Practice 80 high-yield MCQs on the blood supply and nerve supply of the eye from A.K. Khurana’s Comprehensive Ophthalmology. Includes answers with short explanations for NEET PG, NEXT, AIIMS, and MRCSEd exam preparation.
Ophthalmic Artery & Branches
1. Ophthalmic artery is a branch of:
A. External carotid artery
B. Internal carotid artery ✅
C. Vertebral artery
D. Basilar artery
Exp: Ophthalmic artery arises from ICA just after cavernous sinus.
2. Ophthalmic artery enters orbit through:
A. Inferior orbital fissure
B. Optic canal ✅
C. Superior orbital fissure
D. Foramen rotundum
Exp: It passes with optic nerve through optic canal.
3. Central retinal artery is a branch of:
A. External carotid artery
B. Ophthalmic artery ✅
C. Posterior ciliary artery
D. Maxillary artery
Exp: CRA is a direct branch of ophthalmic artery.
4. Central retinal artery supplies:
A. Entire retina
B. Inner 2/3 of retina ✅
C. Outer retina only
D. Optic nerve head only
Exp: Outer retina supplied by choroidal circulation.
5. Short posterior ciliary arteries supply:
A. Retina
B. Choroid and optic nerve head ✅
C. Cornea
D. Conjunctiva
Exp: SPCAs → choroid + optic disc.
Ciliary Circulation
6. Long posterior ciliary arteries pierce sclera near:
A. Corneal limbus
B. Optic nerve ✅
C. Equator
D. Ora serrata
Exp: LPCAs enter around optic nerve.
7. Long posterior ciliary arteries run forward to form:
A. Major arterial circle of iris ✅
B. Minor circle
C. Central retinal artery
D. Circle of Zinn
Exp: Major circle = LPCAs + anterior ciliary arteries.
8. Circle of Zinn-Haller formed by:
A. Short posterior ciliary arteries ✅
B. Long posterior ciliary arteries
C. Anterior ciliary arteries
D. Central retinal artery
Exp: Anastomosis around optic nerve head.
9. Blood supply of ciliary body mainly from:
A. CRA
B. Major arterial circle ✅
C. Minor arterial circle
D. SPCAs only
Exp: Ciliary body richly supplied by major arterial circle.
10. Cornea is avascular, but nutrition is from:
A. Limbal vessels, aqueous, tear film ✅
B. Central retinal artery
C. Choroid only
D. None
Exp: Cornea nourished by aqueous, tears, limbus.
Venous Drainage
11. Central retinal vein drains into:
A. Cavernous sinus (via superior ophthalmic vein) ✅
B. Inferior ophthalmic vein
C. Pterygoid plexus
D. Jugular vein directly
Exp: CRV joins ophthalmic veins → cavernous sinus.
12. Vorticose veins drain:
A. Retina
B. Choroid ✅
C. Optic nerve
D. Conjunctiva
Exp: 4–6 vortex veins drain choroid.
13. Superior ophthalmic vein communicates with:
A. Facial vein ✅
B. Jugular vein
C. Pterygoid plexus
D. Dural sinuses only
Exp: Facial–ophthalmic connection → cavernous sinus thrombosis risk.
14. Cavernous sinus receives blood from:
A. Ophthalmic veins ✅
B. Jugular veins directly
C. Vorticose veins directly
D. Central artery of retina
Exp: Orbital veins → cavernous sinus.
15. Cavernous sinus thrombosis can spread from:
A. Upper lip
B. Danger area of face ✅
C. Neck
D. Ear
Exp: Facial vein communicates with ophthalmic veins.
Arterial Supply of Ocular Structures
16. Lens gets nutrition mainly from:
A. Central retinal artery
B. Aqueous humor ✅
C. Choroid
D. Ciliary body
Exp: Avascular lens nourished by aqueous.
17. Outer retina supplied by:
A. Central retinal artery
B. Choroid ✅
C. Posterior ciliary artery
D. Anterior ciliary artery
Exp: Photoreceptors nourished by choroid.
18. Fovea receives blood supply from:
A. Central retinal artery
B. Choroid (diffusion) ✅
C. Major arterial circle
D. LPCAs
Exp: Central fovea avascular → depends on choroid.
19. Optic disc blood supply mainly by:
A. CRA
B. Short posterior ciliary arteries ✅
C. Long posterior ciliary arteries
D. Choroid only
Exp: SPCAs form circle of Zinn.
20. Conjunctiva mainly supplied by:
A. Anterior ciliary arteries ✅
B. Posterior ciliary arteries
C. Choroid
D. Retinal vessels
Exp: ACA branches → conjunctiva.
Cranial Nerves Related to Orbit
21. Nerve supplying lateral rectus:
A. Oculomotor
B. Abducens ✅
C. Trochlear
D. Trigeminal
Exp: CN VI supplies LR.
22. Nerve supplying superior oblique:
A. Trochlear ✅
B. Abducens
C. Oculomotor
D. Trigeminal
Exp: CN IV supplies SO.
23. All other extraocular muscles supplied by:
A. Oculomotor ✅
B. Trochlear
C. Abducens
D. Sympathetic
Exp: CN III supplies SR, IR, MR, IO, LPS.
24. Sensory innervation of cornea is by:
A. Ophthalmic division of trigeminal ✅
B. Maxillary nerve
C. Facial nerve
D. Abducens
Exp: Cornea is V1 (nasociliary branch).
25. Lacrimal gland parasympathetic fibres come via:
A. Facial nerve (greater petrosal) ✅
B. Oculomotor
C. Trigeminal
D. Abducens
Exp: Facial → pterygopalatine → lacrimal.
Autonomic Pathways
26. Parasympathetic supply to sphincter pupillae via:
A. Oculomotor nerve (Edinger-Westphal → ciliary ganglion) ✅
B. Trochlear
C. Abducens
D. Sympathetic
Exp: CN III → CG → short ciliary nerves.
27. Dilator pupillae innervation:
A. Sympathetic fibres ✅
B. Parasympathetic
C. CN III motor root
D. Facial nerve
Exp: Sympathetic from SCG.
28. Ciliary muscle innervation:
A. Parasympathetic (CN III via ciliary ganglion) ✅
B. Sympathetic
C. Facial nerve
D. Trochlear
Exp: Accommodation is parasympathetic.
29. Sympathetic pathway for pupil dilation originates from:
A. Hypothalamus → ciliospinal centre (C8–T2) ✅
B. Pons → Edinger nucleus
C. Midbrain → CN IV
D. Medulla → CN XII
Exp: Three-neuron sympathetic pathway.
30. Lesion in sympathetic pathway causes:
A. Horner’s syndrome ✅
B. CN III palsy
C. Optic atrophy
D. Papilledema
Exp: Classic triad: miosis, ptosis, anhidrosis.
Clinical Nerve Syndromes
31. Complete oculomotor nerve palsy results in:
A. Ptosis, dilated pupil, eye down & out ✅
B. Vertical diplopia
C. Esotropia
D. Anhidrosis
Exp: CN III supplies most EOMs + parasympathetic.
32. Trochlear nerve palsy worsens on:
A. Looking down ✅
B. Looking up
C. Looking lateral
D. Looking medial
Exp: SO needed for downgaze.
33. Abducens nerve palsy leads to:
A. Esotropia ✅
B. Exotropia
C. Hypertropia
D. Hypotropia
Exp: LR palsy → eye turned medially.
34. In Horner’s syndrome, pupil is:
A. Miotic ✅
B. Dilated
C. Mid-dilated fixed
D. Reacts sluggishly
Exp: Sympathetic loss → miosis.
35. Relative afferent pupillary defect (RAPD) occurs in:
A. Optic nerve lesion ✅
B. Oculomotor palsy
C. Abducens palsy
D. Horner’s syndrome
Exp: Optic nerve conduction defect.
Pupillary Reflexes
36. Afferent limb of light reflex:
A. Optic nerve ✅
B. Oculomotor
C. Abducens
D. Facial
Exp: Retina → optic nerve.
37. Efferent limb of light reflex:
A. Optic nerve
B. Oculomotor nerve ✅
C. Trochlear
D. Trigeminal
Exp: Parasympathetic via CN III → sphincter pupillae.
38. Afferent limb of accommodation reflex:
A. Optic nerve ✅
B. Oculomotor
C. Facial
D. Abducens
Exp: Visual input via CN II.
39. Efferent limb of accommodation reflex:
A. Oculomotor nerve ✅
B. Trochlear
C. Abducens
D. Trigeminal
Exp: CN III innervates ciliary muscle + sphincter pupillae.
40. Argyll Robertson pupil seen in:
A. Neurosyphilis ✅
B. Horner’s
C. Adie’s pupil
D. Optic atrophy
Exp: Light reflex absent, accommodation present.
Pupillary Abnormalities
41. Adie’s tonic pupil shows:
A. Sluggish light reflex, preserved near response ✅
B. No near response
C. Dilated fixed pupil
D. Miosis with anhidrosis
Exp: Light–near dissociation with slow constriction.
42. Holmes-Adie syndrome includes:
A. Tonic pupil + absent deep tendon reflexes ✅
B. Miosis + ptosis
C. Mydriasis + proptosis
D. Fixed pinpoint pupils
Exp: Neurological disorder with tonic pupil.
43. Hutchinson’s pupil indicates:
A. Uncal herniation compressing CN III ✅
B. Trochlear palsy
C. Horner’s syndrome
D. Optic neuritis
Exp: Uncal herniation → ipsilateral dilated pupil.
44. Marcus Gunn pupil is due to:
A. Optic nerve lesion (afferent defect) ✅
B. Oculomotor palsy
C. Trochlear palsy
D. Abducens palsy
Exp: RAPD = defective afferent limb.
45. In Horner’s syndrome, anisocoria is more obvious:
A. In light
B. In dark ✅
C. Same in both
D. Absent
Exp: Sympathetic defect → smaller pupil cannot dilate in dark.
Blood Supply – Clinical Aspects
46. Central retinal artery occlusion causes:
A. Sudden painless monocular blindness ✅
B. Painful loss of vision
C. Diplopia
D. Gradual visual loss
Exp: CRAO = acute, painless, severe loss.
47. Classic fundus sign in CRAO:
A. Cherry-red spot ✅
B. Cotton wool spots
C. Drusen
D. Retinitis
Exp: Cherry-red fovea due to intact choroidal supply.
48. Cilioretinal artery (when present) arises from:
A. Ciliary circulation ✅
B. Central retinal artery
C. Choroid only
D. Ophthalmic vein
Exp: Variant branch from posterior ciliary circulation.
49. Cilioretinal artery protects central vision in:
A. Central retinal artery occlusion ✅
B. Retinitis pigmentosa
C. Optic neuritis
D. Papilledema
Exp: Preserves macular supply.
50. Ischemic optic neuropathy results from occlusion of:
A. Short posterior ciliary arteries ✅
B. Central retinal vein
C. Long posterior ciliary arteries
D. Anterior ciliary artery
Exp: SPCAs supply optic nerve head.
Cavernous Sinus & Nerves
51. Nerve most commonly affected in cavernous sinus thrombosis:
A. Abducens (CN VI) ✅
B. Trochlear
C. Oculomotor
D. Trigeminal
Exp: CN VI lies centrally, highly vulnerable.
52. Nerves in lateral wall of cavernous sinus:
A. CN III, IV, V1, V2 ✅
B. CN II, III, IV, VI
C. CN V3, VII, IX
D. CN XI, XII
Exp: Lateral wall has III, IV, V1, V2.
53. Contents of cavernous sinus include all EXCEPT:
A. Abducens nerve
B. Internal carotid artery
C. Optic nerve ✅
D. Sympathetic plexus
Exp: CN II is outside cavernous sinus.
54. Pain sensation from cornea is carried by:
A. Nasociliary branch of V1 ✅
B. Lacrimal branch
C. Maxillary nerve
D. Facial nerve
Exp: Nasociliary → long ciliary nerves.
55. Loss of corneal reflex (afferent limb) indicates lesion of:
A. Trigeminal nerve (ophthalmic division) ✅
B. Facial nerve
C. Oculomotor nerve
D. Trochlear nerve
Exp: Afferent V1, efferent CN VII.
Reflexes & Clinical Tests
56. Efferent limb of corneal reflex:
A. Facial nerve ✅
B. Trigeminal nerve
C. Oculomotor nerve
D. Abducens
Exp: Orbicularis oculi contraction by CN VII.
57. Ciliospinal reflex mediated by:
A. Sympathetic pathway ✅
B. Parasympathetic
C. Trigeminal
D. Facial
Exp: Dilation of pupil on neck stimulation.
58. Swinging flashlight test is used to detect:
A. RAPD (Marcus Gunn pupil) ✅
B. Horner’s syndrome
C. Argyll Robertson pupil
D. Adie’s pupil
Exp: Detects afferent pupillary defect.
59. Dilation lag after darkness is feature of:
A. Horner’s syndrome ✅
B. Oculomotor palsy
C. Optic neuritis
D. Adie’s pupil
Exp: Sympathetic failure → delayed dilation.
60. Near reflex pathway includes:
A. Accommodation, convergence, miosis ✅
B. Accommodation, mydriasis
C. Convergence, mydriasis
D. Miosis, abduction
Exp: Triad of near reflex.
Special Circulations
61. Choroidal blood flow is:
A. Among highest in body ✅
B. Lowest in body
C. Moderate
D. Absent
Exp: High flow meets metabolic needs of retina.
62. Retinal circulation autoregulated mainly by:
A. Local metabolic factors ✅
B. Autonomic nerves
C. Hormones
D. Lymphatics
Exp: Retinal vessels autoregulate, unlike choroid.
63. Choroidal circulation is controlled by:
A. Autonomic nerves (sympathetic + parasympathetic) ✅
B. Autoregulation
C. Local metabolic only
D. Pituitary
Exp: Choroid richly autonomic innervated.
64. Blood-retinal barrier formed by:
A. Retinal capillary endothelium + RPE tight junctions ✅
B. Choroidal endothelium
C. Bruch’s membrane only
D. Vitreous
Exp: Dual barrier system.
65. Fenestrated capillaries in eye present in:
A. Choriocapillaris ✅
B. Retina
C. Iris sphincter
D. Cornea
Exp: Retina capillaries non-fenestrated; choroid fenestrated.
Clinical Blood/Nerve Syndromes
66. “Amaurosis fugax” usually due to:
A. Transient CRA embolism ✅
B. Optic neuritis
C. Retinitis
D. Glaucoma
Exp: Transient monocular blindness.
67. Orbital apex syndrome involves:
A. CN II, III, IV, V1, VI ✅
B. CN III, IV, VI only
C. CN V only
D. CN VII only
Exp: Apex lesion → optic + orbital nerves.
68. Superior orbital fissure syndrome involves:
A. CN III, IV, VI, V1 ✅
B. CN II only
C. CN VII only
D. CN V3 only
Exp: SOF syndrome = ophthalmoplegia, sensory loss.
69. Oculomotor nerve nucleus located in:
A. Midbrain (level of superior colliculus) ✅
B. Pons
C. Medulla
D. Spinal cord
Exp: CN III nucleus at midbrain.
70. Trochlear nerve unique because:
A. Exits dorsally ✅
B. Longest intracranial course
C. Crosses entirely
D. All above ✅
Exp: All statements true.
Miscellaneous
71. Longest intracranial course of any CN:
A. Trochlear ✅
B. Abducens
C. Oculomotor
D. Optic
Exp: CN IV is longest intracranial.
72. Nerve most prone to raised ICP:
A. Abducens (CN VI) ✅
B. Trochlear
C. Oculomotor
D. Facial
Exp: Long intracranial course, vulnerable to stretch.
73. Optic nerve is surrounded by:
A. Meninges (dura, arachnoid, pia) ✅
B. Periorbita
C. Tenon’s capsule only
D. Orbital fascia only
Exp: CNS extension → meninges around CN II.
74. Raised ICP first seen as:
A. Papilledema ✅
B. Optic atrophy
C. Central scotoma
D. Retinitis
Exp: CSF pressure transmitted via meninges.
75. “Onion skin” field loss seen in:
A. Chiasmal compression ✅
B. Glaucoma
C. CRAO
D. Papilledema
Exp: Concentric field loss from optic chiasma lesion.
76. Ocular ischemic syndrome due to:
A. Carotid artery stenosis ✅
B. Vertebral stenosis
C. Basilar thrombosis
D. Cavernous sinus thrombosis
Exp: Severe carotid stenosis → chronic hypoperfusion.
77. “Altitudinal field defect” typical of:
A. Anterior ischemic optic neuropathy ✅
B. Glaucoma
C. Chiasmal compression
D. Retinitis
Exp: AION → altitudinal loss.
78. Orbital venous system is:
A. Valveless ✅
B. With valves
C. Completely isolated
D. Independent of cavernous sinus
Exp: Valveless → risk of spread to brain.
79. Which nerve supplies lacrimal gland sensation?
A. Lacrimal nerve (branch of V1) ✅
B. Greater petrosal
C. Facial motor
D. Auriculotemporal
Exp: Sensory by lacrimal (V1).
80. Parasympathetic ganglion for eye:
A. Ciliary ganglion ✅
B. Pterygopalatine ganglion
C. Otic ganglion
D. Submandibular ganglion
Exp: Ciliary ganglion parasympathetic to sphincter & ciliary muscle.
