OPHTHALMOLOGY | 2022

1
OCULAR MOTILITY
Lecturer: Dr. Abines
OCULAR MOTILITY
Pre-Test:
1. Which muscle is paired correctly with its primary action?
a. Medial rectus – abduction
b. Superior rectus – elevation
c. Lateral rectus – adduction
d. Inferior oblique – depression
2. Type of ocular misalignment
a. Divergence
b. Convergence
c. Version
d. Esotrophia Phoria Latent deviation of the eyes hels straight by
3. Which muscle has secondary binocular vision
function as intorsion? Esophoria; Exophoria; Hyperphoria; Hypophoria
a. Lateral rectus Tropia Strabismus/Manifest deviation
b. Medial rectus Esotropia; Exotropia; Hypertropia; Hypotropia;
c. Superior rectus Incyclotropia; Excyclotropia
d. Inferior rectus Orthophoria Absence of any tendency of either eye to deviate
4. Give the definition of Fusion Rarely seen clinically because a small phoria is
a. Movement of the two eyes in opposite common
directions
b. Formation of one image from the two images
seen simultaneously by the two eyes
c. Movement of the two eyes in same directions
d. None of the above
DEFINITIONS
Conjugate Movement of both eyes in the same direction at
movement the same time
Vergence Movement of the two eyes in opposite directions
Convergence vs divergence
Deviation Magnitude of ocular misalignment, usually
measured in prism diopters or degrees
Comitant vs incomitant; primary vs secondary;
phoria vs tropia
Ductions Monocular eye movements
Adduction, Abduction, Elevation, Depression
Fusion Formation of one image from the two images
seen simultaneously by the two eyes
Motor vs sensory

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PHYSIOLOGY
• 6 extraocular muscles
• Synergistic muscles are those that have the same field of
action
• Antagonistic muscles are those that have opposite fields
of action
• Sherrington’s law states that there is reciprocal
innervation of antagonistic muscles, agonist muscle
contracts, antagonist muscle relaxes
• Yoke muscles are a pair of agonist muscles with the same
primary action
• Hering’s Law states that, for movements of both eyes in
the same direction, the corresponding agonist muscles
receive equal innervation
CLINICAL EVALUATION
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OPHTHALMOLOGY | 2022
2
OCULAR MOTILITY
Lecturer: Dr. Abines
• The neuromuscular system of an infant is immature so
that it is not uncommon in the first few months of life for
ocular misalignments.
• Transient exodeviations are most common and are
associated with immaturity of the accommodation-
convergence system.
• Any ocular misalignment by age 2-3 months should be
investigated.
• History
o Laterality – Does it alternate?
o Direction
o Duration – When was it first noticed? Gradual or
sudden onset?
o Frequency – Constant vs intermitted? Has the
frequency increased?
o Modifying factors – Illness, fatigue
o Past ocular history – Trauma, surgery
o Past medical history – prematurity, developmental
delays, neurological disorders, thyroid disease
o Family history
• Visual Acuity
o Use charts if the child is able to read or identify
pictures
o Use a target of interest for very young child (central,
steady, maintained, can fixate and follow)
• Determine cycloplegic refraction (cyclopentolate)
• Inspection (structural abnormalities causing strabismus)
o Pseudostrabismus – appearance of esotropia
because of a prominent epicanthal fold obscuring all
or part of the nasal sclera. They have normal corneal
light reflex. Prominent folds disappear by 4-5 years
old.
• Tests for Strabismus
o Cover test
▪ Identifies manifest strabismus
▪ Observe one eye
▪ Cover the fellow eye
▪ If the observed eye moves, manifest strabismus
is present
▪ Outward movement means esotropia
▪ Inward movement means exotropia
o Uncover test
▪ Provides information on fixation preference
▪ Identifies latent strabismus if there is no
manifest strabismus
▪ As cover is removed, position of the eye changes
• Manifest strabismus is present and it is
the preferred eye
• Interruption of binocular vision allowed
it to deviate and latent strabismus is
present
▪ As cover is removed, no movement is seen
 OPHTHALMOLOGY | 2022
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OCULAR MOTILITY
Lecturer: Dr. Abines
• Manifest strabismus is present but there TYPES OF STRABISMUS
is alternate fixation
• No manifest or latent strabismus

• Infantile Esotropia
o Manifest by 6 months
o Deviation is comitant (angle of deviation is the same
in all gazes)
o Not related to refractive error
o Due to faulty innervational control or anatomic
variations
o Genetically passed on as autosomal dominant
o Large deviation (40PD)
o Nystagmus is present
o Eye used for fixation is the better eye
o Surgical treatment
o Alternate cover test
▪ Total deviation
▪ Cover placed alternately and rapidly in front of
one eye to the other
▪ Using a prism can quantify the amount of
strabismus until neutralization
o Hirschberg method
▪ Patient fixates on light 33 cm
▪ 1 mm = 7
▪ Degrees = 15 PD
o Krimsky Test
▪ Patient fixes on a light at a distance
▪ Prism is placed in the deviating eye
▪ Strength of the prism required to center the
corneal reflection
o Sensory Examination
▪ Binocular vision and stereopsis
• Random dot stereogram
• Titmus fly test
• Lange
• Accommodative Esotropia
▪ Suppression testing
o Normal physiologic mechanism of accommodation
o Overactive convergence response, insufficient
divergence
▪ High hyperopia
• Begins at 2-3 years old
• Glasses allows the eye to be aligned
▪ High AC/A ratio
• Deviation is greated at near than at
distance
• Bifocal glasses
• Partially accommodative esotropia
o Mixed mechanism – part muscular imbalance and
part accommodative/convergence imbalance
o Glasses decrease the angle of deviation but
esotropia is not eliminated

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 OPHTHALMOLOGY | 2022
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OCULAR MOTILITY
Lecturer: Dr. Abines
o Surgery is performed for the non-accomodative PRINCIPLES OF THERAPY
component
• Main objectives of treatment
o Reversal of amblyopia, suppression and loss of
stereopsis
o Best possible alignment
o Timing of treatment – instituted as soon as
diagnosis is made
• Medical Treatment
o Spectacles
▪ Small refractive errors need not be
corrected
• Incomitant Strabismus ▪ Full hyperopic correction for esotropia
o Due to paresis or restriction of action of one or more o Prisms
extraocular muscles ▪ Can be stuck on glasses
o Abducens nerve palsy, fracture of medial orbital wall o Occlusion therapy
and entrapment of medial rectus muscle, Grave’s ▪ Sound eye is covered to stimulate the
ophthalmolopathy, Duane’s syndrome, birth amblyopic eye
injuries, congenital anomaly o Atropine penalization
o Acquired abducens palsy is initially managed by ▪ Poor compliance to patching
occlusion of the paretic eye or with prisms ▪ Cycloplegia on the good eye, encourages
• Duane Retraction Syndrome the use of the amblyopic eye
o Limitation of abduction and adduction • Surgical Treatment
o Retraction of the globe
o Narrowing of the palpebral fissure on attempted
adduction
o Associated with other anomalies (heterochromia,
cataract, choroidal coloboma, microphthalmos,
Goldenhar’s syndrome, cleft palate)
o Violates to the Sherrington’s Law (Nerve fibers of the
oculomotor nerve to the medial rectus may also go o Resection – Muscle is strengthened by
to the lateral rectus – accounts for globe retraction) detaching, shortening, then sutured to the eye
o Surgery only in primary position misalignment or at the original insertion site
significant head turn o Recession – Muscle is weakened by detaching
• Intermittent Exotropia and suturing at a measured distance behind the
o Onset in the first year original insertion
o History reveals that the condition has become
progressively worse
o Manifest with distance fixation
o Convergence is excellent
o No correlation with a specific refractive error
o Ambylopia is uncommon
o Surgery if with deterioration of control, enlarging
angle of deviation
• Constant Exotropia
o Less common
o Present at birth
o At risk for neurologic impairment and
developmental delays, consult with pedia neuro
necessary
o If acquired by age 6-8, no diplopia if suppression is
present
o Surgery nearly always indicated
o If poor vision is the cause, prognosis for
maintenance of stable position is less favorable

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OPTICS R EF R ACTION
• Branch of physics which involves the behavior and properties • Light travels in a straight line. But when it reaches another
of lights
o Physical optics
▪ Physical optics, also known as wave optics,
consider light as a wave
o Physiologic optics
▪ The study of light as it encounters our
photoreceptors(within the retina)
o Neuro-ophthalmic optics
▪ The study of visual perception and pathway (signal
form retina to occipital lobe)
o Geometric optics
▪ Speed, frequency, and wavelength of light are
related by the following expression:
▪ Frequency =Speed/Wavelength
▪ In different optical media, speed and wavelength
of light change, but frequency is constant
▪ Color depends on frequency, so that the color of a
ray of light is not altered as it passes through
optical media except by selective non-
transmittance or fluorescence.
S N ELL’S LAW
METH ODS OF R EF R ACTION - B OOK
• Objective refraction
• Defines the amount of bending that takes place when light ray
strikes a medium
angle of incidence = n2
----------------------------- -----
angle of refraction n1
• If a ray travels from a medium of lower refractive index into a
medium of higher refractive index, it is bent toward the
normal
• If a ray travels from a medium of higher refractive index to a
medium of lower index, it is bent away from the normal.
• At each refracting surface, the change in direction of each of
these rays is calculated according to the principles of Snell’s • Subjective Refraction
law.
LAW S OF R EF LECTIO N & R EF R ACTION ( B OOK)
1. Incident, reflected, and refracted rays all reside in a
plane known as the plane of incidence, which is normal
(at a right angle) to the interface.
2. For reflection, relative to the normal, the angles of
reflection and incidence are equal.
3. For refraction, the product of the index of refraction of
the medium of the incident ray and the sine of the angle • Cycloplegic Refraction
of incidence of the incident ray is equal to the product of
the same terms of the refracted ray (designated by a
prime): n sin I = n′ sin I′ (Snell’s law).
4. A ray of light passing from one point to another follows
the path that takes the least time to negotiate (Fermat’s
principle). Optical path length is the index of refraction
times the actual path length.
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OPHTHALMOLOGY | 2022
1
OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book
medium, it will bend.
REFRACTIVE INDICES
Medium Refractive
Index
Air 1.000
Cornea 1.376
Aqueous humor 1.336
Lens (cortex-core) 1.386-
1.406
Vitreous humor 1.336
o Objective refraction is performed by retinoscopy, in
which a streak of light, known as the intercept, is
projected into the patient’s eye to produce a similarly
shaped reflex, the retinoscopic reflex, in the pupil
o Parallel alignment of the intercept and the
retinoscopic reflex indicates the presence of only a
spherical error, or an additional cylindrical error in
which the intercept coincides with one of the principal
meridians.
o The intercept is then swept across the patient’s pupil,
and the effect on the retinoscopic reflex is noted
o If it moves in the same direction (with movement),
plus lenses are placed before the patient’s eye; and if
it moves in the opposite direction (against movement),
minus lenses are added—until the pupillary reflex fills
the whole pupillary aperture and no movement is
detected (point of neutralization).
o The spherical correction is checked by small changes,
initially increasing the plus power so as to overcome
any accommodative effort, until the clearest image is
obtained.
o A cross cylinder consists of two planocylindrical lenses
of equal power but opposite sign superimposed such
that their axes of refractive power lie at right angles to
one another.
o This can usually be achieved in adults by fogging
techniques in which plus lenses are used to overcome
accommodative effort
 OPHTHALMOLOGY | 2022
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OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book
TH E EYE AS A CAMER A 5. Check if patient is not leaning forward to see better
(reducing testing distance) or 'peeking'.
6. Use pinhole if patient’s vision not better, even with
correction.

numerator test distance

-------------------- = ---------------------------
denominator letter size read

7. Ask the patient to come closer to the chart if largest letter

is not identified (Recorded as 5/60, 4/60, 3/60, 2/60, or
1/60)
8. Do counting fingers if the largest letter at 3 feet distance
is still not identified (Recorded as CF @ 3ft, CF @ 2ft, CF
@ 1ft, CF @ 6 inches)
9. If the patient cannot see your fingers even at 6 inches
Refractive components of the eye or the focusing power is : distance, test for presence of hand movements. Check for
• 2/3 cornea and “air/tear” interface light projection in 4 quadrants (Recorded as +/- HM with
• 1/3 lens 4 Good/2-3 Fair/1 Poor light projection)
• These two elements converge parallel rays because : 10. If the patient cannot point at which quadrant the light is
1. Cornea has higher refractive index than air. being projected but able to perceive light, record this as
2. lens has higher refractive index than vitreous Light perception (LP).
humour. 11. Lastly, if patient cannot see the light you are presenting,
3. Cornea & lens are spherically convex in shape record this as No light perception (NLP).
DIOPTER MAG N IF ICATION - B OOK
• Measurement of the refractive power of a lens, equal to • Linear magnification is the ratio of the height of the image
the reciprocal of the focal length in meters (1/meters) to the height of the object.
• Refractive power is inversely proportional to focal length • For an infinitely thin lens in air—as assumed by the
LEN S ES algebraic method—this ratio is equal to the ratio of the
distance of the image to the distance of the object
AB B ER ATION S OF S PH ER ICAL LEN S - B OOK
• The variation of refractive index with frequency of light
(dispersion) results in greater refraction of blue than red
light (chromatic aberration)
• Marginal rays are refracted more than paraxial rays,
1. Positive/convex lens: converging lens producing spherical aberration
2. Negative/concave lens: diverging lens • Coma, a characteristic comet-shaped blur, is the result of
spherical aberration of light originating away from the
Example: +1 D lens focuses light at 1m. +2 D lens focuses light at optical axis of the lens.
0.5m. • When light traverses a spherical lens obliquely, there is
VIS U AL ACU ITY an additional cylindrical lens effect—astigmatism of
oblique incidence.
• Sharpness or clarity of vision
• Curvature of field is the production of a curved image
• 20/20 (feet) or 6/6 (meter): normal vision. A person can
from a flat object.
see clearly at 20 feet what is normally seen at that
distance. CYLIN DR ICAL LEN S ES - B OOK
• Chart is placed at 20 feet or 6 meters • Planocylindrical lens :one flat surface and one cylindrical
• Fraction describes the smallest size of letter the patient surface, resulting in no optical power in the meridian of
can identify correctly its axis and maximum power 90° away and forming a line
image, parallel to the axis of the lens, from a point object
VIS U AL ACU ITY DETER MIN ATION F OR F AR
• Spherocylindrical lens:cylindrical surface is curved in two
• Standard Snellen Chart meridians but not to the same extent.
• Bailey-Lovie Chart • In ophthalmic lenses, these principal meridians are at 90°
• ETDRS Chart to each other.
• Tumbling E Chart • The effect of a spherocylindrical lens on a point object is
• Landolt C Chart to produce a geometric figure known as the conoid of
• LEA Chart Sturm, consisting of two focal lines separated by the
• Teller Acuity Chart interval of Sturm.

1. Know your testing distance.

2. Note if spectacle correction worn.
3. Test one eye at a time by occluding.
4. Ask patient to read down chart as far as they can.

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 OPHTHALMOLOGY | 2022
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OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book

ACCOMMODATION

• ability of the eye to focus divergent rays of light on the

retina
• ciliary muscles contract lens zonules relax and increase MYOPIA
AP diameter • near sighted
• increased refractive power • patient has long eyeball or steeply curved cornea
• focus of light is anterior to the retina
VIS U AL ACU ITY DETER MIN ATION F OR N EAR • can be corrected by spherical biconcave (-) lens
1. The Jaeger chart is held at a specified reading distance • eye is longer than average: axial myopia
(such as 12 inches) • refractive elements are more refractive than
2. Ask patient to read the numbers or passage with the average: curvature myopia or refractive myopia
smallest type they can see (without and with correction) • point reached where the image is most sharply
Sc cc ph Near sc Near cc focused on the retina : "far point”
• Myopic person has the advantage of being able to
OD 20/30 20/25 20/20 J3 J1 read at the far point without glasses even at the age
OS 20/40 20/25 NI J5 J1 of presbyopia
• High degree -> results in greater susceptibility to
ER R OR S OF R EF R ACTION degenerative retinal changes, including retinal
detachment
• Emmetropia: images are focused directly on the retina
H YPER OPIA ( H YPER METR OPIA, F AR S IG HTEDN ESS )
• Emmetropia is absence of refractive error, and ametropia
• far sighted
is the presence of refractive error
• unaccommodated eye would focus the image
behind the retina
• patient has short eyeball or shallowly curved cornea
• focus of light is posterior to the retina
• due to reduced axial length (axial hyperopia), as
occurs in certain congenital disorders, or reduced
refractive error (refractive hyperopia), as
exemplified by aphakia
• amount decreases with age as presbyopia (decrease
in ability to accommodate) increases
• too high: unable to correct by accommodation ->
deprivation amblyopia in children

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 OPHTHALMOLOGY | 2022
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OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book
• frequent cause of esotropia (crossed eyes) and PR ES B YOPIA
monocular amblyopia
• can be corrected by spherical biconvex (+) lens
• Latent Hyperopia: degree of hyperopia overcome by
accommodation
AS TIG MATIS M

• disparity in corneal curvature within the different

axes
• the eye produces an image with multiple focal points • decreased ability of the lens to accommodate,
or lines especially at 40 yrs. of age
• can be corrected by cylinder lens: plus (+) or minus • person with emmetropic eyes (no refractive error)
(-); Philippines use minus cylinder will begin to notice inability to read small print or
discriminate fine close objects at about age 44–46.
• Regular • worse in dim light and usually worse early in the
Astigmatism: there morning or when the subject is fatigued
are two principal • symptoms increase until about age 55, when they
meridians, with stabilize but persist
constant power and • can be corrected by biconvex (+) lens (plus adds)
orientation across • corrected by use of a plus lens to make up for the
the pupillary lost automatic focusing power of the lens
aperture, resulting in • Reading glasses : near correction in the entire
two focal lines aperture of the glasses, making them fine for reading
• Astigmatism with but blurred for distant objects
the rule: the principal • Half-glasses : abate nuisance by leaving the top open
meridians are at right and uncorrected for distance vision
angles and their axes • Bifocals do the same but allow correction of other
lie within 20° of the refractive errors.
horizontal and • Trifocals correct for distance vision by the top
vertical, which the segment, the middle distance by the middle section,
greater refractive and the near distance by the lower segment.
power is in the • Progressive power (varifocal) lenses similarly correct
vertical meridian for far, middle, and near distances but by
• Astigmatism against the rule: the principal progressive change in lens power rather than
meridians are at right angles and their axes lie within stepped changes
20° of the horizontal and vertical, which the greater
refractive power is in the horizontal meridian
• Oblique astigmatism: regular astigmatism in which
the principal meridians do not lie within 20° of the MEAS U R IN G ER R OR S OF R EF RACTION
horizontal and vertical 1. Automated refractor
• Irregular astigmatism: the power or orientation of 2. Phoropter
the principal meridians changes across the pupillary 3. Loose lens and trial frames
aperture 4. Retinoscopy

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OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book
MAN AG EMEN T OF ER R OR S OF R EF R ACTION
1. Spectacles
a. Single vision lenses
b. Bifocals
c. Progressive lenses
2. Contact lens
a. Soft contact lens
b. Rigid gas permeable contact lens
3. Refractive Surgery
• degree of ablation is based on corneal
topography, pachymetry and refractive error
a) Photorefractive keratotomy (PRK)

a. similar to (PRK)
b. corneal flap is surgically done by a keratome
blade prior to laser ablation
e) Femtosecond Laser Assisted In-Situ Keratomileusis
(Femto-LASIK)

a. removal of corneal epithelium prior to use of an

excimer laser which ablates corneal tissue

b) Radial keratotomy (RK)

a. similar to LASIK but safer

b. uses femtosecond laser in creation of the flap;
excimer laser used in ablating corneal tissue
c. no creation of flap
d. lenticule is extracted through a small incision
f) Small Incision Lenticule Extraction (SMILE)
a. done in myopic patients with steep cornea
b. radial incisions are made at peripheral cornea
c) Astigmatic keratotomy (AK)

a. safest laser refractive procedure

b. Femtosecond laser used to create the lenticule
g) Phakic Intraocular Lens Implantation
a. similar to RK but incisions are placed
transversely, perpendicular to the meridian of
an astigmatic cornea
d) Laser Assisted In-Situ Keratomileusis (LASIK)

a. used in severely high myopia (-7D to - 10D) or

hyperopia (>+7D)
b. artificial IOL is placed piggy back on the natural
lens

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 OPHTHALMOLOGY | 2022
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OPTICS AND REFRACTION
Notes from Dr. Rodriguez-Bernardino + Book
h) Refractive Lens Exchange

a. Clear lens extraction

b. Similar to cataract surgery
(Phacoemulsification)
c. To correct high errors of refraction (more than
10 D) beyond the range of laser correction
i) Corneal Intrastromal Rings

a. rings placed in the corneal stroma altering the

shape

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 OPHTHALMOLOGY FINALS QUIZZES 2024
Topics:
● Laser in Ophthalmology
● Ocular Manifestations of Systemic Disease
● Neuro-Ophtha
● Sclera and Uvea
● Optics & Refraction
● Ocular Motility
MD2024 FINALS QUIZZES

Laser in Ophthalmology MD2024 10/10

1. It is common for the posterior capsule to Cataract Surgery

opacify after cataract surgery due to proliferation ● Postoperatively, there may be secondary
and metaplasia of lens epithelial cells. This laser opacification of the posterior capsule that
medium is used to remove the opacity and requires discission using the
improve vision of patients who had posterior neodymium:YAG laser
capsule opacity after cataract surgery and Vaughan 19th ed p. 182-183
intraocular lens placement.

a. Diode laser
b. Helium-neon laser
c. Argon-fluoride laser
d. Nd:YAG laser

2. Laser iridotomy is used to create a hole in the Glaucoma

iris and treat this condition. ● Laser iridotomy creates a small hole in the
peripheral iris to overcome pupil block.
a. Iris atrophy ● In acute angle-closure glaucoma, it is
b. Cataract undertaken to treat and prevent
c. Glaucoma recurrence in the affected eye and for
d. Pupillary paralysis prophylactic treatment of the fellow eye.
● It is also undertaken in chronic and
subacute primary angle-closure glaucoma
and in secondary angle-closure glaucoma
due to posterior synechiae.
Vaughan 19th ed p. 444

3. Pan-Retinal Photocoagulation (PRP) is utilized ● Panretinal laser photocoagulation (PRP)

in: induces regression of new vessels and
reduces the incidence of severe visual
a. Retinal artery occlusion loss from proliferative diabetic retinopathy
b. Retinopathy in diabetics by 50%.
c. Photoretinitis Vaughan 19th ed p. 204
d. Retinitis pigmentosa
4. Nd:YAG laser is used in the following 1. Cataract Surgery
conditions except? ● Postoperatively, there may be secondary
opacification of the posterior capsule that
a. Retinal ischemia requires discission using the
b. Cataract neodymium:YAG laser
c. Glaucoma
d. Posterior capsule opacity - Vaughan 19th ed p. 182-183

2. ACUTE ANGLE CLOSURE GLAUCOMA

● Once the intraocular pressure is under
control, laser peripheral iridotomy should
be undertaken to form a permanent
connection between the anterior and
posterior chambers, thus preventing
recurrence of iris bombé.
● This is most often done with the
neodymium:YAG laser

- Vaughan 19th ed p. 245-246

5. The following are types of photocoagulation Lasers with thermal effect:

and photodisruption surgeries except: 1. Photocoagulation
● Pan-Retinal Photocoagulation
a. PRP (PRP) - used for diabetic patients
b. Capsulotomy 2. Photodisruption
c. LASIK ● Laser Capsulotomy
d. Laser dacryocystorhinostomy ● Laser Dacryocystorhinostomy
(DCR)
● Laser Iridotomy
3. Photovaporization

Lasers with photochemical effect:

1. Photoablation
● Photorefractive keratectomy (PRK)
● Argon fluoride (ArF)
● Excimer laser
● LASIK
2. Photoradiation/photodynamic therapy
● Treatment of ocular tumors of
choroidal neovascularization

Hanabishi Trans

6. Short wavelength of light. Shortest wavelength on the spectrum si Violet

(Ultraviolet) then longest si red (infrared) so the
a. Red closer the color is sa kanila ang palatandaan mo.
b. Yellow Blue is the closest color sa violet among the
c. Green options here kaya siya ang may short wavelength
d. Blue here.
7. You see a 44-year-old patient in consultation Myopic patients will lose some accommodative
for refractive surgery. You would like her to try range going from glasses to contact lenses.
contact lenses first. Which of the following is true
regarding accommodation?

a. Myopic patients will lose some

accommodative range going from glasses
to contact lenses.
b. Toric contact lenses do not affect
accommodative range as much as
spherical ones
c. None of the choices
d. Hyperopic patients will lose some
accommodative range going from glasses
to contact lenses

8. A patient interested in LASIK is noted to have Brimonidine 0.2% may help with postoperative
“large” ́pupils in dim light. Which of the following night vision issues.
is correct regarding such patients?

a. The transition zone between ablated and

unablated cornea should be 1.5mm larger
than the pupil.
b. Large pupils are defined as 7.0mm
c. Brimonidine 0.2% may help with
postoperative night vision issues.
d. Older generation lasers used larger
optical zones without transition zones

9. A patient present with proliferative diabetic Tonic pupil may occur after retinal laser
retinopathy and is consented for panretinal Photocoagulation.
photocoagulation (PRP). Which of the following is
NOT a complication of laser photocoagulation? - Vaughan 19ed p.308

a. Exudative retinal detachment

b. Permanent loss of corneal sensation
c. Choroidal detachment
d. Pupillary abnormalities

10. Which of the statements is correct? Xanthophyll

● Yellow macular pigment
a. Hemoglobin minimally absorbs red and ● Strongly absorbs blue light
infrared wavelengths ● Weakly absorbs green.
b. Xanthophyll absorbs infrared light best ● Does not absorb yellow, orange, or red
c. None of the choices light
d. Melanin poorly absorbs the visible Hemoglobin
spectrum of light ● Strongly absorbs blue, green, yellow,
orange
● Weakly absorbs red light
 Melanin
● Absorbs all visible wavelength

Ocular Manifestations of Systemic Disease MD2024 10/10

1. A cherry red spot ́ in the retina may be seen in
the following conditions, EXCEPT?
a. Tay-Sachs disease
b. None of the choices
c. Central retinal artery occlusion
d. Niemann-Pick disease
Cherry-red spot can be seen in:
CRAO
● Acute central retinal artery occlusion with
cherry-red spot and preserved retina due
to cilioretinal arterial supply
BRAO
● Branch retinal artery occlusion also
causes sudden painless visual loss but
usually manifesting as impairment of
visual field that usually is permanent.
● Visual acuity is reduced only if there is
foveal involvement.
● The extent of the fundal abnormalities,
primarily retinal opacification as in central
retinal artery occlusion but sometimes
accompanied by cotton-wool spots along
its border, is determined by the extent of
retinal infarction.
Sandhoff disease
● The striking ocular finding of a cherry-red
spot in the macula is seen in a number of
lysosomal storage disorders, for example,
gangliosidosis (Tay-Sachs disease,
Sandhoff ’s disease, and generalized
GM1), Niemann-Pick type A
(sphingomyelin lipidosis), neuraminidase
deficiency (sialidosis and Goldberg’s
syndrome), and Farber’s disease.
-Vaughan 19ed p207 and 324

2. All of the following can be seen in the fundus Nonproliferative diabetic retinopathy
exam of a nonproliferative diabetic retinopathy ● Intraretinal microvascular changes without
patient, EXCEPT? extraretinal fibrovascular growth
● Fundoscopy
a. Dot-blot hemorrhages ○ Dot/blot hemorrhages, exudates,
b. Neovascularization cotton wool spots
c. Retinal edema ○ Dilation and beading of retinal
d. Intraretinal microvascular abnormalities veins
○ Intraretinal microvascular
abnormalities (IRMA)
○ Microaneurysm, capillary
nonperfusion, retinal edema
Proliferative diabetic retinopathy
● Presence of neovascularization
3. A 43-year-old female was seen at our Thyroid – Related Eye Disease (TRED)
institution for a follow up check up of Thyroid eye ● Grave’s Disease, Hashimoto’s thyroiditis,
disease (TED), which of the following is most euthyroid state
likely the pathogenesis of the TED? ● Eyelid retraction
a. Up regulation of orbital fibroblast ○ Restrictive myopathy of inferior
b. Proliferation of the extraocular myocytes rectus muscle
c. Increase in circulating immunoglobulin M ○ Inflammatory infiltration of levator
d. Proliferation of T3 and T4 in the ocular palpebrae superioris
tissues ○ Overstimulation of Muller’s muscle
(Sympathetic)
● Exophthalmos
○ Increase in orbital volume due to
fat and muscle hypertrophy
● Lid lag on downgaze
● Restrictive extraocular myopathy
● Compressive optic neuropathy

Lecture-based

4. A 34-year-old male has a 2-week history of Anterior uveitis

productive cough, back pain, and unintentional Presentation:
weight loss who subsequently referred to ● Mutton fat keratic precipitates
ophthalmology due to photophobia. Slit lamp ● Iris nodules
biomicroscopy revealed a circumcorneal ciliary ● Synechia
flush, keratic precipitates, iris nodules, synechias
and a grade 2 cells and flares on both eyes. What Lecture-based
is your diagnosis?

a. Panuveitis
b. Anterior uveitis
c. Intermediate uveitis
d. Posterior uveitis

5. A 28-year-old female came into our institution Toxoplasmosis

due to gradual loss of vision of her left eye.
Patient was noted to have a weak immune
system. Visual acuity was noted to be 10/200 on
the left eye and 20/25 on the right eye. Slit lamp
biomicroscopy revealed grade 3 cells and flares
on the left eye. Fundus exam showed a focal,
white retinitis with overlying moderate vitritis
adjacent to a chorioretinal scar. What is most
likely the etiologic agent?
● Most common cause of infectious
retinochoroiditis in adults & children
● Toxoplasma gondii
● Clinical presentation
○ Mild to moderate anterior uveitis
○ Focal, white retinitis with overlying
moderate vitritis (“headlight in the
fog”) adjacent to a chorioretinal
scar (satellite lesion)

a. Toxascarisleonine Lecture-based
b. Toxocaracanis
c. Toxoplasmosis gondii
d. Toxapexserebii
6. An immunocompromised patient with a CD4+ CMV Retinitis
≤50 cells/uL was referred to our service due to ● Immunocompromised patients (CD4+ ≤50
sudden onset of blurring of vision. Visual acuity cells / μL)
was noted to be hand movement with fair light ● Clinical Presentation:
projection on both eyes. Fundus exam showed a ○ Fulminant retinitis
large area of hemorrhage against a background ■ Large area of hemorrhage
of whitened, edematous or necrotic retina. against background of
whitened, edematous or
a. Retinal dystrophy necrotic retina
b. CMV retinitis ■ Posterior pole to the
c. Retinitis pigmentosa vascular arcades
d. Bardet-biedl syndrome ■ “Ketchup and mustard”
appearance
○ Granular/indolent form
■ Little or no retinal edema,
hemorrhage, vasculitis
■ Retinal periphery
○ Perivascular form
■ Frosted branch angiitis
Lecture-based

7. TB disease can be treated by taking several Ethambutol

drugs for 6 to 9 months. Which of the following ● For treatment of tubercular and
first-line anti-TB agents may affect the vision of non-tubercular mycobacterial disease
the patient? ● Optic neuritis (retrobulbar neuritis)
○ Seen between 4 and 12 months of
a. Isoniazid start of therapy
b. Ethambutol ○ Bilateral, symmetric, painless,
c. Pyrazinamide gradual blurring of central vision
d. Rifampicin ● Treatment and prevention
○ Ophthalmologic examination prior
to the start of therapy (color vision
test, perimetry)
○ Most px recover their vision weeks
to months after discontinuation
Lecture-based

8. This disease is a rare, autosomal recessive Wilson’s disease

abnormality in copper metabolism which usually ● Rare autosomal recessive disease of
causes changes in the basal nuclei, cirrhosis of young adults
the liver, and corneal pigmentation called the ● Characterized by abnormal copper
Kayser-Fleischer ring. The ring appears as a metabolism
green or brown band peripherally at which ● Kayser-Fleischer ring (see Chapter 6):
level/layer of the cornea? peripheral circumferential corneal
discoloration due to deposition of copper
a. Corneal endothelium at Descemet’s membrane
b. Corneal epithelium -Vaughan 19ed p. 356
c. Bowman’s layer
d. Descemet’s membrane
9. Oculocutaneous albinism consists of a
heterogenous group of conditions characterized
by generalized reduction in or absence of
melanin pigmentation and inherited as autosomal
recessive traits. Mutations have been found on
chromosomes 9, 11, and 15. Which of the
following is the most prominent symptom of this
disease?
a. Photophobia
b. Hyperemia
c. Decreased visual acuity
d. Nystagmus

10. Behcet’s disease consists of the clinical triad BEHÇET’S DISEASE

of relapsing uveitis, aphthous and genital ● Ocular involvement is associated with the
ulceration. Which haplotype is most commonly HLA-B51 haplotype.
associated with this disease?
a. HLA-B27 - Vaughan 19ed p355
b. HLA-B51
c. HLA-Dw53 HLA-B27 = Ankylosing Spondylitis
d. HLA-DR4 HLA-Dw53 = Vogt-Koyanagi-Harada Disease
HLA-DR4 = Vogt-Koyanagi-Harada Disease

Neuro-Ophtha MD2024

1. Ciliospinal center of Budge as part of the

Oculosympathetic pathway is made up of spinal
nerves
a. C8-T2
b. C6-T7
c. C8-T5
d. C7-T5

2. RAPD stands for? relative afferent pupillary defect (RAPD)

a. Relative afferent pupillary delay
b. Responsive afferent pathway defect Vaughan p. 306
c. Rapid afferent pupillary defect
d. Relative afferent pupillary defect

3. RAPD is also known as? Marcus-Gunn pupil is used synonymously with

a. Prostitutes pupil RAPD
b. Marcus-Gunn pupil
c. Argyll-Robertsan pupil
d. Homers pupil

4. True about Adies tonic pupil, except? TONIC PUPIL

a. It is usually congenital/heritable ● may be identified by the delayed dilation
b. Responds to pilocarpine following a near response from which it
c. Presents as vermiform constrictions derives its name
d. Common in females ● Abnormal spiraling (“vermiform”)
 movements of the iris when constricting to
a light stimulus, best seen on slitlamp
examination
● Constriction to dilute (0.125%) pilocarpine
eye drops.

5. True regarding Argyll-robertsons pupil, except?

a. Presents as miotic and irregular pupil
b. Can be caused by syphilis
c. Unilateral and symmetric
d. Poor dilation to dark and mydriatics

6. Third nerve abnormality with contralateral loss

of sensation and tremor?
a. Nothangel syndrome
b. Weber syndrome
c. Horners syndrome
d. Benedict syndrome

7. The following statements are true regarding

the IV cranial nerve, except?
a. The CN that exits the ventral side of the
brainstem
b. The longest cranial nerve
c. Pathology diagnosed by
Parks-Bielschowsky test
d. The cranial nerve that can easily

8. Internuclear ophthalmoplegia is due to the

damage to the?
a. Vestibular nuclei
b. Dorellos canal
c. Para pontine reticular formation
d. Medical longitudinal fasciculus

9. The three characteristics of the saccadic

system, except?
a. Amplitude
b. Latency
c. Velocity
d. accuracy

10. Rapid, painless loss of vision, optic disc

edema which should typically resolve within 6 to
8 weeks followed by atrophy to the disc?
a. Giant cell arteritis
b. Toxic neuritis
c. Optic neuritis
d. Lebers hereditary optic neuropathy
 Sclera and Uvea MD2024

1. This syndrome is characterized by recurrent, BEHCET’S DISEASE

multisystem disease associated by oral
aphthous stomatitis, skin lesion and
ulceration?
a. Toxoplasma retinochoroiditis
b. Sarcoidosis
c. Vogt koyanagi harada syndrome
d. Behcets disease
● hallmark: occlusive vasculitis – nagbabara,
kaya may singaw: oral, genital
● Idiopathic, recurrent, multisystem disease
● Affects young men; comes and goes
● Blindness d/t optic atrophy and ischemia
● Associated with HLA-B51
● Recurrent oral aphthous stomatitis, skin
lesions, arthritis, epididymitis, intestinal
ulceration, vascular problems

2. Vogt-Koyanagi- Harada disease is associated VOGT-KOYANAGI-HARADA DISEASE/VKH

with what human leukocyte antigen? ● Autoimmune disease that attacks the
a. HLA DR6 pigmented cells of the body
b. HLA DR5 ● Involves the eyes, auditory system
c. HLA DR4 (tinnitus), meninges and skin –
d. HLA DR3 uveo-meningeal disease
● Female to male ratio of 2:1
● 3rd to 5th decade of life
● Immune reaction to uveal
melanin-associated protein, melanocytes
or pigment epithelium (vitiligo – patchy,
white-black hair/alopecia)
● Strongly associated with HLA-DR4

3. The following are features of a granulomatous

uveitis EXCEPT?
a. Large mutton fat precipitates
b. Can be diffuse
c. Chronicity
d. Common recurrence

- Vaughan 19th ed p148

4. The following are features of endophthalmitis
EXCEPT?
a. Purulent
b. Hypopyon
c. Chemosis
d. Diffuse hyperemia
Lahat sa choices meron si endophthalmitis eh
pero i’d go with hypopyon here kasi ang nasa
book, endogenous type of endophthalmitis lang
ang may hypopyon so yun hihi meow

5. The following are treatment options for

patients with uveitis EXCEPT?
a. Cycloplegics
b. Biologicals
c. Steroids
d. Pupillary constrictors

6. Alpha adrenergic agonistic drug has NO

effect in this scleral layer
a. Deep vessels
b. Ciliary vessels
c. Conjunctival vessels
d. Tenon capsule vessels
 Phenylephrine is an α-adrenergic receptor agonist
that is commonly used to dilate the pupils

7. This is a common benign self-limiting disease EPISCLERITIS

of the eye associated with unilateral redness ● relatively common localized inflammation
with mild discomfort, tenderness, discomfort of the vascularized connective tissue
and absence of discharge? overlying the sclera.
a. Episcleritis ● unilateral in about two-thirds of cases
b. Iritis ● Recurrence is the rule. The cause is not
c. Cyclitis known
d. Scleritis ● An associated local or systemic disorder,
such as ocular rosacea, atopy, gout,
infection, or collagen-vascular disease, is
present in up to one-third of patients.
● Symptoms:
○ Redness
○ Mild irritation or discomfort
● Ocular examination reveals:
○ episcleral injection, which may be
nodular, sectoral, or diffuse
○ NO inflammation or edema of the
underlying sclera
○ keratitis and uveitis are uncommon
○ Conjunctivitis is ruled out by the
lack of palpebral conjunctival
injection or discharge.
● Common, benign, self-limiting (1–2
weeks); you put a drop of epinephrine then
it blanches/disappears, so you give
Eyemo/Mycin
● Affects young adults (affects women three
times as frequently as men)
● Unilateral redness with mild discomfort,
tenderness and watering

8. Scleromalacia perforans ANTERIOR NECROTIZING SCLERITIS

a. Anterior non-necrotizing scleritis with WITHOUT INFLAMMATION
inflammation ● Also known as Scleromalacia perforans
b. Posterior scleritis ● Typically occurs in women w/ long
c. Intermediate scleritis standing rheumatoid arthritis
d. Anterior necrotizing scleritis without ● Usually bilateral
inflammation ● Progressive exposure of uvea due to
scleral thinning
● TREATMENT IS INEFFECTIVE !!!
9. Management of episcleritis involves the
following EXCEPT?
a. Topical NSAIDS
b. Topical vasoconstrictors
c. Artificial tears
d. Topical antibiotic ointments Pwede din ata dito yung topical NSAIDS kasi sabi
sa book, di siya effective in treating Episcleritis
pero safest si antibiotic dito kasi wala siyang
mention as part of the treatment plan.
- Vaughan 19th ed. P169 nalang po for
reference

10. It is the accumulation of white blood cells, Hypopyon is the accumulation of neutrophils and
microbes, and fluid in the anterior chamber of fibrin that typically settles ventrally within the
the eye? anterior chamber. Inflammation within the iris and
a. Mutton fat keratic precipitates ciliary body is usually referred to as anterior
b. Bussaca nodules uveitis (or less commonly iridocyclitis).
c. Hyphema
d. Hypopyon

Optics and Refraction MD2024

1. The eye changes its refractive power to focus Accommodation

on near objects by a process called
accommodation. Which statement is FALSE of
accommodation?
a. Increased curvature of the lens
b. Thickening of the lens
c. Relaxation of the ciliary muscles
d. Relaxed lens capsule
Vaughan 19th ed p. 412
● The eye changes refractive power to focus
on near objects by a process called
accommodation.
● Study of Purkinje images, which are
reflections from various optical surfaces in
the eye, has shown that accommodation
results from changes in the crystalline
lens.
● Contraction of the ciliary muscle results in
thickening and increased curvature of the
lens, probably due to relaxation of the lens
capsule.

2. Which of the following correctly describes the REFRACTIVE ERRORS

presence of a refractive error? ● Emmetropia is absence of refractive error
a. Emmetropia ● Ametropia is the presence of refractive
b. Hypertropia error
c. Ametropia Types of refractive errors:
d. Hypotropia ● Presbyopia
● Myopia
● Hyperopia
● Latent hyperopia
● Astigmatism
Vaughan 19th ed p. 412-414
3. The greater refractive power is in the vertical Astigmatism
meridian. What type of astigmatism is this? ● When the principal meridians are at right
a. With the rule astigmatism angles and their axes lie within 20° of the
b. Against the rule astigmatism horizontal and vertical, the astigmatism is
c. Oblique astigmatism subdivided into:
d. Irregular astigmatism ○ Astigmatism with the rule, in which
the greater refractive power is in
the vertical meridian
○ Astigmatism against the rule, in
which the greater refractive power
is in the horizontal meridian.
● Oblique astigmatism is regular
astigmatism in which the principal
meridians do not lie within 20° of the
horizontal and vertical.
● Irregular astigmatism, the power or
orientation of the principal meridians
changes across the pupillary aperture.
Vaughan 19th ed p. 414

4. The greater the refractive power is in the Astigmatism

horizontal meridian. What type of astigmatism is
this?
a. With the rule astigmatism
b. Against the rule astigmatism
c. Irregular astigmatism
d. Oblique astigmatism
Vaughan 19th ed p. 414
● When the principal meridians are at right
angles and their axes lie within 20° of the
horizontal and vertical, the astigmatism is
subdivided into:
○ Astigmatism with the rule, in which
the greater refractive power is in
the vertical meridian
○ Astigmatism against the rule, in
which the greater refractive power
is in the horizontal meridian.
● Oblique astigmatism is regular
astigmatism in which the principal
meridians do not lie within 20° of the
horizontal and vertical.
● Irregular astigmatism, the power or
orientation of the principal meridians
changes across the pupillary aperture.

5. The principal meridians do not lie within the 20 Astigmatism

degrees of the horizontal and vertical meridian.
What type of astigmatism is this?
a. Oblique astigmatism
b. Against the rule astigmatism
c. Irregular astigmatism
d. With the rule astigmatism
● When the principal meridians are at right
angles and their axes lie within 20° of the
horizontal and vertical, the astigmatism is
subdivided into:
○ Astigmatism with the rule, in which
the greater refractive power is in
the vertical meridian
○ Astigmatism against the rule, in

6. The power or orientation of the principal Astigmatism
meridians change across the pupillary aperture.
What type of astigmatism is this?
a. Irregular astigmatism
b. Oblique astigmatism
c. Against the rule astigmatism
d. With the rule astigmatism
Vaughan 19th ed p. 414
7. Objective refraction is performed by Objective Refraction
retinoscopy, in which a streak of light is projected
into the patient’s eye to produce a similarly
shaped reflex in the pupil. The streak of light is
swept across the patient’s pupil and the effect of
the shaped reflex is noted. If the streak of light
moves in the SAME direction or “with the
movement”, what type of lens should be placed
on the patient’s eye during refraction?
a. Concave lens
b. Meniscus lens
c. Cylindrical lens (incorrect)
d. Convex lens
which the greater refractive power
is in the horizontal meridian.
● Oblique astigmatism is regular
astigmatism in which the principal
meridians do not lie within 20° of the
horizontal and vertical.
● Irregular astigmatism, the power or
orientation of the principal meridians
changes across the pupillary aperture.
Vaughan 19th ed p. 414
● When the principal meridians are at right
angles and their axes lie within 20° of the
horizontal and vertical, the astigmatism is
subdivided into:
○ Astigmatism with the rule, in which
the greater refractive power is in
the vertical meridian
○ Astigmatism against the rule, in
which the greater refractive power
is in the horizontal meridian.
● Oblique astigmatism is regular
astigmatism in which the principal
meridians do not lie within 20° of the
horizontal and vertical.
● Irregular astigmatism, the power or
orientation of the principal meridians
changes across the pupillary aperture.
● Objective refraction is performed by
retinoscopy, in which a streak of light,
known as the intercept, is projected into
the patient’s eye to produce a similarly
shaped reflex, the retinoscopic reflex, in
the pupil.
● The intercept is then swept across the
patient’s pupil, and the effect on the
retinoscopic reflex is noted (Figure 21–25).
● If it moves in the same direction (with
movement), plus lenses are placed before
the patient’s eye
● If it moves in the opposite direction
(against movement), minus lenses are
added—until the pupillary reflex fills the
whole pupillary aperture and no movement
is detected (point of neutralization).
Vaughan 19ed p417

8. Objective refraction is performed by Objective Refraction
retinoscopy, in which a streak of light is projected
into the patient’s eye to produce a similarly
shaped reflex in the pupil. The steak of light is
swept across the patient’s pupil and the effect of
the shaped reflex is noted. If the streak of light
moves in the OPPOSITE direction or “Against the
movement”, what type of lens should be placed
on the patient’s eye during refraction?
a. Concave lens
b. Meniscus lens
c. Cylindrical lens
d. Convex lens
9. An automated refraction was done to a 45 year
old patient and it revealed a 0.00 sph - 1.75 = cyl
x 100cm on both eyes, what kind of refractive
error does the patient have?
a. Hyperopia
b. Presbyopia (incorrect)
c. Astigmatism
d. Myopia
10. What is Conoid of Sturm?
a. Is a combination of two oblique cylinders
(incorrect)
b. Is a series of focal lines that converge to
form an image
c. Is a complex of conical space bound by
the two focal lines of a sphero-cylinder
d. Is formed by the focal sphere of a
sphero-cylinder
Note:
PLUS lens = Biconvex Lens
MINUS lens = Biconcave Lens
● Objective refraction is performed by
retinoscopy, in which a streak of light,
known as the intercept, is projected into
the patient’s eye to produce a similarly
shaped reflex, the retinoscopic reflex, in
the pupil.
● The intercept is then swept across the
patient’s pupil, and the effect on the
retinoscopic reflex is noted.
● If it moves in the same direction (with
movement), plus lenses are placed before
the patient’s eye
● If it moves in the opposite direction
(against movement), minus lenses are
added—until the pupillary reflex fills the
whole pupillary aperture and no movement
is detected (point of neutralization).
Vaughan 19ed p.417
Note:
PLUS lens = Biconvex Lens
MINUS lens = Biconcave Lens
Spherocylindrical lens
● The effect of a spherocylindrical lens on a
point object is to produce a geometric
figure known as the conoid of Sturm,
consisting of two focal lines separated by
the interval of Sturm.
Vaughan 19ed p. 407
 Vaughan 19ed p. 409

Ocular Motility MD2024

1. When both eyes are looking up and right,

which extraocular muscles are activated?
a. Left superior rectus and right inferior
oblique
b. Right superior rectus and left inferior
oblique
c. Left inferior rectus and right superior
oblique
d. Right inferior rectus and left superior
oblique

2. When both eyes are looking down and left,

which extraocular muscles are activated?
a. Left superior rectus and right inferior
oblique
b. Right superior rectus and left inferior
oblique
c. Left inferior rectus and right superior
oblique
d. Right inferior rectus and left superior
oblique

3. When both eyes are looking up and left, which

extraocular
muscles are activated?
a. Left superior rectus and right inferior
oblique
b. Right superior rectus and left inferior
oblique
c. Left inferior rectus and right superior
oblique
d. Right inferior rectus and left superior
oblique

4. When both eyes are looking down and right,

which extraocular muscles are activated?
a. Left superior rectus and right inferior
oblique
b. Right superior rectus and left inferior
oblique
c. Left inferior rectus and right superior
oblique
d. Right inferior rectus and left superior
oblique

5. Amblyopia is a vision loss without any organic

or anatomic ocular pathology and is/are caused
by the following EXCEPT
a. Strabismic
b. Refractive
c. Deprivation
d. None of the choices

6. Dissimilar relationship in the 2 eyes, between

corresponding retinal areas and their respective
foveas indicates?
a. Normal retinal correspondence
b. Anomalous retinal correspondence
c. Diplopia
d. Eccentric fixation

7. Movement of the two eyes in the same

direction at the same time
a. Conjugate movement
b. Convergent movement
c. Divergent movement
d. Duction movement

8. Each point of the retina in each eye is capable

of using stimuli that strike sufficiently close to the
corresponding retinal point in the other eye. The
representation in space of this region of fusible
points is called?
a. Corresponding retinal points
b. Panum’s area
c. Sensory Fusion
d. Stereopsis

9. As a patient with right LR palsy looks to the

right field of gaze, with the right eye fixating.
What muscle overacts?
a. Right LR
b. Right MR
c. Left LR
d. Left MR
10. The superior branch of CN III innervates the
superior rectus and?
a. Pupillary sphincter
b. Medial rectus
c. Levator palpebrae superioris
d. Orbicularis oculi
 OPHTHALMOLOGY | 2022
1
FINALS CANVAS
Please use at your own risk
OPTICS AN D R E F R ACTION 2022 OB LIQU E AS TI G MATIS M: R EG U LAR AS TIG MATIS M IN
1. The eye changes its refractive power to focus on near W H ICH TH E PR IN CIPAL MER IDIAN S DO N OT LIE W ITHIN
objects by a process called accommodation. Which 20° OF TH E H OR IZ ON TAL AN D VER TICAL
statement is FALSE of accommodation? 6. The power of orientation of the principal meridians
a. Relaxed lens capsule change across the pupillary aperture. What type of
b. Relaxation of the ciliary muscles astigmatism is this?
c. Thickening of the lens a. Oblique astigmatism
d. Increased curvature of the lens b. With the rule astigmatism
c. Against the rule astigmatism
d. Irregular astigmatism
IR R EG ULAR AS TIG M ATIS M : TH E POW ER OR
OR IEN TATION OF TH E PR IN CIPAL MER IDIAN S CH AN GES
ACR OS S TH E PU PILLAR Y APER TU R E
7. Objective refraction is performed by retinoscopy, in
which streak of light is projected into the patient’s eye to
produce a similarly shaped reflex in the pupil. The streak
of light is swept across the patient’s pupil and the effect
of the shaped reflex is noted. If the streak of light moves
in the SAME direction or “WITH THE MOVEMENT”, what
type of lens should be placed on the patient’s eye during
refraction?
a. Menicus lens
2. Which term describes the presence of a refractive error? b. Concave lens
a. Hypertropia c. Convex lens
b. Ametropia d. Cylindrical lens
c. Emmetropia IF IT MOVES IN TH E S AME DIR ECTION ( W ITH
d. Hypotropia MOVEMEN T) , PLU S LEN S ES AR E PLACED B EF OR E TH E
EMMETR OPIA IS AB S EN CE O F R EF R ACTIVE ER R OR , AND PATIEN T’S EYE; AN D IF IT MOVES IN TH E OPPOS ITE
AMETR OPIA IS TH E PR ES EN CE OF R EF R ACTIVE ER R OR DIR ECTION ( AG AIN S T MOVEMEN T) , MIN U S LEN S ES AR E
ADDED—U N TIL TH E PU PILL AR Y R EF LEX F ILLS TH E
3. The greater refractive power is in the vertical meridian.
W H OLE PU PILLAR Y APER TU R E AN D N O MOVEMEN T IS
What type of astigmatism is this?
DETECTED ( POIN T OF N EU TR ALIZ ATION ) .
a. Oblique astigmatism
b. With the rule astigmatism
c. Irregular astigmatism
d. Against the rule astigmatism
AS TIG M ATIS M WITH TH E R ULE : TH E PR IN CIPAL
MER IDIAN S AR E AT R IG H T AN G LES AN D TH EIR AXES LIE
W ITH IN 20° OF TH E H OR IZ ON TAL AN D VER TICAL, W H ICH
TH E G R EATER R EF R ACTIVE POW ER IS IN TH E VER TICAL
MER IDIAN
4. The greater refractive power is in the horizontal
meridian. What type of astigmatism is this? 8. Objective refraction is performed by retinoscopy, in
a. Irregular astigmatism which streak of light is projected into the patient’s eye to
b. Oblique astigmatism produce a similarly shaped reflex in the pupil. The streak
c. Against the rule astigmatism of light is swept across the patient’s pupil and the effect
d. With the rule astigmatism of the shaped reflex is noted. If the streak of light moves
AS TIG M ATIS M AG AIN S T TH E R ULE : TH E PR IN CIPAL in the OPPOSITE direction or “AGAINST THE
MER IDIAN S AR E AT R IG H T AN G LES AN D TH EIR AXES LIE MOVEMENT”, what type of lens should be placed on the
W ITH IN 20° OF TH E H OR IZ ON TAL AN D VER TICAL, W H ICH patient’s eye during refraction?
TH E G R EATER R EF R ACTIVE POW ER IS IN TH E H OR IZ ONTAL a. Menicus lens
MER IDIAN b. Concave lens
c. Convex lends
5. The principal meridians do not lie within the 20 degrees
of the horizontal and vertical meridian. What type of d. Cylindrical lens
9. An automated refraction was done to a 45 year old
astigmatism is this?
a. Irregular astigmatism patient and it revealed a 0.00 sph -1.75= cyl x 100° on
b. Against the rule astigmatism both eyes, what kind of refractive error does the patient
have?
c. With the rule astigmatism
d. Oblique astigmatism a. Myopia
b. Hyperopia
c. Astigmatism
d. Prebsyopia

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S PH = S PH ER E ; IN DICATES AMOU N T OF LEN S POW ER

PR ES CR IB ED F OR N EAR S IG H TED OR F AR SIG H TED VIS ION.
IT IS MEAS U R ED IN DIOPTER AN D U S ES ( +) F OR
F AR S IG H TEDN ES S ( H YPER OPIA) AN D ( - ) F OR
N EAR S IG H TEDN ES S ( MY OPIA)
CYL & AXIS : A CYLIN DER ( CYL) AN D AXIS N U MB ER
( B ETW EEN 0 AN D 180 DEG R EES ) AR E R EQU IR ED TO
COR R ECT AS TIG MATIS M. B OTH PAR AMETER S W ILL B E
R EQU IR ED TOG ETH ER .
Z ER O S PH = N O R EF R ACTIVE ER R OR
CYLIN DER = W H ER E N U MER ICAL DIG ITS AR E ON LY
R EQU IR ED IF YOU H AVE AS TIG MATIS M IN EITH ER OR
B OTH OF YOU R EYES
10. What is the Conoid of Sturm?
a. Is a complex conical space bound by the two
focal lines of a sphero-cylinder
b. Is a combination of two oblique cylinders
c. Is a series of focal lines that converge to form
an image
d. Is bound by the focal sphere of a sphero-
cylinder
TH E EF F ECT OF A S PH ER OCYLIN DR ICAL LEN S ON A
POIN T OB JECT IS TO PR ODU CE A G EOMETR IC F IG U R E
KN OW N AS TH E CONOID OF S TUR M , CON S IS TIN G OF
TW O F OCAL LIN ES S EPAR ATED B Y TH E IN TER VAL OF
S TU R M.

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OCU LAR MOTILITY 2022 PR ES EN T. H IS TOR Y S H OU LD ADDR ES S : PR EVIOU S
H IS TOR Y OF PATCH IN G OR EYE DR OPS , PAS T
COMPLIAN CE W ITH TH ES E TH ER APIES , PR EVIOU S
OCU LAR S U R G ER Y OR DIS EAS E AN D F AMILY H IS TOR Y OF
S TR AB IS MU S OR OTH ER OCU LAR PR OB LEMS .
6. Dissimilar relationship in the 2 eyes, between corresponding
retinal areas and their respective foveas indicates?
a. Normal retinal correspondence
b. Anomalous retinal correspondence
c. Diplopia
d. Eccentric fixation
AR C IS AN ADAPTATION TH AT OCCU R S W H EN LIG H T
F R OM TH E POIN T IN S PACE TH AT IS B EIN G F OCU S ED ON
H ITS TH E F OVEA OF ON E EYE AN D H ITS AN EXTR A -
F OVEAL R ETIN AL POIN T IN TH E CON TR ALATER AL EYE.
U N DER N OR MAL CIR CU MS TAN CES , H AVIN G TH E S AME
IMAG E S TIMU LATE TW O DIS S IMILAR POIN TS OF TH E
R ETIN A W OU LD PR ODU CE DIPLOPIA.
7. Movement of the two eyes in the same direction at the same
time
a. Conjugate movement
b. Convergent movement
c. Divergent movement
d. Duction movement

1. When both eyes are looking up and right, which extraocular

muscles are activated?
a. Left superior rectus and right inferior oblique
b. Right superior rectus and left inferior oblique
c. Left inferior rectus and right superior oblique
d. Right inferior rectus and left superior oblique
2. When both eyes are looking down and left, which extraocular
muscles are activated?
a. Left superior rectus and right inferior oblique
b. Right superior rectus and left inferior oblique
c. Left inferior rectus and right superior oblique
d. Right inferior rectus and left superior oblique
3. When both eyes are looking up and left, which extraocular
muscles are activated?
a. Left superior rectus and right inferior oblique
b. Right superior rectus and left inferior oblique 8. Each point of the retina in each eye is capable of using stimuli
c. Left inferior rectus and right superior oblique that strike sufficiently close to the corresponding retinal point
d. Right inferior rectus and left superior oblique in the other eye. The representation in space of this region of
4. When both eyes are looking down and right, which extraocular fusible points is called?
muscles are activated? a. Corresponding retinal points
a. Left superior rectus and right inferior oblique b. Panum’s area
b. Right superior rectus and left inferior oblique c. Sensory Fusion
c. Left inferior rectus and right superior oblique d. Stereopsis
d. Right inferior rectus and left superior oblique
5. Amblyopia is a vision loss without any organic or anatomic TH E R EG ION IN VIS U AL S PACE OVER W H ICH W E
PER CEIVE S IN G LE VIS ION IS KN OW N AS "PAN U M' S
ocular pathology and is/are caused by the following EXCEPT
a. Strabismic F U S ION AL AR EA", W ITH OB JECTS IN F R ON T AN D B EH IND
b. Refractive TH IS AR EA B EIN G IN PH YS IOLOG ICAL DIPLOPIA ( I.E.,
c. Deprivation DOU B LE VIS ION ) .
d. None of the above 9. As a patient with right LR palsy looks to the right fi eld of gaze,
AMB LYOPIA R EPR ES EN TS DIMIN IS H ED VIS ION with the right eye fi xating. What muscle overacts?
a. Right LR
OCCU R R IN G DU R IN G TH E YEAR S OF VIS U AL
DEVELOPMEN T S ECON DAR Y TO AB N OR MAL VIS U AL b. Right MR
c. Left LR
S TIMU LATION . IT IS U S U ALLY U N ILATER AL B U T IT CAN
B E B ILATER AL. TH E DIMIN IS H ED VIS ION IS B EYON D TH E d. Left MR
LEVEL EXPECTED F R OM TH E OCU LAR PATH OLOG Y
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10. The superior branch of CN III innervates the superior rectus

and?
a. Pupillary sphincter
b. Medial rectus
c. Levator palpebrae superioris
d. Orbicularis oculi