A 30-year-old mason is examined two hours after wet cement and lime splashed into his eye; irrigation was done in casualty. A month later his cornea is scarred and vascularised, while a colleague who had battery acid splashed into his eye at work recovered fully. Why do alkali burns usually cause deeper damage than acid burns?

Alkalis saponify cell membranes and penetrate

Alkalis act only after a delay of some hours

Alkalis are always more concentrated than acids

Alkalis coagulate surface proteins as a barrier

A 35-year-old man had a perforating injury of the left eye from a thorny branch eight weeks ago, repaired with some prolapsed uvea. He now has pain, photophobia and blurred vision in the right, uninjured eye. The right eye shows mutton-fat keratic precipitates, vitritis and small yellow-white spots in the peripheral fundus. What is the next best step?

High-dose systemic corticosteroids

Intravitreal vancomycin and ceftazidime

Topical antibiotics with review

A 3-year-old boy from a tribal hamlet in Jharkhand is brought to the PHC because he stumbles about after dusk. He has foamy, triangular grey patches on the temporal conjunctiva of both eyes, and the corneas are clear. What vitamin A treatment schedule should the medical officer follow?

2 lakh IU orally on days 1, 2 and 14

2 lakh IU orally once, then in 6 months

2 lakh IU orally on days 1 and 2 only

1 lakh IU orally on days 1, 2 and 14

Refraction, community ophthalmology and ocular trauma

25 NEET-PG practice questions on Refraction, community ophthalmology and ocular trauma, part of Ophthalmology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 30-year-old mason is examined two hours after wet cement and lime splashed into his eye; irrigation was done in casualty. A month later his cornea is scarred and vascularised, while a colleague who had battery acid splashed into his eye at work recovered fully. Why do alkali burns usually cause deeper damage than acid burns?
1. AAlkalis saponify cell membranes and penetrate
2. BAlkalis act only after a delay of some hours
3. CAlkalis are always more concentrated than acids
4. DAlkalis coagulate surface proteins as a barrier
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Answer: A · Alkalis saponify cell membranes and penetrate
Alkalis such as lime, cement and ammonia saponify the fatty acids of cell membranes, so they pass rapidly through the cornea into the anterior chamber and damage the limbal stem cells, iris, lens and ciliary body. Acids coagulate and precipitate surface proteins, which form a barrier that limits deeper penetration. The extent of limbal ischaemia is a key guide to prognosis, because loss of limbal stem cells leads to vascularisation and scarring. Severe acid burns, however, can still be serious.
- B: Alkali damage begins within seconds, which is why immediate irrigation matters.
- C: The difference is the mechanism, not concentration.
- D: Protein coagulation that limits penetration is the action of acids, not alkalis.
Question 2 · Hard
A 35-year-old man had a perforating injury of the left eye from a thorny branch eight weeks ago, repaired with some prolapsed uvea. He now has pain, photophobia and blurred vision in the right, uninjured eye. The right eye shows mutton-fat keratic precipitates, vitritis and small yellow-white spots in the peripheral fundus. What is the next best step?
1. AIntravitreal vancomycin and ceftazidime
2. BTopical antibiotics with review
3. COral acyclovir in high doses
4. DHigh-dose systemic corticosteroids
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Answer: D · High-dose systemic corticosteroids
Bilateral granulomatous panuveitis weeks after a penetrating injury with uveal prolapse is sympathetic ophthalmia. Exposure of uveal and retinal antigens triggers a T-cell autoimmune response against both eyes, and the yellow-white spots are Dalen-Fuchs nodules. Treatment is prompt high-dose systemic corticosteroids, often with immunosuppressants for long-term control. It is prevented by careful early repair of wounds with uveal prolapse, and by early removal of a blind, irreparable injured eye.
- A: Intravitreal antibiotics treat endophthalmitis, which would affect the injured eye, not the fellow eye.
- B: Antibiotics do not treat an autoimmune uveitis and delay would threaten vision.
- C: Acyclovir treats viral retinitis, which does not follow trauma to the other eye.
Question 3 · Medium
A 9-year-old girl's spectacle power has gone from -1.5 D to -3.0 D in each eye over one year. Both parents wear thick glasses for myopia, and she spends most evenings on a tablet. Apart from more time outdoors, which treatment has evidence for slowing the progression?
1. AOral vitamin A supplements
2. BUnder-corrected spectacles
3. CLow-dose atropine eye drops
4. DDaily pinhole spectacle use
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Answer: C · Low-dose atropine eye drops
Low-dose atropine eye drops at bedtime slow the progression of childhood myopia, with few side effects at the low strengths used (0.01% is a common choice). More time outdoors in daylight reduces the onset of myopia, and near work and screen time are limited. Specially designed myopia-control spectacle lenses and contact lenses are other options. High myopia matters because it raises the lifelong risk of retinal detachment, myopic maculopathy and glaucoma.
- A: Vitamin A treats deficiency and has no effect on axial myopia.
- B: Under-correction does not slow progression and may speed it up.
- D: Pinhole spectacles reduce blur temporarily but do not affect eye growth.
Question 4 · Medium
A 3-year-old boy from a tribal hamlet in Jharkhand is brought to the PHC because he stumbles about after dusk. He has foamy, triangular grey patches on the temporal conjunctiva of both eyes, and the corneas are clear. What vitamin A treatment schedule should the medical officer follow?
1. A2 lakh IU orally once, then in 6 months
2. B2 lakh IU orally on days 1, 2 and 14
3. C2 lakh IU orally on days 1 and 2 only
4. D1 lakh IU orally on days 1, 2 and 14
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Answer: B · 2 lakh IU orally on days 1, 2 and 14
Night blindness with Bitot's spots means clinical xerophthalmia, which is treated, not just prevented. The WHO schedule for a child over 12 months is 2 lakh (200,000) IU of oral vitamin A immediately, the same dose the next day, and a third dose two weeks later; infants of 6-12 months get half this dose. The child then rejoins the six-monthly prophylaxis under the national programme. Diet counselling on green leafy vegetables, yellow fruits and breastfeeding helps prevent relapse.
- A: A single dose with six-monthly repeats is prophylaxis, not treatment of xerophthalmia.
- C: The two-day schedule omits the third dose at two weeks.
- D: 1 lakh IU is the dose for infants aged 6-12 months.
Question 5 · Medium
During a door-to-door eye survey in a district, a 63-year-old farmer has presenting visual acuity of 5/60 in the better eye because of cataract. Using the definition of blindness that India adopted in 2017 under its national blindness programme, how should he be classified?
1. ABlind, as acuity is below 6/60
2. BNormal vision for his age
3. CBlind, as acuity is below 6/18
4. DVisually impaired, not blind
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Answer: D · Visually impaired, not blind
In 2017 India changed its definition of blindness to presenting visual acuity below 3/60 in the better eye, in line with the WHO, replacing the older cut-off of below 6/60. At 5/60 this man is therefore counted as visually impaired but not blind, which is why the programme was renamed the National Programme for Control of Blindness and Visual Impairment. His impairment is fully avoidable with cataract surgery and an intraocular lens. The change lowered India's reported blindness figures without any change in actual eye health.
- A: Below 6/60 was the old Indian cut-off, replaced in 2017.
- B: 5/60 is far below normal vision at any age.
- C: Below 6/18 marks the start of visual impairment, not blindness.
Question 6 · Medium
An eye team visits a remote hill village where several older women have in-turned lashes rubbing on scarred corneas, and children have follicles on the upper tarsal conjunctiva. The team leader lists the WHO strategy for this disease: 1. Surgery for trichiasis. 2. Mass oral azithromycin as the antibiotic component. 3. 'F' stands for fluorescein staining of the cornea. 4. 'E' includes clean water and latrines. Which statements are correct?
1. A1 and 2 only
2. B1, 2 and 3 only
3. C1, 2 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 7 · Medium
A 19-year-old college cricketer is hit on the left eye by a ball. He has double vision on looking up, the left eye cannot be elevated fully, the globe looks sunken and the left cheek and upper lip are numb. Which investigation is most appropriate?
1. AB-scan ultrasonography of the eye
2. BCT of the orbits with coronal sections
3. CMRI of the brain without contrast
4. DPlain X-ray of the skull lateral view
Answer and explanation in LearnFree account
Question 8 · Easy
An 11-year-old boy in Class 6 cannot read the blackboard from the back bench but reads his textbook easily. His vision improves with a pinhole, and retinoscopy shows that light rays from distance focus in front of the retina in both eyes. Which spectacle lens corrects his vision?
1. AConvex spherical lens
2. BCylindrical lens
3. CPrism with base out
4. DConcave spherical lens
Answer and explanation in LearnFree account
Question 9 · Hard
A 28-year-old blacksmith felt something strike his right eye while hammering an iron rod. Vision is 6/36, there is a small self-sealed corneal wound with a matching hole in the iris, and the lens is becoming opaque. Fundus view is poor. What is the investigation of choice before surgery?
1. ACT scan of the orbits
2. BPlain X-ray of the orbit
3. CGonioscopy of the angle
4. DMRI of the orbits
Answer and explanation in LearnFree account
Question 10 · Medium
A rapid survey of avoidable blindness in a district examines 3,000 people aged 50 years and above. Sixty are blind; of these, 40 are blind from cataract, 8 from glaucoma, 7 from corneal opacity and 5 from posterior segment disease. What proportion of blindness in this sample is due to cataract?
1. AAbout 67%
2. BAbout 2%
3. CAbout 1.3%
4. DAbout 40%
Answer and explanation in LearnFree account
Question 11 · Easy
A 35-year-old construction worker arrives in casualty five minutes after wet lime (chuna) splashed into his right eye. He is in severe pain and the eye is watering. What should be done first?
1. ASend him to the eye department for slit lamp
2. BInstil antibiotic ointment and pad the eye
3. CIrrigate the eye with water or saline at once
4. DNeutralise the eye with a weak acid solution
Answer and explanation in LearnFree account
Question 12 · Medium
A 14-year-old girl is hit in the right eye by a shuttlecock. Vision is 6/12, there is a 2 mm layer of blood in the lower anterior chamber and the IOP is 24 mmHg. Her father asks whether she can take a painkiller from home. Which medicine should she avoid?
1. ATopical prednisolone
2. BParacetamol
3. CTopical atropine
4. DAspirin
Answer and explanation in LearnFree account
Question 13 · Hard
Pachymetry is 455 µm in both eyes of a software engineer who wants to be free of glasses. Refraction is -9.00 D sphere, stable for 3 years, with normal corneal topography, an anterior chamber depth of 3.2 mm and a healthy endothelial cell count. Which option is most suitable?
1. AClear lens extraction with an IOL
2. BImplantable phakic collamer lens
3. CLASIK
4. DRadial keratotomy
Answer and explanation in LearnFree account
Question 14 · Medium
Under the National Programme for Control of Blindness and Visual Impairment (NPCBVI), consider these activities: 1. School eye screening with free spectacles for children with refractive errors. 2. Free cataract surgery through government and NGO hospitals. 3. Support for eye banks, eye donation and corneal transplantation. 4. Free LASIK for all adults with myopia. Which are part of the programme?
1. A1, 2 and 3 only
2. B1 and 2 only
3. C1 and 4 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 15 · Medium
A sugarcane cutter was struck in the left eye by a sickle an hour ago. There is a 6 mm full-thickness corneoscleral laceration with dark uveal tissue prolapsing through it, a peaked pupil and acuity of hand movements. He is in severe pain and has vomited once in the PHC, where a nurse wants to apply a firm pad and bandage before referral. The district hospital, 40 km away, has an ophthalmologist and an operating theatre available tonight. Besides tetanus cover and IV antibiotics, what is the correct care before surgery?
1. AFirm pressure patch, review next day
2. BRigid shield, no pressure, urgent repair
3. CExcise prolapsed uvea at the slit lamp
4. DTopical atropine and steroid drops
Answer and explanation in LearnFree account
Question 16 · Medium
A retired clerk with no refractive error for distance finds it hard to read at 25 cm. His amplitude of accommodation is now 2 D. Assuming he can use all of his remaining accommodation, what is the least near addition he needs to read at 25 cm?
1. A+4.00 D
2. B+2.00 D
3. C+3.00 D
4. D+1.00 D
Answer and explanation in LearnFree account
Question 17 · Easy
Triangular, foamy, silvery-grey spots on the temporal bulbar conjunctiva are seen in a child of 4 from a tribal hamlet who also has dry conjunctiva and night blindness. In the WHO classification of xerophthalmia, how are these spots graded?
1. AX1A
2. BX1B
3. CX2
4. DX3A
Answer and explanation in LearnFree account
Question 18 · Hard
Six months after a lime (chuna) injury to the right eye, a mason has a vascularised, opaque corneal surface covered by conjunctival epithelium in all quadrants, with recurrent epithelial breakdown. His left eye is healthy. A penetrating keratoplasty alone is being considered by the junior resident. What is the best plan?
1. AAutologous limbal graft (SLET) from the left eye
2. BLamellar keratoplasty from a donor alone
3. CPenetrating keratoplasty alone now
4. DRepeated amniotic membrane grafts only
Answer and explanation in LearnFree account
Question 19 · Easy
Retinoscopy shows different refractive power in the vertical and horizontal meridians of a student's eyes, at right angles to each other. Which lens corrects this?
1. AConcave spherical lens
2. BConvex spherical lens
3. CPrism
4. DCylindrical lens
Answer and explanation in LearnFree account
Question 20 · Medium
Cycloplegic refraction is planned for a 3-year-old child with a convergent squint who seems to look at toys with great effort. The squint is larger for near than for distance, and both eyes have good fixation and normal fundi. Which cycloplegic is most appropriate to reveal the full hypermetropia?
1. ATropicamide 1% drops
2. BAtropine 1% ointment
3. CPhenylephrine 10% drops
4. DHomatropine 2% drops
Answer and explanation in LearnFree account
Question 21 · Medium
Eight hours after welding a gate without a face shield, a welder wakes at 2 a.m. with severe pain, watering and photophobia in both eyes. Fluorescein shows fine punctate staining over both corneas, and acuity is 6/9 in each eye. There is no foreign body under the lids, and the anterior chambers are quiet. Which treatment is most appropriate?
1. AUrgent corneal scraping for culture
2. BCycloplegic, lubricant ointment and oral analgesics
3. CTopical anaesthetic drops to use at home
4. DTopical steroid drops every hour
Answer and explanation in LearnFree account
Question 22 · Medium
During subjective refraction of a myope, a -4.00 DS lens is in the trial frame. On the duochrome test the patient reports what is shown. What is the correct next step?
Figure: MedExams
1. AReduce the minus lens in 0.25 D steps
2. BAdd a plus cylinder
3. CIncrease the minus lens in 0.25 D steps
4. DAccept the lens as the end point
Answer and explanation in LearnFree account
Question 23 · Hard
The optician's card for both eyes is shown. A lens workshop works in plus-cylinder form. How should the right eye be written?
Figure: MedExams
1. A-1.50 DS / +2.00 DC axis 180
2. B-0.50 DS / +2.00 DC axis 180
3. C-3.50 DS / +2.00 DC axis 180
4. D-3.50 DS / +2.00 DC axis 90
Answer and explanation in LearnFree account
Question 24 · Easy
At a school screening camp, a girl reads the Snellen chart from 6 m down to the line marked by the arrow and cannot read any smaller line. How is her visual acuity recorded?
Figure: MedExams
1. A6/36
2. B6/24
3. C6/18
4. D6/12
Answer and explanation in LearnFree account
Question 25 · Medium
At a screening camp the right-eye vision of four children was recorded without and with a pinhole, as tabulated. Which child most likely needs referral to rule out disease of the eye rather than an error of refraction?
Figure: MedExams
1. AThe child who improves from 6/18 to 6/6
2. BThe child who improves from 6/24 to 6/9
3. CThe child whose acuity stays 6/60
4. DThe child who improves from 6/36 to 6/6
Answer and explanation in LearnFree account

Refraction, community ophthalmology and ocular trauma

A 9-year-old girl's spectacle power has gone from -1.5 D to -3.0 D in each eye over one year. Both parents wear thick glasses for myopia, and she spends most evenings on a tablet. Apart from more time outdoors, which treatment has evidence for slowing the progression?

A 3-year-old boy from a tribal hamlet in Jharkhand is brought to the PHC because he stumbles about after dusk. He has foamy, triangular grey patches on the temporal conjunctiva of both eyes, and the corneas are clear. What vitamin A treatment schedule should the medical officer follow?

During a door-to-door eye survey in a district, a 63-year-old farmer has presenting visual acuity of 5/60 in the better eye because of cataract. Using the definition of blindness that India adopted in 2017 under its national blindness programme, how should he be classified?

A 19-year-old college cricketer is hit on the left eye by a ball. He has double vision on looking up, the left eye cannot be elevated fully, the globe looks sunken and the left cheek and upper lip are numb. Which investigation is most appropriate?

An 11-year-old boy in Class 6 cannot read the blackboard from the back bench but reads his textbook easily. His vision improves with a pinhole, and retinoscopy shows that light rays from distance focus in front of the retina in both eyes. Which spectacle lens corrects his vision?

A 28-year-old blacksmith felt something strike his right eye while hammering an iron rod. Vision is 6/36, there is a small self-sealed corneal wound with a matching hole in the iris, and the lens is becoming opaque. Fundus view is poor. What is the investigation of choice before surgery?

A rapid survey of avoidable blindness in a district examines 3,000 people aged 50 years and above. Sixty are blind; of these, 40 are blind from cataract, 8 from glaucoma, 7 from corneal opacity and 5 from posterior segment disease. What proportion of blindness in this sample is due to cataract?

A 35-year-old construction worker arrives in casualty five minutes after wet lime (chuna) splashed into his right eye. He is in severe pain and the eye is watering. What should be done first?

A 14-year-old girl is hit in the right eye by a shuttlecock. Vision is 6/12, there is a 2 mm layer of blood in the lower anterior chamber and the IOP is 24 mmHg. Her father asks whether she can take a painkiller from home. Which medicine should she avoid?

Pachymetry is 455 µm in both eyes of a software engineer who wants to be free of glasses. Refraction is -9.00 D sphere, stable for 3 years, with normal corneal topography, an anterior chamber depth of 3.2 mm and a healthy endothelial cell count. Which option is most suitable?

A retired clerk with no refractive error for distance finds it hard to read at 25 cm. His amplitude of accommodation is now 2 D. Assuming he can use all of his remaining accommodation, what is the least near addition he needs to read at 25 cm?

Triangular, foamy, silvery-grey spots on the temporal bulbar conjunctiva are seen in a child of 4 from a tribal hamlet who also has dry conjunctiva and night blindness. In the WHO classification of xerophthalmia, how are these spots graded?

Retinoscopy shows different refractive power in the vertical and horizontal meridians of a student's eyes, at right angles to each other. Which lens corrects this?

Cycloplegic refraction is planned for a 3-year-old child with a convergent squint who seems to look at toys with great effort. The squint is larger for near than for distance, and both eyes have good fixation and normal fundi. Which cycloplegic is most appropriate to reveal the full hypermetropia?

During subjective refraction of a myope, a -4.00 DS lens is in the trial frame. On the duochrome test the patient reports what is shown. What is the correct next step?

The optician's card for both eyes is shown. A lens workshop works in plus-cylinder form. How should the right eye be written?

At a school screening camp, a girl reads the Snellen chart from 6 m down to the line marked by the arrow and cannot read any smaller line. How is her visual acuity recorded?

At a screening camp the right-eye vision of four children was recorded without and with a pinhole, as tabulated. Which child most likely needs referral to rule out disease of the eye rather than an error of refraction?