NEET PG Ophthalmology Syllabus

What is the definitive treatment for visually significant cataract?

Surgical removal — most commonly phacoemulsification with intraocular lens (IOL) implantation.

Name the classic morphologies of congenital cataract and one important metabolic cause.

Morphologies include lamellar (zonular), polar, sutural, and nuclear. Important causes: congenital rubella (and TORCH), galactosemia, and Lowe syndrome; galactosemia classically causes an 'oil-droplet' cataract.

What are phakomatoses, and name three classic examples with their hallmark ocular finding.

Neurocutaneous syndromes with hamartomas. Examples: Neurofibromatosis-1 (Lisch nodules/iris hamartomas), Tuberous sclerosis (retinal astrocytic hamartoma), and Sturge-Weber (choroidal hemangioma + congenital glaucoma).

What is the pathophysiology of primary open-angle glaucoma (POAG)?

A chronic, usually bilateral optic neuropathy with an OPEN angle and increased resistance to aqueous outflow at the trabecular meshwork, causing progressive RNFL/optic nerve damage and characteristic visual field loss, often with raised IOP.

What is the classic visual field defect and optic disc change in glaucoma?

Arcuate (Bjerrum) scotomata and nasal step early; increased cup-to-disc ratio (cupping) with neuroretinal rim thinning. Central vision is preserved until late.

What is the typical presentation of acute angle-closure glaucoma?

Sudden severe eye pain, headache, nausea/vomiting, halos around lights, markedly raised IOP, a fixed mid-dilated pupil, corneal edema, and a red eye with a shallow anterior chamber.

What is the definitive/preventive treatment for angle-closure due to pupillary block?

Laser peripheral iridotomy (creates an alternate aqueous pathway); acute attack is first managed medically (e.g., pilocarpine, acetazolamide, topical hypotensives, hyperosmotics).

Name two important types of secondary glaucoma and their mechanism.

Neovascular glaucoma (new vessels obstruct the angle, e.g., after diabetic/CRVO ischemia) and pseudoexfoliation/pigmentary glaucoma (material/pigment clogs the trabecular meshwork). Others: steroid-induced and lens-induced (phacomorphic/phacolytic).

List the classification stages of diabetic retinopathy.

Non-proliferative diabetic retinopathy (NPDR: mild, moderate, severe — microaneurysms, dot/blot hemorrhages, hard exudates, cotton-wool spots, venous beading) and Proliferative diabetic retinopathy (PDR: neovascularization, vitreous hemorrhage, traction detachment). Diabetic macular edema can occur at any stage.

What is the '4-2-1 rule' used to define severe NPDR?

Severe NPDR = any of: diffuse intraretinal hemorrhages/microaneurysms in 4 quadrants, OR venous beading in 2 quadrants, OR intraretinal microvascular abnormalities (IRMA) in 1 quadrant.

Compare the two main types of age-related macular degeneration (AMD).

Dry (non-exudative, ~90%): drusen and geographic atrophy, slow central vision loss. Wet (exudative/neovascular): choroidal neovascularization causing leakage/hemorrhage and rapid central distortion; treated with anti-VEGF injections.

What is the hallmark early clinical finding of dry AMD?

Drusen — yellowish sub-retinal pigment epithelium deposits at the macula. Metamorphopsia (distortion) is detected on Amsler grid testing.

What is rhegmatogenous retinal detachment and its classic symptoms?

Detachment due to a retinal break/tear allowing fluid under the retina. Symptoms: sudden flashes (photopsia), a shower of floaters, and a progressing 'curtain' or shadow over the visual field.

Name the three types of retinal detachment.

Rhegmatogenous (retinal break), Tractional (fibrovascular traction, e.g., PDR), and Exudative/serous (subretinal fluid without a break, e.g., tumor or inflammation).

What are the cardinal features of optic neuritis?

Subacute monocular vision loss, pain on eye movement, dyschromatopsia (impaired color/red desaturation), a relative afferent pupillary defect, and a normal or swollen disc; strongly associated with multiple sclerosis.

How do you distinguish papilledema from other causes of optic disc swelling?

Papilledema is bilateral optic disc swelling due to raised intracranial pressure; vision is usually preserved early (vs optic neuritis/AION), with enlarged blind spot and often headache/transient visual obscurations.

What ocular sign characterizes a complete third (oculomotor) nerve palsy, and which etiology spares the pupil?

'Down and out' eye with ptosis and a dilated (mydriatic) pupil. A pupil-sparing CN III palsy suggests an ischemic/microvascular cause (e.g., diabetes); pupil involvement suggests a compressive lesion (e.g., posterior communicating artery aneurysm).

What is the deficit in a fourth (trochlear) nerve palsy and the compensatory head posture?

Weak superior oblique → vertical diplopia worse on downgaze/reading and on tilting head toward the affected side; patient compensates with a head tilt away from the affected side (Bielschowsky head tilt test positive).

What is the deficit in a sixth (abducens) nerve palsy?

Weak lateral rectus → failure of abduction with horizontal diplopia worse on looking toward the affected side and esotropia in primary gaze; a non-localizing sign of raised ICP.

Describe Horner's syndrome and its classic triad.

Disruption of the oculosympathetic pathway: ptosis (mild, Muller's muscle), miosis, and anhidrosis, often with apparent enophthalmos. Anisocoria is greater in the dark.

What is internuclear ophthalmoplegia (INO), and what lesion causes it?

Impaired adduction of the ipsilateral eye with abducting nystagmus of the contralateral eye on horizontal gaze, due to a lesion of the medial longitudinal fasciculus (MLF); bilateral INO is classic for multiple sclerosis.

What is Argyll Robertson pupil and its classic association?

Small, irregular pupils that accommodate (constrict to near) but do not react to light ('light-near dissociation'); classically associated with neurosyphilis.

Define amblyopia and name its three main causes.

Amblyopia ('lazy eye') is reduced best-corrected vision from abnormal visual development with no structural cause, treatable in the critical period. Causes: strabismic, refractive (anisometropic/ametropic), and deprivation (e.g., congenital cataract/ptosis).

What test detects manifest strabismus and which detects latent deviation (phoria)?

The cover test detects manifest strabismus (tropia); the cover-uncover/alternate cover test reveals latent deviation (phoria). Corneal light reflex (Hirschberg test) estimates the angle.

Differentiate esotropia from exotropia.

Esotropia = inward (convergent) deviation of the eye; exotropia = outward (divergent) deviation. (Hypertropia = upward, hypotropia = downward.)

What is the most common cause of leukocoria in a child that must be urgently excluded?

Retinoblastoma — the most common intraocular malignancy of childhood, presenting with leukocoria (white pupillary reflex) and/or strabismus; associated with RB1 gene mutation.

Differentiate viral, bacterial, and allergic conjunctivitis by discharge and key signs.

Viral: watery discharge, follicles, preauricular lymphadenopathy (often adenovirus). Bacterial: purulent/mucopurulent discharge, papillae. Allergic: bilateral itching, watery/stringy mucoid discharge, papillae, history of atopy.

What is dry eye syndrome and the two main mechanistic types?

A multifactorial disease of the tear film causing ocular discomfort and surface damage. Types: aqueous-deficient (e.g., Sjogren syndrome) and evaporative (most common, usually meibomian gland dysfunction). Schirmer test and tear break-up time aid diagnosis.

What is blepharitis, and how does anterior differ from posterior blepharitis?

Inflammation of the eyelid margins. Anterior blepharitis affects the lash base (staphylococcal or seborrheic); posterior blepharitis is meibomian gland dysfunction. Management centers on lid hygiene and warm compresses.

Name the most common primary intraocular malignancy in adults and where it arises.

Uveal (choroidal) melanoma — the most common primary intraocular tumor in adults, arising from uveal melanocytes; metastasizes characteristically to the liver.

What is the clinical triad of thyroid eye disease (Graves' orbitopathy) and its hallmark imaging finding?

Proptosis (exophthalmos), eyelid retraction/lid lag, and restrictive extraocular myopathy with diplopia; the most serious complication is compressive optic neuropathy. CT/MRI shows enlarged extraocular muscle bellies with tendon sparing (classically inferior and medial recti — 'I'M SLow').