100+ Free FRCOphth Part 2 Oral Practice Questions

Explanation: Cutibacterium acnes is the classic cause of chronic, delayed-onset (weeks to months) post-operative endophthalmitis, often sequestered in the capsular bag with a low-grade granulomatous picture and a characteristic white capsular plaque. It responds poorly to vitreous tap-and-inject alone, frequently requiring intracapsular vancomycin or capsulectomy.

Explanation: Microbial keratitis requires a corneal scrape for Gram stain, culture and sensitivities before commencing intensive topical antibiotics, as it guides targeted therapy and identifies organisms such as Acanthamoeba, fungi or resistant bacteria. In the UK, central or sight-threatening ulcers are scraped before empirical fortified or fluoroquinolone drops.

Explanation: Corneal collagen cross-linking (CXL) with riboflavin and UV-A is the established intervention to halt progression of keratoconus by stiffening the corneal stroma, and is indicated in documented progressive disease in a young patient. NICE supports CXL for progressive keratoconus.

Explanation: Acute anterior uveitis is treated with intensive topical corticosteroid to control inflammation and a cycloplegic/mydriatic (e.g. cyclopentolate) to relieve ciliary spasm pain and break or prevent posterior synechiae. Underlying systemic associations (e.g. HLA-B27) are sought if recurrent.

Explanation: A true dendritic ulcer with terminal bulbs and reduced corneal sensation is herpes simplex epithelial keratitis, treated with topical antiviral such as aciclovir 3% ointment or ganciclovir 0.15% gel. Topical steroids alone are contraindicated as they worsen epithelial disease.

Explanation: Sarcoid uveitis frequently causes cystoid macular oedema, a leading cause of vision loss in chronic uveitis, and OCT monitoring is essential. Other sarcoid posterior findings include periphlebitis (candle-wax drippings) and choroidal granulomas.

Explanation: Intraoperative floppy iris syndrome (IFIS) is most strongly associated with systemic alpha-1 adrenergic antagonists such as tamsulosin, used for benign prostatic hyperplasia, which cause iris dilator atony. Even past use can produce IFIS, so a careful drug history is essential and strategies (iris hooks, intracameral phenylephrine) are planned.

Explanation: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation typically within 12-48 hours of anterior segment surgery, caused by contaminants in instruments, solutions or intraocular agents, producing diffuse limbus-to-limbus corneal oedema and anterior chamber reaction that responds to intensive topical steroids. The absence of pain disproportionate to signs and a negative culture distinguish it from endophthalmitis.

Explanation: Necrotising scleritis is strongly associated with systemic vasculitides, particularly granulomatosis with polyangiitis (ANCA-associated) and rheumatoid arthritis, which require urgent systemic immunosuppression. Investigation includes ANCA, ANA, RF and inflammatory markers because untreated disease threatens both sight and life.

Explanation: Acanthamoeba keratitis classically affects contact-lens wearers with pain disproportionate to signs, radial perineural infiltrates and a ring infiltrate, and is confirmed by corneal scrape, confocal microscopy (double-walled cysts) or culture on non-nutrient agar with E. coli overlay. It is treated with biguanides (PHMB) and diamidines.