Prometric Exam Questions for Ophthalmology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the OPH5841 Paper

The ophthalmology specialist paper (OPH5841; consultants sit COP6072) tests the eye registrar's decisions: which red eye is sight-threatening, how to treat angle-closure tonight, when a diabetic eye needs laser or injection, how to manage a retinal detachment, a corneal ulcer in a contact lens wearer, and the child with a white reflex. Diabetic eye disease is a major Gulf workload, and the paper reflects it. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the ophthalmologist guide. For timed papers use the Ophthalmology specialist bank, about 2,000 questions. Optometrists sit a separate paper (optometrist guide).

The acute red eye

Question 1

A 65-year-old hypermetropic woman presents with severe eye pain, nausea, a fixed mid-dilated pupil, a hazy cornea and an intraocular pressure of 55 mmHg. Immediate management is:

1. Topical steroid only
2. Intravenous acetazolamide, topical beta blocker, alpha agonist and pilocarpine once the pressure begins to fall, with laser peripheral iridotomy to both eyes once the cornea clears
3. Dilating drops
4. Reassurance and review in a week

Answer: B. Acute angle-closure glaucoma threatens sight within hours. Lower the pressure medically, then perform iridotomy; the fellow eye is treated prophylactically because it shares the anatomy.

Question 2

A contact lens wearer has a painful red eye with a central corneal infiltrate and epithelial defect. The management is:

1. Topical steroid immediately
2. Corneal scrape for Gram stain and culture, then intensive topical broad-spectrum antibiotics (such as a fluoroquinolone or fortified cefuroxime and gentamicin) hourly, with no steroid until the organism is controlled and no contact lens use
3. Oral antibiotics only
4. Patch the eye and review in three days

Answer: B. Bacterial keratitis in a lens wearer is treated as Pseudomonas until proven otherwise. Acanthamoeba is considered in lens wearers with disproportionate pain. Steroids are added later, only with microbiological control.

Question 3

A 30-year-old has a unilateral red eye with photophobia, a small irregular pupil, cells and flare in the anterior chamber, and keratic precipitates. First-line treatment is:

1. Topical antibiotic
2. Intensive topical corticosteroids and a cycloplegic, with investigation for systemic associations (HLA-B27, sarcoidosis, TB, syphilis) in recurrent or bilateral disease
3. Antihistamine drops
4. Pilocarpine

Answer: B. Anterior uveitis is treated with steroids and cycloplegia to relieve pain and prevent posterior synechiae. TB must be excluded before systemic immunosuppression in Gulf populations.

Glaucoma and cataract

Question 4

A 60-year-old has primary open-angle glaucoma with a pressure of 28 mmHg and early visual field loss. First-line treatment is:

1. Oral acetazolamide long term
2. A topical prostaglandin analogue once nightly (or selective laser trabeculoplasty as a first-line alternative), with a target pressure and regular field and OCT monitoring
3. Immediate trabeculectomy
4. Observation without treatment

Answer: B. Prostaglandin analogues are the most effective single topical agent; SLT is now accepted as first-line. Surgery is for progression despite maximal tolerated therapy.

Question 5

Two days after uncomplicated phacoemulsification, a patient has worsening pain, reduced vision, hypopyon and vitritis. The management is:

1. Increase topical steroids and review in a week
2. Treat as acute postoperative endophthalmitis: urgent vitreous tap for culture and intravitreal antibiotics (vancomycin and ceftazidime), with vitrectomy for severe presentations
3. Oral antibiotics only
4. Remove the intraocular lens

Answer: B. Endophthalmitis is a sight-threatening emergency within days of surgery. Intravitreal antibiotics are given within hours; vision at presentation guides vitrectomy.

Question 6

Which of the following is the most common cause of reduced vision six months after cataract surgery?

1. Retinal detachment
2. Posterior capsule opacification, treated with Nd:YAG laser capsulotomy
3. Endophthalmitis
4. Corneal decompensation

Answer: B. Capsule opacification is common and simply treated; detachment and macular oedema are considered when laser does not restore vision.

Retina

Question 7

A 55-year-old with type 2 diabetes has centre-involving diabetic macular oedema with a visual acuity of 6/18. First-line treatment is:

1. Observation
2. Intravitreal anti-VEGF injections (ranibizumab, aflibercept or bevacizumab) with monthly loading, with macular laser or intravitreal steroid for selected cases, alongside glycaemic and blood pressure control
3. Panretinal laser
4. Oral steroids

Answer: B. Anti-VEGF therapy has replaced laser as first line for centre-involving DMO with reduced vision. Systemic control of HbA1c, blood pressure and lipids slows progression.

Question 8

A patient has proliferative diabetic retinopathy with new vessels on the disc. The treatment that reduces severe visual loss is:

1. Focal laser to the macula only
2. Panretinal photocoagulation, with anti-VEGF as an alternative or adjunct, and vitrectomy for non-clearing vitreous haemorrhage or tractional detachment threatening the macula
3. Topical steroids
4. No treatment until haemorrhage

Answer: B. PRP halves the risk of severe visual loss in high-risk PDR. Anti-VEGF is effective but requires sustained follow-up, which is a practical consideration in migrant populations.

Question 9

A myopic 45-year-old reports sudden flashes, a shower of floaters and a curtain across the upper visual field. Vision is 6/9 and the macula is attached on examination. The management is:

1. Review in two weeks
2. Urgent same-day or next-day referral for surgical repair (vitrectomy, scleral buckle or pneumatic retinopexy) of a macula-on rhegmatogenous retinal detachment, with posturing advice meanwhile
3. Laser to the macula
4. Reassurance

Answer: B. A macula-on detachment is an emergency because visual prognosis falls sharply once the macula detaches. Flashes and floaters without detachment need dilated examination for retinal tears, treated with laser.

Neuro-ophthalmology and paediatrics

Question 10

A 72-year-old has sudden painless loss of vision in one eye to counting fingers, a relative afferent pupillary defect, jaw claudication and an ESR of 85. The management is:

1. Observation and review in a week
2. Immediate high-dose corticosteroids (intravenous methylprednisolone then oral prednisolone) for suspected giant cell arteritis to protect the fellow eye, with temporal artery biopsy within two weeks
3. Aspirin alone
4. Anti-VEGF injection

Answer: B. Arteritic anterior ischaemic optic neuropathy threatens the other eye within days. Steroids are started before biopsy; the biopsy remains positive for weeks.

Question 11

A 30-year-old woman has subacute unilateral visual loss with pain on eye movement and a relative afferent pupillary defect; the optic disc looks normal. The most likely diagnosis and the key investigation are:

1. Glaucoma; visual fields
2. Retrobulbar optic neuritis; MRI brain and orbits to assess demyelinating lesions and multiple sclerosis risk, with intravenous methylprednisolone to hasten recovery
3. Central retinal artery occlusion; carotid Doppler
4. Cataract; biometry

Answer: B. Optic neuritis recovers in most cases; MRI lesion load predicts MS. Oral low-dose prednisolone alone increases recurrence and is avoided.

Question 12

A parent notices a white pupillary reflex in a photograph of their 18-month-old. The next step is:

1. Reassure; it is a camera artefact
2. Urgent ophthalmology referral for dilated examination under anaesthesia to exclude retinoblastoma, with congenital cataract, Coats disease and other causes in the differential
3. Review at age five
4. Prescribe glasses

Answer: B. Leukocoria is retinoblastoma until proven otherwise; early diagnosis saves the eye and the life. Family screening follows a confirmed diagnosis.

Question 13

A 4-year-old has a constant left esotropia and a visual acuity of 6/36 in that eye with a normal fundus. The management is:

1. Surgery before any other treatment
2. Full cycloplegic refraction with glasses, then occlusion or atropine penalisation of the better eye to treat amblyopia, with strabismus surgery considered once acuity is optimised
3. Observation until age ten
4. Eye drops for infection

Answer: B. Amblyopia treatment is most effective before about seven years of age. Refractive correction comes first, then occlusion; surgery aligns the eyes but does not treat amblyopia.

Trauma and systemic disease

Question 14

A worker has a chemical splash to the eye with an alkaline cleaning agent. The first action is:

1. Detailed history before any treatment
2. Immediate copious irrigation with saline or water for at least 15 to 30 minutes until the conjunctival pH is neutral, with removal of particulate matter, then assessment of limbal ischaemia and corneal clarity
3. Patch the eye
4. Neutralise with a weak acid

Answer: B. Alkali penetrates deeper than acid; irrigation before anything else determines the outcome. Limbal ischaemia grades severity and prognosis.

Question 15

A 40-year-old has a 5 mm hyphaema after blunt trauma with an intraocular pressure of 35 mmHg and is of sickle cell trait. Which statement is correct?

1. Carbonic anhydrase inhibitors are the drug of choice
2. Avoid acetazolamide and hyperosmotic agents because they promote sickling in the anterior chamber; use topical beta blockers and alpha agonists, head elevation, a shield and cycloplegia, with early surgical washout for persistent raised pressure or rebleeding
3. Aspirin for pain
4. No follow-up is needed

Answer: B. Sickle trait and disease are common across the Gulf, Africa and South Asia; sickled cells obstruct the trabecular meshwork, so pressure thresholds for surgery are lower and acetazolamide is avoided.

How to use these questions

• Learn the sight-threatening emergencies as sequences: angle closure, keratitis, endophthalmitis, detachment, GCA, chemical injury.
• Know the diabetic eye pathway in detail, including when to inject, laser and operate.
• Cover paediatrics and neuro-ophthalmology, where cataract and refractive surgeons lose marks.
• Practise under time in the Ophthalmology bank with the error-log method.

Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool; the Gulf's eye hospitals and diabetic eye programmes recruit continuously.

Frequently asked questions

How many questions are in the ophthalmology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and about 70% for consultants.

Does the paper include refractive and oculoplastic surgery?

At the level of indications, contraindications and complications, not surgical technique.

Can an MS or FRCS in ophthalmology skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.