Pediatric Ophthalmology and Amblyopia Management MCQs

Ophthalmology · 43 free questions with answers & explanations.

1. Retinopathy of prematurity (ROP) is screened in neonates born at ≤32 weeks gestational age and/or birth weight ≤1500 g. The MOST aggressive form of ROP requiring immediate treatment is:
2. A 4-year-old child is found to have amblyopia in the right eye (vision 6/60) secondary to dense right esotropia (accommodative). After refractive correction with glasses, the most appropriate treatment for amblyopia is:
3. In a child diagnosed with retinoblastoma, which finding on examination is MOST consistent with Reese-Ellsworth Group V (or IIRC Group E) — indicating eye at risk for enucleation?
4. Leukocoria (white pupillary reflex) in a 2-year-old child has a differential diagnosis. Which of the following causes can be distinguished from retinoblastoma MOST reliably by the presence of calcification on CT scan?
5. A 3-year-old boy is brought with a squint. His visual acuity is 6/60 in the right eye and 6/6 in the left. The right eye shows constant left hypertropia with no movement of the left eye when covered (no re-fixation). The pattern of movements is: elevation restricted in adduction and depression restricted in abduction of the right eye. The diagnosis is:
6. A premature infant born at 28 weeks gestation weighing 1100 g is screened for retinopathy of prematurity (ROP). Stage 3 ROP is found in zone II with plus disease. According to current ICROP3 criteria, the appropriate treatment threshold (treatment-warranted ROP) is:
7. A 5-year-old girl has right amblyopia (visual acuity 6/36) with right esotropia of 30 PD. Her right eye cycloplegic refraction is +5.00D and left +1.00D. The amblyopia treatment plan should be:
8. In congenital nasolacrimal duct obstruction (CNLDO), the site of membranous obstruction that fails to canalise at birth is:
9. A 6-month-old infant presents with nystagmus, photophobia, and poor visual fixation from birth. The mother has albinism. On slit-lamp, the iris transilluminates fully. OCT of the macula shows absence of the foveal pit (foveal hypoplasia). The nystagmus is best explained by:
10. Retinopathy of prematurity (ROP) screening criteria in India per NNF guidelines include examination of all preterm infants with gestational age ≤34 weeks OR birth weight ≤2000 g. The screening should begin at:
11. A child aged 4 years has been diagnosed with anisometropic amblyopia (right eye 6/60, left eye 6/6). The right eye has +5.00 D hypermetropia, left eye +0.50 D. After 6 weeks of full spectacle correction, right VA is still 6/24. The next most appropriate step is:
12. Nystagmus blockage syndrome (NBS) is characterized by which combination of findings?
13. A 4-year-old child is found to have a dense right amblyopia (BCVA 6/60) due to a large right esotropia. The left eye BCVA is 6/6. After prescribing full cycloplegic refraction and allowing 8 weeks of glasses wear, the next step in management is:
14. Retinopathy of prematurity (ROP) screening guidelines in India recommend that the first screening should be performed in preterm neonates at:
15. A full-term neonate has a white pupillary reflex (leukocoria) noted at birth in the left eye. The most common cause of leukocoria in the FIRST year of life is:
16. In the management of unilateral congenital dense cataract, the single most important factor determining visual outcome is:
17. A 4-year-old child is found to have a unilateral esotropia of 35 prism diopters with hypermetropia of +5.0 D in the deviating eye and +5.5 D in the fellow eye. The first and most important step in management is:
18. Retinopathy of prematurity (ROP) screening should be initiated at:
19. In the CRYO-ROP and ETROP studies, the threshold for treatment of ROP was revised. According to ETROP, treatment is recommended for which type of ROP?
20. The critical period for amblyopia treatment (occlusion therapy) extends up to which age, and what is the MOST critical window for maximum neural plasticity?
21. Leukocoria (white pupillary reflex) in a 2-year-old child should be urgently evaluated. The most common cause of leukocoria in children under 3 years is:
22. A 4-year-old girl is found to have best-corrected visual acuity of 6/6 in the right eye and 6/36 in the left eye. Cycloplegic refraction reveals +5.0 D in the right and +1.0 D in the left eye. There is no strabismus. The type of amblyopia is:
23. A neonate is noted to have a white reflex (leukocoria) in the right eye. Ultrasound B-scan shows a highly calcified intraocular mass with posterior shadowing. The lesion is unilateral and the child is 18 months old. Genetic testing of the tumor is planned. The gene involved in SPORADIC unilateral retinoblastoma is mutated in BOTH alleles:
24. In the management of retinopathy of prematurity (ROP), which zone and stage combination constitutes PLUS disease and is the MOST important indicator for treatment?
25. A 3-year-old child is diagnosed with esotropia measuring 35 prism diopters. Cycloplegic refraction shows +4.0 D OU. After full hyperopic correction for 3 months, residual esotropia is 10 prism diopters. This residual deviation represents:
26. In the treatment of amblyopia by penalisation (optical/pharmacological), atropine penalisation of the fellow (sound) eye works by which mechanism?
27. A newborn with a total unilateral cataract — the MOST critical priority in management is:
28. Nystagmus blockage syndrome (NBS) presents clinically with which characteristic combination?
29. In the Hirschberg corneal light reflex test, 1 mm of corneal reflex displacement from the pupillary centre corresponds approximately to how many prism dioptres of deviation?
30. A 4-year-old child is found to have a visual acuity of 6/6 in the right eye and 6/60 in the left eye. On examination the left eye has a high accommodative esotropia (AC/A ratio > 6:1) with good binocular fusion when wearing full hyperopic correction. The primary treatment is:
31. Retinopathy of prematurity (ROP) screening in India should be initiated at what corrected gestational age and for which infants?
32. In Type 1 ROP (requiring treatment), laser photocoagulation is applied to:
33. The critical period for amblyopia treatment (after which treatment is unlikely to be effective) ends at approximately:
34. A 4-year-old child is diagnosed with dense unilateral amblyopia (6/60 in the amblyopic eye, 6/6 in the fellow eye) caused by a unilateral congenital cataract treated at 6 weeks of age. Current management is spectacle correction with patching of the fellow eye. After 6 months of treatment, the amblyopic eye has improved to 6/24 but progress has plateaued. What should be tried next?
35. A 3-year-old child has a dense unilateral cataract detected at birth that was surgically removed at 6 weeks. Following surgery with contact lens correction, patching of the fellow eye is prescribed. What is the minimum daily patching duration recommended for treatment of deprivation amblyopia in this age group?
36. A 2-year-old child presents with a white reflex (leukocoria) in the right eye detected in a photo. Ultrasound shows a calcified intraocular mass. RetCam imaging and examination under anaesthesia is performed. An international classification of retinoblastoma (IIRC) is used. A group D eye has: large tumours, vitreous seeding, and subretinal seeding but an attached retina. What is the first-line management for a unilateral Group D retinoblastoma in a 2-year-old?
37. A 4-year-old presents with intermittent exotropia that is larger at distance than at near, with a difference of >15 prism dioptres. This pattern is known as what, and what does it suggest about motor fusion?
38. Retinopathy of prematurity (ROP) zone I, stage 3+ disease is found on screening. Based on ET-ROP (Early Treatment of Retinopathy of Prematurity) study results, what is the preferred primary treatment?
39. A 4-year-old child is diagnosed with amblyopia secondary to a 4-dioptre unilateral hypermetropia. Spectacle correction is prescribed. If after 16 weeks of spectacle wear alone VA has improved from 6/60 to 6/18, the NEXT step is:
40. Retinopathy of prematurity (ROP) — Plus disease is defined by:
41. A 6-month-old infant presents with leukocoria and a large white reflex in the left eye. B-scan shows calcification. CT reveals intraocular calcification. The PREFERRED initial management of unilateral retinoblastoma confined to the globe (IIRC group D) is:
42. Which of the following is the MOST sensitive clinical finding for detecting paediatric strabismic amblyopia in a pre-verbal child?
43. A newborn has small non-reactive pupils, absent red reflex, and dense bilateral cataracts. The MOST urgent reason to proceed with cataract surgery within the first 6–8 weeks of life is: