics rarely develop retinopathy within first 5 years, they can go for
fundal examination after 5 years but type 2 diabetics should undergo fundal examination
immediately.
171. Lady with type II DM she is at risk of developing a pathology in Retina. (September 2018)
172. Patient known type II diabetic with loss of visual acuity had some laser treatment. Changes in
Macula. (September 2018)
173. 5% povidone iodine has lowest risk of corneal and conjuctival toxicity.
174. Topical antibiotics for 3 days preoperatively and 5% povidone iodine before surgery significantly
reduce bacterial conjuctival colonies.
175. Check urine for reducing substance in a child with bilateral cataracts, muscle weakness and a
history of death of infant sibling. (a case of galactossemia)
176. Most common ocular finding in Sturge-Weber syndrome is choroidalhemangioma(Apple and
Rabb MCQs). There is also glaucoma in it.
177. Lisch nodules are hamartomas in eye.
178. Most common intraocular lesion of tuberous sclerosis is astrocytichamartoma(Apple and Rabb
MCQs).
179. RetinoBlastoma is often bilateral in familial cases (Apple and Rabb MCQs).
180. Large Retinoblastoma is an indication of ENUCLEATION. (Sep 2017)
181. Early diagnosis of Retinoblastoma can be done by taking CSF samples. (Sep 2017)
182. In RB patients, most common second malignancy is osteosarcoma.
183. Child had retinoblastoma and treated and cured. After few years developed a tumor of lower
limb. This tumor is Osteogenic sarcoma. (May and September 2018)
184. RB gene is on long arm of chromosome 13.
185. A child presents with proptosis. The underlying lesion shows small blue cells and rosettes. Gene
responsible od Rb gene. (Nov 2017)
186. Newborn with white pupillary reflex, large eyeball and calcification on CT has retinoblastoma
(Chandkians 6thed page 574)

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187. Retinoblastoma worst prognostic feature is Optic nerve involvement. (September 2018)
188. RB is of (medullary) neural tube origin, it commonly metastasizes to optic nerve.
189. In RB, there is raised LDH in aqueous humor.
190. To check aqueous LDH concentration, 0.1 to 0.15 ml (total is 0.25 to 0.3 ml) of aqueous obtained
by paracentesis. (Chandkians 6thed page 574)
191. Leukokoria is called pseudoretinoblastoma.
192. Retinoblastoma prevalence = 1 in 18000-30000 (Medscape)
193. Congenital glaucoma and congenital cataract prevalence = 1 in 10000
194. Most common metastasizing neoplasm to uveal tract is bronchogenic carcinoma (Apple and Rabb
MCQs).
195. Mass in choroid is due to metastasis from LUNGS. (May 2017)
196. Cancer of which of the following organ metastasizes to choroid? Lungs. (September 2018)
197. Primary uveal melanoma commonly metastasizes to liver (Apple and Rabb MCQs). (September
2018)
198. Primary malignant melanoma of choroids most commonly metastasizes to liver (Chandkians 6thed
page 549). Posterior uveal tumors mostly metastasize to liver (Chandkians 6thed page 572).
199. Basal cell carcinoma is most common eyelid tumor, but in elderly, sebaceous gland carcinoma is
more common in upper eyelid.
200. Least malignant eye tumor is BASAL CELL CARCINOMA. (Sep 2017 & Nov 2018)
201. Most malignant eye tumor is optic glioma, it arises from astrocytes. It presents as unilateral
progresive painless proptosis (T.N 3rded page 106) (Nov 2017)
202. Most common primary malignantintraocular tumor in adults = Uveal melanoma
203. Most common primary malignantintraocular tumor in children = Retinoblastoma
204. Most common benignorbital mass in adults = Cavernous haemangioma
205. Most common benignorbital mass in children = Capillary haemangioma
206. Most common malignantorbital tumor in children = Rhabdomyosarcoma (Progressive swelling
with redness of lids, but lids are not hot)
207. Most common malignant lacrimal gland tumor = Adenocystic carcinoma
208. Most common metastasis to orbit in children = Neuroblastoma
209. Myofibrils and cross striations are seen on histology in case of rhabdomyosarcoma. (Nov 2017)
210. Cause of oculosympathetic paralysis is pancoast tumor.
211. Tumor in optic canal will likely affect ophthalmic artery. (Nov 2017)
212. Optic canal if fractured, structures damaged are Optic nerve and Ophthalmic artery. (May 2017)
213. Contents of Optic canal are Ophthalmic artery and Optic nerve. (Sep 2017)

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214. In total CRAO, retinal neuronal destruction occurs within 90 minutes (Apple and Rabb MCQs).
(60 mins in Snells)
215. Hypertension causes CRAO most likely due to INFARCTION. (May 2017)
216. Sudden unilateral decrease in visual acuity, headache and pain on looking upward with no history
of chronic disease in a young patient is most likely optic neuritis (Apple and Rabb MCQs).
217. Finger like projections are Papilloma. (May 2017)
218. Conjuctival papillomas are often viral.(Apple and Rabb MCQs).
219. Limbus is the common site of conjuctival hyperplastic and neoplastic growths (Apple and Rabb
MCQs).
220. Keratocanthoma is also known as self-healing squamous cell carcinoma (Apple and Rabb
MCQs).
221. Horopter is a line or a surface containing all those points in space of which images fall on
corresponding points of the retinas of the two eyes. (Sep 2017)
222. Diplopia happens when light is not being reflected on corresponding points . Gaze center is away
from Horopter. (September 2018)
223. Esotropia is associated with hypermetropia and accomodation.
224. Exophoria is latent divergent squint.
225. Cover/Uncover test is done in HETEROPHORIA (orthophoria is normal/ideal condition).
226. In cover/uncover test of right eye to detect squint, if right eye retains central fixation when left
eye is covered, the right eye has orthophoria(Chandkians 6thed page 575)
227. In paralytic heterotropia, secondary angle of deviation is more than primary.
228. Regurgitation test is positive in NLD blockage.
229. In congenital NLD blockage, probing and syringing is done.
230. In a patient of epiphora, after getting negative flourescence disappearance and negative Jones
tests, next step is probing (Chandkians 6thed page 571). (September 2018)
231. Negative Jones 1 test but positive Jones 2 test shows NLD obstruction (Chandkians 6thed page
571). (September 2018)
232. A newborn with a ridge within NLD region has pathology in Maxillary and Nasal bones
(Chandkians 6thed page 548)
233. Schimer 1 test will be positive if length of wet filter paper is less than 6mm after 5 minutes.
234. Veil/Curtain falling and shower of black spots are symptoms of retinal detachment.
235. Tobacco dust/Schaffer’s sign is present in retinal detachment.
236. Retinal detachment is seperation of RPE from neurosensory retina. It leads to retinal
degeneration.

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237. Iris bombe are 360 degree posterior synechiae.
238. Sympathetic ophthalmia means granulomatous pan uveitis in the non-injured eye after few weeks
of uvealincarcination injury in other eye.
239. Herbert pits are a sign of Trachoma.
240. Follicular hypertrophy in stage II-A of trachoma, Arlt’s line (scarring) is in stage III (late stage)
241. TP pannus is NOT in WHO grading of Trachoma.
242. Trachoma is most common cause of cicatricial entropion in Pakistan.
243. Ankyloblephron means lids adherent to EACH OTHER.
244. Symblepheron - lids adhere to globe
245. Sjogren syndrome is associated with HLA-DR52 (Medscape) Anti-SS antibodies are diagnostic.
It may also be associated with Rheumatoid arthritis.
246. Dry mouth and Dry eyes = Sjogren Syndrome {autoimmune disease} (May 2017) (May 2018)
247. Most evident clinical finding of Sjogren syndrome is DRY EYES and MOUTH. (Sep 2017)
248. Greater petrosal nerve injury = Dry eye (usually in middle cranial fossa fracture) (T.N 3rded page
99)
249. Pterygopalatine/Sphenopalatine/Meckel ganglion injury = Dry eye
250. Deep petrosal nerve on its way to lacrimal gland synapses in sphenopalatine ganglion. (Nov
2017)
251. Pretectal nucleus injury = Argyl Robertson pupil (Absent light reflex but intact accomodation)
(usually caused by syphilis) (Sep 2017 had a similar question answer was TECTAL REGION OF
MIDBRAIN)
252. Edinger-Westphal nucleus (preganglionic parasympathetic) injury = Absent light reflex + Absent
accomodation
253. Ciliary ganglion (postganglionic parasympathetic) injury = Adies pupil/Dilated pupil (usually by
viral infection)
254. Cervical sympathetic chain (postganglionic sympathetic) injury = Horner syndrome (Irregular
Miosis + Ptosis + Anhydrosis)
255. No response to mydriatics in Horner syndrome. No cycloplegia in Horner syndrome.
False/apparent enophthalmos is present (Snell 2nd ed pg 372). Hydroxyamphetamine dilates a
preganglionic or central Horner’s pupil if postganglionic pathways are intact. (John Ferris 2nd ed pg
339)
256. Cerebellopontine angle injury = Abducent(6) + Facial (7) + Vestibulocochlear(8) nerves involved
257. In Coat’s disease, there are deposits of cholesterol in retina, it is common in males and often
unilateral.

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258. Headache and bilateral papilladema after one month of meningitis means hydrocephalus.
259. Persistant hyperplastic vitreous is usually sporadic, long term visual prognosis is poor in it.
260. In aging, there is focal collagen concentration decrease in vitreous.
261. River blindness is casued by Onchocerca Volvulus (Rabia Ali 4thed page 440 and T.N 3rded page
168).
262. Pineal gland tumor sign is paralysis of upward gaze also known as ‘setting sun’ sign.
263. If corneal scrappings reveal narrow angled septate hyphae, the causative organism is Aspergillus.
264. Fungal infection is likely if trauma is from a tree branch.
265. Patient with trauma to eye by a wooden stick. Fungus (September 2018)
266. Central retinal artery occlusion likely cause is atherosclerosis (according to reference books, but
in CPSP demo questions its answer is embolism)
267. A thrombosis in artery to Retina will do? Infarction?Liquefactive Necrosis? (May 2017)
268. Multiple sclerosis also affects optic nerve (Rabia Ali 4thed page 96)
269. Partial ptosis + Painful swallowing = Myasthenia Gravis(SK pearls 2nded golden 1 page 237)(Nov
2018)
270. Child having partial ptosis which increases in evening, initial investigation which will help in
diagnosis is Tensilon Test. (May 2018)
271. In diabetic female, there is 5% risk of progression to proliferative diabetic retinopathy in
pregnancy.
272. Ipsilateral glaucoma and chorioretinal scarring slows down the progress of diabetic retinopathy.
273. In Axenfield syndrome, there is posterior embryotoxon and facial anomaly.
274. In juvenile arcus, there is anterior embryotoxon.
275. If there is difficulty coming downstairs, lesion is likely is in superior oblique/trochlear nerve.
276. In trochlear nerve lesion, there is diplopia on adduction (T.N 3rded page 97 and 105)
277. In 4th nerve lesion, there is DIPLOPIA in DOWNWARD GAZE and ADDUCTION. (May 2017)
278. If a person has difficulty looking down, lesion is in MIDBRAIN. (Sep 2017)
279. Damage to occipitotemporal lobe leads to difficulty in recognizing familiar faces (prosopagnosia)
280. Corneal dystrophy is a hereditary condition.
281. Macular dystrophy is autosomal recessive stromal dystrophy.
282. In epidural haemmorhage, rupture of middle meningeal artery leads to accumulation of blood
between calvaria and dura.
283. After head trauma, proptosis along with a continuous rushing sound means a fistula is formed
between cavernous sinus and internal carotid artery.

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284. Band keratopathy means the deposition of calcium between corneal epithelium and Bowman’s
membrane.
285. In Fuch’s dystrophy, there is corneal edema due to loss of endothelial cells.
286. Corneal dystrophy with some white fibrillar deposit is in Lattice Dystrophy. (Sep 2017)
287. GAP-43 protein is important in neuronal regeneration. Glial cells are important for repair after
stroke.
288. Crocodile tears means tear production during eating, cause is injury to facial nerve.
289. If eye does not blink on touching cornea of ipsilateral or contralateral side, the lesion is in
ipsilateral facial nerve.
290. Oculocardiac reflex affarent is Trigeminal and efferent is Vagus.
291. Internal capsule lesion leads to contralateral hemiplegia and contralateral homonymous crescent
defect. (A patient can't see laterally with his left eye and he don't feel sensations in the lower right
body, The lesion will be in left internal capsule)
292. Patient suffers from right hemiplegia, angle of mouth deviates to left while talking and there is
dribbling of saliva from corner of mouth. Lesion is in internal capsule (Nov 2017)
293. Patient having difficulty in closing his eye,angle of mouth deviating to opposite side while talking
and water dribbling from mouth after a cold inducded injury (Bells palsy/LMN of facial nerve). The
most likely site of lesion is facial canal. (Nov 2017)
294. A patient can close his eyes but the rest of the body is hemiplegic = Lesion is in anterior part of
Posterior limb of the internal capsule. Do not click any options containing genu because the genu of
the internal capsule contains the corticobulbar fibers.(May 2017)
295. Lesion of PICA = Nystagmus + Hemianopia + Horner + Loss of temperature sensation on face.
296. In a child having intermittent nystagmus which is irregular and on examination ophthalmic and
neurological examination is normal, the lesion will be in Cerebellum.
297. Corneal arcus in a child or young adult may be due to severe systemic disease (Apple and Rabb
MCQs)
298. NO enlargment of corneal nerves in herpes simplex keratitis, but it can happen in keratoconus,
leprosy, neurofibromatosis and multiple myeloma.
299. Autoimmune keratitis is peripheral ulcerative keratitis. (AAO.org)
300. Viscoelastic gel protects ocular tissue.
301. Chest pain and lens dislocation happens in Marfan syndrome (T.N 3rded page 84) Two scenerios
were from marfan one dissecting aortic aneurysm and other was Ectopia lentis in Nov 2018.
302. 2 years old child with fever, arthralgia and blindness is suffering from chronic juvenile arthritis
(T.N 3rded page 84)(May 2017)

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303. In 80% leukemia patients, there is also OCULAR involvement.
304. In 40% leukemia patients, there is also RETINAL involvement.
305. Corneal pigmentation is NOT a complication of contact lenses.
306. Aphakia can be corrected by spectacles, contact lenses, anterior chamber IOL and posterior
chamber IOL.
307. Descematocele can lead to corneal perforation.
308. Painful peripheral corneal ulceration of unknown etiology is called Mooren’s ulcer, needs
steroids for treatment.
309. Rubeosis iridis is NOT seen in hypertensive retinopathy.
310. Amaurotic cat’s eye reflex is seen in retrolental fibroplasias, retinoblastoma and complete retinal
detachment.
311. Xanthelasma is NOT malignant.
312. Krukenberg Spindle is seen in pigment dispersion syndrome.
313. Patient presents with blurred vision along with headache mostly in the temporal region. o/e
temporal region is hard and tender. The underlying disease is giant cell arteritis/temporal arteritis.
(Sep & Nov 2017) (May 2018 & Nov 2018)
314. An ophthalmologist can prevent Hepatitis B transmission by pre op screening of all patients .
(Sep 2017) Same question was repeated in Nov 2018 And answer was to avoid sharp instruments as
given in guidelines to prevent hepatitis transmission.(Nov 2018)
315. Pain on one side of face, ptosis, eyeball deviated down and out with dilated pupil in occulomotor
nerve injury. (March 2018)
316. Diplopia at downward gaze in trochlear nerve injury. (March 2018)
317. A farmer spraying in field becomes unconcious and has frothing from mouth presents with
bilateral pinpoint pupils. (March 2018)
318. History of blunt trauma associated with corneal edema, fixed dilated pupil and pain due to raised
IOP. (March 2018)
319. Young patient with blunt trauma, decreased vision with dilated pupils, hazy cornea, what is the
cause of the pupillary defect? Trauma to sphincter pupillae. (September 2018)
320. Loss of accommodation, lesion would be at the level of midbrain. (March 2018 & Nov 2018)
321. Truck driver slept with window open, in the morning mouth deviated to one side and unable to
shut eye. Inability to shut the eye is due to orbicularis oculi muslce. (March 2018)
322. Oculocardiac reflex afferent is trigeminal nerve and efferent is vagus nerve. (March 2018)
323. Patient developed gradual loss of peripheral vision over 3 years. On examination has bitemporal
hemianopia. The visual loss is due to pitutary adenoma. (March 2018)

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324. Patient with bitemporal hemianopia. Lesion is at: Center of optic chiasma. (September 2018)
325. Right handed person with left inferior quadrantanopia, lesion in right parietal lobe. (i.e.
contralateral inferior quadrantanopia) (March 2018)
326. Child had trauma with ball followed by restriction in upward movement of eye and diplopia due
to blow out fracture of orbit. (March and September 2018)
327. When emmetropic person becomes presbyopic, the near point increases. (March 2018)
328. White pupillary reflex (leukocoria) in an infant diagnosed with PHPV is because of Hyperplastic
pupillary membrane. (May and September 2018)
329. Patient with right sided CN 6 palsy with left sided deviation of mouth and left sided weakness of
upper and lower limbs. Site of lesion is PONS (September 2018)
330. Fire fighter damages his eye by burning and afterwards develops corneal edema. Most likely
cause is: Direct damage to corneal endothelium. (September 2018)
331. Cotton wool spots are present in Diabetic retinopathy. (September 2018)
332. Histological feature of background diabetic retinopathy is MICROANEURYSMS. (September
2018)
333. In Retrolental fibroplasia, neovascularization occurs at Peripheral retina. (September 2018)
334. Deficiency of Vitamin A and Vitamin D in 50 years old man with long standing fat malabsorption
= Keratomalacia. (September 2018)
335. Patient with dished-in face appearance, cleft palate, syndactyly, broad nose and exophthalmos.
Alpert syndrome. (September 2018)
336. Most common congenital diseases Multifactorial. (September 2018)
337. Patient tall man with blurred vision, impotent. On x-ray deep pituitary fossa. Diagnosis is
Prolactinoma. (September 2018)
338. Teacher could not differentiate between colors, cause is Absent cones. (September 2018)

339.Loss of convergence lesion is at midbrain.(Nov 2018)

340.Artery involved in wallenberg syndrom Is posterior inferior cerebellar artery or vertebral artery as
PICA was not in options.(Nov 2018)

341. Hemophilia Factor 8 minor deficiency ( Nov 2018 )

342. Definitive diagnosis of temporal arteritis is Temporal artery biopsy. (Nov 2018)

343.A scenerio on wegeners granulomatosis H/O paranasal sinus infection with renal findings. (Nov
2018)

344.Demyelination of nerves is by Lead poisoning . (Nov 2018) ( Ref Harsh mohan textbook of
pathology)

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345. Patient having bilateral parotid enlargement with itching in eyes and dry mouth plus H/O difficulty
in swallowing is Sjogren syndrom Not scleroderma as Former is associated with other autoimmune
diseases too.(Nov 2018).

346.Most sensitive test for SLE is ANA. (Nov 2018).

SOME ADDITONAL POINTS

LOCALIZATION OF LESION IN THE VISUAL PATHWAY

1. Ipsilateral complete blindness, light reflex absent >> Ipsilateral optic nerve.

2. Bitemporal heteronymous hemianopia >> Optic chiasma

3. Nasal hemianopia >> Lateral part of optic chiasma (temporal fibers which don’t cross)
4. Bitemporal heteronymous superior quadrantanopia >> Anterior part of optic chiasma. 🕘🕒
5. Bitemporal heteronymous inferior quadrantanopia >> Posterior part of optic chiasma 🕤🕞

ALL RETEROCHIASMAL LESIONS CAUSE CONTRALATERAL HOMONYMOUS


DEFECTS
6. Contralateral homonymous hemianopia, light reflex absent >> Optic tract

LESIONS BEHIND THE OPTIC TRACT DON’T AFFECT THE LIGHT REFLEX
7. Contralateral homonymous hemianopia, light reflex intact >> LGB, complete lesion of optic
radiation

Contralateral homonymous superior quadrantanopia, light reflex intact >> Lateral fibers of optic
radiation i.e. the Meyer’s loop travelling in the temporal lobe

8. Contralateral homonymous inferior quadrantanopia, light reflex intact >> Medial fibers of the
optic radiation travelling in the parietal lobe

LESIONS BEHIND THE OPTIC RADIATION SPARE THE MACULA


9. Contralateral homonymous superior quadrantanopia with macular sparing, light reflex intact >>
Lingual gyrus (where the Meyer’s loop ends)

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10. Contralateral homonymous inferior quadrantanopia with macular sparing, light reflex intact >>
Cuneus gyrus (where the medial fibers end)

11. Contralateral homonymous hemianopia with macular sparing, light reflex intact >> Visual cortex

OTHER LESIONS
1. Contralateral temporal crescent defect (this affects only one eye) = lesion in the most
anterior part of the calcarine sulcus
2. Gradual loss of vision, unable to recognize objects and interpret= left angular gyrus
3. Prosopagnosia i.e. face blindness = lesion in area 20, 21 or area 37.
4. Tip of Occipital lobe = Left homonymous scotoma
5. Junctional Scotoma = lesion in anterior part of optic chiasma and some part of optic nerve
>> superotemporal qauadrantanopia with a central scotoma on the side of involvement.

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