I am Dr. Naeem Munir from Pakistan. I am currently working in Saudi Arabia. I
appeared in FRCS Muscat in December 2008. This was my 1st attempt and
ALHAMADULILLAH, I passed with the grace of God. I dedicate my success to prayers
of my mother, wife, children (Maham, Amal and Abdullah) and my patients. It will
be unfair if I do not acknowledge the support and guidance extended to me by my
consultant Dr. Abdul Rehman Gaber Sulman whenever it was needed.
In this exam, one needs to complete all the course at least a month before
examination date. In the last days before the exam, one must practice for
problem solving papers, MCQ’s, viva questions and concentrate more on clinical
skill as all these will be required in the examination.
The books which I studied thoroughly were:
- Willis Eye Manual
- Wong (only encircled topics for management of clinical problems)
- Oxford hand book of Medicine
- American Academy of ophthalmology systemic disease section.
Chua page is very important and goldmine for practicing for the exam. after
reading all books. Past candidate experiences must be read because they modify
your approach towards exam.
Now I would narrate my experience
DAY 1 (30th November 2008)
First, the theory paper.
Two hours are given, it is better to formulate a plan for each question before
starting writing the answers. A key for each question is mandatory
Q1. A 40 years old lady is seen at your clinic with a history of intermittent
pain, redness and watering in the left eye for 6 months, occurring particularly
at night. During the last attack 5 days ago, the vision in the eye had become
blurred and she had been aware of colored haloes. On examination acuities were
6/6 with refraction and both eyes were quiet with normal IOPs.
What are the possible different diagnosis and how would you investigate and
treat this patient ?
Q2. A 25 year old female patient is myopic and has always had reduced vision in
the left eye. Her best corrected VA is 6/6 right with -4.00 DS and 6/60 left
with -7.00DS. She usually only wears a soft contact lens in her right eye. Two
days before her wedding she is referred to your clinic with pain and redness in
her right eye and an obvious corneal opacity.
How would you investigate and manage this case ?
One thing important about answer was that after all management options, if it
turned out to be microbial keratitis, wedding must be delayed after consulting
with parents and patient as the problem was in the better eye of the patient
Q3. A 75 years old lady who is a carer for her invalid husband presents with
sudden loss of vision in the right eye, with the left having been poor for many
years. On examination acuities are counting fingers left and 6/60 right and she
has a macular BRVO in the right eye. On left side there is a dense cataract.
What are the possible treatment options for this patient and how should she be
Important thing was to refer this patient to Social Services after all treatment
MCQ paper -60 MCQs (5 stems each) in 2 hours
I attempted 190 stems in the 1st go and extended it to 210 in the revision.
I had my viva the very next day which was a good thing.
Pathology and ophthalmic surgery British examiner & An Arabic
After introduction he showed me a slide of involutional entropion. He asked
about diagnosis, pathophysiology, and management. Steps of Weis procedure and
sutures used during surgery. How much time vicryl takes to get absorbed. Then he
showed me another slide of pseudo exfoliation. Asked about risks associated with
it during surgery. He asked also what difficulties a surgeon can come across
during cataract surgery in this case. He was interested in the management of
meiosis and zonulodialysis. He asked how I will deal with meiosis and
zonulodialysis. also asked about complications of trabeculactomy during and
after surgery. He was interested in suprachoroidal hemorrhage. He also asked
about bleb failure and its management. Role of antimetabolites in glaucoma
surgery. Bell rang.
He started with phacoemulsification. He asked how would you manage if PC is
ruptured before nucleus is cracked and after it is cracked. Management of
dislocated nucleus in the vitreous. Various options for IOL implantation in this
case. Complication of AC IOL. Then he asked me the pathology of chalazion,
showed me a slide of BCC. And last he asked how you do vitrevtomy while doing
phaco. Bell rang I answered all questions and I was happy.
Ophthalmic Medicine Best viva I have ever come across.
1st Examiner – A British Lady
She was an expressionless lady. She showed me a laptop picture of papilloedema.
Asked about its causes , how would you manage this case. She was interested to
hear about malignant hypertension and pseudo tumour cerebri. Then showed me a
photograph of buried drusens. Asked about it and different ocular associations
with it. Then another photograph of right eye esotropia with cataract of a child
of 3-4 years old. Asked about D/D, management of unilateral congenital cataract
in detail, D/D of leucocoria.
2nd examiner - An Indian Dr. Khalid Sharif
He started with corneal manifestation of HSV. He asked details of disciform
keratitus. How to treat it. Then he asked how you will treat it if patient
refuses steroids. He asked about Lotemax. Next question was vortex keratopathy,
causes. Then he asked if patient is using tablet amiadrone, would you stop the
medicine. Next he inquired about indication of cyclosporine in ophthalmology.
Also asked about AMD, use of anti VEGF and its dosage and complications.
Bell rang. I didn’t drop any question. I was happy and sensing to go to
General Medicine And Neuro-ophthalmology
1st Examiner Dr Gupta
He started with causes of vertical diplopia, which diplopia can recover
spontaneously, management of restrictive myopathy due to TED. How and when to
use otolinum toxin and its complications. He showed a projected slide of a
patch of choroiditis. Asked about D/D , started discussion on tuberculous
choroiditis, drugs used for ocular T.B, their side effects and details of visual
field defects caused by them. Also asked about other causes of centrocecal
scotoma. Then he inquired about Leber's optic neuropathy, its mode of
inheritance. He also asked about different ocular manifestations due to
deficiency of different vitamins. Bell rang.
2nd Examiner Dr Maedi
He was a difficult examiner. He started with emergency treatment of pulmonary
oedema, its signs and symptoms, causes. He was interested in nearly all causes.
Then he asked about hyperosmolar hyperglycemic non ketotic acidosis, its
management. Next a strange question for me. What is metabolic disease. Next
question was about management of pneumonia, its causative organism and its
complications. I was not satisfied with my answers. Then he asked my favourite
question, complications of steroids. I gave detailed answer. I narrated systemic
and ocular complications. Then he asked about management of osteoporosis. Lastly
he inquired about indications of steroids for systemic and ocular diseases. Bell
Clinical Examination (Third day 03-12-2008)
I was given 36 minutes and I saw 7 patients in this time. I was quick in picking
up findings and telling to the examiners at the same time to save time. I was
dealing with patients in Arabic Language, so it also saved time.
A British examiner and An Indian Examiner
Examine left eye of a young girl on slit lamp. She had PKP. I told all positive
findings. He asked what will you see in this case. I said sings of rejection.
Asked about sings of rejection, then asked how old PKP. I said more than a year
as all sutures were out. Asked about refraction in such cases and its
management. Then asked me to see the other eye. She had keratoconus. I told him
about Vogt’s lines, deep AC, apical protrusion etc., He asked about other signs
of keratoconus away from slit lamp. I told him oil drop reflex sign on
ophthalmoscope, scissor reflex on retinoscope. He asked me to demonstrate oil
ropd reflex test and Munson sign. In the end he asked about keratometry readings
for mild, moderate & severe keratoconus.
A young patient had left Duan retraction syndrome. It was type 1. I was asked to
check the ocular motility. I asked the examiner that I would like to start with
cover, uncover test. He said no need. I did ocular motility examination. I told
my findings, I gave my diagnosis. He asked why Duan’s. I said due to retraction
of globe in adduction. He asked mechanism of retraction and about management of
this case. Patient was orthophoric in primary position. So I said refraction.
Examination left eye of an old man with +90D. Patient had optic atrophy with
monocular RPE disturbance. Examiner asked is it glaucomatous. I said it does not
seem to be glaucomatous even then I will like to examine the other eye. He said
go ahead. I examined the other eye. I told that as other eye has normal cup,
neuroretinal rim so left eye has optic atrophy which is not glaucomatous. He
asked what can be the cause I said in this age group ischaemic optic
atrophy(common cause), optic neuritis, compressive optic neuropathy etc. He said
how will you manage this patient. I started with history etc. He said any
investigations, I said ESR to rule out GCA and other investigations . He was
An old lady for slit lamp examination of right eye. She had many findings. I
first examined her on chair for a second than took her for slit lamp
examination. She had dermatochalasis, trichiasis, entropion trachomatous
conjunctival scarring and diffuse stormed corneal opacities, aphakia,
iridodonesis, PI at 2’O clock ( It was difficult to see beneath the hazy
cornea). Examiner asked about the level of corneal opacities. I said stromal,
then he asked why aphakia. I said due to diffuse corneal opacities, It was not
possible for surgeon to manage ECCE or phaco. Examiner was happy.
Then he asked me to see left eye also she had PKP, aphakia, vitreous in AC,
peaked pupil. The he asked what corneal opacities may be in right eye. I said
corneal dystrophy which type, I said macular dystrophy asked bout inheritance
pattern and the age where PkP is needed usually.
A young man sitting on chair. I was asked to see fundus of left eye with
ophthalmoscope, I asked sister in the room to dim the light and examined the
fundus. He had macular pigmentary disturbance at fovea, I said, I would like to
see with + 90D, examiner said OK. I saw with 90D on slit lamp and asked to see
the other eye also. Examiner happy and allowed. The other eye was normal but
pupil was pharmacologically dilated. I gave D/D but stressed on post CSR fundus.
Examiner asked how will you proceed. I said FFA, asked about different patterns
on FFA. I answered smoke stack, ink blot then he asked me the indications of
laser treatment in CSR. I answered.
A young boy for slit lamp examination of left eye. He had trauma to left eye
with many finding. He had corneal repair with 10/0 nylon, entry wound in iris at
3,o clock, irregular pupil, Big PC defect, anterior hyaloid phase broken, limbal
sutures also. I was asked how old the surgery. I said less then six weak. Why, I
said corneal sutures are still present. He ased which repair has been done. I
said primary. How will you mange this case. I said as there is no PC and already
corneal injury, I will like to go for scleral fixation of PC IOL
Cover uncover test of a young patient. He was wearing glasses. I checked glasses
( Myopic astigmatism ), He had alternate esotropia of 21degrees. No A/V pattern.
He asked how will you measure I said with prisms. He asked about possible
refractive error. I said myopia, he asked which glasses he is wearing I said
myopic astigmatism more on left side. Knock came on the door, time was up and I
was smelling success in the exam.
Result was announced in the evening .
Thanks to Almighty Allah, I passed, I wish god luck in next exam. for all. I
will be happy to help anyone who is interested. My Email is