A 74-year-old man has sudden painless loss of vision in the left eye to finger counting. For three weeks he has had a temporal headache, pain in the jaw on chewing and scalp tenderness. The left fundus shows a pale, milky retina with a cherry-red spot at the fovea. What is the next best step?

Check ESR and CRP and start steroids now

Intravitreal anti-VEGF injection

Ocular massage and anterior chamber paracentesis

Panretinal laser photocoagulation

A 58-year-old man from Kochi has gradually blurred vision in the left eye over two months. There is a smooth, dome-shaped retinal detachment without folds; the subretinal fluid moves to the inferior retina when he lies down and sits up. No retinal break is found despite careful search, and a brown, elevated mass is seen beneath the retina temporally. What type of detachment is this?

Rhegmatogenous retinal detachment

Combined tractional-rhegmatogenous detachment

A 39-year-old man with type 1 diabetes has had dense vitreous haemorrhage in the left eye for three months. Vision is hand movements. B-scan shows thick fibrovascular membranes inserting into the posterior pole, with a tented detachment of the retina that involves the macula; no retinal break is seen and the detachment is concave and does not move with eye movement. What is the most appropriate management?

Pars plana vitrectomy with membrane removal

Panretinal photocoagulation alone

Scleral buckle without vitrectomy

A 60-year-old man has a central retinal vein occlusion in the right eye with vision of 6/36. OCT shows marked cystoid macular oedema. Fluorescein angiography shows good capillary perfusion and there is no neovascularisation. What is the most appropriate treatment?

Intravitreal anti-VEGF injections

Retina: diabetic retinopathy, CRAO, CRVO, ARMD, detachment

30 NEET-PG practice questions on Retina: diabetic retinopathy, CRAO, CRVO, ARMD, detachment, 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 · Hard
A 74-year-old man has sudden painless loss of vision in the left eye to finger counting. For three weeks he has had a temporal headache, pain in the jaw on chewing and scalp tenderness. The left fundus shows a pale, milky retina with a cherry-red spot at the fovea. What is the next best step?
1. AIntravitreal anti-VEGF injection
2. BOcular massage and anterior chamber paracentesis
3. CPanretinal laser photocoagulation
4. DCheck ESR and CRP and start steroids now
Show answerHide answer
Answer: D · Check ESR and CRP and start steroids now
The fundus shows central retinal artery occlusion: the ischaemic inner retina swells and turns opaque, while the thin foveola, which has no inner retina, still shows the red choroid. Headache, jaw claudication and scalp tenderness in an elderly man point to giant cell arteritis as the cause. High-dose corticosteroids must be started at once, after drawing blood for ESR and CRP and without waiting for temporal artery biopsy, because the other eye can be lost within days. Ocular massage and paracentesis aim to dislodge an embolus, which is not the mechanism here.
- A: Anti-VEGF injections treat macular oedema or wet ARMD, not arteritic occlusion.
- B: Massage and paracentesis are tried for embolic occlusion and do nothing to protect the other eye in arteritis.
- C: Panretinal laser treats neovascularisation in proliferative retinopathy, not an acute arterial occlusion.
Question 2 · Easy
The earliest ophthalmoscopically visible sign of diabetic retinopathy is:
1. ACotton-wool spots
2. BNeovascularisation of the disc
3. CMicroaneurysms
4. DHard exudates
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Answer: C · Microaneurysms
Microaneurysms, seen as tiny, sharply defined red dots, mostly temporal to the macula, are the earliest clinical sign of diabetic retinopathy. They form where capillary walls weaken after loss of pericytes. Hard exudates, haemorrhages and cotton-wool spots follow as leakage and ischaemia increase. Neovascularisation marks the proliferative stage.
- A: Cotton-wool spots are nerve fibre layer infarcts from more advanced ischaemia.
- B: Disc new vessels define proliferative retinopathy, the late stage.
- D: Hard exudates are lipid deposits from leaking vessels and appear after microaneurysms.
Question 3 · Medium
A 58-year-old man from Kochi has gradually blurred vision in the left eye over two months. There is a smooth, dome-shaped retinal detachment without folds; the subretinal fluid moves to the inferior retina when he lies down and sits up. No retinal break is found despite careful search, and a brown, elevated mass is seen beneath the retina temporally. What type of detachment is this?
1. AExudative retinal detachment
2. BTractional retinal detachment
3. CRhegmatogenous retinal detachment
4. DCombined tractional-rhegmatogenous detachment
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Answer: A · Exudative retinal detachment
A smooth detachment whose fluid shifts with posture and that has no break is exudative (serous); fluid leaks from the choroid through a damaged retinal pigment epithelium. Here the likely cause is a choroidal tumour such as melanoma; other causes include Vogt-Koyanagi-Harada disease, posterior scleritis, severe hypertension and pre-eclampsia. Treatment is directed at the cause, not at sealing a break. B-scan ultrasonography helps characterise the mass.
- B: Tractional detachment is concave and immobile, with membranes, not a mass.
- C: Rhegmatogenous detachment has a break, and its fluid does not shift freely.
- D: A combined detachment needs traction membranes and a break.
Question 4 · Hard
A 39-year-old man with type 1 diabetes has had dense vitreous haemorrhage in the left eye for three months. Vision is hand movements. B-scan shows thick fibrovascular membranes inserting into the posterior pole, with a tented detachment of the retina that involves the macula; no retinal break is seen and the detachment is concave and does not move with eye movement. What is the most appropriate management?
1. APars plana vitrectomy with membrane removal
2. BPanretinal photocoagulation alone
3. CPneumatic retinopexy with gas
4. DScleral buckle without vitrectomy
Show answerHide answer
Answer: A · Pars plana vitrectomy with membrane removal
Fibrovascular membranes pulling the retina into a concave, immobile detachment is tractional retinal detachment, a complication of proliferative diabetic retinopathy. Once it involves the macula, and with non-clearing haemorrhage, pars plana vitrectomy is needed to clear the blood, peel the membranes and relieve traction, with endolaser photocoagulation during surgery. Pre-operative anti-VEGF is often used to reduce bleeding. Laser alone cannot relieve traction and cannot be delivered through dense blood.
- B: Laser cannot pass through dense haemorrhage and does not release traction.
- C: Pneumatic retinopexy closes a single break in a rhegmatogenous detachment; there is no break here.
- D: A buckle supports a rhegmatogenous break and does not remove posterior traction membranes.
Question 5 · Medium
A 60-year-old man has a central retinal vein occlusion in the right eye with vision of 6/36. OCT shows marked cystoid macular oedema. Fluorescein angiography shows good capillary perfusion and there is no neovascularisation. What is the most appropriate treatment?
1. AObservation for a year
2. BMacular grid laser
3. CPanretinal photocoagulation
4. DIntravitreal anti-VEGF injections
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Answer: D · Intravitreal anti-VEGF injections
Macular oedema is the commonest cause of visual loss in central retinal vein occlusion. Intravitreal anti-VEGF injections reduce the oedema and improve vision; a dexamethasone implant is an alternative. Macular grid laser reduces oedema angiographically in CRVO but does not improve vision, unlike in branch occlusion. Panretinal laser is reserved for neovascularisation, which is absent in a well-perfused eye.
- A: Prolonged untreated oedema damages the photoreceptors permanently.
- B: Grid laser does not improve vision in CRVO macular oedema.
- C: Panretinal laser is for neovascularisation, which he does not have.
Question 6 · Medium
A 44-year-old man with type 1 diabetes for 20 years has 6/9 vision in both eyes. The right fundus shows new vessels on the optic disc covering about half the disc area, with a small preretinal haemorrhage. There is no macular oedema and no tractional detachment. What is the next best step?
1. AFocal laser to the macula
2. BPars plana vitrectomy
3. CPanretinal photocoagulation
4. DReview after three months
Answer and explanation in LearnFree account
Question 7 · Medium
A 50-year-old man with proliferative diabetic retinopathy wakes with sudden painless loss of vision in the right eye to hand movements. There is no red reflex and the fundus cannot be seen. The anterior segment and IOP are normal. What is the most important first investigation?
1. AOptical coherence tomography
2. BB-scan ultrasonography
3. CFundus fluorescein angiography
4. DElectroretinography
Answer and explanation in LearnFree account
Question 8 · Medium
A 62-year-old woman develops a non-ischaemic central retinal vein occlusion in her right eye. She has no diabetes and her blood pressure is controlled. Applanation tonometry shows 28 mmHg in both eyes with open angles and a cup-disc ratio of 0.7 in the left eye. Which condition is the most likely ocular risk factor for her occlusion?
1. AAge-related macular degeneration
2. BPrimary open-angle glaucoma
3. CPrimary angle-closure glaucoma
4. DPosterior vitreous detachment
Answer and explanation in LearnFree account
Question 9 · Medium
A 61-year-old man from Coimbatore with long-standing diabetes has a fasting glucose of 220 mg/dL. Microscopy of his retinal capillaries, if done, would show which change as the earliest structural lesion behind his retinopathy?
1. ALoss of capillary pericytes
2. BLymphocytic vasculitis of veins
3. COnion-skin thickening of arterioles
4. DFibrinoid necrosis of arterioles
Answer and explanation in LearnFree account
Question 10 · Hard
A 26-year-old woman with type 1 diabetes and moderate non-proliferative retinopathy is planning her first pregnancy; her HbA1c is 9.4%. Consider four statements: 1. Retinopathy may progress during pregnancy. 2. She should have a dilated eye examination in each trimester and in the year after delivery. 3. Rapid tightening of glucose control can transiently worsen retinopathy. 4. If proliferative retinopathy develops, the pregnancy must be terminated. Which statements are correct?
1. A1, 2 and 3 only
2. B1, 2, 3 and 4
3. C1 and 2 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 11 · Medium
A 69-year-old man has recent distortion of vision in the left eye and a small subretinal haemorrhage at the macula. Before starting treatment, the retina specialist wants to confirm and outline a choroidal neovascular membrane by showing early lacy hyperfluorescence that leaks in the late phase. Which investigation is used?
1. AElectroretinography
2. BVisual evoked potential
3. CFundus fluorescein angiography
4. DB-scan ultrasonography
Answer and explanation in LearnFree account
Question 12 · Easy
A 52-year-old man with type 2 diabetes reports that straight lines look slightly wavy in his right eye. Fundoscopy shows circinate rings of hard exudates near the fovea with retinal thickening. Which investigation best confirms and measures the macular oedema?
1. AElectroretinography
2. BB-scan ultrasonography
3. CVisual evoked potential
4. DOptical coherence tomography
Answer and explanation in LearnFree account
Question 13 · Medium
A 48-year-old man has had new flashes and floaters in his left eye for one day. Visual fields are full. Indirect ophthalmoscopy with scleral depression shows a horseshoe-shaped retinal tear in the superotemporal periphery with a little fluid around it, but no detachment. What is the next best step?
1. ALaser photocoagulation around the tear
2. BReassurance and review after six months
3. CPars plana vitrectomy with silicone oil
4. DScleral buckle with external drainage
Answer and explanation in LearnFree account
Question 14 · Easy
A 70-year-old woman from Kanpur with hypertension has blurred vision in her left eye for two days. Fundoscopy shows dilated, tortuous veins, flame-shaped and blot haemorrhages scattered in all four quadrants, cotton-wool spots and a swollen disc. What is the diagnosis?
1. ACentral retinal vein occlusion
2. BHypertensive retinopathy grade 1
3. CBranch retinal vein occlusion
4. DCentral retinal artery occlusion
Answer and explanation in LearnFree account
Question 15 · Medium
A 59-year-old man with hypertension has blurred vision in the right eye. Flame-shaped haemorrhages and cotton-wool spots fill a wedge of the superotemporal retina whose apex lies where a retinal artery crosses over a vein. What explains the site of the occlusion?
1. AVenous valves at the crossing trap thrombus
2. BThe vein is compressed by the optic nerve sheath
3. CThe artery ruptures into the vein at the crossing
4. DArtery and vein share a common sheath at the crossing
Answer and explanation in LearnFree account
Question 16 · Medium
A 55-year-old woman had cataract surgery a year ago. She has had a shadow in the lower field of her right eye for one day; she can still read 6/6 with that eye. Fundoscopy shows a superior bullous retinal detachment with a single break at 12 o'clock; the macula is still attached. What is the most appropriate management?
1. ALaser barrage and observation
2. BSurgical repair within 24 hours
3. CBed rest and oral steroids
4. DElective surgery after a month
Answer and explanation in LearnFree account
Question 17 · Medium
A 55-year-old schoolteacher with type 2 diabetes has blurred central vision in the left eye, 6/24. OCT shows centre-involving macular oedema with a central thickness of 480 µm. There are no new vessels. HbA1c is 8.1%. What is the most appropriate treatment for the eye?
1. AIntravitreal anti-VEGF injections
2. BOral acetazolamide
3. CPanretinal photocoagulation
4. DObservation until vision is 6/60
Answer and explanation in LearnFree account
Question 18 · Easy
A 66-year-old man with atrial fibrillation who stopped his anticoagulant notices sudden, painless, near-total loss of vision in his left eye while reading the newspaper. There is a marked relative afferent pupillary defect. The retina is pale and milky, the arterioles are thread-like, and the fovea stands out as a cherry-red spot. What is the diagnosis?
1. ARhegmatogenous retinal detachment
2. BCentral retinal vein occlusion
3. CCentral retinal artery occlusion
4. DDiabetic vitreous haemorrhage
Answer and explanation in LearnFree account
Question 19 · Hard
A 70-year-old man who smokes 15 bidis a day has a disciform scar from wet ARMD in the right eye and large confluent drusen in the left eye with 6/9 vision. He asks for a vitamin supplement to protect his left eye. Which formulation is most appropriate for him?
1. AVitamins C and E, zinc, copper and beta-carotene
2. BVitamins C and E, zinc, copper, lutein and zeaxanthin
3. CVitamin A in high dose with omega-3 fatty acids
4. DVitamin B12 with folic acid and pyridoxine
Answer and explanation in LearnFree account
Question 20 · Easy
A 72-year-old retired clerk from Mysuru has many soft drusen and pigment clumping at both maculae, with vision of 6/9 in each eye. He is advised to check each eye daily at home to detect early distortion that may signal a new complication. Which test is he taught?
1. ASnellen chart
2. BAmsler grid
3. CIshihara plates
4. DConfrontation fields
Answer and explanation in LearnFree account
Question 21 · Hard
A 68-year-old woman has a central retinal vein occlusion in the left eye. Consider four findings: 1. A dense relative afferent pupillary defect. 2. Visual acuity of 6/60 or worse at presentation. 3. Extensive capillary non-perfusion on fluorescein angiography. 4. Mildly dilated, tortuous veins with few scattered dot haemorrhages. Which findings indicate the ischaemic type?
1. A1 and 3 only
2. B1, 2 and 3 only
3. C2, 3 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 22 · Medium
A 76-year-old woman with wet ARMD in her right eye is started on intravitreal aflibercept. Her son, a pharmacist, asks how this drug differs from ranibizumab. What is the structure and action of aflibercept?
1. AHumanised antibody fragment against VEGF-A
2. BFull-length humanised IgG1 antibody to VEGF-A
3. CFusion protein of VEGF receptor domains and IgG Fc
4. DAptamer that binds only the VEGF-165 isoform
Answer and explanation in LearnFree account
Question 23 · Medium
A 64-year-old smoker with hypertension from Ludhiana had sudden painless loss of the upper half of the visual field of his right eye an hour ago. The inferior half of the retina is pale and swollen, and a bright, glistening yellow plaque sits at a bifurcation of the inferotemporal arteriole. ESR is 12 mm/h and he has no headache or jaw pain. Which investigation is most important to find the source?
1. AFundus fluorescein angiography
2. BCarotid duplex ultrasonography
3. CTemporal artery biopsy
4. DLumbar puncture
Answer and explanation in LearnFree account
Question 24 · Medium
A 47-year-old shopkeeper from Indore is found to have type 2 diabetes at an NP-NCD screening camp. His vision is 6/6 in both eyes and he has no eye complaints. When should his first dilated fundus examination be done?
1. AOnly when his vision drops
2. BAfter five years of diabetes
3. CWhen HbA1c stays above 9%
4. DAt the time of diagnosis
Answer and explanation in LearnFree account
Question 25 · Medium
A 30-year-old woman examined for a retinal detachment is noted to have four findings: 1. Pigment cells ('tobacco dust') in the anterior vitreous. 2. Subretinal fluid that shifts to the lowest part when she changes posture. 3. A convex, corrugated detached retina that undulates with eye movement. 4. IOP slightly lower than in the other eye. Which findings fit a rhegmatogenous detachment?
1. A1 and 3 only
2. B1, 2, 3 and 4
3. C2, 3 and 4 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account

5 more Retina: diabetic retinopathy, CRAO, CRVO, ARMD, detachment questions

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Retina: diabetic retinopathy, CRAO, CRVO, ARMD, detachment

A 74-year-old man has sudden painless loss of vision in the left eye to finger counting. For three weeks he has had a temporal headache, pain in the jaw on chewing and scalp tenderness. The left fundus shows a pale, milky retina with a cherry-red spot at the fovea. What is the next best step?

The earliest ophthalmoscopically visible sign of diabetic retinopathy is:

A 60-year-old man has a central retinal vein occlusion in the right eye with vision of 6/36. OCT shows marked cystoid macular oedema. Fluorescein angiography shows good capillary perfusion and there is no neovascularisation. What is the most appropriate treatment?

A 44-year-old man with type 1 diabetes for 20 years has 6/9 vision in both eyes. The right fundus shows new vessels on the optic disc covering about half the disc area, with a small preretinal haemorrhage. There is no macular oedema and no tractional detachment. What is the next best step?

A 50-year-old man with proliferative diabetic retinopathy wakes with sudden painless loss of vision in the right eye to hand movements. There is no red reflex and the fundus cannot be seen. The anterior segment and IOP are normal. What is the most important first investigation?

A 61-year-old man from Coimbatore with long-standing diabetes has a fasting glucose of 220 mg/dL. Microscopy of his retinal capillaries, if done, would show which change as the earliest structural lesion behind his retinopathy?

A 52-year-old man with type 2 diabetes reports that straight lines look slightly wavy in his right eye. Fundoscopy shows circinate rings of hard exudates near the fovea with retinal thickening. Which investigation best confirms and measures the macular oedema?

A 48-year-old man has had new flashes and floaters in his left eye for one day. Visual fields are full. Indirect ophthalmoscopy with scleral depression shows a horseshoe-shaped retinal tear in the superotemporal periphery with a little fluid around it, but no detachment. What is the next best step?

A 70-year-old woman from Kanpur with hypertension has blurred vision in her left eye for two days. Fundoscopy shows dilated, tortuous veins, flame-shaped and blot haemorrhages scattered in all four quadrants, cotton-wool spots and a swollen disc. What is the diagnosis?

A 59-year-old man with hypertension has blurred vision in the right eye. Flame-shaped haemorrhages and cotton-wool spots fill a wedge of the superotemporal retina whose apex lies where a retinal artery crosses over a vein. What explains the site of the occlusion?

A 55-year-old schoolteacher with type 2 diabetes has blurred central vision in the left eye, 6/24. OCT shows centre-involving macular oedema with a central thickness of 480 µm. There are no new vessels. HbA1c is 8.1%. What is the most appropriate treatment for the eye?

A 70-year-old man who smokes 15 bidis a day has a disciform scar from wet ARMD in the right eye and large confluent drusen in the left eye with 6/9 vision. He asks for a vitamin supplement to protect his left eye. Which formulation is most appropriate for him?

A 72-year-old retired clerk from Mysuru has many soft drusen and pigment clumping at both maculae, with vision of 6/9 in each eye. He is advised to check each eye daily at home to detect early distortion that may signal a new complication. Which test is he taught?

A 76-year-old woman with wet ARMD in her right eye is started on intravitreal aflibercept. Her son, a pharmacist, asks how this drug differs from ranibizumab. What is the structure and action of aflibercept?

A 47-year-old shopkeeper from Indore is found to have type 2 diabetes at an NP-NCD screening camp. His vision is 6/6 in both eyes and he has no eye complaints. When should his first dilated fundus examination be done?