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Glaucoma questions and MCQs for residents

Glaucoma covers aqueous humor dynamics, intraocular pressure measurement, gonioscopy, optic nerve and visual field assessment, primary open-angle and angle-closure glaucoma, the secondary glaucomas, childhood glaucoma, and medical, laser and incisional treatment. It corresponds to BCSC Section 10, Glaucoma.

Boards emphasize mechanism. Questions ask you to classify an angle on gonioscopy; recognize the secondary glaucoma behind a clinical picture, whether pigmentary, pseudoexfoliative, neovascular, uveitic, lens-related or steroid-induced; match a drug class to its mechanism and adverse effects; and interpret a visual field or optical coherence tomography scan for progression. Complications after trabeculectomy and tube shunt surgery, including the differential of a shallow anterior chamber, are common themes.

Use practice questions to connect each finding to its underlying mechanism rather than memorizing isolated facts. When you miss one, trace the decision flowchart from anatomy (open or closed angle) to cause and treatment, then let spaced repetition return pharmacology and gonioscopy facts at the right intervals. Mixed blocks that combine image-based items with pharmacology and surgical complications build the pattern recognition that written and oral exams reward.

Free glaucoma practice questions

Glaucoma questions are in the OphthoMentor app: create a free account to practise them with explanations, flowcharts and spaced-repetition review.

High-yield glaucoma topics for boards

  • Aqueous humor production and outflow: trabecular versus uveoscleral pathways
  • Gonioscopy: angle landmarks, indentation technique and grading systems
  • Goldmann applanation tonometry: sources of error, including central corneal thickness
  • Optic disc assessment: cup-to-disc ratio, ISNT rule, disc hemorrhages, RNFL defects
  • Glaucomatous field defects: nasal step, arcuate scotoma, paracentral loss
  • Ocular hypertension: risk factors for conversion, including thinner central cornea
  • Normal-tension glaucoma: excluding compressive and other nonglaucomatous optic neuropathies
  • Primary angle closure: pupillary block, plateau iris, laser peripheral iridotomy
  • Acute angle-closure crisis: presentation and stepwise emergency management
  • Pigment dispersion syndrome: Krukenberg spindle, iris transillumination defects, dense trabecular pigment
  • Pseudoexfoliation syndrome: LOXL1 variants, capsular deposits, Sampaolesi line, zonular weakness
  • Neovascular glaucoma: retinal ischemia, anti-VEGF therapy, panretinal photocoagulation
  • Uveitic and steroid-induced glaucoma: mechanisms and management
  • Lens-related glaucomas: phacolytic, phacomorphic, lens particle, ectopia lentis
  • Iridocorneal endothelial syndrome: Chandler syndrome, essential iris atrophy, Cogan-Reese
  • Primary congenital glaucoma: epiphora, photophobia, blepharospasm, Haab striae, CYP1B1, angle surgery
  • Prostaglandin analog adverse effects: iris darkening, lash growth, periorbitopathy
  • Topical drug cautions: beta-blockers in asthma, brimonidine in infants
  • Trabeculectomy and tube shunts: bleb leak, blebitis, hypotony, tube exposure
  • Shallow chamber after filtration: overfiltration, choroidal effusion, pupillary block, misdirection, suprachoroidal hemorrhage

How glaucoma is examined

Glaucoma (BCSC Section 10) is a core topic on the OKAP and ABO written exams. Questions tend to combine an image, such as a gonioscopic view, optic disc photograph, visual field printout or OCT scan, with a clinical scenario, then ask for the mechanism, the most appropriate next step or the expected adverse effect of a treatment.

EBOD and FRCOphth written papers cover the same principles; across all of these exams, landmark clinical trials, target pressure and the choice between medical, laser and surgical options are recurring themes. In oral and clinical examinations, glaucoma cases typically test a structured approach: describe the disc and field, classify the angle, identify risk factors for progression and justify a management plan, including prompt recognition of emergencies such as acute angle closure.