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MRCP PART 1 · OPHTHALMOLOGY

Ophthalmology questions
for MRCP Part 1.

Clinora has 188 ophthalmology single best answer questions covering 187 topics. Every question explains all five options, separates the key clue from what it means and what to do next, and links to its source. Try the 5 sample questions below, then practise more for free.

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FREE SAMPLE QUESTIONS

Try 5 ophthalmology questions

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Question 1Acute angle-closure glaucomaEasy

A 67-year-old develops abrupt severe unilateral eye pain, blurred vision with coloured haloes, vomiting and headache. The eye is red, the cornea hazy and the pupil fixed in a mid-dilated position. What is the most appropriate immediate management?

  1. AStart emergency pressure-lowering treatment and arrange immediate ophthalmology review
  2. BPrescribe topical chloramphenicol and review after 48 hours
  3. CGive a topical corticosteroid alone for presumed anterior uveitis
  4. DPatch the eye and arrange routine optometry review
  5. EDilate the pupil with tropicamide to improve fundal examination
Show answer and explanation

Answer: A Start emergency pressure-lowering treatment and arrange immediate ophthalmology review

Sudden severe eye pain, blurred vision with haloes, headache and vomiting, with a red eye, hazy cornea and fixed mid-dilated pupil, is acute angle-closure glaucoma. The iris blocks the drainage angle, so pressure inside the eye rises sharply, often above 50 mmHg. That causes corneal oedema (the haze and haloes) and can permanently damage the optic nerve within hours. Treatment is an emergency. Start pressure-lowering treatment straight away, under ophthalmology guidance: typically IV or oral acetazolamide and topical drugs such as a beta-blocker, an alpha-agonist and pilocarpine, with analgesia and antiemetics. Refer immediately. The definitive treatment is laser peripheral iridotomy, usually to both eyes, because the other eye is also at risk. Risk factors include long-sightedness, older age, female sex, East Asian ancestry, and drugs that dilate the pupil (anticholinergics, sympathomimetics and tricyclics). Topiramate can cause angle closure in both eyes. Vomiting and headache can make this look like a neurological or abdominal problem, so always examine the eye.

Key clue
A painful red eye with haloes, vomiting, corneal haze and a fixed mid-dilated pupil
What it means
The cluster indicates acute angle closure rather than infection or uveitis
What to do
Start emergency pressure-lowering treatment and arrange immediate ophthalmology review

Why the other options are less appropriate

  • B This is not conjunctivitis. Antibiotics do nothing for the pressure, and waiting 48 hours risks permanent sight loss.
  • C Uveitis usually causes a small pupil and does not cause a sudden very high pressure. Steroid alone would leave the angle closed.
  • D Routine review is unsafe; damage to the optic nerve can be irreversible within hours.
  • E Dilating the pupil can make the angle closure worse. Mydriatics must be avoided.

Source: College of Optometrists: Clinical Management Guidelines

Question 2Chemical eye injuryMedium

An industrial cleaner containing alkali splashes into a worker’s eye. He arrives within ten minutes with severe pain and blepharospasm. What should happen first?

  1. AMeasure visual acuity before any treatment
  2. BInstil fluorescein and photograph the cornea
  3. CBegin immediate copious irrigation and continue while checking ocular pH
  4. DNeutralise the alkali with a weak acid solution
  5. EWait for ophthalmology before touching the eye
Show answer and explanation

Answer: C Begin immediate copious irrigation and continue while checking ocular pH

Alkali in the eye is an emergency because alkalis break down cell membranes and keep penetrating into the cornea and anterior chamber until they are washed out. Acids coagulate surface proteins and tend to penetrate less. The single most important step is immediate, copious irrigation, started wherever the patient first arrives and before any examination, including visual acuity. Give topical anaesthetic drops to overcome blepharospasm, then irrigate with saline, Hartmann's solution or, if nothing else is available, clean tap water, using at least 1–2 litres. Evert the eyelids and remove any particles from the fornices. Check the pH of the tear film with litmus paper and continue until it is around 7.0–7.5, then recheck after a few minutes, as the pH can drift back. Only then record visual acuity, examine with fluorescein and look for limbal whitening (ischaemia), which predicts a poor outcome. All significant alkali injuries need same-day ophthalmology review. Complications include corneal scarring, glaucoma, cataract and loss of limbal stem cells.

Key clue
Recent alkali exposure with ongoing ocular pain and blepharospasm
What it means
Continuing chemical contact is the immediate reversible threat to ocular tissue
What to do
Begin immediate copious irrigation and continue while checking ocular pH

Why the other options are less appropriate

  • A Visual acuity is normally recorded first, but chemical injury is the exception. Irrigation must start before anything else.
  • B Fluorescein examination is needed, but only after irrigation. Delaying allows the alkali to keep penetrating.
  • D Neutralising with acid can produce heat and further injury, and it delays irrigation. Use saline or water only.
  • E Waiting for ophthalmology allows ongoing damage. Irrigation should start at the first point of contact.

Source: College of Optometrists: Clinical Management Guidelines

Question 3Retinal tear or detachment warning symptomsEasy

A 62-year-old reports sudden flashes and many new floaters in one eye followed by a dark curtain spreading across the temporal field. What is the best action?

  1. AArrange same-day dilated retinal assessment
  2. BReassure and review in six months
  3. CDiagnose migraine aura and prescribe a triptan
  4. DRequest routine refraction before deciding
  5. EStart topical antibiotic drops
Show answer and explanation

Answer: A Arrange same-day dilated retinal assessment

Flashes and new floaters show traction on the retina, usually from posterior vitreous detachment. Flashes come from mechanical stimulation of the retina, and floaters from vitreous opacities or blood. A dark curtain spreading across the field means the retina has detached. A temporal field defect corresponds to detachment of the nasal retina. College of Optometrists guidance treats these symptoms with a field defect as an emergency, needing same-day assessment by an ophthalmologist. Urgency matters because the macula may still be attached. Repair before the macula detaches preserves central vision much better, so macula-on detachments are usually operated on within about 24 hours. Treatment is vitrectomy, scleral buckling or pneumatic retinopexy. Flashes and floaters without a field defect still need a dilated fundus examination within about 24 hours, because a retinal tear can be sealed with laser or cryotherapy. Risk factors include high myopia, previous cataract surgery, trauma and detachment in the other eye.

Key clue
New photopsia and floaters followed by a spreading monocular field curtain
What it means
A retinal tear has probably progressed to detachment
What to do
Arrange same-day dilated retinal assessment

Why the other options are less appropriate

  • B Waiting 6 months allows the detachment to spread to the macula and cause permanent loss of central vision.
  • C Migraine aura is usually bilateral and homonymous and resolves within an hour. A persistent curtain in one eye is not aura.
  • D Refraction measures focusing error and cannot detect a retinal break or detachment. It would delay treatment.
  • E Retinal detachment is a mechanical separation, not an infection. Antibiotic drops play no part.

Source: College of Optometrists: Clinical Management Guidelines

Question 4Retinal vein occlusion with macular oedemaMedium

A 69-year-old with hypertension has a new central retinal vein occlusion. OCT confirms centre-involving macular oedema and visual acuity is reduced. What management is most appropriate?

  1. ABegin lifelong systemic anticoagulation solely to improve the eye
  2. BApply immediate prophylactic panretinal photocoagulation to every non-ischaemic CRVO
  3. CObserve untreated for one year despite disabling oedema
  4. DOffer intravitreal anti-VEGF treatment while assessing and controlling vascular risk factors
  5. EPerform carotid endarterectomy without vascular imaging
Show answer and explanation

Answer: D Offer intravitreal anti-VEGF treatment while assessing and controlling vascular risk factors

In central retinal vein occlusion, vision is usually lost because of centre-involving macular oedema, which OCT has shown here. VEGF released by the ischaemic retina makes the vessels leak. Intravitreal anti-VEGF treatment with ranibizumab or aflibercept is the first-line treatment in the Royal College of Ophthalmologists guidance and is approved by NICE. Injections are monthly until stable, then spaced out. A dexamethasone intravitreal implant is an alternative, particularly in people at high cardiovascular risk or who cannot attend often, but it raises intraocular pressure and causes cataract. Panretinal photocoagulation is not given routinely. It is used once neovascularisation of the iris or angle appears, which is most likely in ischaemic CRVO in the first 3 months, the so-called 90-day glaucoma. Look for systemic causes: check blood pressure, glucose or HbA1c, lipids, full blood count and ESR, and measure intraocular pressure, because glaucoma is a risk factor. Consider wider tests for thrombophilia or hyperviscosity in younger patients.

Key clue
Retinal vein occlusion with OCT-confirmed centre-involving oedema and reduced vision
What it means
The visual problem is macular oedema responsive to intravitreal vascular-endothelial-growth-factor inhibition
What to do
Offer intravitreal anti-VEGF treatment while assessing and controlling vascular risk factors

Why the other options are less appropriate

  • A Anticoagulation does not clear the vein blockage or reduce oedema, and adds bleeding risk. It is not used for the eye alone.
  • B Panretinal photocoagulation treats neovascularisation once it appears. It is not given routinely as prevention in non-ischaemic CRVO.
  • C Untreated centre-involving oedema with reduced vision can cause lasting visual loss. Anti-VEGF treatment works best when started early.
  • E Retinal vein occlusion is not a carotid problem. Carotid surgery is never chosen without imaging and a proper indication.

Source: Royal College of Ophthalmologists: Retinal Vein Occlusion Guideline

Question 5Cataract referralEasy

A 74-year-old with bilateral cataracts has stopped night driving and struggles to read medication labels despite updated spectacles. Visual acuity is 6/12. What is the most appropriate action?

  1. ARefuse referral because acuity is better than 6/18
  2. BWait until the cataract becomes white
  3. CPrescribe long-term steroid drops
  4. DRefer only if both eyes reach the same acuity
  5. EDiscuss cataract surgery and refer if the person wishes, based on functional impact
Show answer and explanation

Answer: E Discuss cataract surgery and refer if the person wishes, based on functional impact

The deciding features are functional: the person has stopped night driving and cannot read medication labels despite updated spectacles. NICE NG77 says referral for cataract surgery should be based on a discussion of how the cataract affects the person's sight and quality of life, whether one or both eyes are affected, the likely benefits and risks, and whether the person wants surgery. NICE states that access to surgery should not be restricted by visual acuity alone, and that second-eye surgery should be offered using the same criteria as the first eye. Glare at night and difficulty with fine print are typical of cataract and can be disabling even when Snellen acuity looks reasonable. Driving matters here: the DVLA requires binocular acuity of at least 6/12, with glasses if needed, and the ability to read a number plate at 20 metres, so this person is at the limit. Risks to discuss include posterior capsule opacification, the commonest late complication, treated with YAG laser capsulotomy, and rarer endophthalmitis and retinal detachment.

Key clue
Cataract causes meaningful driving and medication-reading limitation despite refraction
What it means
Quality-of-life impact, risks, benefits and preference determine surgical referral
What to do
Discuss cataract surgery and refer if the person wishes, based on functional impact

Why the other options are less appropriate

  • A NICE states that access to cataract surgery should not be restricted by visual acuity alone; functional impact and the person's wishes decide.
  • B Waiting for a mature cataract prolongs disability and makes surgery technically harder; there is no requirement for a dense lens.
  • C Steroid drops do not reverse age-related lens opacity, and long-term use can itself cause cataract and raised intraocular pressure.
  • D Each eye is assessed on its own merits; NICE recommends the same criteria for second-eye surgery as for the first.

Source: NICE NG77: Cataracts in adults — recommendations

That is 5 of 188. Carry on with ophthalmology in the practice bank, with progress tracking, flashcards and timed sessions.

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Topics covered

Show all 187 ophthalmology topics
  • A complication in the only functional eye
  • Acanthamoeba keratitis
  • Acute allergic conjunctivitis
  • Acute angle-closure glaucoma
  • Acute dacryocystitis
  • Acute dacryocystitis escalation
  • Acute homonymous hemianopia
  • Acute posterior vitreous detachment
  • Acute postoperative endophthalmitis
  • Acute red eye
  • Acute retinal necrosis
  • Acute third nerve palsy pupil involvement
  • Adenoviral conjunctivitis
  • Adie tonic pupil
  • Advanced chronic open-angle glaucoma
  • Air-puff tonometry alone
  • Amaurosis fugax
  • Anterior chamber hyphema
  • Anterior ischaemic optic neuropathy
  • Anterior uveitis synechiae prevention
  • Anti-VEGF with very poor acuity
  • Arteritic anterior ischaemic optic neuropathy
  • Asymptomatic early AMD
  • Best vitelliform macular dystrophy
  • Birdshot chorioretinopathy
  • Branch retinal vein occlusion
  • Capsular tension ring in pseudoexfoliation
  • Carotid–cavernous fistula
  • Cataract biometry
  • Cataract functional impact
  • Cataract referral
  • Cataract surgery with diabetic eye disease
  • Central retinal artery occlusion
  • Central serous chorioretinopathy association
  • Centre-involving diabetic macular oedema
  • Centre-involving DMO below 400 micrometres
  • Centre-involving DMO with good vision
  • Charles Bonnet syndrome
  • Chemical eye injury
  • Cherry-red-spot retinal artery occlusion
  • Choosing anaesthesia for cataract surgery
  • Choroideremia
  • COAG case-finding before referral
  • Coats disease
  • Confirmed retinal toxicity changes driving advice
  • Confirmed toxicity needs a coordinated treatment decision
  • Congenital glaucoma red flags
  • Congenital nasolacrimal duct obstruction
  • Conjunctivitis contact precautions
  • Contact-lens associated microbial keratitis
  • Contact-lens microbial keratitis
  • Corneal abrasion
  • Corneal disease
  • Corneal ulcer
  • Cystoid macular oedema after cataract surgery
  • Cytomegalovirus retinitis
  • Dense cataract prevents optical biometry
  • Diabetic eye disease
  • Diabetic macular oedema
  • Diabetic retinopathy
  • Diabetic retinopathy pregnancy surveillance
  • Diplopia localisation
  • Emergency acute angle closure
  • Endogenous endophthalmitis
  • Endophthalmitis after surgery
  • Episcleritis
  • Ethambutol optic neuropathy
  • Fellow-eye prophylaxis after acute angle closure
  • Fluorescein corneal staining
  • Fuchs uveitis syndrome
  • Giant cell arteritis
  • Giant-cell arteritis with visual loss
  • Glaucoma
  • Glaucoma referral tonometry limitation
  • Herpes simplex epithelial keratitis
  • Herpes zoster ophthalmicus
  • Imaging suspected wet AMD
  • Immediate irrigation after alkali ocular injury
  • Infantile haemangioma visual risk
  • Inflammatory eye disease
  • Initial treatment of non-advanced COAG
  • Interim treatment before glaucoma surgery
  • Internuclear ophthalmoplegia
  • Intraoperative floppy iris syndrome
  • Ischaemic central retinal vein occlusion
  • Keratoconus
  • Keratoconus clue
  • Late dry age-related macular degeneration
  • Learning from first-eye refractive error
  • Leber hereditary optic neuropathy
  • Lens dislocation in homocystinuria
  • Low vision certification discussion
  • Low-risk ocular hypertension
  • Macular degeneration symptom
  • Macular disease
  • Malignant hypertensive retinopathy
  • Marfan ectopia lentis
  • Marginal keratitis mechanism
  • Missing angle assessment
  • Monitoring wet active AMD
  • Multifocal intraocular lenses
  • Multiple evanescent white dot syndrome
  • Neovascular glaucoma mechanism
  • Neuro-ophthalmology
  • New central distortion
  • Non-arteritic anterior ischaemic optic neuropathy
  • Non-centre-involving diabetic macular oedema
  • Non-clearing vitreous haemorrhage in PDR
  • OCT cannot settle neovascularisation
  • OCT excludes neovascularisation
  • Ocular cicatricial pemphigoid
  • Ocular infection
  • Ocular ischaemic syndrome
  • Ocular melanoma warning sign
  • Ocular migraine differential
  • Ocular myasthenia
  • Ocular sarcoidosis
  • Ocular syphilis with posterior uveitis
  • Ocular toxoplasmosis
  • Ocular trauma
  • One abnormal structural test is not yet definite toxicity
  • Open-angle glaucoma risk
  • Optic nerve disease
  • Optic neuritis
  • Orbital blow-out fracture
  • Orbital blow-out fracture entrapment
  • Orbital cellulitis
  • Orbital disease
  • Paediatric squint amblyopia window
  • Painful Horner syndrome
  • Papilloedema
  • Photodynamic therapy in wet AMD
  • Posterior capsule opacification
  • Preservative-free glaucoma drops
  • Preserving pre-existing monovision
  • Preventing a wrong lens implant
  • Preventing cystoid macular oedema
  • Preventing postoperative endophthalmitis
  • Previous laser refractive surgery changes corneal planning
  • Progression despite apparently controlled IOP
  • Proliferative diabetic retinopathy
  • Proptosis with painful eye movements
  • Pseudotumour cerebri medication association
  • Pterygium
  • Purtscher retinopathy
  • Recalculate the dose after substantial weight change
  • Recurrent atypical chalazion
  • Red eye in contact-lens wearer
  • Referral based on the correct pressure test
  • Referral threshold for COAG-related conditions
  • Repeat selective laser trabeculoplasty
  • Retinal detachment
  • Retinal disease
  • Retinal monitoring history must follow the patient between services
  • Retinal tear or detachment warning symptoms
  • Retinal vascular disease
  • Retinal vein occlusion
  • Retinal vein occlusion with macular oedema
  • Retinitis pigmentosa symptom pattern
  • Retinoblastoma red reflex
  • Retinopathy of hypertension
  • Retinopathy of prematurity
  • Scleritis
  • Scleritis red flag
  • Steroid-induced ocular hypertension
  • Stevens–Johnson syndrome ocular emergency
  • Stopping anti-VEGF in inactive wet AMD
  • Subtarsal foreign body
  • Suspected open-globe injury
  • Suspected wet age-related macular degeneration
  • Temporary anti-VEGF before PRP
  • Terson syndrome
  • The pressure is not the whole diagnosis
  • Third-nerve palsy red flag
  • Thyroid eye disease red flags
  • Thyroid eye disease: urgent feature
  • Topiramate-associated bilateral angle closure
  • Traumatic hyphaema
  • Treating active wet AMD after referral
  • Trochlear nerve palsy
  • Two ocular pathways, one patient
  • Uveitis
  • Vitamin A deficiency
  • Vitreous haemorrhage
  • Vitreous haemorrhage presentation
  • Vogt–Koyanagi–Harada disease
  • When bilateral simultaneous surgery is considered

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