Eye lid

1
 Anatomy
1) The following structures are present in the lid except:
a) Meibomian glands
b) Some accessory lacrimalglands.
c) Goblet cells
d) Zeis glands
2) the Levator Aponeurosis gives attachments to the following except:
a) The anterior surface of the tarsus.
b) The lateral orbital tubercle.
c) The anterior lacrimal crest.
d) The skin of the upper eye lid.
3) The maximal elevation of the upper eyelid that can be achieved on contraction of a healthy Levator
a) 15mm
b) 18mm.
c) 25mm.
d) 30mm.
4) The orbicularis oculi muscle includes the following parts except:
a) Riolan's muscle.
b) Horner's muscle.
c) Pre-tarsal muscle.
d) Muller's muscle.
5) The 7th cranial nerve innervates the following structures except:
a) The orbicularis oculi muscle.
b) The frontalis muscle.
c) The lacrimal gland.
d) The outer half of the conjunctiva.
6) The Levator palpebral superioris muscle is innervated by:
a) The superior division of 3rd cranial nerve.
b) The inferior division of 3rd cranial nerve.
c) The sympathetic chain
d) None of the above
7) All the following arteries share in lid supply except
a) Medial palpebral artery
b) Posterior ciliary artery
c) Lateral palpebral artery
d) superficial temporal artery
8) Superior tarsal muscle (Muller's muscle) is supplied by the:
a) Third cranial nerve
b) Sympathetic nerve fibers
c) Parasympathetic nerve fibers
d) Seventh cranial nerve
9) The anterior and posterior lamellae of the lid can be separated at the level of the lid margin by the:
a) Lash line
b) Line of Meibomian gland orifices
c) Gray line
d) Mucocutenous junction

2
10) Muller's muscle is responsible for :
a) Reflex Blepharospasm
b) Gentle closure of the palpebral fissure.
c) Initiation and maintenance of lid elevation
d) Pumping of tears along the nasolacrimal duct.
11) As regards lid margins; choose the correct statements
a) The grey line indicates position of the premuscular areolar tissue
b) The white line represents the openings of Meibornian glands .
c) The lacrirnal puncti are normally visible 6 mm frorn the medial canthi
D) The average central distance between both lid margins is 9-10 mm.

Blepharitis
12) All of the following statements concerning ulcerative Blepharitis are correct except:
a) Causative organism is Morax-Axenfield.
b) Can be complicated by keratitis.
c) Can be complicated by Madarosis.
d) Treated by antibiotics.
13) Squamous Blepharitis may be caused by :
a) Uncorrected errors of refraction.
b) Bad hygiene.
c) Malnutrition
d) Dandruff of the scalp.
e) All of the above.
14) Treatment of ulcerative Blepharitis include the following except:
a) Local lid hygiene
b) Local antibiotics eye ointment
c) Systemic antibiotics.
d) Epilation of lashes.
15) Sodium bicarbonate 3% is not used In the management of:
a) Squamous Blepharitis ·
b) Acidic ocular bums
c) Phthirus pubis.
d) Ulcerative Blepharitis
16) Angular Blepharitis is:
a) Usually followed by Madarosis
b) Caused by Moraxella.
c) Treated by zinc sulfate eye drops (5 %}
d) Restricted to the inner canthi of the lid margins.
17) In angular blepharo-conjunctivitis skin maceration is due to:
a) Skin allergy to the invading organisms.
b) Proteolytic enzymes secreted by the invading organisms.
c) Toxins of the Invading organisms.
d) Prolonged Epiphora.

3
18) The usual causative organism of ulcerative Blepharitis is:
a) E.Coli
b) Pneumococcus.
c) Staphylococcus Aureus
d) Morax-Axenfield diplobacillus
19) Ptylosis refers to:
a) Loss of lashes
b) maldirected lashes
c) Blocked Meibomian orifices
d) Hypertrophied drooping lid
20) Male patient complaining of continuous redness of both eyes with frequent loss of lashes. On
examination the lid margin shows yellow crusts left painful ulcer on removal. The most probable
diagnosis is:
a) Squamous Blepharitis
b) Ulcerative Blepharitis
c) Angular Blepharitis
d) Parasitic Blepharitis
21) A male patient 18 years old complaining of presence of scales on his lashes, he had also dandruff on
(his eye brows, the possible diagnosis is:
a) Angular Blepharitis
b) Squamous Blepharitis
c) Ulcerative Blepharitis
d) Contact dermatitis
Inflammation of lid glands
22) A 52-year old patient with, recurrent chalazion (three times) in the upper eye lid is best managed by
a) Antibiotics and steroids.
b) Systemic antibiotics and antihistaminic.
c) Excision and curette operation.
d) Excision and histopathology.
23) As regards Hordeolum internum, the following are false except
a) Its swelling is related to the eyelashes
b) it evacuation is mandatory
c) it disappears spontaneously with no complications
d) it may result in chalazion formation
24) The stye is an acute suppurative inflammation of:
a) Meibomian glands.
b) Accessory lacrimal glands.
c) Main lacrimal gland
d) Glands of the lash follicle.
25) Chalazion is defined as:
a) Acute suppurative inflammation of the Meibomian glands.
b) Acute non suppurative inflammation of Meibomian glands.
c) Chronic non- granulomatous inflammation of Meibomian glands.
d) Chronic granulomatous inflammation of Meibomian glands.

4
26) Chalazion can cause the following complications except
a) Mechanical ptosis.
b) Anterior uveitis.
c) Irregular astigmatism.
d) Internal Hordeolum
27) Treatment of Hordeolum internum include all of the following except
a) Hot fomentation
b) Antibiotics
c) Evacuation
d) Epilation of the related lash
28) Which of these is a common occurrence with chalazia:
a) Complete spontaneous resolution with time
b) Conjunctival side of the lesion is reddish or purplish
c) Transformation to malignancy
d) Presentation as nodule in the intermarginal strip
29) Chalazion:
a) Is also called as tarsal cyst
b) Can result in pre-septal cellulitis if untreated
c) Heals if the affected lash is pulled out
d) Is a non-suppurative inflammation of a Zeis gland
30) Pain is a rare symptom of:
a) stye
b) chalazion
c) orbital cellulites
d) Scleritis

Disorders of eye lashes

31) 40. As regards Distichiasis; which is true?
a) It never dates since birth
b) It usually arise at the muco-cutaneous junction of the lid margin
c) It is always associated with photophobia, lacrimation, and Blepharospasm.
d) It may be associated with dysfunctioning Meibomian glands.
32) Van Millengen's operation is indicated in:
a) Trichiasis and entropion of the upper eye lid.
b) Pure Trichiasis of the upper eyelid.
c) Trichiasis and entropion of the lower eye lid.
d) Pure Trichiasis of the lower eye lid.
33) Patient complaining of foreign body sensation was found to have 10 mal-directed lashes in the middle
of the upper eye lid .the lid margin was otherwise normal. The best treatment is:
a) Middle of his upper eye lid. Snellen's operation.
b) Van Millengen's operation.
c) Electrolysis.
d) Z-plasty.
34) Trichiasis is not caused by:
a) Dacryocystitis.
b) Trachoma.
c) Ulcerative Blepharitis.
d) Chemical injuries of the lid margin.

5
35) Pure Trichiasis of the lower lid is surgically treated by:
a) Snellen's operation. .
b) Van Millengen's operation.
c) Fasanella-Servat operation.
d) Webster's operation.
36) For Trichiasis which is: complicated by a corneal ulcer; the urgent treatment:
a) Epilation. ·
b) Electrolysis.
c) Argon laser application.
d) Trans positional flaps
37) Causes of Madarosis includes:
a) Tumors
b) Blepharitis
c) Leprosy
d) All of the above
38) Patient has an upper lid Trichiasis with history of chronic eye irritation. The commonest cause Is:
a) Infected chalazion
b) Stye
c) Spring catarrh
d) Trachoma
Entropion &ectropion
39) Rolling inward of the lower lid margin can be due to:
a) Scarring of the lid skin.
b) Ophthalomoplegia.
c) Facial palsy.
d) Trachoma
40) Cicatricial ectropion of the lower lid due to extensive scarring of the skin is best treated by:
a) Lower lid taping.
b) Skin grafting.
c) V-Y procedure.
d) Lateral tarsoraphy.
41) in elderly; entropion never be:
a) Involutional.
b) Spastic
c) Cicatricial.
d) Paralytic
42) Cicatricial entropion may occur, secondary to :
a) Cicatricial pemphegoid.
b) Trachoma.
c) Chemical bums.
d) Stevens-Johnson syndrome.
e) All of the above.
43) As regards ectropion; which is true?
a) The clinical picture depends on severity, not duration.
b) The Epiphora is a result, not a cause.
c) Snellen's sutures may be used for correction of paralytic ectropion
d) All mild cases may be treated with conjunctival cauterization.

6
44) Tarsal wedge resection operation is indicated in:
a) Pure Trichiasis of the upper eye lid
b) Trichiasis and entropion of the upper eye lid
c) Trichiasis and entropion of the lower eye lid.
d) Pure Trichiasis of the lower eye lid.
45) Recurrent spastic entropion can be treated by:
a) Horner's muscle weakening
b) Skin and muscle graft
c) Z-plasty
d) Skin and muscle removal
46) Ectropion of the upper lid most commonly
a) Spastic ectropion
b) Senile ectropion
c) Paralytic ectropion
d) Cicatricial ectropion

Ptosis & Lagophthalmos

47) The Levator muscle action can be tested by :
A- MRD-1 b- MLD. c- Berke's method. d- Hirschberg corneal reflex.
48) The MRD1 in at patient having 6mm ptosis is
A- 4.5 mm. B- 2.5 mm. C- 1.5 mm. d- Minus 1.5 mm
49) A patient presents with sudden onset of 7th, nerve palsy affecting all the facial muscles. The first line of
treatment is:
a) Continuous ocular lubrication.
b) Immediate lateral tarsoraphy.
c) Immediate resection don of the levatoi1 muscle.
d) Corticosteroids use
50) Causes of Lagophthalmos include the followings except:
a) Thyroid exophthalmos.
b) Facial palsy.
c) Lid Coloboma.
d) Severe entropion
51) The commonest cause of bilateral Ptosis is:
a) Sympathetic paralysis
b) 3rd nerve palsy.
c) Congenital
d) Mechanical.
52) Clinical features of Horner's syndrome may include the following except:
a) Unilateral mild ptosis.
b) Absence of ciliospinal reflex
c) Miosis.
d) Hydrosis.
53) Ptosis may be a misdiagnosis if there is:
a) Ipsilateral hypotropia
b) Contra lateral enophthalmus.
c) Contra lateral hypertrpoia.
d) Facial asymmetry.

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54) Which of e following should be treated as early as possible?
a) Myasthenic ptosis.
b) Hysterical ptosis.
c) Acquired ptosis.
d) Severe unilateral congenital ptosis.
55) The most important examination in cases presenting With Congenital ptosis is:
a) The function of the Levator muscle.
b) The state of the extra ocular muscles.
c) The examination of the cranial nerves.
d) The examination of the fundus.
56) Congenital ptosis maybe associated with the ·following congenital anomalies except:
a) Epicanthus.
b) Blepherophimosis
c) Marcus-Gun phenomenon.
d) Congenital naso-lacrimal duct obstruction.
57) Complications of congenital ptosis include the following except:
a) Amblyopia.
b) Lumber lordosis.
c) Ocular torticollis.
d) Complicated cataract
58) Congenital ptosis is characterized by:
a) Absent eyelid crease
b) Chin elevation
c) Forehead corrugation
d) All of the above
59) Levator resection operation should be used in:
a) Mild ptosis with good Levator function
b) Moderate ptosis with good Levator function'
c) Moderate ptosis with poor Levator function
d) Severe ptosis with poor Levator function
60) As regards Myasthenic ptosis; which are wrong ?.
a) It is unilateral in most cases.
b) It may be increased after repeated upward fixation.
c) It can't be compensated by frontalis muscle.
d) It may be improved by prostigmine injection.
e) It may be treated by Mullerectomy.
61) Diagnosis of ptosis can be done by the following:
a) Absence of lid crease ·
b) Margin reflex distance
c) Levator excursion
d) All of the above
62) 4 year old child with severe bilateral congenital myogenic ptosis with poor Levator function
a) Will have a chin up head position
b) Will benefit from bilateral frontalis suspension procedure
c) Is likely to have amblyopia
d) All of the above are true

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63) Moderate degree of congenital ptosis is best treated by
a) Sling operation
b) Levator resection and advancement
c) Motai's operation
d) None of the above
64) The best time for treatment of mild degree of unilateral congenital ptosis at
a) After birth
b) Two years of age
c) School age
d) Puberty
65) A patient with good Levator muscle action, ptosis disappears upon instillation of phenylephrine.
The best operative modality for such case will be:
a) Fasanella-servat operation
b) LPS resection
c) Unilateral frontalis sling operation
d) Bilateral frontalis sling operation
66) AII of the following are causes of Lagophthalmos except
a) Thyroid exophthalmos
b) Lid Coloboma
c) sever ectropion
d) sever entropion
67) Xanthelasma can occur in:
a) Hypolipidemia
b) Hyperlipidemia
c) Hypoglycemia
d) Hypocalcaemia
68) The following is correct about capillary haemangioma of the lid
a) Strawberry Colord flat or elevated lesion
b) It is associated with systemic disorders
c) Unilateral
d) Can be treated with steroids
e) All of the above
69) Basal cell carcinoma of the lid account for:
a) 10% of lid tumors
b) 30% of lid tumors
c) 70% of lid tumors
d) 90% of lid tumors
70) Squamous cell carcinoma of the lid account for:
a) 5 % of lid tumors
b) 30% of lid tumors
c) 70% of lid tumors
d) 90% of lid tumors
71) Causes of Coloboma include:
a) Congenital
b) Trauma
c) Tumors
d) All of the above

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72) A 70-year-old patient.is suffering from excessive watering of his eyes, on examination, the lower
Puncti and the posterior margins of both lower lids are well seen without touch. We expect to find
a) Weak orbicularis oculi
b) Scar of skin of lids
c) Adenoma of tarsus
d) Deviation of angle of mouth
73) Components in Blepherophimosis include the following except

a) Bilateral ptosis
b) Epicanthus
c) Telecanthus
d) Entropion
74) All of the following statements regarding Dermatochalasis are true EXCEPT
a) It commences during puberty
b) It results in pseudo ptosis
c) Blepharoplasty can correct the disorder
d) There is redundant skin around the eye lids
Answers

1 C 27 d 54 d

2 C 28 b 55 a
3 b 29 a 56 d
4 d 30 b 57 d
5 d 31 d 58 d
6 a 32 b 59 b
7 b 33 b 60 A,
e
8 B 34 a 61 d
9 c 35 d 62 d
10 c 36 a 63 b
11 B,d 37 d 64 c
12 a 38 d 65 a
13 e 39 d 66 d
14 d 40 b 67 b
15 c 41 d 68 e
16 b 42 e 69 d
17 b 43 70 a
18 c 44 b 71 d
19 d 45 d 72 a
20 b 46 d 73 d
21 b 47 c 74 a
22 d 48 d
23 d 49 a
24 d 50 d
25 d 52 d
26 b 53 d

10
 Lacrimal
apparatus

11
 Anatomy
1) The lacrimal secretory system consists of the following except :
e) Lacrimal gland
f) Accessory lacrimal gland
g) Goblet cells
h) Lacrimal sac
2) The lacrimal drainage system consist of the following parts except :
a) Puncti
b) Canaliculi
c) Lacrimal sac
d) Goblet cell
3) As regards the lacrimal gland tissue; which is false
a) The glands of Wolfring are located at the upper border of the tarsus.
b) The main lacrimal gland lies in the upper inner part of the orbit.
c) The gland of Krause is located in the superior fornix.
d) The lacrimal tissue secretes the aqueous portion of tears.
4) The accessory lacrimal tissues are mainly responsible for :
a) Basic tear secretion.
b) Reflex tear secretion.
c) Both of them.
5) Several ducts pass from the orbital portion of the lacrimal gland and open into:
a) The lateral aspect of the superior fornix.
b) The medial aspect of the superior fornix.
c) The medial aspect of the inferior fornix.
d) The lateral aspect of the inferior fornix.
6) The lacrimal sac is:
a) Related to medial palpebral ligament
b) Related to lateral palpebral ligament
a) Related to the roof of the orbit
b) Not related to lacrimal portion of orbicularis oculi muscle
7) From the punctum to the common canaliculus measures:
a) 2mm horizontal then 8mm vertical.
b) 3mm vertical then 8mm horizontal.
c) 3mm horizontal then 8mm vertical.
d) 2mm vertical then 8mm horizontal.
8) regards the nasolacrimal duct ; the following are true except
a) It is directed downwards, backwards and laterally.
b) It measures about 16mm in length.
c) It takes sensory innervation from the 5. Cranial nerve.
d) It has a bidirectional valve at its lower end.
9) The tear film consists of:
a) Mucus and aqueous layer.
b) Mucus and lipid layer.
c) Lipid and aqueous layer.
d) Lipid, aqueous and mucus layer.

12
10) The lipid layer function is:
a) Retardation of the tear evaporation.
b) Supplying nutrition to the cornea.
c) Converting the cornea into a hydrophilic surface.
d) Defense against microorganisms.
11) The aqueous layer function is:
a) Retardation of the teat evaporation.
b) Preventing the tear dropping over the cheeks.
c) Converting the cornea into a hydrophilic surface.
d) Defense against microorganisms.
12) The mucus layer function is:
a) Retardation of the tear evaporation.
b) Supplying nutrition to the cornea.
c) Converting the cornea into a hydrophilic surface.
d) Defense against microorganisms.
13) About tear drainage during awaking hours; which is true?
a) All tears will evaporate.
b) All tears will pass to the nose.
c) Some tears will evaporate, while the majority will pass to the nose.
d) Some tears will pass to the nose, while the majority will evaporate.
14) Mucus part of the tear film is secreted by:
a) Main lacrimal gland.
b) Accessory lacrimal glands.
c) Goblet cells of the conjunctiva.
d) Meibomian glands.
15) All the following statements about the pre-corneal tear film are correct except:
a) It provides nutrition to the cornea.
b) It protects the cornea through its anti-bacterial effect.
c) It lubricates the corneal surface.
d) It is not affected by deficiency of the Goblet cells.

D acrocystitis
16) Chronic Dacryoadenitis ; the following may be present except:
a) Tenderness over the lacrimal gland.
b) Down and in proptosis.
c) S - Shaped deformity of the upper eyelid.
d) Xerosis.
17) A case diagnosed as having chronic Dacryocystitis will present with the following clinical picture except
a) Fullness related to the medial canthus.
b) Epiphora.
c) Swelling below the media canthus.
d) -ve regurge test

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18) A patient complains of watering of the eye. On pressing over the medial canthal ligament,
Regurgitation of fluid occurs. The best treatment is:
a) Systemic and local antibiotics.
b) Probing of the naso lacrimal duct.
c) Dacro-cystectomy.
d) Dacryocystorhinostomy.
19) A 40-years old patient has Epiphora. On lacrimal irrigation from the lower punctum, saline gets out
from the upper punctum. The best treatment is:
a) Systemic and local antibiotics.
b) Probing of the naso lacrimal duct.
c) Dacryocystorhinostomy.
d) Dacryo-cystectomy.
20) A middle aged patient with chronic dacrocystitis .on examination the nose showed atrophic rhinitis .the
ideal treatment is :
a) Probing
b) Massage
c) Dacryocystectomy
d) Dacryocystorhinostomy
21) Chronic dacrocystitis increase the risk of :
a) Phylectenular conjunctivitis
b) Vernal conjunctivitis
c) Pneumococcal conjunctivitis
d) Dendritic corneal ulcer
22) The most important organism responsible for chronic dacrocystitis is
a) Morax axenfield
b) Pneumococcus
c) Candida albicans
d) Streptococcus
23) Acute dacrocystitis is treated by
a) Dacryocystectomy
b) Dacryocystorhinostomy
c) Probing of lacrimal sac
d) Antibiotic & hot fomentation
24) Complications of acute Dacryocystitis include all of the following except:
a) Cavernous sinus thrombosis.
b) Orbital cellulitis.
c) Fistula
d) Squint
25) Lacrimation in the neonates requires proper ophthalmic examination to check for the following:
a) Ophthalmia neonatorum.
b) Nasolacrimal duct obstruction.
c) Corneal ulcer.
d) Congenital glaucoma.
e) All of the above.

14
26) Chronic dacrocystitis may cause the following except :
a) Recurrent conjunctivitis
b) Recurrent dendritic ulcer
c) Corneal ulcer with hypopyon
d) Post-operative endophthalmitis
27) Mother noticed in her 3-month-old infant continuous epiphora and frequent muco-purulent discharge.
Your advice for primary treatment should be:
a) Syringing.
b) Antibiotics and massage.
c) Dacryo-cysto-rhinostomy.
d) Dacryo-cystectomy.
28) A 14-month-old child presented with recurrent redness and discharge in the left eye since birth.
Regurge test was positive. Treatment should be in the form of:
a) Long term use of antibiotics.
b) Massage to the lacrimal passages.
c) Probing of the lacrimal passages.
d) Dacryo-cysto-rhinostomy.
29) 20-A +ve regurge test is diagnostic of
a) Nasolacrimal duct obstruction.
b) Canalicular obstruction.
c) Punctual Occlusion.
d) Ectropion.
30) The most common cause of nasolacrimal duct obstruction in infants is:
a) Imperforate Hasner's valve.
b) Venous congestion of the peri-ductal venous plexus.
c) Adhesions around the nasolacrimal duct.
d) Tumors of the bony canal in which the duct passes.
31) Probing of congenital naso lacrimal duct should not be done before the age of:
a) Two months.
b) Four months.
c) Six months.
d) Nine months.
Watering & dry eye
32) Epiphora following 7th nerve palsy may be due to :
a) Lower eyelid entropion
b) Lagophthalmos with reflex hypo-secretion.
c) Failure of the lacrimal pump system.
33) Epiphora is common with the following except
a) Nasal polypi.
b) Distichiasis.
c) Coloboma of the lower lid margin.
d) Paralysis of the orbicularis muscle.

15
34) Investigations done in a case of Epiphora include all of the following except:
a) Examination of the cheeks and face for scars.
b) Examination of the lid margin.
c) Jones dye test.
d) Fluorescein angiography.
35) The hard stop in probing and irrigation done in a case of Epiphora corresponds to:
a) The junction of the common canaliculus with the lacrimal sac.
b) The medial wall of the sac.
c) The punctum.
d) None of the above.
36) Contrast Dacrocystography is indicated in the following conditions:
a) To confirm the site of obstruction especially prior to lacrimal surgery.
b) To aid in the diagnosis of diverticula and fistula.
c) To diagnose the filling defects caused by tumors or stones.
d) All of the above.
37) Which of the following are symptoms of dry eye syndrome
a) Burning or stinging eyes
b) Excessive tearing
c) A decreasing tolerance of contact lenses
d) All of the above
38) On measuring the tear production using Schirmer test the result is abnormal if the wetting of
The filter paper is:
a) Less than 2mm in 5 minutes.
b) Less than 3mm in 5 minutes.
c) Less than 5mm in 5 minutes.
d) Less than 7mm in 5 minutes.
39) Tear film break up time measures:
a) Tear film production.
b) Tear film distribution.
c) Tear film volume.
d) Tear film stability.
40) The following can be utilized in the assessment of the pre -corneal tear film except:
a) Fluorescein break up time.
b) Rose Bengal stain.
c) Schirmer’s test.
d) Conjunctival swab.
e) Slit lamp examination.
41) Tear film Break -up time test measures :
a) Tear film production
b) Tear film distribution
c) Tear film volume
d) Tear film stability

16
42) The risk factors for dry eye are
a) Aging
b) Menopause
c) Autoimmune diseases
d) All of the above
43) A female patient 50 years old (with rheumatoid arthritis) complaining that her vision improves with
blinking, the most probable diagnosis is?
a) Allergic conjunctivitis.
b) Mucopurulent conjunctivitis.
c) Dry eye.
d) Errors of refraction.
44) As regards Bitot' spots; which is true?
a) They may complicate liver cirrhosis.
b) They represent a hyaline degeneration of the conjunctiva
c) They are covered by a foamy material that is secreted by Morax-Axenfield
d) They never need surgical intervention.
45) One of the following is not an indication for dacryo-cysto-rhinostomy:
a) Lacrimal fistula.
b) Acute dacrocystitis after treatment of infection
c) Chronic dacrocystitis.
d) Mucocele of the lacrimal sac.
46) About DCR; which are wrong?
a) It should be done as early as possible in management of nasolacrimal duct obstruction.
b) It may be done if there is a mucocele with patent lower canaliculus.
c) It is absolutely contraindicated if there is atrophic rhinitis.
D) It is absolutely contraindicated if there is T.B. of the lacrimal sac.
Answers

1 d 17 d 34 d

2 d 18 d 35 b
3 b 19 c 36 d
4 c 20 c 37 d
5 a 21 c 38 c
6 a 22 b 39 d
7 d 23 d 40 d
8 d 24 d 41 d
9 d 25 e 42 d
10 a 26 b 43 c
11 d 27 b 44 a
12 c 28 b 45 a
13 c 29 a 46 a
14 c 30 a
15 d 31 d
16 a 32 c
17 d 33 b

17
Conjunctiva

18
 Anatomy & conjunctivitis
1) As regards conjunctiva; choose the correct statements:
a) It is firmly adherent only to the tarsus.
b) The sulcus subtarsalis is 2 mm away from the lid margin.
c) The lateral fornix is the shallowest.
d) The posterior conjunctival arteries are responsible for the circurm- corneal flush.
2) The normal flora of the conjunctiva are the following except:
a) Staph - albus
b) Staph – Aureus
c) Xerosis bacilli
d) diplococci like pneumococci e- Saprophytic fungi
3) The most commonly serious complication of muco-purulent conjunctivitis is:
a) Madarosis.
b) Conjunctival scarring.
c) Dry eye.
d) Corneal ulcer.
4) In ophthalmia neonatorum the most common dangerous causative organism is:
a) E. coli.
b) Gonococci.
c) Xerosis bacilli.
d) Herpes simplex virus.
5) Lacrimation in neonates necessitates proper ophthalmic examination to check for the following except:
a) Microphthalmia.
b) Birth corneal trauma.
c) Ophthalmia neonatorum.
d) Buphthalmos.
e) Nasolacrimal duct obstruction
6) A child 5-year old was presented with bilateral red eye. His mother mentioned that his lids were stuck
together on waking up in the morning. On examination, vision was 6/6, the lashes were glued together.
The most reliable diagnosis is:
a) Spring catarrh.
b) Active trachoma.
c) Muco-purulent conjunctivitis.
d) Viral conjunctivitis.
7) True membrane formation occurs in the following conditions:
a) Diphtheritic conjunctivitis. c) Mucopurulent conjunctivitis.
b) Allergic conjunctivitis. d) Phylectenular conjunctivitis.
8) In the treatment of herpes simplex conjunctivitis we may get benefit from:
a) Hot fomentations. C) . Boric acid lotion
b) Cold compresses. D) Lead acetate fomentations.
9) On August 1999, many of Egyptian citizens have complained of bilateral red watery eyes. On examination, a marked
follicular reaction was present mainly on the lower palpebral conjunctiva, accompanied by preauricular
lymphadenopathy. The possible diagnosis was:
a) Active trachoma.
b) Epidemic keratoconjunctivitis.
c) Mucopurulent conjunctivitis.
d) Purulent conjunctivitis.
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10) In viral epidemic kerato conjunctivitis characteristically there is :
a) Copious purulent discharge.
b) Copious muco purulent discharge.
c) Excessive watery lacrimation.
d) Mucous ropy white discharge.
11) In Ophthalmia Neonatorum, all are true except:
a) Any form of conjunctivitis occurring in the first month of life.
b) Should be differentiated from congenital dacrocystitis.
c) Washing of the body from downward up preventive for this condition
d) The diagnosis depends mainly on the clinical picture
12) In membranous conjunctivitis, the following is true:
a) Membrane is formed by condensation of the discharge & exudates over the conjunctival surface
b) The most common cause is Diphtheria.
c) Removal of membrane leaves intact epithelium.
d) In children with corneal involvement, atropine eye drops are used.
13) in viral conjunctivitis, all the following are true except:
a) It is a self-limiting within 14 days.
b) Characterized by enlarged tender pre-auricular lymph nodes.
c) It is usually non- contagious.
d) One of the causes of follicular conjunctivitis.
14) Bandage of the eye is contraindicated in:
a) Corneal abrasion discharge.
b) Bacterial corneal ulcer.
c) Mucopurulent conjunctivitis
d) After glaucoma surgery
15) All of the following may be seen with trachoma except:
a) Follicular conjunctivitis.
b) Trant's spots.
c) Herbert’s pits.
d) Conjunctival scarring.
16) In trachoma the patient is infectious when there is:
a) Arlet's line.
b) Herbert’s pits.
c) Post-trachoma concretions.
d) Follicles and papillae in the palpebral conjunctiva.
17) Which of the following is not a consequence of trachoma:
a) Arlet's line.
b) Stellate conjunctival scars.
c) Anterior Symblepharon.
d) Concretions in the palpebral conjunctiva.
18) An important complication of trachoma is dry eye due to:
a) Fibrosis of the palpebral conjunctiva affecting the Meibomian glands.
b) Healing of the pannus affecting the Goblet cells.
c) Fibrosis of the upper fornix affects the accessory lacrimal glands.
d) Atrophy of the main lacrimal gland.

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19) A patient complained of sandy sensation. On examination there were areas of epithelial edema, sub
epithelial infiltration with inflammatory cells, surrounded by small blood vessels in a rosette shape in
the upper edge of the cornea. What would you expect to find on everting his upper eye lids on the
palpebral conjunctiva?
a) Large expressible follicles.
b) Cobble stone papillae.
c) Pseudo membrane.
d) Diffuse edema with petechial hemorrhage.
20) In trachoma:
a) Sulphonamide is an effective treatment
b) Is caused by Chlamydia Trachomatis type D.
c) Trachomatous Pannus is usually rounded & very vascular,
d) T4 is characterized by follicles & papillae formation.
21) Trachoma is a disease characterized by:
a) Epithelial cellular infiltration.
b) Formation of papillae & follicles.
c) In stage 4, there are inclusion bodies in the conjunctival scraping.
d) Can be treated by quinolones antibiotics.
22) In trachoma which is false
a) Commonly caused by serotypes A,B , C of Chlamydial trachomatis
b) Follicles present are generally small < 0.5 mm
c) Herbert's pits are present at the superior Limbus
d) Healed trachoma generally has no activity
23) Herbert's pits in trachoma are characterized by except:
a) Result from cicatrization of Limbal follicles
b) Produce a scalloped Limbal border
c) Are pathognomonic of trachoma
d) Are Present in diseases other than trachoma
e) Persist throughout life
24) In trachoma, the patient is highly infectious When there is
a) Arlet's line
b) Herbert's pits
c) PTCs
d) Immature follicles in the palpebral conjunctiva
25) Arlet's line is present in:
a) Upper palpebral conjunctiva
b) Bulbar conjunctiva
c) Cornea
26) inclusion bodies in trachoma are :
a) Intranuclear
b) lntracytoplasmic
c) Both
d) None of the above

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 Allergy conjunctivitis
27) Conjunctival Phlycten is due to :
a) T.B. infection of the conjunctiva
b) Staph. Infection of the conjunctiva
c) Chlamydial infection of the conjunctiva
d) Delayed hypersensitivity to an endotoxin
28) Phylectenular pannus is characterized by the following except:
a) Affect any part of the cornea
b) Vessels are straight and lies deep to Bowman's membrane
c) Infiltration ends in a straight line
d) Thin and very vascular.
29) Corneal manifestations of phylectenular kerato-conjunctivitis may be one of the following except
a) Interstitial keratitis
b) Phlycten
c) Pannus
d) Corneal ulcer
30) Phylectenular conjunctivitis is treated by
a) Topical antibiotics
b) Topical Steroids
c) Antiviral eye drops
d) Topical Sulphonamides
31) Trant's spots are noticed in cases of:
a) Active trachoma
b) Bulbar spring catarrh
c) Corneal Phlycten
d) Vitamin A deficiency
32) A painful, tender, non-itchy localized redness of the conjunctiva can be due to:
a) bulbar spring catarrh. C) Vascular pterygium
b) Episcleritis. D) Phylectenular conjunctivitis
33) The following sign is not found in vernal conjunctivitis:
a) Bulbar masses on both sides of the Limbus.
b) Ropy discharge in the fornix.
c) Papillae in the lower fornix.
d) Ciliary injection.
34) Vernal conjunctivitis is not treated with:
a) Antibiotics.
b) Corticosteroids.
c) Non-steroidal anti-inflammatory.
d) Mast cell stabilizers.

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35) A female patient 18-year old, who is contact lens wearer since two years, is complaining of redness,
lacrimation and foreign body sensation of both eyes. On examination, visual acuity was 6/6 with
negative fluorescein test. The expected diagnosis can be:
a) Acute viral uveitis.
b) Giant papillary conjunctivitis.
c) Bacterial corneal ulcer.
d) Acute congestive glaucoma.
36) A school teacher has noticed that one of her students was frequently rubbing his eyes. On examination,
there was conjunctival injection & gelatinous masses on the Limbus. This boy most probably suffers
from:
a) Phylectenular conjunctivitis.
b) Mucopurulent conjunctivitis.
c) Bulbar spring catarrh.
d) Purulent conjunctivitis.
37) Cobble stone papillae are pathognomonic of:
a) Trachoma.
b) Inclusion Blenorrhae.
c) Palpebral spring catarrh.
d) Adenoviral conjunctivitis.
38) Management of spring catarrh must not include:

a) Dark sun glasses.

b) Cold fomentation.
c) Systemic corticosteroids.
d) Topical steroids for a short period.
39) Bitot spots are present in dry eyes as a result of:
a) Vitamin B deficiency.
b) Vitamin D deficiency.
c) Vitamin A deficiency.
d) Vitamin C deficiency.
40) Tranta spots are tiny white spots present on the limbus in:
a) Healed trachomatous pannus.
b) Active trachomatous pannus.
c) Bulbar spring catarrh.
d) Palpebral spring catarrh.
41) Phylectenular conjunctivitis is due to delayed hypersensitivity response to the following, except:
a) Certain types of antibiotics.
b) Microbial proteins of the tubercle bacillus (Gohn’s focus 1ry T.B.).
c) Proteins of staphylococci or candida, present in tonsils and adenoids.
d) Bacterial products of staphylococcus (in the lid margins) and chlamydial infection.
42) A patient complains of maceration of skin of the lids and conjunctival redness at the inner and outer
canthi. Conjunctival swab is expected to show:
a) Staphylococcus Aureus.
b) Streptococcus pneumonia.
c) Streptococcus viridians.
d) Morax-Axenfield diplobacilli.

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43) In the above patient the skin maceration is due to:
a) Dried purulent discharge at the canthi.
b) Skin allergy to the invading organism.
c) Proteolytic enzymes secreted by the organism.
d) Toxins secreted by the organism.
44) Keratoconjunctivitis include the following except:
a) Spring catarrh.
b) Trachoma.
c) Phlycten.
d) Pterygium.
45) A 10-years old boy complains of recurrent attacks of lacrimation, photophobia, extreme itching and
ropy discharge. On eversion of his eye lids the palpebral conjunctiva may show:
a) Pink vascular tapering papillae.
b) Violet cobble stone papillae.
c) True membrane bleeds on removal.
d) Generalized follicular reaction.
46) The safest long term effective therapy for a patient who is complaining of recurrent itching. mucoid
discharge, photophobia and conjunctival injection is:
a) Antihistaminic eye drops c) Antibiotics eye drops
b) Dexamethasone eye drops d) Boric acid lotion
47) Which of the following is specific for the diagnosis of allergic conjunctivitis?
a) Eye redness
b) Itching
c) Foreign body sensation
d) Excessive lacrimation
48) The antigen in phylectenular conjunctivitis could be all the following except
a) Intestinal parasites c) Staphylococcal Blepharitis.
b) Tuberculin .protein. d) Pollens.
49) Spring catarrh Is characterized by following except:
a) Itching
b) Watery discharge.
c) Cobble-stone papillae formation.
d) Cold foments may help to relieve the patient symptoms.
50) As regards spring catarrh, the following are true except:
a) More common in boys than girls
b) Presence of Trant's spots which disappear with treatment
c) Can affect the cornea
d) Presence of fibrosis and scarring of the conjunctiva

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 Pterygium
51) An old male patient complained of bilateral small yellow nodules on either side of the cornea,
The most possible diagnosis is:
a) Phlycten b- Episcleritis c- Pinguecula d- Bulbar spring catarrh.
52) A 24-years old soldier complains of triangular membrane encroaching from his nasal conjunctiva onto
the cornea just beyond the Limbus. His visual acuity is 6/12 that can be corrected with -1.00 cylinder to
6/6. The best management is:
b) Surgical excision.
c) Surgical excision and B irradiation.
d) Regular follow up.
e) Glasses and follow up
53) A male patient complained of bilateral small yellow triangular masses on either side of the cornea. Your
decision for management should be:
a) I mmediate surgical excision.
b) Surgical excision followed by B irradiation.
c) Surgical excision and repair by conjunctival graft.
d) Artificial tears.
54) Pterygium can be a cause of the following except:
a) Irregular astigmatism.
b) Keratoconus.
c) Dry eye. d. Corneal vascularization.
55) Pterygium is caused mainly by
a) Exposure to infra- red rays
b) Exposure to allergen
c) Exposure to ionic radiation
d) Exposure to U.V. rays

56) In recurrent Pterygium, the operation of choice is:

a) Simple excision.
b) Excision with bare area
c) Tucking ( Mc Rynold's operation)
d) Excision with graft
57) Pterygium may cause the following complications except:
a) Symblepharon.
b) Corneal vascularization.
c) Corneal ulceration.
d) Diminution of vision
58) Alkali bum may cause all of the following except:
a) Symblepharon.
b) Pseudo-membrane formation.
c) Corneal ulceration.
d) Pseudo-pterygium formation.

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59) Symblepharon can be caused by the following except:
a) Trachoma.
b) Steven-Johnson syndrome.
c) Kock-Week's bacillus.
d) Diphtheria.
60) A patient came with an acid splashed into his eye. During healing strands of adhesions are forming
between the bulbar and palpebral conjunctiva. Which of the following you do not like to add to your
treatment?
a) Vitamin A eye ointment.
b) Lubricant ointments.
c) Soft contact lens.
d) Hard contact lens.
Answers

1 b 27 d 54 b

2 b 28 c 55 d
3 d 29 a 56 d
4 b 30 b 57 a
5 b 31 b 58 b
6 c 32 b 59 c
7 a 33 d 60 c
8 B 34 a
9 b 35 b
10 c 36 c
11 c 37 c
12 b 38 c
13 c 39 c
14 c 40 c
15 b 41 a
16 d 42 d
17 c 43 c
18 c 44 d
19 a 45 b
20 a 46 a
21 b 47 b
22 b 48 d
23 d 49 b
24 d 50 d
25 a 51 c
26 b 52 e
53 d

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