“Ophthalmology MCQs on Accommodation, Light Reflex & Pupillary Reflexes (Q1–30) with answers. Learn key concepts like presbyopia, RAPD, Argyll Robertson pupil, Adie’s pupil & Horner’s syndrome.”
1. Accommodation is mediated primarily by:
A. Lens capsule
B. Ciliary muscle
C. Zonules only
D. Iris sphincter
View Answer
B. Ciliary muscle ✅ Exp: Contraction of ciliary muscle relaxes zonules → lens becomes more convex.
2. Near response triad includes:
A. Accommodation, convergence, miosis
B. Accommodation, dilation, convergence
C. Convergence, divergence, miosis
D. Accommodation, cycloplegia, dilation
View Answer
A. Accommodation, convergence, miosis ✅ Exp: Classic triad for near vision.
3. Normal amplitude of accommodation at age 10:
A. 2 D
B. 7 D
C. 14 D
D. 20 D
View Answer
C. 14 D ✅ Exp: Maximal in childhood, declines with age.
4. At age 40, average amplitude of accommodation is:
A. 10 D
B. 6 D
C. 2 D
D. 1 D
View Answer
B. 6 D ✅ Exp: Presbyopia begins as amplitude falls <5 D.
5. Presbyopia occurs due to:
A. Ciliary muscle weakness
B. Lens sclerosis & reduced elasticity
C. Zonular rupture
D. Iris atrophy
View Answer
B. Lens sclerosis & reduced elasticity ✅ Exp: Lens hardens with age.
6. The dioptric demand for reading at 25 cm is:
A. 2 D
B. 3 D
C. 4 D
D. 6 D
View Answer
C. 4 D ✅ Exp: Accommodation = 1/distance in meters (1/0.25 m = 4 D).
7. Accommodation reflex pathway involves:
A. Cortex → Edinger-Westphal nucleus → ciliary ganglion
B. Optic nerve → LGN → lateral rectus
C. Brainstem → superior colliculus → abducens
D. RPE → optic nerve → hypothalamus
View Answer
A. Cortex → Edinger-Westphal nucleus → ciliary ganglion ✅ Exp: Cortical input triggers midbrain nuclei → ciliary ganglion.
8. Cycloplegic drugs abolish accommodation by blocking:
A. Adrenergic receptors
B. Muscarinic receptors
C. Beta receptors
D. NMDA receptors
View Answer
B. Muscarinic receptors ✅ Exp: Atropine, cyclopentolate block muscarinic action in ciliary muscle.
9. Which drug stimulates accommodation?
A. Atropine
B. Pilocarpine
C. Tropicamide
D. Homatropine
View Answer
B. Pilocarpine ✅ Exp: Cholinergic agonist → ciliary contraction.
10. Paralysis of accommodation is called:
A. Cycloplegia
B. Presbyopia
C. Mydriasis
D. Hyperopia
View Answer
A. Cycloplegia ✅ Exp: Due to anticholinergic drugs or CN III palsy.
11. Light reflex pathway begins with:
A. Optic tract
B. Optic nerve → pretectal nucleus
C. Optic chiasm → LGN
D. Edinger-Westphal nucleus
View Answer
B. Optic nerve → pretectal nucleus ✅ Exp: Light input reaches pretectal nucleus.
12. Efferent pathway of light reflex:
A. CN II
B. CN III parasympathetic fibers
C. Sympathetic pathway
D. CN IV
View Answer
B. CN III parasympathetic fibers ✅ Exp: Via Edinger-Westphal → ciliary ganglion → sphincter pupillae.
13. The neurotransmitter at pupillary sphincter is:
A. Acetylcholine
B. Noradrenaline
C. Dopamine
D. Serotonin
View Answer
A. Acetylcholine ✅ Exp: ACh at muscarinic receptors contracts sphincter.
14. Direct light reflex is:
A. Constriction of ipsilateral pupil to light
B. Constriction of contralateral pupil
C. Both pupils constrict equally
D. Dilation of ipsilateral pupil
View Answer
A. Constriction of ipsilateral pupil to light ✅ Exp: Direct response = same eye.
15. Consensual light reflex is:
A. Constriction of contralateral pupil to light
B. Constriction of ipsilateral pupil
C. Both pupils dilate
D. No response
View Answer
A. Constriction of contralateral pupil to light ✅ Exp: Opposite eye constricts via bilateral innervation.
16. Relative afferent pupillary defect (RAPD) is best tested by:
A. Cover test
B. Swinging flashlight test
C. Maddox rod
D. Worth’s test
View Answer
B. Swinging flashlight test ✅ Exp: Detects asymmetric afferent defect.
17. In RAPD, affected eye shows:
A. Paradoxical dilation on light
B. Normal constriction
C. No change
D. Slow constriction
View Answer
A. Paradoxical dilation on light ✅ Exp: Swinging light causes dilation due to weaker afferent signal.
18. Marcus Gunn pupil indicates lesion in:
A. Optic nerve
B. Oculomotor nerve
C. Sympathetic pathway
D. Ciliary ganglion
View Answer
A. Optic nerve ✅ Exp: Afferent pathway defect (optic nerve, retina).
19. Argyll Robertson pupil is associated with:
A. Syphilis
B. Diabetes
C. Glaucoma
D. Optic neuritis
View Answer
A. Syphilis ✅ Exp: Light-near dissociation; classic in neurosyphilis.
20. Light-near dissociation is seen in:
A. Argyll Robertson pupil
B. Adie’s tonic pupil
C. Optic neuritis
D. Both A & B
View Answer
D. Both A & B ✅ Exp: AR pupil (syphilis) and Adie’s pupil show preserved near reflex but absent light reflex.
21. Dark adaptation involves regeneration of:
A. Opsin
B. Rhodopsin
C. Iodopsin
D. Retinol
View Answer
B. Rhodopsin ✅ Exp: Rod pigment regeneration allows night vision.
22. Primary vitamin involved in dark adaptation:
A. Vitamin A
B. Vitamin B1
C. Vitamin C
D. Vitamin D
View Answer
A. Vitamin A ✅ Exp: Retinol → 11-cis-retinal.
23. Time taken for full dark adaptation:
A. 5 min
B. 15–30 min
C. 60 min
D. 2 min
View Answer
Exp: Rod adaptation takes 20–30 minutes.
24. The Purkinje shift during dark adaptation refers to:
A. Shift of spectral sensitivity to shorter wavelengths
B. Shift to longer wavelengths
C. No change
D. Shift in visual field
View Answer
A. Shift of spectral sensitivity to shorter wavelengths ✅ Exp: Rods dominate, peak at 507 nm (blue-green).
25. Light adaptation occurs within:
A. Seconds
B. Minutes
C. Hours
D. Days
View Answer
A. Seconds ✅ Exp: Cones adapt quickly to bright light.
26. Adie’s tonic pupil results from lesion in:
A. Ciliary ganglion
B. Optic nerve
C. Oculomotor nucleus
D. Edinger-Westphal nucleus
View Answer
A. Ciliary ganglion ✅ Exp: Parasympathetic denervation of sphincter.
27. Pupil in Adie’s tonic pupil is:
A. Large, reacts poorly to light, better to near
B. Small, brisk light reflex
C. Large, brisk reflex
D. Mid-dilated, fixed
View Answer
A. Large, reacts poorly to light, better to near ✅ Exp: Classic light-near dissociation.
View Answer
28. Holmes-Adie pupil shows hypersensitivity to:
A. 0.125% pilocarpine
B. Atropine
C. Tropicamide
D. Cocaine
A. 0.125% pilocarpine Exp: Denervated sphincter supersensitive to dilute pilocarpine.
29. Horner’s syndrome triad includes:
A. Miosis, ptosis, anhidrosis
B. Mydriasis, ptosis, sweating
C. Miosis, lid lag, proptosis
D. Ptosis, mydriasis, hyperhidrosis
View Answer
A. Miosis, ptosis, anhidrosis ✅ Exp: Sympathetic lesion → classic triad.
30. Cocaine test for Horner’s syndrome works by:
A. Blocking reuptake of norepinephrine
B. Blocking ACh
C. Blocking dopamine
D. Blocking serotonin
View Answer
A. Blocking reuptake of norepinephrine ✅ Exp: Normal pupil dilates; Horner’s pupil fails to dilate.
