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Exam Review

Key Facts: RCPSC Ophthalmology Exam

2 MCQ papers

Written component is Paper 1 and Paper 2, each featuring single-best-answer questions

RCPSC - Format of the Examination in Ophthalmology

3 hours per paper

Each written MCQ paper is 3 hours, for 6 hours of written testing

RCPSC - Format of the Examination in Ophthalmology

70%

Pass score required on the written component

RCPSC - Format of the Examination in Ophthalmology

C$5,130

2026 comprehensive objective exam fee covering written and applied components

RCPSC - Assessment and exam fees 2026

C$850

Assessment of training eligibility fee

RCPSC - Assessment and exam fees 2026

Decoupled

Passing the written but not the applied does not require retaking the written

RCPSC - Format of the Examination in Ophthalmology

100

Free original single-best-answer practice questions here

OpenExamPrep

The Royal College Certification Examination in Ophthalmology is Canada's certifying exam for ophthalmologists. The written component has single-best-answer MCQs, with a 70% passing score, followed by an OSCE-style applied component. 2026 fees are C$5,130 for both components (or C$2,565 each), plus a C$850 assessment fee.

Sample RCPSC Ophthalmology Practice Questions

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

1A 10-month-old infant presents with unilateral tearing, mattering, and crusting of the eyelashes since birth. There is no conjunctival injection or corneal clouding, and a palpable mass is absent in the lacrimal sac area. What is the most appropriate initial management?
A.Nasolacrimal duct probing under general anesthesia
B.Crigler massage of the lacrimal sac and observation
C.Dacryocystorhinostomy with silicone intubation
D.Broad-spectrum topical fluoroquinolone drops four times daily
Explanation: Congenital nasolacrimal duct obstruction (CNLDO) is common, affecting up to 20% of newborns, and resolves spontaneously in over 90% of cases by 1 year of age. Initial management consists of conservative measures, including Crigler lacrimal sac massage and warm compresses. Probing is generally deferred until after 12 months of age unless there is severe, recurrent dacryocystitis.
2A 6-year-old child presents with limited elevation of the left eye in adduction. The elevation of the left eye is completely normal in abduction. Forced duction testing of the left eye shows severe restriction of passive elevation in adduction. What is the most likely diagnosis?
A.Congenital superior oblique palsy
B.Duane retraction syndrome type 2
C.Brown syndrome
D.Inferior rectus entrapment from orbital floor fracture
Explanation: Brown syndrome (superior oblique tendon sheath syndrome) is characterized by limited elevation in adduction with normal or near-normal elevation in abduction, accompanied by a positive forced duction test in elevation and adduction. It is caused by mechanical restriction of the superior oblique tendon passing through the trochlea. In contrast, superior oblique palsy causes hypertropia and weakness of depression in adduction.
3According to Canadian screening guidelines, which infant meets the criteria for retinopathy of prematurity (ROP) screening?
A.An infant born at 33 weeks gestational age with a birth weight of 1400g and an uncomplicated course
B.An infant born at 32 weeks gestational age with a birth weight of 1600g
C.An infant born at 29 weeks gestational age with a birth weight of 1200g
D.An infant born at 34 weeks gestational age with a birth weight of 1800g
Explanation: Canadian guidelines for ROP screening recommend screening all infants with a birth weight of 1250g or less, or a gestational age of 30 weeks and 6 days or less (i.e., GA <= 30 6/7 weeks). Additionally, infants weighing between 1250g and 2000g with an unstable clinical course can be screened at the discretion of the neonatologist. The infant born at 29 weeks and 1200g meets both the gestational age and birth weight criteria.
4A patient with Duane retraction syndrome type 1 exhibits which clinical constellation?
A.Limited abduction, normal or slightly limited adduction, and globe retraction on adduction
B.Limited adduction, normal abduction, and globe retraction on abduction
C.Bilateral limitation of abduction, normal adduction, and no globe retraction
D.Limited abduction, limited adduction, and globe retraction on abduction only
Explanation: Duane retraction syndrome (DRS) type 1 is the most common type and is characterized by marked limitation or absence of abduction, normal or slightly limited adduction, and globe retraction with narrowing of the palpebral fissure on attempted adduction. It is caused by congenital aberrant innervation of the lateral rectus muscle by branches of the oculomotor nerve (CN III) in the absence of the abducens nerve (CN VI). Co-contraction of the medial and lateral recti during adduction pulls the globe backward.
5A newborn presents with bilateral congenital facial weakness and bilateral limitation of abduction. The infant also exhibits syndactyly and chest wall asymmetry (Poland anomaly). Which genetic or clinical condition is most strongly associated with this presentation?
A.Goldenhar syndrome
B.Cogan congenital ocular motor apraxia
C.Mobius syndrome
D.Alport syndrome
Explanation: Mobius syndrome is a rare congenital neurological disorder characterized by facial diplegia (CN VII palsy) and bilateral abducens (CN VI) palsy, leading to limited lateral gaze and a mask-like facies. It is frequently associated with limb deformities (e.g., syndactyly, clubfoot) and craniofacial anomalies or chest muscle defects (Poland anomaly). Pathogenesis involves brainstem hypoplasia or vascular disruption during embryogenesis.
6A mother is concerned that her 4-month-old infant's eyes appear crossed. On examination, you note prominent epicanthal folds and a wide nasal bridge. The corneal light reflexes are centered symmetrically in both pupils, and there is no movement on the cover-uncover test. What is the most appropriate next step?
A.Perform urgent strabismus surgery to prevent amblyopia
B.Prescribe part-time patching of the dominant eye
C.Reassure the mother and schedule a routine follow-up in 6 months
D.Order a brain MRI to rule out a posterior fossa tumor
Explanation: Pseudostrabismus is a common mimic of esotropia in infants due to facial features such as prominent epicanthal folds, a wide nasal bridge, or a narrow interpupillary distance. It is diagnosed by confirming symmetric corneal light reflexes (Hirschberg test) and the absence of any corrective shift on cover-uncover testing. Reassurance and routine follow-up are appropriate because the appearance will improve as the facial skeleton matures, and true strabismus can still develop later.
7A 3-year-old child presents with an esotropia of 25 prism diopters at distance and near. Cycloplegic refraction reveals +4.50 D OD and +4.75 D OS. With full cycloplegic correction, the esotropia is completely resolved, and the eyes are orthophoric. What is the diagnosis?
A.Partially accommodative esotropia
B.Non-accommodative esotropia
C.Refractive accommodative esotropia
D.Sensory esotropia
Explanation: Refractive accommodative esotropia is characterized by an esotropia that is fully corrected (to within 8 prism diopters of orthophoria) by wearing the full cycloplegic hyperopic correction. It is caused by the physiological link between accommodation and convergence: the hyperopic child must accommodate to clear the image, driving excessive accommodative convergence. If the fusional divergence amplitudes cannot overcome this convergence, esotropia results.
8During a clinical evaluation, a patient's deviation is measured at 15 prism diopters of esophoria at near (33 cm) with their distance correction. When a -2.00 D lens is placed over both eyes, the deviation at near increases to 27 prism diopters of esophoria. Using the gradient method, what is the patient's AC/A ratio?
A.4:1
B.6:1
C.8:1
D.12:1
Explanation: The gradient method calculates the AC/A ratio by measuring the change in ocular alignment caused by inducing a known change in accommodation with lenses, while keeping distance constant. The formula is: AC/A = (Deviation with lens - Baseline deviation) / Lens power. Here, AC/A = (27 - 15) / 2 = 12 / 2 = 6 prism diopters per diopter of accommodation (6:1).
9Which clinical feature is characteristic of infantile esotropia?
A.Onset after 18 months of age
B.Small, variable angle of deviation
C.Association with latent nystagmus and dissociated vertical deviation (DVD)
D.High incidence of spontaneous resolution without surgery
Explanation: Infantile esotropia typically presents within the first 6 months of life with a large, stable angle of deviation (>30 prism diopters). It is frequently associated with cross-fixation, latent nystagmus, dissociated vertical deviation (DVD), and inferior oblique overaction. Spontaneous resolution is rare, and early surgical alignment is usually required to promote development of stereopsis.
10A 5-year-old child presents with an intermittent exotropia of 30 prism diopters at distance. The deviation is controlled well at near (orthophoric). Refraction is plano in both eyes, and the visual acuity is 20/20 bilaterally. What is the most reasonable initial management strategy?
A.Immediate bilateral lateral rectus recession surgery
B.Over-minus lens therapy of -2.00 D to drive accommodation and convergence
C.Observation, monitoring for deterioration in control or increase in angle
D.Urgent MRI of the brain and orbits
Explanation: For a child with intermittent exotropia who has normal visual acuity and good control at near, initial observation and monitoring are highly appropriate. Over-minus lenses can be used to delay surgery in patients with deteriorating control, but are not the absolute first step for stable patients. Surgery is reserved for patients with poor or deteriorating control, or those who develop constant exotropia.

About the RCPSC Ophthalmology Exam

The Royal College Certification Examination in Ophthalmology is the national certifying examination for specialist ophthalmologists in Canada, administered by the Royal College of Physicians and Surgeons of Canada. The written component consists of single-best-answer MCQs across two papers (each 3 hours), testing clinical knowledge across all subspecialties. The applied component is a structured oral/practical (OSCE) examination. The exam is decoupled, meaning passing the written component allows candidates to sit the applied component, and candidates who pass the written but fail the applied do not need to retake the written component. The passing score is 70%.

Exam sponsor: Royal College of Physicians and Surgeons of Canada (RCPSC). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two-component exam. Written component is two single-best-answer MCQ papers (~100-110 questions each, 3 hours per paper). Applied component is a structured oral/practical (OSCE) examination. The written component must be passed before the applied component.

Time Limit

Written: 3 hours for Paper 1 and 3 hours for Paper 2 (6 hours total).

Passing Score

70% passing score on the written component. Decoupled format.

Exam / Certification Fees

2026 registration: C$5,130 for both components (comprehensive objective exam) or C$2,565 per component separately, plus an assessment fee of C$850.

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.

35%

Retina, Uveitis and Glaucoma

Covers medical and surgical disease of the retina and vitreous, intraocular inflammation and uveitis syndromes, and glaucoma diagnosis, medical therapeutics, and surgical/laser procedures.

45%

Pediatric, Cornea, Refractive and Neuro-ophthalmology

Covers pediatric ophthalmology, strabismus, corneal diseases, external eye diseases, refractive surgery, neuro-ophthalmic conditions, orbit, adnexa, and ophthalmic plastic surgery.

20%

Cataract, Pathology and Optics

Covers cataract surgery, lens pathology, anterior segment anomalies, ophthalmic pathology, and physical, geometric, and clinical optics.

Preparing for the RCPSC Ophthalmology Exam

What You Need to Know

  • Passing score: 70% passing score on the written component. Decoupled format.
  • Assessment: Two-component exam. Written component is two single-best-answer MCQ papers (~100-110 questions each, 3 hours per paper). Applied component is a structured oral/practical (OSCE) examination. The written component must be passed before the applied component.
  • Time limit: Written: 3 hours for Paper 1 and 3 hours for Paper 2 (6 hours total).
  • Exam / certification fees: 2026 registration: C$5,130 for both components (comprehensive objective exam) or C$2,565 per component separately, plus an assessment fee of C$850. 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

RCPSC Ophthalmology: Suggested Study Strategy

1Prioritize high-weight topics: Retina/Uveitis (~20%) and Glaucoma (~15%) make up over a third of the exam.
2Do not ignore Optics and Pathology (~10% each); these can be highly discriminating sections on the written papers.
3Practice single-best-answer technique: identify the 'MOST likely', 'INITIAL', or 'NEXT step in management' since options may all be reasonable but only one is the single best.
4Review Canadian national guidelines for ophthalmic screening, such as diabetic retinopathy screening and glaucoma monitoring.

Frequently Asked Questions

How many questions are on the Royal College Ophthalmology written exam?

The written component has two papers of multiple-choice questions, each containing about 100-110 single-best-answer MCQs.

What is the passing score for the Royal College Ophthalmology exam?

The pass score is 70% on the written component. It is decoupled from the applied component, so passing the written but failing the oral means you do not have to retake the written exam.

Is the exam written-only or does it have an oral component?

It has two components: a computer-based written MCQ component and a separate OSCE-style applied oral/practical component. You must pass the written exam to be invited to the applied exam.

How much does the Royal College Ophthalmology exam cost?

For 2026, the fee is C$5,130 for both components (comprehensive objective exam) or C$2,565 for each component separately. A separate assessment-of-eligibility fee of C$850 also applies.

What resources are best for studying?

Most candidates study the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) series, Canadian Ophthalmological Society (COS) guidelines, and standard ophthalmic pathology textbooks.