A 66-year-old man who had uneventful cataract surgery with IOL implantation three days ago at an eye camp returns with increasing pain, a red eye and vision dropping to hand movements. There is lid swelling, a 2 mm hypopyon and a poor red reflex. What is the next best step?

Vitreous tap and intravitreal antibiotics

Frequent topical steroids and review

Nd:YAG laser posterior capsulotomy

Oral antibiotics with a review in a week

A 32-year-old brass-utensil worker from Moradabad was hit in the left eye by a flying metal chip a year ago and did not seek care. Now his vision is reduced; the slit lamp shows a greenish-golden ring at the periphery of Descemet's membrane and a petal-shaped greenish opacity under the anterior lens capsule. An X-ray of the orbit shows a small radio-opaque foreign body inside the globe. Which process explains these findings?

Chalcosis from a retained copper alloy

Siderosis from a retained iron particle

Lens-induced uveitis from capsule rupture

Wilson disease unmasked by the injury

A 68-year-old man had cataract surgery complicated by a small posterior capsule tear, and his vision was 6/9 at the one-week review. At seven weeks he notices blurred central vision (6/24) in a quiet eye. Fluorescein angiography shows dye leaking into the macula in a petal-shaped pattern. What is the most likely diagnosis?

Pseudophakic cystoid macular oedema

Posterior capsule opacification

Rhegmatogenous retinal detachment

Chronic low-grade endophthalmitis

A 72-year-old man receives a retrobulbar block with a lignocaine-bupivacaine mixture for cataract surgery. About five minutes later he becomes drowsy, then unresponsive, and stops breathing; the pupil of his fellow eye is dilated and unreactive. Pulse and blood pressure are maintained. What is the most likely mechanism?

Spread along the optic nerve sheath to the brainstem

Oculocardiac reflex from pressure on the globe

Retrobulbar haemorrhage compressing the optic nerve

Intra-arterial injection reaching the brain directly

A 70-year-old retired tailor from Surat is pleased that for the past year he can thread a needle without his reading glasses, though his distance vision has become hazy. Retinoscopy shows a new myopic shift, and the lens nucleus looks yellow-brown on the slit lamp. What explains his improved near vision?

Raised refractive index of the nucleus

Recovery of accommodation in the lens

Flattening of the anterior corneal curvature

Increased axial length of the eyeball

Cataract and its surgery

25 NEET-PG practice questions on Cataract and its surgery, 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 66-year-old man who had uneventful cataract surgery with IOL implantation three days ago at an eye camp returns with increasing pain, a red eye and vision dropping to hand movements. There is lid swelling, a 2 mm hypopyon and a poor red reflex. What is the next best step?
1. AVitreous tap and intravitreal antibiotics
2. BFrequent topical steroids and review
3. CNd:YAG laser posterior capsulotomy
4. DOral antibiotics with a review in a week
Show answerHide answer
Answer: A · Vitreous tap and intravitreal antibiotics
Pain, falling vision, hypopyon and vitreous haze in the first week after cataract surgery mean acute post-operative endophthalmitis until proved otherwise. Vitreous is sampled for Gram stain and culture, and broad-spectrum antibiotics such as vancomycin and ceftazidime are injected intravitreally the same day. Early vitrectomy is considered when vision is reduced to light perception. Clusters of cases after an eye camp should be reported, as they can come from contaminated fluids or instruments.
- B: Steroids alone would let an infection progress; they are only an adjunct.
- C: Nd:YAG capsulotomy treats posterior capsule opacification months to years later.
- D: Oral antibiotics do not reach adequate levels in the vitreous, and a week's delay costs the eye.
Question 2 · Medium
A 32-year-old brass-utensil worker from Moradabad was hit in the left eye by a flying metal chip a year ago and did not seek care. Now his vision is reduced; the slit lamp shows a greenish-golden ring at the periphery of Descemet's membrane and a petal-shaped greenish opacity under the anterior lens capsule. An X-ray of the orbit shows a small radio-opaque foreign body inside the globe. Which process explains these findings?
1. ASiderosis from a retained iron particle
2. BLens-induced uveitis from capsule rupture
3. CWilson disease unmasked by the injury
4. DChalcosis from a retained copper alloy
Show answerHide answer
Answer: D · Chalcosis from a retained copper alloy
A retained intraocular foreign body of a copper alloy such as brass slowly releases copper, which deposits in basement membranes: Descemet's membrane (a Kayser-Fleischer-like ring) and the anterior lens capsule (sunflower cataract). This is chalcosis; a foreign body of nearly pure copper instead causes a violent, endophthalmitis-like reaction. Iron gives siderosis, with rusty deposits, iris heterochromia and retinal toxicity. The foreign body should be removed, usually by vitrectomy.
- A: Siderosis gives rusty brown deposits and heterochromia, not a greenish ring.
- B: Lens-induced uveitis causes inflammation, not copper-coloured rings.
- C: Wilson disease is a systemic copper disorder, unrelated to a retained chip.
Question 3 · Medium
A 68-year-old man had cataract surgery complicated by a small posterior capsule tear, and his vision was 6/9 at the one-week review. At seven weeks he notices blurred central vision (6/24) in a quiet eye. Fluorescein angiography shows dye leaking into the macula in a petal-shaped pattern. What is the most likely diagnosis?
1. APosterior capsule opacification
2. BPseudophakic cystoid macular oedema
3. CRhegmatogenous retinal detachment
4. DChronic low-grade endophthalmitis
Show answerHide answer
Answer: B · Pseudophakic cystoid macular oedema
Cystoid macular oedema after cataract surgery (Irvine-Gass syndrome) typically appears some weeks after the operation, more often after a complicated one with capsule rupture or vitreous loss. Prostaglandin-mediated leakage from perifoveal capillaries fills cystic spaces in the outer plexiform layer, giving the petaloid pattern on angiography; OCT shows the cysts without dye. Topical NSAIDs with steroids are the first treatment, and most cases resolve.
- A: Capsule opacification develops over months to years and does not leak dye at the macula.
- C: Detachment causes a field defect and an elevated retina, not petaloid leakage.
- D: Chronic endophthalmitis causes recurrent inflammation and a capsular plaque, not a quiet eye.
Question 4 · Medium
A 72-year-old man receives a retrobulbar block with a lignocaine-bupivacaine mixture for cataract surgery. About five minutes later he becomes drowsy, then unresponsive, and stops breathing; the pupil of his fellow eye is dilated and unreactive. Pulse and blood pressure are maintained. What is the most likely mechanism?
1. ASpread along the optic nerve sheath to the brainstem
2. BOculocardiac reflex from pressure on the globe
3. CRetrobulbar haemorrhage compressing the optic nerve
4. DIntra-arterial injection reaching the brain directly
Show answerHide answer
Answer: A · Spread along the optic nerve sheath to the brainstem
If the needle enters the dural sheath of the optic nerve, local anaesthetic spreads in the subarachnoid space to the optic chiasm and brainstem. Within minutes this causes drowsiness, apnoea, contralateral amaurosis and sometimes cranial nerve palsies. Treatment is supportive: secure the airway and ventilate, support the circulation, and the effect wears off as the drug is cleared. This is why monitoring and resuscitation equipment must be ready during every orbital block.
- B: The oculocardiac reflex causes bradycardia, not apnoea with a dilated fellow pupil.
- C: Retrobulbar haemorrhage causes proptosis and a tense orbit, not apnoea.
- D: Intra-arterial injection causes seizures almost at once, during the injection.
Question 5 · Medium
A 70-year-old retired tailor from Surat is pleased that for the past year he can thread a needle without his reading glasses, though his distance vision has become hazy. Retinoscopy shows a new myopic shift, and the lens nucleus looks yellow-brown on the slit lamp. What explains his improved near vision?
1. ARecovery of accommodation in the lens
2. BFlattening of the anterior corneal curvature
3. CIncreased axial length of the eyeball
4. DRaised refractive index of the nucleus
Show answerHide answer
Answer: D · Raised refractive index of the nucleus
Nuclear sclerosis increases the refractive index of the lens nucleus, making the eye more myopic (index myopia). A presbyope who becomes slightly myopic can read without glasses again, which is called 'second sight'. It is a sign that the cataract is progressing, and distance vision keeps falling as the nucleus browns. Frequent changes of spectacle power are often the first clue.
- A: Accommodation does not recover; the hardened lens accommodates even less.
- B: Corneal flattening would make the eye more hypermetropic, not myopic.
- C: Axial length does not grow in an adult eye with age-related cataract.
Question 6 · Medium
A district hospital in Odisha plans to expand its cataract service. Consider these statements comparing manual small-incision cataract surgery (MSICS) with phacoemulsification: 1. MSICS does not need an ultrasound machine and costs less per operation. 2. MSICS cannot place a posterior chamber IOL in the capsular bag. 3. Phacoemulsification uses a smaller incision and so usually induces less astigmatism. 4. MSICS copes well with very dense, brunescent nuclei. Which statements are correct?
1. A1 and 3 only
2. B2, 3 and 4 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 7 · Hard
A 67-year-old man had uneventful phacoemulsification four months ago. Since then he has had repeated mild redness and blurring that improve on topical steroids but return each time they are tapered. Now there are large mutton-fat keratic precipitates, a few vitreous cells and a white plaque on the posterior capsule inside the capsular bag. An intravitreal vancomycin injection a month ago helped only briefly. What is the next best step?
1. AOral fluconazole for presumed fungal infection
2. BVitrectomy with removal of the capsular bag
3. CNd:YAG laser capsulotomy to clear the plaque
4. DLong-term topical steroids at a higher dose
Answer and explanation in LearnFree account
Question 8 · Easy
A 34-year-old man from Thrissur comes to the eye OPD with slowly blurring vision. He has frontal baldness, bilateral ptosis, wasting of the temporal muscles, and he cannot let go quickly after a handshake. Slit-lamp examination shows fine, multicoloured glistening crystals scattered in the lens cortex. Which condition does this lens finding point to?
1. AMyotonic dystrophy
2. BHypoparathyroidism
3. CWilson disease
4. DDown syndrome
Answer and explanation in LearnFree account
Question 9 · Easy
A 14-year-old boy was hit on the right eye by a cricket ball. Some weeks later his vision is mildly blurred, and slit-lamp examination after dilatation shows a petal-shaped opacity in the posterior cortex of the lens, with a faint ring of pigment on the anterior lens capsule. What is this lens opacity called?
1. ASnowflake cataract
2. BRosette cataract
3. CSunflower cataract
4. DChristmas tree cataract
Answer and explanation in LearnFree account
Question 10 · Hard
A 71-year-old man had an anterior chamber IOL placed after a complicated cataract operation three years ago. Over months his vision has blurred, worse on waking, and he now has episodes of severe pain and watering. The cornea is thickened and hazy with epithelial bullae; IOP is 16 mmHg and the fundus glow is dull. The fellow eye, operated without complication, has a clear cornea. What is the definitive treatment?
1. AHypertonic saline drops for life
2. BTopical dorzolamide to clear oedema
3. CEndothelial keratoplasty with IOL exchange
4. DNd:YAG laser posterior capsulotomy
Answer and explanation in LearnFree account
Question 11 · Medium
A 30-year-old man has had several attacks of anterior uveitis in the right eye over eight years. His vision has dropped to 6/36. Slit-lamp examination shows posterior synechiae and an opacity just in front of the posterior capsule with a 'breadcrumb' look and a red, green and blue sheen. What is the most likely type of cataract?
1. AComplicated cataract
2. BMorgagnian cataract
3. CCuneiform cortical cataract
4. DBlue dot (cerulean) cataract
Answer and explanation in LearnFree account
Question 12 · Medium
An 82-year-old widower with bilateral mature cataracts, fully alert and oriented, declines surgery after its risks and benefits are explained, saying he is content as he is. His son, who lives with him, asks the surgeon to operate anyway and offers to sign the consent form. What should the surgeon do?
1. AOperate under sedation as it is low-risk
2. BOperate on the son's written consent
3. CSeek a court order to allow the surgery
4. DRespect the patient's refusal and record it
Answer and explanation in LearnFree account
Question 13 · Hard
A 64-year-old woman had phacoemulsification with an IOL calculated by the SRK formula (P = A - 2.5L - 0.9K) to give emmetropia. A month later the eye is quiet and the IOL well centred, but she reads well without glasses and needs a minus lens for distance. On rechecking, her axial length had been recorded 1 mm shorter than the true value, because the contact A-scan probe indented the cornea. What best explains her result?
1. AThe IOL was about 0.9 D too strong
2. BThe IOL was about 2.5 D too strong
3. CThe IOL was about 0.9 D too weak
4. DThe IOL was about 2.5 D too weak
Answer and explanation in LearnFree account
Question 14 · Medium
A 58-year-old schoolteacher had uneventful phacoemulsification with an acrylic IOL in her left eye two years ago and saw 6/6 afterwards. Her vision has slowly blurred again to 6/24. The IOL is well centred, and retroillumination shows clusters of glistening, pearl-like cells behind the optic. What is the treatment of choice?
1. AArgon laser to the iris periphery
2. BNd:YAG laser posterior capsulotomy
3. CExchange of the intraocular lens
4. DTopical steroid and NSAID drops
Answer and explanation in LearnFree account
Question 15 · Medium
The morning after routine phacoemulsification, a 63-year-old woman has blurred vision but little pain. There is diffuse corneal oedema from limbus to limbus, many anterior chamber cells with a small hypopyon, and B-scan shows a clear vitreous. Three other patients from the same theatre list have the same picture. What is the most likely diagnosis?
1. AToxic anterior segment syndrome
2. BAcute bacterial endophthalmitis
3. CPseudophakic bullous keratopathy
4. DRetained lens fragment uveitis
Answer and explanation in LearnFree account
Question 16 · Hard
During phacoemulsification of a hard nucleus in a 69-year-old man, the posterior capsule tears and vitreous presents. The surgeon removes the remaining lens matter and performs an anterior vitrectomy. The capsulorhexis is intact and round, and there is good support for a lens in the ciliary sulcus. Which lens implantation is most appropriate?
1. AIris-claw IOL fixed to the iris
2. BThree-piece IOL in the ciliary sulcus
3. CSingle-piece acrylic IOL in the sulcus
4. DLeave aphakic for a later secondary IOL
Answer and explanation in LearnFree account
Question 17 · Medium
A day after uneventful phacoemulsification, a 65-year-old woman has a dull ache in the operated eye. Vision is 6/12, the cornea shows mild epithelial oedema, the anterior chamber is deep and quiet with no cells or hypopyon, and IOP is 36 mmHg (fellow eye 15 mmHg). What is the most likely cause of the raised pressure?
1. ASteroid response to postoperative drops
2. BEarly bacterial endophthalmitis
3. CViscoelastic left in the anterior chamber
4. DPupillary block by the intraocular lens
Answer and explanation in LearnFree account
Question 18 · Medium
A 60-year-old farmer from Bundelkhand has a dense white cataract in the right eye, and the fundus cannot be seen. He perceives light, but his projection of rays is inaccurate in the temporal quadrants. Which investigation should be done before cataract surgery is planned?
1. AFundus fluorescein angiography
2. BGonioscopy of both eyes
3. CB-scan ultrasonography
4. DOptical coherence tomography
Answer and explanation in LearnFree account
Question 19 · Medium
Two days after manual small-incision cataract surgery, a 70-year-old man has watering and blurred vision in the operated eye. The anterior chamber is shallow, and IOP is 6 mmHg; there is no pain and no hypopyon. Which bedside test should be done to confirm the suspected cause?
1. ASchirmer test with filter paper
2. BFincham test with a stenopaeic slit
3. CSeidel test with fluorescein dye
4. DJones dye test of the tear duct
Answer and explanation in LearnFree account
Question 20 · Hard
A 75-year-old woman from a village near Gaya, whose right cataract was never operated, has had severe pain and redness in that eye for three days. Vision is perception of light with accurate projection. The cornea is oedematous, the anterior chamber is deep with heavy flare and white flocculent particles in the aqueous, and the lens is milky white with its brown nucleus sunk to the bottom of the capsular bag. IOP is 48 mmHg, and gonioscopy after topical glycerine shows open angles. The left eye has a deep anterior chamber and an early cataract. What is the definitive treatment?
1. ALower the IOP, then extract the lens
2. BTrabeculectomy alone, leaving the lens
3. CLaser peripheral iridotomy in both eyes
4. DLong-term pilocarpine and timolol drops
Answer and explanation in LearnFree account
Question 21 · Easy
A 61-year-old man had a complicated cataract operation on his right eye and was left without an IOL; his left eye is phakic with 6/9 vision. He is given a +10 D spectacle lens for the right eye but sees double and cannot wear it. What is the reason?
1. AResidual astigmatism from the incision
2. BPosterior capsule opacification
3. CSixth nerve palsy after the block
4. DAniseikonia from spectacle magnification
Answer and explanation in LearnFree account
Question 22 · Medium
A 46-year-old interventional cardiologist who has worked in a cath lab for 15 years complains of glare from oncoming headlights and difficulty reading in bright sunlight; his vision in a dim room is nearly normal. He is not diabetic and has never used steroids. Which type of cataract is most likely?
1. APosterior subcapsular cataract
2. BNuclear sclerotic cataract
3. CAnterior polar cataract
4. DCuneiform cortical cataract
Answer and explanation in LearnFree account
Question 23 · Medium
A 4-week-old boy is brought to a medical college eye department because his grandmother noticed a white reflex in his left pupil. Examination under anaesthesia shows a dense central cataract in the left eye; B-scan of the left eye and the right eye are normal. Consider these statements about his care: 1. Surgery should be done early, as the opacity can cause deprivation amblyopia. 2. If an IOL is placed, its power is chosen to leave the eye somewhat hypermetropic. 3. Patching of the right eye will be needed after surgery. 4. As in adults, the posterior capsule should be left intact. Which statements are correct?
1. A1 and 3 only
2. B1, 2, 3 and 4
3. C1, 2 and 3 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 24 · Easy
Before small-incision cataract surgery at a district hospital, a 64-year-old woman undergoes biometry so that the power of her posterior chamber IOL can be calculated by the SRK formula. Which two measurements, besides the lens constant, does this formula need?
1. APupil size and lens thickness
2. BIOP and central corneal thickness
3. CRefraction and visual acuity
4. DAxial length and keratometry
Answer and explanation in LearnFree account
Question 25 · Easy
A 17-year-old girl with type 1 diabetes and an HbA1c of 13.5% notices blurred vision over a few weeks. Both lenses show dense white subcapsular flakes that look like snowflakes. Accumulation of which substance in the lens fibres explains this cataract?
1. ASorbitol formed by aldose reductase
2. BGalactitol formed from galactose
3. CCalcium oxalate in the lens cortex
4. DGlycogen in the lens epithelium
Answer and explanation in LearnFree account

Cataract and its surgery

A 66-year-old man who had uneventful cataract surgery with IOL implantation three days ago at an eye camp returns with increasing pain, a red eye and vision dropping to hand movements. There is lid swelling, a 2 mm hypopyon and a poor red reflex. What is the next best step?

A 60-year-old farmer from Bundelkhand has a dense white cataract in the right eye, and the fundus cannot be seen. He perceives light, but his projection of rays is inaccurate in the temporal quadrants. Which investigation should be done before cataract surgery is planned?

Two days after manual small-incision cataract surgery, a 70-year-old man has watering and blurred vision in the operated eye. The anterior chamber is shallow, and IOP is 6 mmHg; there is no pain and no hypopyon. Which bedside test should be done to confirm the suspected cause?

A 61-year-old man had a complicated cataract operation on his right eye and was left without an IOL; his left eye is phakic with 6/9 vision. He is given a +10 D spectacle lens for the right eye but sees double and cannot wear it. What is the reason?

Before small-incision cataract surgery at a district hospital, a 64-year-old woman undergoes biometry so that the power of her posterior chamber IOL can be calculated by the SRK formula. Which two measurements, besides the lens constant, does this formula need?

A 17-year-old girl with type 1 diabetes and an HbA1c of 13.5% notices blurred vision over a few weeks. Both lenses show dense white subcapsular flakes that look like snowflakes. Accumulation of which substance in the lens fibres explains this cataract?