FMGE REVISION

2025 JANUARY
LID COLOBOMA
•Surface ectoderm anomaly

•Long term problem -

IRIS COLOBOMA
Q . What is the ration of lumen of arteries to vein in retina
a.2:3 b.3:2 c.1: 3

d.1:1
Q.A53-year-oldmanwithtype2diabetesmellitusis found
on annual review to have new vessel formation at the optic
disc.Visualacuityinbotheyesisnotaffected(6/9).Blood
pressure is155/84 mmHg. HbA1c 68 mmol/mol (8.4%)
Whatisthe mostimportantinterventioninthispatient?
A. Follow-up ophthalmoscopy in 3 months
B. Add aspirin
C. Tight glycemic control

D.Laser
DIABETIC RETINOPATHY

PROLIFERATIVE DIABETIC RETINOPATHY

PAN RETINAL PHOTOCOAGULATION

Q. A young adult male presented with sudden
painless loss of vision. He recovered spontaneously
within 3 months. Most likely cause of his blindness is

•Central serous retinopathy

•Macular hole
•Myopic crescent
•Vitreous hemorrhage
CSR : NEUROSENSORY DETACHMENT

CRVO –THUNDER STORM / TOMOATO SPLASHED RETINA

Venous tortuosity +
100 day glaucoma:
neovascular glaucoma after almost
three months after CRVO .
 CYSTIOD MACULAR EDEMA

DRIP Ur NOSE
D Diabetic retinopathy
R Retinitis pigmentosa
I Irvine Gasssyndrome
P PG analogues , Pilocarpine

Ur Uveitis

N Niacin
O Occlusion ( CRVO, BRVO)
S Surgery
E Epinephrine, Estrogen blocker ( tamoxifen )
 HONEY COMB APPEARANCE

FFA IN CME
PETALLOID APPEARANCE
Q. Least prescribed drug for glaucoma in a diabetic
patient with macular edema

a.Alpha agonist
b.PG analogues
c.Beta blockers
d.Pilocarpine
•Cherry Tree Never Grow Tall in Mud and Sand

•C –CRAO , CO poisoning
•T-Tay Sachdisease
•N-NeimannPick
•G-GeneralisedGangliosidosis( GM1 type 1)
•T-Trauma
•M-Metachromatic leukodystrophy, Methanol poisoning
• S –Sandoff’sdisease
Q.A 40 year old male came with sudden onset of
flashes . He wears thick glasses since his early
childhood. What is most likely cause
a.RD b.CRAO c.CRVO
d.Vitreous
hemorrhage

RHEGMATOGENOUS RETINAL DETACHMENT

BULL’S EYE MACULOPATHY
• Cone Dystrophy
• Stargardt’sdisease
• Chloroquine Retinopathy
• Clofazimine Toxicity
• Age Related Macular
• Degeneration
• Leber’sCongenital
• Amaurosis
Chronic macular hole
Inverse Retinitis
pigmentosa
RETINITIS
PIGMENTOSA • Symptoms
Early –
Late -

• Signs –Classically a triad is seen in retina -BAP ➢B

➢A
➢P
ERG A –hyperpolarization of
photoreceptors , decrease c GMP,
closure of Na channel
B-increase extracellular K level

C-retinal metabolism
Q. Bronze beaten appearance of retina is seen in

a. Stargardt’sdisease
b.Best disease
c.Retinitis pigmentosa
d.Sarcoidosis
DARK CHOROID IN FFA
Q. Investigation of choice In best disease is

a.Electroretinogram
b.Multifocal ERG
c. Electro- oculogram
d. Visual evoked potential
EPISCLERITIS SCLERITIS

Inflamation of episcleral vessles Inflammation of deep sclera vessels

Young adults mostly Painless Older individuls Painful, radiation to

usually jaw, photophobia

Localised ,diffuse, nodular Self Necrotising or Non necrotising

limiting, topical NSAIDS Treatment-topical and oral steroids

Generally not associated with systemic Systemic association seen
disease Autoimmune, RA, Wegener, PAN, AS,
Gout, psoriasis, roseaca, SLE, GOUT, HZO, Hansen’s VKH,
hypersensitity to Tuberculin protein sarcoidosis
Pretty Common Uncommon
Q. False about episcleritis

a.Inflammation of tenon’s capsule

b.Superficial vascular plexus involve
c.MC in women
d.Ocular complications are more as compared to
scleritis
SCLEROMALACIA PERFORANS
• Type III hypersensitivity reaction , anterior
necrotizing scleritis without inflammation

•Typically occurs in elderly women with long-

standing rheumatoid arthritis.

•Absence of pain, almost normal vision,

scleral thinning, staphyloma are seen .

• Obliteration of arterial supply and

sequestrum formation ANTERIOR STAPHYLOMA
STAPHYLOMA LOCATION COMMENTS
ANTERIOR Over cornea, underlying MC cause; perforated
iris corneal ulcer
INTERCALARY Within 3 mm to limbus, MC cause : Peripheral
underlying root of iris Ulcerative Keratitis
>traumatic perforation
CILIARY After 3 mm from limbus, MC cause : Scleritis >
underlying ciliary body Perforation > Absolute
Glaucoma MC cause:
EQUATORIAL At equator of eyeball,
Scleritis > Myopia MC
underlying choroid
cause : Pathologic
POSTERIOR Behind equator,
posterior pole Myopia
MORPHOLOGICAL TYPES OF CATARACT
SNOWFLAKE OIL DM
DROPLET SUNFLOWER GALACTOSEMIA
CHRISTMAS TREE WILSON , CHALCOSIS
ROSETTE SHIELD BREAD MYOTONIC DYSTROPHY
CRUMB / BLUNT TRAUMA
POLYCHROMATIC LUSTRE ATOPIC DERMATITIS
COMPLICATED CATARACT

ROSETTE SHAPED
SHIELD CATARACT

POLYCHROMATIC LUSTRE
Q . A patient with gradual decrease of vision for distance since few
years . He claims his near vision is improved now . On Slit lamp
examination this was seen . What is the most likely cause of his
refractive condition
a.Axial myopia
b.Index myopia
c.Positional myopia
d.Curvaturalmyopia
FINCHAM TEST
•STENOPIC SLIT
•DIFFERENTIATES BETWEEN COLORED HALOES OF
INCIPENT CATARACT
Q. What is this step in phacosurgery and what is the stain
FROM
used
ANGLE CLOSURE GLAUCOMA
a.Can opener capsulorhexiswith methylene blue dye
b.CCC with alcianblue dye
c.CCC with trypan blue dye
d.Capsulotomy with trypan blue dye
Q. Which is this instrument shown in the
picture
a.Universal lid speculum
b.Lid retractor
c.Lid clamp
d.Cat paw retractor

KELMAN –Mc PHERSON FORCEPS

•Non tooth smooth edge angled platform 5mm long suitable for tying
sutures
•Guide suture threads and hold the scleral edge of the corneal
incision.
•Hold IOL helping in its implantation
•Loading IOL

LIM’S FORCEPS
•TOOTH FORCEPS –FINE TEETH (1X2 ) AND HAS TYING PLATFORM

USES –
HOLD THE SCLERAL/ CORNEAL EDGES
ENDOPHTHALMITIS
P V R
AFTER CATARACT SURGERY

Staph epidermidis MC cause

Treated by intravitreal

antibiotics
Pars plana vitrectomy
ELSCHNIG PEARLS

SOMMERING RING
POSTERIOR
CAPSULAR
OPACIFICATION
Q. Which of the following is the not associated with this
anomaly of eye

a. Homocystenuria
b.Marfan syndrome
c. Buphthalmos
d.Goldenhar syndrome

CONGENITAL CATARACT

ANGRY SUN
APPEARANCE
BLIND SPOT
2. Retrobulbar neuritis : intra orbital part is inflamed
Symptoms –
Signs –
Diagnosis -

3. Neuro retinitis –
•Macular star formation
Optic neuritis
•Def
Primary optic atrophy
•Cause :

Types –1. Papillitis -

 Horner’s syndrome
 HI PAMELA ( pneumonic )
 HI HETEROCHROMIAIRIDIUM P PTOSIS ( MILD ) due to
 muller dysfunction
 A ANHYDROSIS
 M MEIOSIS( due to absence of dilator muscle function )
 E ENOPHTALMOS( apparent )
 L LOSS OF CILIOSPINAL REFELX A ANISOCORIA (
 INCREASE IN DARK)

Q. How is Argyll Robertson pupil defined?

A)The pupil doesn’t react to the light but it is reacting to the

convergence
B)The pupil reacts to light but does not accommodate
C)Unilaterally constricted pupil
D)Unilaterally dilated pupil
 Vossious ring
Ringof pigments from iris on anterior lens capsule as
eyeballs contracts anteroposteriorly for a second when
there is a huge impact

Iridodialysis –
separation of iris
from its root
Gives a D shaped pupil
Patient complaints of
………………….

Q. A patient gave a history of chunafalling into eye. All of

the following would be part of his immediate management
except

a. Irrigation with copious normal saline

b. Frequent sodium citrate drops
c. Thorough slit lamp examination
Q. What level of vision quantifies a patient to be labelled as
economically blind ?

a.Vision < 6/60 –3/60 •Economic -<6/60 –3/60

b.Vision < 3/60 –1 / 60 •Social -< 3/60 –1/60
c.Vision < 1/60 –PL •Manifest -<1/60 to PL
d.No perception of light • Absolute –no PL

•Globally, five conditions have been identified for immediate attention

for achieving the goals of Vision 2020.
•Trachoma
•Onchocerciasis
• Refractive Errors R Cataract
• C Childhood blindness H
Rastriya Bal Suraksha Karyakram
•30 selected health conditions
•From birth till 18 years
• Vit A def
• Congenial cataract
• ROP
• Vision impairment

TRACHOMA

ARLT’S LINE
OPHTHALMIA NEONATORUM

OPHTHALMIA NEONATORUM
• Come Girl Out Have Coffee

• Chemical 1-2 day-1% silver nitrate –CREDE’S method BITOT SPOT

• Gonococcal -<3 days-MOST SEVERE
• Other 3-5 days
• Herpes –5-7 days
•Chlamydia -> 1 week -2 week -MC
COBBLE STONE PAPILLAE

Denny Morgan line

PSUEDOGERONTOXON

SHIELD ULCER : VKC

Q . A female came to OPD with itching and redness in
eye with a history of using contact lenses since more
than 2 years . On everting eyelid this picture was
seen . What is the most probable diagnosis
a. VKC
b.Giant papillary conjunctivitis
c.Acute follicular conjunctivitis
d.Trachoma

Phlyctenular conjunctivitis
LIMBAL DERMOID
Lmbal dermoid present in a dome shape
i with a keratinized surface,
sometimes with hair follicles and cilia.

Dermoid is comprised of collagen

connective tissue
covered by epidermal epithelium

PTERYGIUM ( SURFER’S EYE)

AUTOGRAFTING

Q. In macular corneal opacity what is visible

a.Iris detail
b.Pupil margin
c.Both Iris and pupil details
d.None of them visible
Corneal opacities
•NEBULAR

•2. MACULAR

•3. LEUCOMATOUS

COCHET-BONNET ESTHESIOMETER
Decreased corneal sensation FUNGAL CORNEAL ULCER
•Herpes , DM, Leprosy
•FUNGUS :
• Ulcer
•HISTORY : trauma by vegetative material ,
• Surgery
long term steroids
• Tumour
• Cocaine •SYMPTOMS : less than signs
• NSAIDs
•Feathery margins , Immunological ring of Weissley
•Satellite lesions , hypopyon is fixed and unsterile (
presence of fungal hyphae) •Nocardia ulcer
resembles fungal ulcer •Treatment by 5 %
natamycin
DENDRITIC ULCER
•TRUE

•MANAGEMENT : ointment acyclovir

STEROIDS

• are contraindicated
HERPEZ ZOSTER OPHTHALMICUS

HUTCHINSON‘ S
RULE

ocular involvement is
frequent if side/ tip of
nose presents with
vesicular lesions
(because of nasociliary
nerve –common nerve
supply to tip of nose
and cornea)
ACANTHAMOEBA KERATITIS
Risk factors : Contact lens misusage / bathing in dirty water

➢ C/F :
➢ Most painful ulcer
➢ Difficult to diagnose-mimics other ulcers
➢

Treatmentby PHMB –poly hexa

methylene biguanide
KERATOCONUS
Idiopathicectasia of cornea in which cornea becomes thinner in
the centre

•ASSOCATIONS : Ectopia lentis, congenital Cataract, VKC, Atopic

dermatitis, Marfan, EhlerDanlos syndrome

PRESENTATION :
Oil droplet reflex ( charleuxsign)

TREATMENT OF KERATOCONUS

1. GLASSES :
2. CORNEAL COLLAGEN CROSS LINKAGE WITH RIBFLAVIN DROPS( C3R)
•Stabilizes the cone –it increases strength of cornea by
300 %. Makes cornea stronger
MANAGEMENT OF KERATOCONUS
1.3. RIGID GAS PERMEABLE LENSES
for long term –corrects the irregularities and curvature

HERTERL’ S
EXOPHTHALMOMETER

Leudde’s :

More accurate than

Hertel’s in presence of
facial asymmetry.
SIGNS FEATURES

DALRYMPLE Lid retraction

VON GRAEFE Lid lag on looking down

STELLWAG Still look , less blinking

JELLINEK Increased pigmentation on lid

ENROTH Edema of lids

MOBIUS Decrease convergence

KOCHER Frightening appearance
Causes of proptosis
2. Orbital cellulitis : severe inflammation of
orbital contents C/F Painful proptosis , decrease
vision, chemosis , ophthalmoplegia , fever etc

Ophthalmic emergency
3. Cavernous sinus thrombosis
C/F :

MARCUS GUNN JAW

WINKING PHENOMENON
Movement of jaw to one side ( contraction
of pterygoid muscle ) leads to elevation of
eyelid
Both LPS and pterygoid muscles are
supplied by branch of fifth nerve-so there
is a co contraction of these 2 muscles
STYE/ HORDEOLUM EXTERNUM
acute painful suppurative
inflammation of moll / gland of
zeis. Staphylococcal infection
Management –antibiotics , anti CHALAZION
inflammatory Hot packs , drainage of
pus

tarsal cyst/ meibomaincyst: chronic painless,

non suppurative ,granulomatous inflammation
of meibomian gland.
 INCISION AND
CURETTAGE

CHALAZION
CLAMP

CURETTE FOR CHALAZION

 • TRICHIASIS

• DISTICHIASIS

ENTROPION : INWARD TURNING OF

LID MARGIN
LEFT LOWER LID ECTROPION

SYMBLEPHARON

ANKYLOBLEPHARON
Chronic dacryocystitis
•Diagnosis :
1. ROPLAS test –regurgitation on
pressure over lacrimal sac

CONGENITAL DACRYOCYSTITIS
SITE OF BLOCK
d/d of watering from eye of newborn baby

CRIGGLER MASSAGE
BONE PUNCH

SCHIRMER’S TEST
Watmanfilter paper number
41 placed at fornix.

Wetting of strip note after

5 minutes

If wetting > 15 mm mark

–normal tear production
 France TRIP toC DR

 Fungal endophthalmitis
 Toxocariasis
 ROP
 Inflammatory cyclitic membrane
 PHPV
 Congenital cataract , coat’s disease, coloboma
 Dysplasia of retina
 Retinoblastoma
DIAGNOSIS –USG BSCAN : CALCIFICATION WITH A MASS SEEN
1.IDO
2.USG B SCAN
3.MRI –
4.Histopathology
FLEXNER WINTERSTEINER ROSETTE
Q . Which is the structure shown in blue arrow the fig

a.SR muscle
b.SO muscle
c.LPS muscle
d.Muller muscle
MNEMONICS
•SIN ------ALL SUPERIORS ARE
INTORTORS
so, all inferiors are
extortors

•RAD -----ALL RECTI ARE ADDUCTORS

SO, all obliques abductors
Nine diagnostic positions of gaze are those in which deviations are
measured. They consist of the six cardinal positions, the primary
position, elevation and depression.
 Q. Identify the test
a.Cover test
b.Cover uncover test
c.Prism test
d.Hirshberg test
Q. Worth four dot test
a.Red glass in front of left eye
b.Has 2 red, 2 green dot
c.In Right eye suppression 3 green dots are seen
d.If 5 dots are seen , it may be normal
WORTH FOUR DOT TEST
TEST FOR STEREOPSIS

MADDOX ROD
•series of red cylinders arranged together converts
point source of light into line perpendicular to its axis
Q. Identify the chart in the given picture
a. Snellen chart
b. ETDRS chart
c. Hess chart
d. PelliRobson chart
REFRACTIVE ACCOMODATIVE ESOTROPIA –patient has high

hypermetropia , uses more accommodation .

With more accommodation is more convergence . Corrected by high
convex glasses
GOLDMAN APPLANATION
 HUMPHREY VISUAL FIELD ANALYSER
a)Vertically oval cup
b)Large cup : disc ratio > 0.7: 1

a)Disc hemorrhage

b)Notching, Nasalization
H1 N2 LAB 3
c)Laminar dot sign

d) Asymmerty
e) Bayonetting
f)Baring of circumlinearvessles
g)Bean pot cupping
 and SAD Steps on Island
I C Bare Wings
1. Isopteric contraction
2.Baring of blind spot
3.Wingshaped paracentral scotoma
4.Seidel’s sotoma= derringer’s scotoma
5.Arcuate (bjerrum) scotoma
6.Double arcuate
7.Peripheral nasal step: unequal contraction of fields in
centre
8.Only temporal island left
ACUTE ANGLE CLOSURE GLAUCOMA
MANAGEMENT OF ACG

PERIPHERAL IRIOTOMY: BOTH EYE

PERIPHERAL IRIDOTOMY BY
Nd YAG LASER

VOGT TRIAD
•SUGGESTIVE OF PAST ATTACK OF ANGLE CLOSURE GLAUCOMA

• P : Pigments on endothelium , pupillary changes

• I : Iris atrophy
• G : Glaucomphleckan
Q. Which of the following is incorrect about the picture given
below

A. Watering may be seen in the newborn baby

B. Cornea is large and hazy
C Shallow AC
D. Surgery can be the best treatment
•Cornea is large and hazy

•AC deep, lens is large and flat

•Eye ball is large ( buphthalmos)

•High IOP , MYOPIA , haab s striae can be seen

Management of buphthalmos

1. Goniotomy

2.Trabeculotomy + trabeculectomy : cutting a part of TM and open the

remaining also
 BULL’S EYE SIGN/ TARGET SIGN
Pseudoexfoliationglaucoma ( PXF)
Pseudoexfoliatedmaterial released ,
deposits at various parts in eye like,
capsule , TM , cornea

Bull’s eye or target sign: multiple rings of material on lens capsule due to
movement of iris and change in size of pupil
PINHOLE differentiates decrease
of vision is due to refractive error
organic cause
macular pathology
DIRECT OPHTHALMOSCOPE INDIRECT OPHTHALMOSCOPE

ROUTINE CENTRAL FUNDUS CENTRE + PERIPHERY 30 DEGREE (8 DD

10 DEGREE FUNDUS SEEN ONLY FUNDUS) SEEN STEREOPSIS

NO VIEW OF RETINA WHEN MEDIA 3 D VIEW RETINA SEEN EVEN IF MEDIA

NOT CLEAR NOT CLEAR

Advantage -IMAGE VIRTUAL, ERECT, Disadvantage -IMAGE REAL, INVERTED

HIGH MAGNIFICATION 15 TIMES LESS MAGNIFICATION ONLY 5 TIMES
LASIK : Laser Assisted In Situ Keratomileusis –
mainly for myopia can be done for hypermetropia , astigmatism

•Stromal thinning done by excimer

laser ( argon fluoride) 193 nm
•For correction of 1 D myopia

approx. 15 micronsthinning done .

flap created by blade here
KERATIC PRECIPITATES

KERATIC PRECIPITATES

Posterior synechiae
FESTOONED PUPIL
6. NODULES

TOXOPLASMOSIS
•History of :
• Active form –headlight in fog appearance
• Chronic form –macular scar
•Anterior segment –spill off anterior uveitis
HEADLIGHT IN FOG
APPEARANCE

TOXOPLASMA SCAR
SATELLITE LESION
pizza pie appearance/ cotton cheese with ketchup –large
areas of retinal necrosis and hemorrhage along vascular
arcades
The advancing edge of these lesions is usually very sharp and spreads
contiguously