Free UKMLA ophthalmology questions with explanations

A. Urgent ophthalmology referral

This presentation of floaters, photopsia, a descending visual field curtain and a pale elevated retina with a tear in a myopic patient is a rhegmatogenous retinal detachment, which requires same-day ophthalmology referral for surgical repair (vitrectomy, scleral buckle or pneumatic retinopexy) per Royal College of Ophthalmologists guidance. Prompt intervention, especially before macular involvement, is critical to preserve vision.

D. High myopia

High myopia is the strongest risk factor for rhegmatogenous retinal detachment: axial elongation of the globe causes peripheral retinal thinning and lattice degeneration, predisposing to retinal tears through which liquefied vitreous tracks into the subretinal space. Other recognised risk factors include previous cataract surgery, ocular trauma and a family history of detachment; acute posterior vitreous detachment is the usual precipitating event, and a previous detachment in the fellow eye carries a comparably high risk.

D. Postoperative endophthalmitis

A painful red eye with reduced vision and hypopyon occurring within days to weeks of cataract surgery is postoperative endophthalmitis, an intraocular bacterial infection and ophthalmic emergency. It complicates roughly 0.1% of cataract operations and is most often caused by coagulase-negative staphylococci; management per Royal College of Ophthalmologists guidance involves urgent intravitreal vancomycin and ceftazidime, with vitreous sampling and possible vitrectomy.

A. R2 (pre-proliferative), refer to hospital eye service

Venous beading in two or more quadrants alongside multiple haemorrhages and cotton wool spots meets the ETDRS '4-2-1' rule for severe non-proliferative diabetic retinopathy, graded R2 (pre-proliferative) under the NHS Diabetic Eye Screening Programme. With no new vessels, pre-retinal/vitreous haemorrhage or fibroproliferation, this is not R3. NDESP requires routine referral to the hospital eye service within 13 weeks.

E. Same-day ophthalmology assessment

Ocular involvement occurs in most patients with Stevens-Johnson syndrome and is the main cause of long-term disability, because conjunctival inflammation heals with scarring, symblepharon and a dry, damaged ocular surface that can cost sight. Daily ophthalmology review during the acute phase allows lubricants, topical corticosteroids, lysis of adhesions and, in severe cases, amniotic membrane grafting to prevent scarring. The sticky discharge reflects sloughed conjunctival epithelium and inflammation rather than bacterial infection, so an antibiotic drop on its own misses the problem.

A. Optic neuropathy

Desaturation of colour vision following orbital cellulitis suggests optic neuropathy, which can arise from compressive, ischaemic, or inflammatory injury to the optic nerve during the acute infection or associated subperiosteal abscess. Reduced colour perception (particularly red desaturation) and a relative afferent pupillary defect are the earliest clinical signs, so formal ophthalmology assessment with visual acuity, colour plates, and pupillary testing is essential.

E. Marginal corneal ulcer

Marginal corneal ulcers (marginal keratitis) are a recognised complication of chronic staphylococcal blepharitis, arising from a type III/IV hypersensitivity reaction to staphylococcal exotoxins at the peripheral cornea. They appear as white, circular or crescent-shaped infiltrates near the limbus, typically with a clear zone separating them from the limbal vessels, and respond to topical antibiotic-steroid combinations alongside lid hygiene.

B. Proliferative vitreoretinopathy

Proliferative vitreoretinopathy (PVR) is the leading long-term complication and cause of failure after rhegmatogenous retinal detachment repair, arising from proliferation of retinal pigment epithelial and glial cells that form contractile fibrous membranes on the retinal surface and within the vitreous, producing tractional redetachment weeks to months postoperatively. Management typically requires pars plana vitrectomy with membrane peeling.

A. Basal cell carcinoma

A slowly growing pearly nodule with telangiectasia and madarosis (eyelash loss) on the lower eyelid is characteristic of basal cell carcinoma, the most common malignant eyelid tumour. Referral for specialist assessment and biopsy is recommended; suspected BCC is usually referred routinely, with a 2-week-wait referral reserved for lesions where delay could have significant impact, for example because of periocular site.

E. It will clear by itself within about two weeks

A subconjunctival haemorrhage is self-limiting: the blood is reabsorbed over one to two weeks, changing from red to yellow as it fades, and no treatment alters this. Antiplatelet and anticoagulant drugs make the bleed more likely but are continued, because a harmless surface bleed never justifies losing cardiovascular protection. Blood pressure should be checked, as here, and recurrent haemorrhages or bleeding elsewhere warrant a blood count and clotting screen (and an INR check if on warfarin). Vision is unaffected so there is no restriction on driving.