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Key Facts: Iran Ophthalmology Specialty Board Exam

150

Written MCQs

Sanjesh Pezeshki

210 min

Exam Duration

Sanjesh Pezeshki

70% (105/150)

Written Pass Mark

MOHME Council

No Penalty

Negative Marking

Sanjesh Pezeshki

AAO BCSC

Primary Reference

Board Syllabus

The Iranian Specialty Board in Ophthalmology is a high-stakes national certification exam administered by Sanjesh Pezeshki. Candidates must answer 152 MCQs in 240 minutes and achieve at least 70% (105 correct) without negative marking to advance to the oral/OSCE clinical board. This 100-question practice bank provides comprehensive, BCSC- and Kanski-referenced English-language clinical vignettes with exhaustive distractor rationales.

Sample Iran Ophthalmology Specialty Board Practice Questions

Try these sample questions to review concepts for the Iran Ophthalmology Specialty Board exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 22-year-old soft contact lens wearer presents with severe left ocular pain, photophobia, and purulent discharge. Slit-lamp examination reveals a 2.5 mm central corneal stromal infiltrate with an overlying epithelial defect, ground-glass stromal haze, and a 1 mm sterile hypopyon. Corneal scraping reveals Gram-negative rods. Which antimicrobial regimen represents the standard empirical monotherapy for this condition?
A.Topical fluoroquinolone monotherapy such as moxifloxacin 0.5% or ciprofloxacin 0.3%
B.Topical fortified cefazolin 5% monotherapy
C.Topical natamycin 5% suspension monotherapy
D.Topical acyclovir 3% ophthalmic ointment five times daily
Explanation: Pseudomonas aeruginosa is the most common cause of contact lens-related bacterial keratitis, characterized by rapid stromal melting, ground-glass haze, and purulent exudate. Fourth-generation fluoroquinolones (such as moxifloxacin or gatifloxacin) or fortified antibiotics (cefazolin plus tobramycin) provide excellent coverage against Pseudomonas and other Gram-negative pathogens. Fluoroquinolone monotherapy offers equivalent bactericidal efficacy and superior compliance compared to traditional compounded fortified combinations in moderate bacterial ulcers.
2A 28-year-old female presents with excruciating right eye pain out of proportion to clinical signs after swimming while wearing disposable contact lenses. Slit-lamp evaluation demonstrates perineural infiltrates (radial keratoneuritis) and patchy anterior stromal haze. Which diagnostic culture medium is required to confirm the suspected amoebic pathogen?
A.Blood agar incubated in 5% carbon dioxide at 37 degrees Celsius
B.Non-nutrient agar with an Escherichia coli overlay
C.Sabouraud dextrose agar without cycloheximide
D.Lowenstein-Jensen medium incubated for six weeks
Explanation: The clinical presentation of radial keratoneuritis and severe pain disproportionate to examination findings in a contact lens wearer exposed to freshwater is pathognomonic for Acanthamoeba keratitis. Culturing Acanthamoeba trophozoites and cysts requires non-nutrient agar seeded with a lawn of live or heat-killed Gram-negative bacteria such as Escherichia coli or Enterobacter aerogenes, upon which the amoebae feed and produce visible migratory tracks. Confocal microscopy or PCR may provide rapid supplementary confirmation.
3A 46-year-old agricultural worker presents with a dry, greyish-white corneal stromal infiltrate featuring feathery, indistinct margins, multiple satellite lesions, and an endothelial plaque following corneal trauma from a tree branch. Based on the Mycotic Keratitis International Trial (MUTT I), which topical therapy is the first-line treatment of choice for filamentous fungal keratitis?
A.Topical voriconazole 1% eye drops
B.Topical amphotericin B 0.15% eye drops
C.Topical natamycin 5% ophthalmic suspension
D.Topical caspofungin 0.5% eye drops
Explanation: The MUTT I landmark randomized controlled trial demonstrated that topical natamycin 5% was significantly superior to topical voriconazole 1% for filamentous fungal keratitis, particularly Fusarium cases, resulting in significantly better final visual acuity, lower rates of corneal perforation, and reduced need for therapeutic penetrating keratoplasty. Amphotericin B is primarily reserved for Candida keratitis, whereas voriconazole may be used adjunctively for deep intrastromal fungal infections.
4A 35-year-old patient with a prior history of recurrent dendritic epithelial keratitis presents with painless visual reduction. Examination reveals localized central stromal and epithelial edema in a circular pattern, with keratic precipitates strictly localized behind the edematous zone and an intact epithelium. According to the Herpetic Eye Disease Study (HEDS) guidelines, what is the most appropriate management strategy for this condition?
A.Topical trifluridine 1% alone eight times daily without corticosteroids
B.Immediate therapeutic penetrating keratoplasty
C.Topical nonsteroidal anti-inflammatory drops and therapeutic bandage contact lens
D.Topical corticosteroid drops combined with prophylactic antiviral coverage
Explanation: This patient presents with herpes simplex virus (HSV) disciform (endothelial) keratitis, an immune-mediated hypersensitivity reaction against viral antigen within the corneal endothelium characterized by localized disc-shaped stromal edema and overlying keratic precipitates. The HEDS I trial established that disciform keratitis responds effectively to topical corticosteroids (e.g., prednisolone acetate 1%) tapered slowly, accompanied by concomitant prophylactic topical or oral antivirals to prevent secondary epithelial reactivation.
5A 64-year-old woman complains of bilateral blurry vision that is markedly worse upon awakening in the morning and improves during the day. Slit-lamp examination reveals beaten-metal endothelial changes (corneal guttae) and central epithelial microcysts. When comparing Descemet Membrane Endothelial Keratoplasty (DMEK) to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for this condition, which clinical advantage is consistently demonstrated by DMEK?
A.Significantly lower risk of intraoperative graft detachment requiring rebubbling
B.Superior final visual acuity and a substantially lower rate of allograft rejection
C.Technical ease with zero learning curve for the corneal surgeon
D.Higher induction of hyperopic refractive shift following donor tissue insertion
Explanation: In Fuchs endothelial corneal dystrophy (FECD), DMEK involves the selective transplantation of isolated donor Descemet membrane and endothelium without adherent stroma. Compared to DSAEK, DMEK achieves superior visual outcomes (frequently 20/20 or better), faster visual rehabilitation, negligible refractive shift, and significantly lower rates of endothelial allograft rejection (<1-2% versus 8-10% for DSAEK). However, DMEK has a steeper surgical learning curve and higher initial rebubbling rates.
6A 19-year-old male with a history of vigorous eye rubbing and atopic eczema presents with progressive myopic astigmatism. Slit-lamp examination reveals fine vertical stress lines in the deep posterior stroma that disappear with gentle digital pressure on the globe. What are these characteristic clinical findings termed?
A.Vogt striae
B.Fleischer rings
C.Hudson-Stahli lines
D.Kayser-Fleischer rings
Explanation: Vogt striae are fine, vertical, parallel lines located in the deep posterior stroma and Descemet membrane, characteristic of keratoconus. They represent biomechanical stress lines caused by corneal thinning and steepening and uniquely disappear transiently when gentle external pressure is applied to the limbus. Fleischer rings are iron deposits in the basal epithelium around the cone base, while Hudson-Stahli lines are physiological iron lines seen in the aging cornea.
7An 18-year-old patient with documented progressive keratoconus undergoes epithelium-off corneal collagen cross-linking (CXL) according to the standard Dresden protocol. Which parameters define the ultraviolet-A (UVA) light irradiance and exposure duration in this protocol?
A.10 mW/cm² irradiance for 9 minutes (total dose 5.4 J/cm²)
B.30 mW/cm² irradiance for 3 minutes (total dose 5.4 J/cm²)
C.9 mW/cm² irradiance for 10 minutes (total dose 5.4 J/cm²)
D.3 mW/cm² irradiance for 30 minutes (total dose 5.4 J/cm²)
Explanation: The landmark Dresden protocol for corneal collagen cross-linking involves removing the central 8-9 mm of corneal epithelium, saturating the stroma with 0.1% riboflavin in 20% dextran every 2 minutes for 30 minutes, confirming yellow riboflavin flare in the anterior chamber, and irradiating with 370 nm UVA light at 3 mW/cm² for 30 minutes (delivering a cumulative fluence of 5.4 J/cm²). The stromal thickness must be at least 400 microns prior to irradiation to protect the corneal endothelium.
8Corneal dystrophies are classically differentiated by histopathological staining and genetic mutations. Which of the following correctly pairs the stromal corneal dystrophy with its inheritance pattern and distinctive histochemical stain?
A.Macular dystrophy; Autosomal dominant; Masson trichrome (hyaline deposits)
B.Lattice dystrophy type 1; Autosomal recessive; Alcian blue (glycosaminoglycans)
C.Granular dystrophy type 1; Autosomal dominant; Masson trichrome (bright red hyaline deposits)
D.Fuchs endothelial dystrophy; X-linked recessive; Oil Red O (cholesterol crystals)
Explanation: Granular corneal dystrophy type 1 is an autosomal dominant dystrophy caused by mutations in the TGFBI gene (chromosome 5q31) that produces discrete crumb-like stromal deposits composed of hyaline, which stain bright red with Masson trichrome. The classic mnemonic 'Marilyn Monroe Always Gets Her Man in L.A. County' summarizes: Macular = Mucopolysaccharide (Alcian blue), Granular = Hyaline (Masson trichrome), Lattice = Amyloid (Congo red). Macular dystrophy is autosomal recessive, while Granular and Lattice are autosomal dominant.
9A 52-year-old male presents with severe pain and peripheral corneal thinning progressing circumferentially in an undermining leading edge with an overhanging lip. Scleral involvement is absent, and extensive laboratory evaluation fails to demonstrate any systemic autoimmune or vasculitic disorder. What is the most likely diagnosis?
A.Mooren ulcer
B.Peripheral ulcerative keratitis secondary to granulomatosis with polyangiitis
C.Terrien marginal degeneration
D.Pellucid marginal degeneration
Explanation: Mooren ulcer is an idiopathic, painful, progressive peripheral ulcerative keratitis characterized by deep circumferential excavation with a distinct steep or overhanging leading edge and an undermined central border. Crucially, Mooren ulcer never involves the adjacent sclera and is not associated with an underlying systemic autoimmune disease, distinguishing it from peripheral ulcerative keratitis (PUK) secondary to rheumatoid arthritis or systemic vasculitis.
10According to the Tear Film & Ocular Surface Society Dry Eye WorkShop II (TFOS DEWS II) criteria, which combination of diagnostic parameters confirms the presence of ocular surface disease consistent with dry eye syndrome?
A.Tear film breakup time of 15 seconds and osmolarity of 290 mOsm/L in both eyes
B.Schirmer I test score of 25 mm at 5 minutes with negative corneal fluorescein staining
C.Symptom score (OSDI ≥13) plus tear film breakup time <10 seconds or tear hyperosmolarity (>308 mOsm/L)
D.Normal tear meniscus height of 0.5 mm with absent ocular surface punctate staining
Explanation: TFOS DEWS II diagnostic criteria require a positive symptom score on a validated questionnaire (Ocular Surface Disease Index [OSDI] ≥13 or DEQ-5 ≥6) accompanied by at least one positive objective marker of homeostatic disruption: non-invasive tear breakup time <10 seconds, tear osmolarity >308 mOsm/L in either eye (or an interocular difference >8 mOsm/L), or significant ocular surface staining (>5 corneal spots or >9 conjunctival spots).

About the Iran Ophthalmology Specialty Board Exam

The Iranian Medical Specialty Board Examination in Ophthalmology (آزمون دانشنامه تخصصی چشم‌پزشکی) is the definitive terminal credential required for subspecialty fellowship qualification, clinical consultant privileges, and academic university appointments across the Islamic Republic of Iran. Conducted annually in late summer by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki) under the Secretariat of the Council for Medical and Specialized Education, this examination tests comprehensive mastery across Cornea & Refractive Surgery, Glaucoma, Vitreoretinal Diseases & Uveitis, Cataract & Anterior Segment Reconstruction, Neuro-Ophthalmology & Oculoplastics, and Pediatric Ophthalmology & Strabismus. The official curriculum is anchored to the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) series and Kanski's Clinical Ophthalmology. Candidates who achieve 70% (105/150) on the written examination qualify to sit for the multi-station clinical OSCE, surgical decision-making, and oral board evaluation. Please note that this resource is an independent English-language MCQ study adaptation authored by OpenExamPrep to assist clinicians and ophthalmology residents in mastering the core syllabus.

Exam sponsor: National Center for Health Assessment (Sanjesh Pezeshki) & Council for Medical and Specialized Education, Ministry of Health and Medical Education (MOHME). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The national certification process comprises two sequential stages: Stage 1 Written Examination (152 single-best-answer MCQs, 240 minutes, testing comprehensive medical and surgical ophthalmology based on the AAO Basic and Clinical Science Course [BCSC] and Kanski's Clinical Ophthalmology) and Stage 2 Clinical/Practical Examination (Objective Structured Clinical Examination [OSCE], Patient Management Problems [PMPs], surgical video evaluations, ophthalmic imaging and slide interpretation, and structured oral vivas).

Time Limit

240 minutes

Passing Score

70% of the written total (105 of 150 points)

Exam / Certification Fees

Official annual registration fee published on the Sanjesh Pezeshki portal (sanjeshp.ir) during the registration window.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

20%

Cornea, External Disease, Refractive Surgery & Anterior Segment

Diagnosis and management of bacterial, fungal, viral (HSV, VZV, CMV), and Acanthamoeba keratitis; corneal dystrophies (TGFBI dystrophies, Fuchs endothelial dystrophy); keratoconus grading and corneal collagen cross-linking; modern keratoplasty (PKP, deep anterior lamellar keratoplasty [DALK], Descemet stripping automated endothelial keratoplasty [DSAEK], Descemet membrane endothelial keratoplasty [DMEK]); ocular surface reconstruction (amniotic membrane, limbal stem cell transplantation); and refractive surgery principles (surface ablation, LASIK, small incision lenticule extraction [SMILE], phakic IOLs).

18%

Glaucoma & Intraocular Pressure Regulation

Physiology of aqueous humor production and trabecular/uveoscleral outflow; diagnostic modalities (Goldmann applanation, gonioscopy, optical coherence tomography of the retinal nerve fiber layer and ganglion cell complex, standard automated perimetry); primary open-angle glaucoma; primary angle-closure spectrum (PACS, PAC, PACG) and laser peripheral iridotomy; secondary open-angle glaucomas (pseudoexfoliation, pigmentary, steroid-induced); secondary angle-closure glaucomas (neovascular, phacomorphic, malignant glaucoma); medical pharmacotherapy; laser trabeculoplasty (ALT, SLT); and surgical interventions (trabeculectomy with mitomycin C, glaucoma drainage devices/valves, minimally invasive glaucoma surgery [MIGS], cyclodestruction).

22%

Retina, Vitreous & Uveitis

Classification, staging, and evidence-based management of diabetic retinopathy (ETDRS, Protocol T/S/V) and diabetic macular edema; neovascular and non-neovascular age-related macular degeneration (anti-VEGF regimens, geographic atrophy); retinal vascular occlusions (CRVO, BRVO, CRAO); rhegmatogenous, tractional, and exudative retinal detachments; pneumatic retinopexy, scleral buckling, and pars plana vitrectomy; uveitis syndromes (anterior, intermediate, posterior, panuveitis) including HLA-B27, Behcet disease, sarcoidosis, toxoplasmosis, acute retinal necrosis, CMV retinitis, and Vogt-Koyanagi-Harada (VKH) disease; and acute postoperative and endogenous endophthalmitis protocols.

15%

Cataract, Lens & Intraocular Lenses

Cataract pathology and morphology (nuclear sclerotic, cortical, posterior subcapsular); optical biometry formulas (third-generation, fourth-generation, post-refractive surgery formulas like Haigis-L, Barrett True-K); phacoemulsification dynamics (fluidics, vacuum, ultrasound power, torsional phaco); surgical techniques in complex cases (small pupil, pseudoexfoliation, zonular laxity, mature white cataract); management of intraoperative capsular tears, anterior vitrectomy, and sulcus vs. scleral-fixated secondary IOL implantation; and postoperative endophthalmitis prophylaxis.

15%

Neuro-Ophthalmology, Orbit & Oculoplastics

Differential diagnosis of optic disc edema (papilledema, idiopathic intracranial hypertension, non-arteritic vs. arteritic anterior ischemic optic neuropathy, optic neuritis / MS / MOGAD / NMOSD); pupillary abnormalities (Horner syndrome, Adie tonic pupil, relative afferent pupillary defect, Argyll Robertson pupil); cranial nerve palsies (III, IV, VI, VII); myasthenia gravis; thyroid eye disease (EUGOGO guidelines, CAS scoring, orbital decompression); orbital tumors and inflammatory disease (idiopathic orbital inflammation, IgG4-related disease, lymphoproliferative disorders); eyelid malpositions (involutional, neurogenic, and congenital ptosis, ectropion, entropion); and lacrimal disorders (dacryocystitis, external vs. endonasal DCR).

10%

Pediatric Ophthalmology & Strabismus

Visual development, critical period, amblyopia therapy (patching, optical penalization); sensory adaptations (anomalous retinal correspondence, suppression); horizontal strabismus (infantile esotropia, accommodative esotropia, sensory esotropia, intermittent and constant exotropia); pattern strabismus (A and V patterns) and oblique muscle overactions; cyclovertical strabismus (superior oblique palsy, Parks-Bielschowsky 3-step test); special strabismus syndromes (Duane retraction syndrome, Brown syndrome); congenital cataract surgical timing; infantile glaucoma (goniotomy, trabeculotomy); and retinopathy of prematurity (ICROP-3 staging, laser and anti-VEGF indications).

Preparing for the Iran Ophthalmology Specialty Board Exam

What You Need to Know

  • Passing score: 70% of the written total (105 of 150 points)
  • Assessment: The national certification process comprises two sequential stages: Stage 1 Written Examination (152 single-best-answer MCQs, 240 minutes, testing comprehensive medical and surgical ophthalmology based on the AAO Basic and Clinical Science Course [BCSC] and Kanski's Clinical Ophthalmology) and Stage 2 Clinical/Practical Examination (Objective Structured Clinical Examination [OSCE], Patient Management Problems [PMPs], surgical video evaluations, ophthalmic imaging and slide interpretation, and structured oral vivas).
  • Time limit: 240 minutes
  • Exam / certification fees: Official annual registration fee published on the Sanjesh Pezeshki portal (sanjeshp.ir) during the registration window. Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Iran Ophthalmology Specialty Board: Suggested Study Strategy

1Master ophthalmic clinical trials and guidelines: memorize key landmark trial findings including ETDRS, DRCR.net (Protocols S, T, V), CATT, HEDS I & II, OHTS, EMGT, and CIGTS.
2Review anterior segment and corneal surgery protocols: focus on indications and differential diagnoses for DALK versus PK, DMEK versus DSAEK, cross-linking criteria (Dresden protocol), and post-refractive ectasia risk scoring.
3Systematize strabismus diagnostics: practice the Parks-Bielschowsky 3-step test for vertical diplopia, understand surgical dose-response curves for horizontal strabismus, and master management algorithms for Duane syndrome and Brown syndrome.
4Integrate retinal imaging with therapeutic regimens: be prepared to differentiate multimodal imaging findings (FAF, OCT, OCTA, FFA, ICGA) for pachychoroid disease, macular dystrophies, retinal vasculitis (e.g. Behcet disease), and white dot syndromes.
5Prioritize neuro-ophthalmology pupil and disc pathways: commit to memory the pharmacology of anisocoria (cocaine, apraclonidine, pilocarpine 0.1% vs. 1%), the workup for isolated third nerve palsy with pupil involvement, and diagnostic criteria for MOGAD versus NMOSD.

Frequently Asked Questions

What is the format, structure, and time limit of the Iranian Ophthalmology Written Board Exam?

The written examination consists of 152 single-best-answer multiple-choice questions (four choices per item) administered over a single 240-minute (4 hours) session. There is no negative marking for incorrect answers.

What is the passing score required to advance to the clinical and oral examination?

Candidates must achieve at least 70% in the written stage, equivalent to scoring 105 points out of a written total of 150. Meeting this minimum cutoff is mandatory to qualify for the practical OSCE, PMP, and oral examination boards.

What are the primary reference textbooks for the Iranian Ophthalmology Board Exam?

The official national curriculum set by the Ministry of Health and Medical Education (MOHME) is primarily anchored to the complete American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) series, alongside Kanski's Clinical Ophthalmology and designated subspecialty guidelines.

What does the Stage 2 Practical / OSCE examination include?

The practical phase evaluates clinical and surgical decision-making across objective stations, including Objective Structured Clinical Examinations (OSCE), Patient Management Problems (PMPs), microscopic and slit-lamp photography, fundus fluorescein angiography (FFA) and OCT interpretation, surgical instrument and complication recognition, and structured oral viva voce stations with academic board examiners.

Who is eligible to take the Iranian Specialty Board Examination in Ophthalmology?

Ophthalmology residents who have completed their certified four-year residency program at an accredited Iranian university of medical sciences and successfully passed their annual in-service and pre-board (Ertegha/Gonavi) examinations are eligible to sit for the National Board Examination administered by Sanjesh Pezeshki.

Is this OpenExamPrep question bank an official examination from Sanjesh Pezeshki?

No. This question bank is an independent English-language educational study adaptation developed by OpenExamPrep. It is specifically designed to assist residents, fellows, and international candidates in reviewing high-yield clinical ophthalmology concepts based on the official BCSC and Kanski board syllabus.