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100+ Free FC Ophth(SA) Final Practice Questions

Prepare for the Fellowship of the College of Ophthalmologists of South Africa Final Examination exam with instant access — no signup required.

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2026 Statistics

Key Facts: FC Ophth(SA) Final Exam

100 Qs

Practice MCQs

FC Ophth(SA) Study Adaptation

2 Days

Exam Duration

CMSA Regulations

R21 500

Exam Fee

CMSA Fee Schedule 2026

50%

Passing Mark

CMSA College of Ophthalmologists

CMSA

Exam Body

College of Ophthalmologists of SA

The FC Ophth(SA) Final is the specialist exit examination by the College of Ophthalmologists of South Africa assessing comprehensive clinical competence, surgical judgment, and ophthalmic pathology.

Sample FC Ophth(SA) Final Practice Questions

Try these sample questions to test your FC Ophth(SA) Final exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old soft contact lens wearer presents with severe right eye pain out of proportion to clinical signs, photophobia, and lacrimation. Slit-lamp examination reveals a delicate radial keratoneuritis and ring-shaped stromal infiltrate. Corneal scraping shows double-walled cysts on calcofluor white staining. Which of the following is the first-line topical antimicrobial therapy?
A.Polyhexamethylene biguanide (PHMB) 0.02% combined with chlorhexidine 0.02%
B.Natamycin 5% ophthalmic suspension alone
C.Fortified tobramycin 1.5% and cefuroxime 5% drops
D.Ganciclovir 0.15% ophthalmic gel and oral aciclovir
Explanation: The clinical presentation of severe pain out of proportion to signs, radial keratoneuritis, ring infiltrate, and double-walled cysts is diagnostic of Acanthamoeba keratitis. Polyhexamethylene biguanide (PHMB) 0.02% or chlorhexidine 0.02% are biguanides that effectively eradicate both active trophozoites and dormant cysts. Combination anti-amoebic therapy with a diamidine (such as propamidine isethionate/Brolene) is often added to maximize cysticidal activity.
2A 19-year-old male with a history of vigorous eye rubbing secondary to vernal keratoconjunctivitis exhibits progressive astigmatism. Slit-lamp biomicroscopy demonstrates corneal iron deposition at the base of the cone (Fleischer ring) and fine vertical stromal lines that disappear under gentle digital pressure (Vogt striae). Pentacam corneal tomography confirms progressive keratoconus with pachymetry of 460 µm at the thinnest point. What is the definitive intervention to halt disease progression?
A.Rigid gas-permeable (RGP) contact lens fitting
B.Corneal collagen cross-linking (CXL) using riboflavin and ultraviolet A light
C.Deep anterior lamellar keratoplasty (DALK)
D.Intrastromal corneal ring segment (ICRS) implantation
Explanation: Corneal collagen cross-linking (CXL) utilizing riboflavin (vitamin B2) photo-sensitizer and ultraviolet A (UVA 365 nm) irradiation is the only proven disease-modifying treatment that halts the biomechanical progression of keratoconus. Riboflavin acts as a photosensitizer creating covalent chemical bonds between stromal collagen fibrils. Pachymetry above 400 µm after epithelial debridement ensures endothelial safety during the standard Dresden CXL protocol.
3A 34-year-old female presents with right eye irritation, mild photophobia, and reduced corneal sensation. Fluorescein staining reveals a branching, dendritic corneal epithelial lesion with terminal bulbs and swollen epithelial cells at the ulcer border. What is the most appropriate initial management step?
A.Initiate topical ganciclovir 0.15% gel or oral valaciclovir and withhold topical corticosteroids
B.Start topical prednisolone acetate 1% four times daily immediately
C.Perform immediate corneal debridement followed by topical fortified vancomycin
D.Fit a therapeutic bandage soft contact lens and initiate topical moxifloxacin
Explanation: Herpes simplex virus (HSV) epithelial keratitis manifests classically as a true dendritic ulcer with terminal bulbs. The primary therapy is topical antiviral medication (ganciclovir 0.15% gel or aciclovir 3% ointment) or oral antiviral therapy (valaciclovir / aciclovir). Topical corticosteroids are strictly contraindicated during active viral epithelial replication because they enhance viral proliferation, transform dendrites into geographic ulcers, and increase corneal perforation risk.
4An agricultural worker sustains a corneal abrasion from an oil palm frond. Ten days later, he presents with a greyish-white corneal infiltrate featuring feathery, hyphate margins, surrounding satellite lesions, and an endothelial plaque. Diagnostic corneal scraping confirms fungal hyphae. Which agent represents the initial drug of choice?
A.Topical natamycin 5% suspension
B.Topical voriconazole 1% alone
C.Topical amphotericin B 0.15% drops
D.Systemic oral fluconazole 400 mg daily
Explanation: Topical natamycin 5% suspension is the FDA-approved first-line drug of choice for filamentous fungal keratitis (such as Fusarium and Aspergillus species), particularly following vegetative ocular trauma. The Mycotic Keratitis Treatment Trial I (MKTT I) demonstrated that natamycin achieved significantly superior visual outcomes and lower perforation rates compared to topical voriconazole 1% for filamentous fungal keratitis.
5A 62-year-old female reports bilateral morning blurriness that improves as the day progresses. Slit-lamp examination reveals bilateral central Descemet membrane guttae ('beaten copper' appearance) and mild central stromal edema. Specular microscopy shows an endothelial cell count of 750 cells/mm² with marked pleomorphism and polymethism. Which surgical procedure offers the thinnest selective endothelial replacement for this condition?
A.Descemet Membrane Endothelial Keratoplasty (DMEK)
B.Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)
C.Penetrating Keratoplasty (PKP)
D.Deep Anterior Lamellar Keratoplasty (DALK)
Explanation: Fuchs endothelial corneal dystrophy (FECD) results from progressive loss of corneal endothelial cells. Descemet Membrane Endothelial Keratoplasty (DMEK) involves selective transplantation of isolated donor Descemet membrane and endothelium (~10–15 µm thick) without donor stroma. DMEK provides the fastest visual recovery, superior anatomical restoration, and significantly lower immunologic graft rejection rates (<1%) compared to DSAEK or penetrating keratoplasty.
6A 55-year-old female with long-standing seropositive Rheumatoid Arthritis presents with acute severe right eye pain and red eye. Examination reveals a crescent-shaped destructive limbal stromal melt with an overlying epithelial defect extending 4 clock hours, accompanied by adjacent episcleral injection. Anterior segment OCT confirms 60% stromal thinning. What is the most crucial initial systemic intervention?
A.High-dose systemic corticosteroids (e.g., intravenous methylprednisolone) and urgent rheumatology co-management for biological immunosuppression
B.Topical prednisolone acetate 1% hourly and topical ciprofloxacin
C.Immediate tectonic corneal patch grafting under local anesthesia without systemic therapy
D.Topical cyclosporine 0.05% twice daily and oral ibuprofen 800 mg thrice daily
Explanation: Peripheral Ulcerative Keratitis (PUK) associated with systemic autoimmune disease (especially Rheumatoid Arthritis) represents a sight- and life-threatening necrotizing vasculitis. Systemic immune suppression with high-dose intravenous pulse methylprednisolone followed by oral steroids and steroid-sparing immunosuppressants (e.g., Rituximab, Cyclophosphamide) is essential. Systemic therapy halts systemic necrotizing vasculitis and corneal destruction; mortality in untreated PUK patients reaches 30% at 10 years due to systemic vasculitic complications.
7A contact lens wearer presents with a rapidly progressive corneal ulcer featuring dense stromal liquefactive necrosis, a 2 mm hypopyon, and voluminous greenish-mucopurulent discharge. Corneal Gram stain reveals Gram-negative rods. Which pathogen and empirical treatment regimen are correct?
A.Pseudomonas aeruginosa; topical fortified tobramycin (1.5%) combined with fortified cefuroxime (5%) or fluoroquinolone monotherapy
B.Staphylococcus aureus; topical vancomycin 5% monotherapy
C.Streptococcus pneumoniae; topical ganciclovir 0.15% and oral doxycycline
D.Acanthamoeba castellanii; topical chlorhexidine 0.02% and oral fluconazole
Explanation: Pseudomonas aeruginosa is the classic causative organism of rapidly progressive, liquefactive bacterial keratitis in contact lens wearers, driven by bacterial proteases and exotoxin A. Gram-negative rods on Gram stain confirm Pseudomonas. Intensive broad-spectrum topical therapy using fortified aminoglycoside (tobramycin 1.5%) plus fortified cephalosporin (cefuroxime 5%) or intensive high-potency fluoroquinolones (e.g., moxifloxacin/levofloxacin) is required immediately.
8A 45-year-old male with no systemic medical conditions presents with excruciating left eye pain and photophobia. Examination shows a painful crescentic ulceration at the temporal limbus with an overhanging leading edge that spreads circumferentially and centrally. Systemic autoimmune serologies (ANA, RF, ANCA) are entirely negative. What is the diagnosis?
A.Mooren ulcer
B.Peripheral Ulcerative Keratitis (PUK) secondary to GPA
C.Terrien marginal degeneration
D.Dellen
Explanation: Mooren ulcer is an idiopathic, painful, progressive outer-lamellar ulcerative keratitis that originates at the corneal margin and spreads circumferentially and centrally with a characteristic steep, overhanging undermined central border. By definition, Mooren ulcer is a diagnosis of exclusion in which all systemic autoimmune and vasculitic diseases (such as RA, GPA, polyarteritis nodosa) have been thoroughly ruled out.
9A 68-year-old female presents with chronic progressive bilateral conjunctival hyperemia, trichiasis, and shortening of the inferior conjunctival fornices with symblepharon formation. Peribulbar conjunctival biopsy for direct immunofluorescence (DIF) reveals continuous linear deposition of IgG, IgA, and C3 along the epithelial basement membrane zone. What is the definitive systemic treatment of choice for moderate-to-severe disease?
A.Systemic dapsone or oral cyclophosphamide / rituximab
B.Topical artificial tears and epilation alone
C.Short course of oral amoxicillin and topical fluorometholone
D.Surgical symblepharon lysis without systemic therapy
Explanation: Ocular Cicatricial Pemphigoid (OCP) / Mucous Membrane Pemphigoid (MMP) is a systemic autoimmune blistering disease characterized by autoantibodies against basement membrane zone antigens (such as BP180, BP230, or integrin beta-4). Management requires systemic immunosuppression: dapsone is first-line for mild-to-moderate disease, while rapidly progressive or severe disease requires systemic cyclophosphamide, mycophenolate mofetil, or rituximab to arrest cicatrization.
10A 40-year-old asymptomatic male undergoing routine refraction is noted to have bilateral, quiet eyes with superonasal marginal corneal thinning, intact epithelium, superficial vascularization, and a leading edge of lipid deposition. Corneal topography shows marked against-the-rule astigmatism. What is the most likely diagnosis?
A.Terrien marginal degeneration
B.Mooren ulcer
C.Keratoconus
D.Pellucid marginal degeneration
Explanation: Terrien marginal degeneration is a rare, non-inflammatory, typically bilateral ectatic corneal condition characterized by painless superonasal marginal thinning with intact epithelium, fine superficial pannus, and a characteristic yellow line of lipid deposition at the central advancing edge. Ectasia in the peripheral zone leads to high against-the-rule or oblique astigmatism.

About the FC Ophth(SA) Final Exam

The Fellowship of the College of Ophthalmologists of South Africa Final Examination — FC Ophth(SA) Final — is the exit qualification for specialist ophthalmology accreditation in South Africa. It evaluates advanced clinical diagnosis, medical and surgical management across cornea, glaucoma, vitreoretinal disease, neuro-ophthalmology, paediatric ophthalmology, oculoplastics, and ophthalmic pathology.

Assessment

Written papers (Paper 1 & Paper 2), clinical cases examination (OSCE / Long & Short cases), and viva voce oral examination.

Time Limit

2 days

Passing Score

Overall 50% with written subminimum

Exam Fee

R24 650 (College of Ophthalmologists of South Africa (Colleges of Medicine of South Africa))

FC Ophth(SA) Final Exam Content Outline

16%

Cornea & External Disease

Infectious keratitis (bacterial, fungal, Acanthamoeba, HSV/VZV), corneal dystrophies, ectasias, peripheral ulcerative keratitis, ocular surface burns, corneal transplantation (PKP, DALK, DMEK/DSAEK), and graft rejection.

17%

Glaucoma Medical & Surgical

Primary open-angle glaucoma, angle-closure glaucoma mechanisms, secondary glaucomas (PXG, pigmentary, uveitic, neovascular, ICE syndrome), trabeculectomy, tube shunts, MIGS, laser iridotomy/trabeculoplasty, and aqueous humor dynamics.

17%

Vitreoretinal Disease & Surgery

Rhegmatogenous and exudative retinal detachment, diabetic retinopathy, retinal vascular occlusions (CRAO, CRVO, BRVO), wet and dry AMD, macular holes, ERM, central serous chorioretinopathy, and endophthalmitis management.

15%

Paediatric Ophthalmology & Strabismus

Infantile and accommodative esotropia, exotropia, complex strabismus syndromes (Duane, Brown, Mobius), amblyopia penalization/patching, congenital cataracts, retinoblastoma, ROP screening/treatment, and congenital glaucoma.

15%

Neuro-Ophthalmology

Optic neuropathies (NAION, AAION/GCA, optic neuritis, LHON), intracranial hypertension (IIH), cranial nerve palsies (CN III, IV, VI), pupillary abnormalities (Horner, Adie tonic, Argyll Robertson), MLF lesions (INO), and visual field defects.

12%

Oculoplastics & Orbit

Orbital cellulitis vs preseptal cellulitis, thyroid eye disease, eyelid ectropion/entropion, eyelid malignancies (BCC, SCC, sebaceous carcinoma), dacryocystitis/DCR, orbital floor blowout fractures, and orbital pseudotumor.

8%

Ophthalmic Pathology & Systemic Disease

Ocular manifestations of HIV, TB, syphilis, sarcoidosis, sympathetic ophthalmia, uveal melanoma, cytomegalovirus retinitis, ocular toxoplasmosis, and phakomatoses (NF1).

How to Pass the FC Ophth(SA) Final Exam

What You Need to Know

  • Passing score: Overall 50% with written subminimum
  • Assessment: Written papers (Paper 1 & Paper 2), clinical cases examination (OSCE / Long & Short cases), and viva voce oral examination.
  • Time limit: 2 days
  • Exam fee: R24 650

Keys to Passing

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

FC Ophth(SA) Final Study Tips from Top Performers

1Focus on clinical decision-making, surgical indications, and complication management across cornea, glaucoma, and vitreoretinal subspecialties.
2Master emergency management algorithms for chemical ocular burns, acute angle-closure glaucoma, endophthalmitis, orbital cellulitis, and giant cell arteritis.
3Review high-yield histopathology features of ocular tumors (uveal melanoma, retinoblastoma, eyelid carcinomas) and systemic granulomatous/infectious ocular diseases.

Frequently Asked Questions

What is the format of the CMSA FC Ophth(SA) Final examination?

The examination comprises written theory papers (Papers 1 and 2 containing clinical short answer questions and essays), an OSCE/clinical cases exam, and oral viva voce examinations before the CMSA Board of Examiners.

What is the pass mark for the FC Ophth(SA) Final?

Candidates must achieve an overall aggregate mark of 50% across all components with a mandatory subminimum requirement in the written papers and clinical examination.

What prerequisites are required to sit the FC Ophth(SA) Final?

Candidates must hold an MBChB degree, active HPCSA registration, pass FC Ophth(SA) Primary and Intermediate exams, and complete at least 36 months of accredited ophthalmology registrar training with a certified clinical logbook.