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100+ Free Ophthalmology Board Practice Questions
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Sample Ophthalmology Board Practice Questions
Try these sample questions to test your Ophthalmology Board exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 24-year-old male presents with progressive visual blur in his left eye. Topography shows an asymmetric hourglass pattern with steepening of 49.5 D inferiorly. You plan to perform corneal collagen cross-linking (CXL). Which of the following matches the FDA-approved Dresden protocol for CXL?
A.Riboflavin 0.1% instillation every 2 minutes for 30 minutes, followed by UVA irradiation at 3 mW/cm² for 30 minutes
B.Riboflavin 0.1% instillation every 5 minutes for 15 minutes, followed by UVA irradiation at 9 mW/cm² for 10 minutes
C.Riboflavin 0.25% instillation every 2 minutes for 10 minutes, followed by UVA irradiation at 30 mW/cm² for 3 minutes
D.Riboflavin 0.5% instillation every 1 minute for 5 minutes, followed by UVA irradiation at 1.5 mW/cm² for 60 minutes
Explanation: The standard Dresden protocol for corneal collagen cross-linking (CXL) involves removing the central 9 mm of epithelium, followed by instillation of riboflavin 0.1% solution every 2 minutes for 30 minutes. Once riboflavin flare is confirmed in the anterior chamber, UVA light irradiation is performed at 3 mW/cm² (total dose of 5.4 J/cm²) for 30 minutes, during which riboflavin is instilled every 2 minutes.
2Based on the Herpetic Eye Disease Study (HEDS) II, what is the primary benefit of oral acyclovir (400 mg twice daily) in patients with a history of ocular Herpes Simplex Virus (HSV) infection?
A.Reducing the rate of recurrences of any form of ocular HSV by approximately 45%
B.Preventing progression from epithelial keratitis to stromal keratitis
C.Improving final visual acuity outcomes in patients with active disciform keratitis
D.Decreasing the recurrence rate of stromal disease specifically by 90%
Explanation: HEDS II evaluated the efficacy of long-term suppressive oral acyclovir (400 mg twice daily) in patients with ocular HSV in the preceding 12 months. It demonstrated that oral acyclovir reduced the recurrence rate of any form of ocular HSV by approximately 45% over a 12-month period, with the greatest benefit seen in patients with a history of stromal keratitis.
3A 45-year-old agricultural worker presents with a corneal ulcer showing feathery borders and satellite lesions. Mycological culture confirms Fusarium species. According to the Mycotic Keratitis International Trial (MUTT I), which treatment regimen is associated with superior clinical outcomes?
A.Topical natamycin 5% suspension
B.Topical voriconazole 1% solution
C.Oral voriconazole 200 mg twice daily combined with topical natamycin 5%
D.Topical amphotericin B 0.15% solution
Explanation: The MUTT I trial compared topical natamycin 5% suspension with topical voriconazole 1% solution for filamentous fungal keratitis. Natamycin was associated with significantly better visual acuity outcomes, lower rates of corneal perforation, and fewer therapeutic penetrations, particularly in cases of Fusarium keratitis.
4A 68-year-old female with Fuchs endothelial corneal dystrophy has symptomatic corneal edema and a best-corrected visual acuity of 20/60. She is scheduled for Descemet Membrane Endothelial Keratoplasty (DMEK). Which of the following is the anatomical layer removed from the host during Descemetorhexis?
A.Descemet's membrane and endothelium
B.Descemet's membrane, endothelium, and posterior stroma
C.Descemet's membrane, endothelium, and Bowman's layer
D.Descemet's membrane only, leaving the host endothelium intact
Explanation: Descemetorhexis is the peeling and removal of the host's diseased Descemet's membrane and endothelium. In DMEK, a donor graft consisting of only Descemet's membrane and endothelium is then transplanted. Unlike DSAEK, DMEK does not include any donor posterior stroma, resulting in faster visual rehabilitation and lower rejection rates.
5A contact lens wearer presents with severe, out-of-proportion ocular pain and a ring-shaped corneal infiltrate. Confocal microscopy reveals double-walled cysts. Which of the following is the most appropriate first-line medical therapy?
A.Topical chlorhexidine 0.02% and polyhexamethylene biguanide (PHMB) 0.02%
B.Topical natamycin 5% and fortified vancomycin 50 mg/mL
C.Topical trifluridine 1% and acyclovir ointment 3%
D.Topical moxifloxacin 0.5% and amphotericin B 0.15%
Explanation: The clinical presentation is highly suggestive of Acanthamoeba keratitis (ring infiltrate, severe pain, contact lens history, double-walled cysts). The cyst form is highly resistant to standard therapies. First-line treatment requires cysticidal agents, specifically biguanides (PHMB 0.02% or chlorhexidine 0.02%) often combined with a diamidine (propamidine isethionate/Brolene).
6A 32-year-old male presents with recurrent episodes of foreign body sensation, photophobia, and tearing in both eyes. Slit-lamp examination reveals multiple elevated, coarse, whitish-gray intraepithelial lesions that stain minimally with fluorescein. The stroma is entirely clear. What is the diagnosis?
A.Thygeson superficial punctate keratitis
B.Epidemic keratoconjunctivitis (EKC)
C.Herpes simplex epithelial keratitis
D.Reis-Bücklers corneal dystrophy
Explanation: Thygeson superficial punctate keratitis (TSPK) characteristically presents as chronic, recurrent, bilateral, elevated epithelial lesions with minimal staining, without stromal involvement or conjunctival injection. The etiology is unknown, and it responds well to low-dose topical steroids or cyclosporine.
7A 28-year-old female with a history of a fingernail injury to her right eye presents with recurrent episodes of severe pain upon awakening, tearing, and blurred vision. She is diagnosed with recurrent corneal erosion (RCE) syndrome. If medical therapy with hypertonic saline and bandage contact lenses fails, which surgical procedure is most appropriate?
A.Phototherapeutic keratectomy (PTK)
B.Deep anterior lamellar keratoplasty (DALK)
C.Descemet stripping automated endothelial keratoplasty (DSAEK)
D.Corneal collagen cross-linking (CXL)
Explanation: For patients with RCE refractory to conservative medical management, phototherapeutic keratectomy (PTK) using an excimer laser is highly effective. It removes the irregular epithelial basement membrane and ablated superficial stroma, allowing for the formation of secure hemidesmosomes between the new epithelium and the stroma. Anterior stromal puncture is another localized option but is typically restricted to non-axial RCE.
8An 80-year-old male with chronic uveitis presents with a horizontal band of calcium deposition in the interpalpebral zone of his cornea, separated from the limbus by a clear zone. What is the most appropriate chemical agent used to chelate the calcium during treatment?
A.Disodium ethylenediaminetetraacetic acid (EDTA) 0.05 M (1.5% to 3.0%)
B.Sodium thiosulfate 10%
C.Mitomycin C 0.02%
D.Proparacaine hydrochloride 0.5%
Explanation: Band keratopathy involves calcium phosphate deposition in Bowman's layer and anterior stroma. Treatment consists of epithelial debridement followed by chemical chelation using disodium EDTA (usually 1.5% to 3.0% solution) applied to the cornea. The EDTA binds the calcium, which can then be gently scraped away, followed by placement of a bandage contact lens.
9A refractive surgeon is evaluating a 26-year-old patient for LASIK. Which of the following preoperative topodiagnostic parameters carries the highest risk score for developing post-LASIK ectasia according to the Randleman Ectasia Risk Score system?
A.Abnormal preoperative corneal topography (e.g., keratoconus or pellucid marginal degeneration)
B.Residual stromal bed (RSB) thickness of 290 microns
C.Preoperative central corneal thickness of 510 microns
D.Patient age of 26 years
Explanation: In the Randleman Ectasia Risk Score system, abnormal topography (e.g., keratoconus, suspect keratoconus, or PMD) is the most heavily weighted risk factor, automatically assigning a score of 4 or 5, which indicates high risk and contraindicates LASIK regardless of other parameters.
10On post-operative day 3 following uneventful LASIK, a patient presents with asymptomatic, fine granular infiltrates localized strictly under the corneal flap, sparing the peripheral interface. There is no epithelial defect or anterior chamber reaction. What is the diagnosis and initial management?
A.Diffuse Lamellar Keratitis (DLK) Stage 1; treat with intensive topical corticosteroids
B.Infectious keratitis; perform immediate flap lift, scrape interface for cultures, and start fortified antibiotics
C.Transient Light Sensitivity Syndrome; treat with topical NSAIDs
D.Epithelial ingrowth; perform immediate mechanical scraping of the interface
Explanation: Diffuse Lamellar Keratitis (DLK, or 'Sands of Sahara') Stage 1 presents with fine granular wave-like inflammatory cells at the flap interface, typically appearing within 1-5 days post-op, sparing the visual axis and with no epithelial defect. The initial management is intensive topical corticosteroids (e.g., prednisolone acetate 1% hourly) with close follow-up.
About the Ophthalmology Board Exam
This practice exam covers cornea/refractive, glaucoma/cataract, retina/uveitis, pediatric ophthalmology/strabismus, and neuro-ophthalmology/oculoplastics.
Assessment
100 multiple-choice questions
Time Limit
3 hours
Passing Score
60%
Exam Fee
Free (Saudi Commission for Health Specialties (SCFHS))
Ophthalmology Board Exam Content Outline
20%
Cornea & External Disease
Corneal dystrophies, infections, dry eye, and refractive surgery principles.
20%
Glaucoma & Lens
Open/closed glaucoma, medical and surgical glaucoma care, and cataract surgery.
20%
Retina, Vitreous & Uveitis
Diabetic retinopathy, AMD, retinal detachment, and uveitis classification.
20%
Pediatric Ophthalmology & Strabismus
Amblyopia, strabismus assessment, and pediatric ocular anomalies.
20%
Neuro-Ophthalmology & Oculoplastics
Optic neuropathies, visual field defects, eyelid and orbital disorders.
How to Pass the Ophthalmology Board Exam
What You Need to Know
- Passing score: 60%
- Assessment: 100 multiple-choice questions
- Time limit: 3 hours
- Exam fee: Free
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
Frequently Asked Questions
What is the format of the Ophthalmology Board exam?
The exam consists of 100 multiple-choice questions covering all five content domains.
What is the passing score for the Ophthalmology Board exam?
Candidates must score at least 60% to pass the exam.