Practical Examination DNB Ophthalmology

Dr. Sameeksha Agrawal Dr. Soumya Podury
1 April 2021 Updated 31 August 2026 7 min read 19 views
Tips & Pearls

The following write-up contains some of the frequently asked topics during the DNB practical examinations. Do keep in mind that this is just a sample, the scope of Ophthalmology is vast and it’s the 3 years effort put in during the course of residency that makes you comfortable to face the examination. It is important to have a thorough knowledge of the frequently asked questions, rather than knowing rare, obscure facts. In the end, it’s all back to basics! Any examiner starts questioning with a basic level of questions that he deems are essential knowledge for the candidate to pass or be qualified as an ophthalmologist, once the candidate clears that level only then does the examiner pose level 2 or level 3, the relatively tough/ rare/ newer questions. This should make clear that in order to clear the examination, level 1 questions MUST and should be answered! And that is what the following literature will focus on mostly.

Exam Pattern:

Most centers usually have:

2 Anterior Segment cases + 2 Posterior Segment Case + 1 Refraction Case =160 marks

Table viva = 140 marks

However, you may even have 2 anterior segments,1 posterior segment, 1 Squint or Oculoplasty case.

For the case presentation, it is important to make it a habit to practice from the beginning and formative years. Every patient you see, make it a point to present the case, even the “simple ones” like refractive errors or cataracts. There should be a flow chart in your mind each time you approach a case. This practice will help not only with improving your fluency and confidence but will also help you with a systematic approach for any case. Specific cases have a very specific proforma of presentation. These must be followed. e.g. ptosis or proptosis, socket exam, squint exam, etc.

Drugs

This forms a part of the table viva. You may be handed over a specific drug or may be asked to choose one from the available drugs. In either case, you must start by mentioning the drug name, it’s concentration, use and mechanism of action. Following is a list of frequently asked groups of drugs and specific drugs for which one must know: Classification and Pharmacological group of the drug , Mechanism of action, Duration of action, Dose, Indication, Contraindication, Uses, Side effects, Pharmacokinetics.

  • Antiglaucoma

  • Antifungal

  • Antibiotic

  • Antiviral

  • Anti-amoebic, Polyhexamethylene biguanide (PHMB) and Chlorhexidine for acanthamoeba keratitis

  • Mydriatics and cycloplegics

  • Lubricants

  • Preservatives

  • Steroids

  • Immunomodulatory drugs

  • NSAID

  • Ketorolac

  • Nepafenac

  • Natamycin

  • Mitomycin C (MMC), 5 fluorouracil (5-FU) (concentration and technique of application)

  • Implant Dexamethasone Sustained Release Device, antivirals and newer sustained drug delivery devices

  • Viscoelastic (triple shell technique)

  • Silicon oil

  • Perfluorocarbon Liquid, C3F8

  • Betadine (concentration of topical solution, scrub solution)

  • Lignocaine and other anesthetics and anesthesia techniques

  • Anti VEGF (Bevacizumab, Ranibizumab)

  • VEGF trap (Aflibercept/Eylea)

Optics:

This perhaps is one of the most interesting and conceptual topics in Ophthalmology. It really is easy to grasp, provided one refers to good textbooks and references for the same. A good idea for beginners would be to cover optics in the first year itself because this is the time when you have enough time on hand to go through standard textbooks rather than cram in the end. For the DNB practical exam following are the FAQs in optics:

Retinoscopy:

  • Principle

  • Working Distance

  • Adjustment For Various Drugs Like Atropine, Cyclopentolate, Tropicamide

  • Transposition, Spherical Equivalents

Refraction:

  • Trial frame, weight, which lens where to keep

  • Trial box how many lenses

  • Prism, plus lens, minus lens –how to identify

  • Concave lens, convex lens, cylinder

  • Convex lens diagnostic use, therapeutic use

  • Jackson cross-cylinder (JCC) uses, refine when to use, how to make a JCC with trial frame lenses

  • Maddox rod, Maddox wing uses

  • Colour vision

  • Worth four dot test

  • Progressive glass, centration

  • Myopia, hyperopia, and astigmatism: definition, types (including Simple myopic astigmatism, mixed, simple hyperopia, etc)

  • PL PR test (Perception of light and Projection of rays)

  • Aberrations (lower and higher-order)

Contact lenses:

  • Types, material, care, lens solution, the making of contact lenses, CL in special cases like keratoconus

Optics of various lenses:

  • 20D, 78D, 90D (correction factors), Gonioscopy, and Gonio lens.

INSTRUMENTS

  • Direct Ophthalmoscope, Indirect Ophthalmoscope – Principle, Magnification, Function

  • Instruments used in Dacryocystectomy (DCT), Dacryocystorhinostomy (DCR), Cataract - Extracapsular cataract extraction(ECCE), Small incision cataract surgery (SICS), Phacoemulsification: know the basics of phacodynamics as well), PKP (Penetrating keratoplasty), squint, ptosis

  • Silicon oil, band, buckle, silicon oil, vitrectomy instruments, forceps, etc

IMAGING

Indication, principle, uses and special signs are seen on specific investigations

  • X-RAY

  • Computed tomography (CT)

  • Magnetic resonance imaging (MRI)

  • Ultrasonography( USG) : B-scan and A-scan

  • Optical coherence tomography (OCT)

  • Fundus Fluorescein Angiography (FFA)

  • Indocyanine angiography(ICG)

  • Heidelberg retinal tomography (HRT)

  • GDx Nerve Fiber Analyzer

  • Ultrasound biomicroscopy (UBM)

  • Anterior segment Optical coherence tomography (ASOCT)

  • Hess chart

  • Diplopia chart

  • Pentacam, Orbscan

  • Corneal Topography

  • PERIMETRY :

  • Definition and description of 30-2, 24-2, 10-2 and their specific utility

  • How to describe fields, reliability indices, global indices (normal values, etc)

  • Specific types of visual field defects ( like central scotoma, centrocecal scotoma, etc)

  • D/D of Tunnel Vision

  • Neurological Field Vs Glaucomatous Field

SURGERIES:

  • Sutures

  • Steps of SICS (small incision cataract surgery) and Phacoemulsification, complication

  • Size of Capsulorrhexis

  • Lens optic size

  • Tunnel size

  • Blumenthal technique

  • Hydro cannula gauze size

  • Squint: Max resection, recession, number of muscles that can be operated upon at a time

  • DCR Anatomy, Diagnostic tests (syringing, probing, etc)

  • Orbital implant

  • Fracture repair (techniques and implants used)

THESIS

  • The aim of the study

  • Type of study, statistical tests employed

  • Highlights and drawbacks of the study

Logbook

Please make sure you carry a neatly covered, well-bound logbook and not loose sheets enclosed in a folder. Your logbook is a reflection of your residency performance and it must not look unkempt.

Miscellaneous

  • Read Colour coding

  • Practice posterior segment diagram of Diabetic retinopathy, Retinal detachment, Branch retinal vein occlusion, central retinal vein occlusion, Choroidal neovascular membrane, Horseshoe tear, operculum, white with and without pressure, etc.

  • Anterior segment cornea case must have a slit diagram.

List of Cases :

CORNEA

  • Ulcer –Bacterial, Fungal, Herpes

  • Healed Viral Keratitis

  • Non-Healing Ulcer

  • Penetrating keratoplasty – Optical Graft, Failed Graft, Therapeutic

  • Descemet stripping endothelial keratoplasty (DSEK ),

  • Deep Anterior Lamellar Keratoplasty (DALK)

  • Keratoconus

  • Peripheral ulcerative keratitis (PUK), Mooren’s Ulcer

  • Pseudophakic bullous keratopathy (PBK)

  • Corneal Opacity, Adherent Leucoma

  • Fuch’s Dystrophy

  • Keratoconus – Acute Hydrops, High Cylinder

  • Iridocorneal Endothelial Syndrome (ICE)Causes Of Iridocorneal Touch, Iridocorneal Dysgenesis

  • Ocular surface squamous neoplasia (OSSN)

  • Corneal Dystrophy

  • Vitamin A Deficiency

LENS

  • Cataract

  • Congenital cataract

  • Ectopia Lentis

  • Posterior capsular opacity (PCO)

  • Spherophakia

UVEA

  • Uveitis – anterior, intermediate, posterior

  • Endophthalmitis

  • Panuveitis

  • Vasculitis, Peripheral Vasculitis

  • Toxoplasma

  • Cytomegalovirus retinitis

  • Choroiditis, multifocal choroiditis

ORBIT

  • Proptosis

  • Thyroid ophthalmopathy,

  • Ptosis

  • Blowout fracture

  • Blunt trauma, penetrating injury

  • Empty socket and contracted socket

  • Read about orbital exenteration, Enucleation, Evisceration, structures removed, Indications, Contraindications

  • Cellulitis

  • Blepharophimosis, ptosis, and epicanthus inversus syndrome

  • Ankyloblepharophimosis

LID

  • Lid Tumour

  • Ectropion

  • Entropion

  • Ptosis

NEURO OPHTHALMOLOGY

  • 3rd Nerve

  • 4th Nerve

  • 6th Nerve

  • 7th Nerve

  • Pale Disc

  • Optic Atrophy

  • Non-arteritic anterior ischemic optic neuropathy (NAAION)

  • Anterior ischemic optic neuropathy (AION)

  • Disc Edema, Papilledema

GLAUCOMA

  • Primary open-angle glaucoma (POAG),

  • Advanced glaucoma

  • Primary angle-closure glaucoma

  • Neovascular glaucoma

  • Pseudoexfoliative glaucoma

  • Pigmentary Glaucoma

  • Patient of Trabeculectomy

  • Secondary glaucoma

RETINA

  • Retinal detachment

  • Vitreous hemorrhage

  • Retinitis pigmentosa

  • Diabetic macular edema

  • Nucleus Drop

  • Dystrophies

VASCULAR DISEASE

  • Central retinal vein occlusion

  • Branch retinal vein occlusion

  • Branch retinal artery occlusion

  • Central retinal artery occlusion

  • Diabetic retinopathy

  • Hypertensive retinopathy

  • Eale’s Disease

  • Sickle cell

  • Macular disorders

  • Age-Related Macular Degeneration – dry, wet

  • CNVM (Choroidal neovascular membrane)

  • Macular hole

  • Central serous retinopathy (CSR)

  • Epiretinal membrane

  • Cystoid macular edema

  • Best disease

LACRIMAL

  • Dacryocystitis

  • Lacrimal apparatus obstruction

  • S/P Dacryocystorhinostomy

SQUINT

  • Exodeviation

  • Esodeviation

  • Duane’s retraction syndrome

  • SO/ IO PALSY (Superior oblique/Inferior oblique palsy)

  • SO/ IO over action (Superior oblique/Inferior oblique overaction)

  • Double elevator palsy

MISCELLANEOUS

  • High Myopia

  • Myasthenia Gravis

  • Symblepharon, Burns

CHECKLIST BEFORE THE EXAM:

  • ADMIT CARD (Seems obvious, but you would be surprised at how many students forget the most obvious!)

  • Pens, Pencils, Color Pencil, Eraser, Sharpener

  • Scale: transparent two long, one small

  • Bangle or compass: to make a fundus diagram, preferable to carry a printed Amsler-Dubois chart as well for the posterior segment case.

  • Retinoscope, Gonioscope

  • 78 D, 90 D, 20 D lens

  • Direct and Indirect ophthalmoscope

  • Paracaine, Moisol (to put on fluorescein strip for doing applanation tonometry), Tropicamide (for dilatation for fundus examination)

  • Torch

  • Thesis

  • Fluorescein strip, cotton

All the best !!