From managing chronic conditions like glaucoma to advising on self-care for dry eye or allergic conjunctivitis, ophthalmic care is a frequent and vital component of pharmacy practice. A pharmacist’s expertise in pharmacology, patient counseling on proper administration techniques, and the ability to triage conditions is essential for preserving vision and ensuring patient safety. This quiz for PharmD students will test your knowledge of the pathophysiology, treatment, and patient education principles for common eye conditions.
1. The primary therapeutic goal in the treatment of open-angle glaucoma is to:
- Cure the disease.
- Improve the patient’s visual acuity.
- Reduce intraocular pressure (IOP).
- Treat the inflammation of the optic nerve.
Answer: Reduce intraocular pressure (IOP).
2. What is the first-line pharmacologic class for treating open-angle glaucoma?
- Beta-blockers
- Prostaglandin analogs
- Alpha-adrenergic agonists
- Carbonic anhydrase inhibitors
Answer: Prostaglandin analogs
3. The primary mechanism of action of prostaglandin analogs like latanoprost is to:
- Decrease the production of aqueous humor.
- Increase the uveoscleral outflow of aqueous humor.
- Act as a miotic to pull the iris away from the trabecular meshwork.
- Block the effects of catecholamines on the ciliary body.
Answer: Increase the uveoscleral outflow of aqueous humor.
4. A unique and often permanent side effect that a pharmacist should counsel a patient on when starting a prostaglandin analog is:
- A change in iris color (darkening).
- Sedation.
- A dry cough.
- A metallic taste.
Answer: A change in iris color (darkening).
5. Ophthalmic beta-blockers like timolol lower IOP by:
- Increasing the outflow of aqueous humor.
- Decreasing the production of aqueous humor by the ciliary body.
- Constricting the pupil.
- Paralyzing the ciliary muscle.
Answer: Decreasing the production of aqueous humor by the ciliary body.
6. A patient with which of the following conditions should use a non-selective ophthalmic beta-blocker with caution due to the risk of systemic absorption?
- Hypertension
- Diabetes
- Asthma or COPD
- High cholesterol
Answer: Asthma or COPD
7. A patient presents with a red, watery eye with a gritty sensation. They report that the other eye was red a few days ago. This is most characteristic of:
- Allergic conjunctivitis
- Bacterial conjunctivitis
- Viral conjunctivitis
- Angle-closure glaucoma
Answer: Viral conjunctivitis
8. A child presents with red eyes and a thick, yellow, purulent discharge that causes their eyelids to be matted shut in the morning. This is most characteristic of:
- Allergic conjunctivitis
- Bacterial conjunctivitis
- Viral conjunctivitis
- Dry eye disease
Answer: Bacterial conjunctivitis
9. A patient complains of intensely itchy, red, and watery eyes that occur every spring. The first-line OTC recommendation for this condition, allergic conjunctivitis, would be:
- A topical antibiotic.
- A topical decongestant like naphazoline.
- An ophthalmic antihistamine/mast cell stabilizer like ketotifen.
- Artificial tears.
Answer: An ophthalmic antihistamine/mast cell stabilizer like ketotifen.
10. A key counseling point for the proper administration of an eye drop is to:
- Instill the drop directly onto the center of the cornea.
- Pull down the lower eyelid to form a pocket and instill the drop there.
- Blink rapidly immediately after instilling the drop.
- Touch the tip of the bottle to the eye to ensure the drop goes in.
Answer: Pull down the lower eyelid to form a pocket and instill the drop there.
11. The technique of “nasolacrimal occlusion” (pressing on the corner of the eye near the nose after instillation) is recommended to:
- Increase the amount of drug absorbed systemically.
- Reduce systemic absorption of the drug and minimize side effects.
- Help the drop spread over the eye.
- Prevent the eye from watering.
Answer: Reduce systemic absorption of the drug and minimize side effects.
12. If a patient needs to instill more than one type of eye drop, how long should they wait between each drop?
- No waiting period is necessary.
- At least 30 seconds.
- At least 5 minutes.
- At least 30 minutes.
Answer: At least 5 minutes.
13. A patient is prescribed both an ophthalmic solution and an ophthalmic ointment. What is the correct order of administration?
- The ointment should be administered first, followed by the solution.
- The solution should be administered first, followed by the ointment.
- The order does not matter.
- They should be mixed together and administered at the same time.
Answer: The solution should be administered first, followed by the ointment.
14. The primary goal of treatment for dry eye disease (keratoconjunctivitis sicca) is to:
- Cure the underlying cause.
- Provide symptomatic relief and maintain the health of the cornea.
- Constrict the pupil.
- Reduce intraocular pressure.
Answer: Provide symptomatic relief and maintain the health of the cornea.
15. A first-line recommendation for a patient with mild dry eye would be:
- A prescription for cyclosporine.
- A high-viscosity artificial tears product.
- A low-viscosity artificial tears product used as needed.
- A topical antibiotic.
Answer: A low-viscosity artificial tears product used as needed.
16. The pharmacist should be aware that many ophthalmic solutions contain the preservative benzalkonium chloride (BAK), which can be irritating and can be absorbed by:
- Hard contact lenses.
- Soft contact lenses.
- The cornea.
- The sclera.
Answer: Soft contact lenses.
17. Which of the following is an “alarm symptom” for an eye condition that requires immediate referral to a physician or ophthalmologist?
- Mild, intermittent itching.
- A small amount of watery discharge.
- Sudden, painless loss of vision.
- Mild redness in one eye.
Answer: Sudden, painless loss of vision.
18. The “dry” form of Age-Related Macular Degeneration (AMD) is characterized by the presence of drusen. A key pharmacist intervention is to recommend:
- A prescription for a VEGF inhibitor.
- Laser therapy.
- An over-the-counter AREDS or AREDS2 formulation vitamin.
- A daily aspirin.
Answer: An over-the-counter AREDS or AREDS2 formulation vitamin.
19. The “wet” form of AMD is treated with:
- Oral antibiotics.
- Intravitreal injections of a VEGF inhibitor like ranibizumab or bevacizumab.
- High-dose oral corticosteroids.
- A topical beta-blocker.
Answer: Intravitreal injections of a VEGF inhibitor like ranibizumab or bevacizumab.
20. A “stye” or hordeolum is a small, painful lump on the eyelid. The primary self-care treatment is:
- Applying a topical antibiotic.
- Applying warm compresses to the area.
- Squeezing the lump to drain it.
- Using an ophthalmic decongestant.
Answer: Applying warm compresses to the area.
21. Blepharitis is a chronic inflammation of the eyelids. The cornerstone of management is:
- Long-term oral antibiotic therapy.
- Good eyelid hygiene, including warm compresses and gentle scrubbing.
- The use of a topical prostaglandin analog.
- A prescription for an antiviral agent.
Answer: Good eyelid hygiene, including warm compresses and gentle scrubbing.
22. A patient comes to the pharmacy after splashing a chemical in their eye. The most important first response is to:
- Immediately and copiously irrigate the eye with water or sterile saline for at least 15 minutes.
- Cover the eye with a patch and send them to the ER.
- Instill an ophthalmic antibiotic.
- Instill a topical anesthetic.
Answer: Immediately and copiously irrigate the eye with water or sterile saline for at least 15 minutes.
23. The alpha-2 adrenergic agonist brimonidine lowers IOP by:
- Decreasing aqueous humor production and increasing uveoscleral outflow.
- Increasing trabecular meshwork outflow only.
- Decreasing aqueous humor production only.
- Constricting the pupil.
Answer: Decreasing aqueous humor production and increasing uveoscleral outflow.
24. A key counseling point for a patient using an ophthalmic suspension is:
- To instill the drop without shaking the bottle.
- To shake the bottle well before each use.
- That the drop will be clear like water.
- To store it in the freezer.
Answer: To shake the bottle well before each use.
25. A pharmacist providing MTM for a geriatric patient should be aware that which class of oral medications can worsen dry eye?
- Statins
- ACE inhibitors
- Anticholinergics (e.g., first-generation antihistamines, TCAs)
- Metformin
Answer: Anticholinergics (e.g., first-generation antihistamines, TCAs)
26. Which of the following is a sign of acute angle-closure glaucoma, a medical emergency?
- Mild, bilateral itching.
- Gradual, painless loss of peripheral vision.
- Severe unilateral eye pain, headache, and seeing halos around lights.
- A gritty sensation in the eye.
Answer: Severe unilateral eye pain, headache, and seeing halos around lights.
27. The primary principle of sterility for ophthalmic products is to:
- Prevent microbial contamination that could cause a serious eye infection.
- Ensure the product is at the correct pH.
- Improve the product’s shelf life.
- Make the product more effective.
Answer: Prevent microbial contamination that could cause a serious eye infection.
28. A pharmacist using the SCHOLAR-MAC method to assess a patient with a red eye is practicing a key part of:
- The patient care process for self-care.
- The dispensing process.
- The billing process.
- The inventory management process.
Answer: The patient care process for self-care.
29. The use of a topical NSAID, like ketorolac eye drops, is indicated for:
- The treatment of glaucoma.
- The management of pain and inflammation after cataract surgery.
- The treatment of bacterial conjunctivitis.
- The prevention of AMD.
Answer: The management of pain and inflammation after cataract surgery.
30. The ultimate goal of ophthalmic pharmacotherapy is to:
- Use the most expensive medications available.
- Preserve vision and improve the patient’s quality of life.
- Ensure the patient uses eye drops for the rest of their life.
- Eliminate all red eye from the population.
Answer: Preserve vision and improve the patient’s quality of life.
31. A pharmacist’s “geriatric sensitivity” is important when counseling an elderly patient on eye drop administration because:
- The patient may have physical limitations, like arthritis or tremor, that make it difficult.
- All elderly patients have perfect vision.
- Elderly patients do not need to be counseled.
- The cost of eye drops is not a concern for this population.
Answer: The patient may have physical limitations, like arthritis or tremor, that make it difficult.
32. Carbonic anhydrase inhibitors (e.g., dorzolamide) lower IOP by:
- Increasing aqueous humor outflow.
- Decreasing aqueous humor production.
- Constricting the pupil.
- Acting as a prostaglandin analog.
Answer: Decreasing aqueous humor production.
33. In which “practice setting” would a pharmacist be most likely to manage complex, post-operative ophthalmic medication regimens?
- A community pharmacy.
- A hospital or an ambulatory care ophthalmology clinic.
- A mail-order pharmacy.
- A nuclear pharmacy.
Answer: A hospital or an ambulatory care ophthalmology clinic.
34. The “leadership” skill of advocacy is demonstrated when a pharmacist:
- Convinces an insurance company to cover a medically necessary glaucoma medication.
- Insists all glaucoma patients use the same eye drop.
- Refuses to counsel any patient on eye drop use.
- Only dispenses brand-name eye drops.
Answer: Convinces an insurance company to cover a medically necessary glaucoma medication.
35. A “business plan” for a new dry eye service would need to include:
- An analysis of the target market (e.g., elderly patients, contact lens wearers).
- A description of the services offered (e.g., patient education, product selection).
- A financial plan for the service.
- All of the above.
Answer: All of the above.
36. A “human factors” approach to ophthalmic medications would consider:
- The design of the eye drop bottle to make it easier for a person with arthritis to squeeze.
- The color of the medication box.
- The price of the medication.
- The name of the manufacturer.
Answer: The design of the eye drop bottle to make it easier for a person with arthritis to squeeze.
37. The service of “deprescribing” might be considered for a patient on a medication known to cause dry eye if:
- The medication is essential for a life-threatening condition.
- The dry eye is mild and easily managed.
- The risk of the dry eye outweighs the benefit of the systemic medication.
- The patient has no other medical conditions.
Answer: The risk of the dry eye outweighs the benefit of the systemic medication.
38. The use of a “negotiation” framework could be helpful when:
- A pharmacist is discussing with a patient the importance of adherence to their glaucoma regimen despite cosmetic side effects.
- A patient is picking up a routine refill.
- A pharmacist is ringing up a sale.
- A pharmacist is checking in a medication order.
Answer: A pharmacist is discussing with a patient the importance of adherence to their glaucoma regimen despite cosmetic side effects.
39. A “forging ahead” mindset in pharmacy means viewing common eye conditions as:
- An opportunity to expand clinical services and improve public health.
- A simple dispensing function.
- A problem for ophthalmologists only.
- A low-priority area of practice.
Answer: An opportunity to expand clinical services and improve public health.
40. The use of an “Electronic Health Record” (EHR) improves ophthalmic care by:
- Providing a clear record of a patient’s IOP trends over time.
- Alerting a prescriber to a documented allergy to an eye drop preservative.
- Facilitating referrals between primary care and ophthalmology.
- All of the above.
Answer: All of the above.
41. From a “financials” perspective, the high cost of some new ophthalmic medications (like those for wet AMD) is a major driver for:
- Increased use of these agents.
- The need for pharmacists to be involved in formulary management and patient assistance programs.
- A reduction in the number of patients diagnosed with these conditions.
- Insurance companies to cover them without question.
Answer: The need for pharmacists to be involved in formulary management and patient assistance programs.
42. A “policy” that allows pharmacists to administer certain long-acting ophthalmic injections would be an example of:
- A reduction in scope of practice.
- An expansion of scope of practice.
- A common practice in all 50 states.
- A violation of federal law.
Answer: An expansion of scope of practice.
43. A pharmacist’s knowledge of “human resources” is relevant to an ophthalmic service by:
- Ensuring that any technician assisting with the service is properly trained and competent.
- Managing the pharmacy’s budget.
- Marketing the service.
- Designing the physical layout of the pharmacy.
Answer: Ensuring that any technician assisting with the service is properly trained and competent.
44. A key “regulation” for all ophthalmic products is that they must be manufactured as:
- Sterile products.
- Non-sterile products.
- Over-the-counter products.
- Prescription-only products.
Answer: Sterile products.
45. “Patient and caregiver communication” is crucial when:
- An elderly patient with dementia relies on their child to administer their glaucoma eye drops.
- A patient has no questions about their medication.
- A pharmacist is working alone.
- A patient is paying with cash.
Answer: An elderly patient with dementia relies on their child to administer their glaucoma eye drops.
46. A “health disparity” in ophthalmic care would be:
- Lower rates of routine eye exams and poorer outcomes for glaucoma among African American patients compared to White patients.
- All patients having equal access to care.
- A new, effective treatment becoming available.
- A pharmacy offering free vision screenings.
Answer: Lower rates of routine eye exams and poorer outcomes for glaucoma among African American patients compared to White patients.
47. A pharmacist providing care to a patient from a “rural population” should be aware that:
- Access to a local ophthalmologist may be limited, increasing the importance of the pharmacist’s triage role.
- All rural patients have excellent vision.
- Transportation is never a barrier to care in rural areas.
- Rural pharmacies are not allowed to dispense eye drops.
Answer: Access to a local ophthalmologist may be limited, increasing the importance of the pharmacist’s triage role.
48. An “analytics and reporting system” could be used in a health system to:
- Identify all patients with glaucoma who are not adherent to their medication.
- Track the incidence of post-operative eye infections.
- Monitor the use of high-cost VEGF inhibitors.
- All of the above.
Answer: All of the above.
49. “Clinical Decision Support” could be used to:
- Alert a prescriber who is ordering a non-selective beta-blocker eye drop for a patient with a documented history of severe asthma.
- Automatically refill a prescription.
- Schedule a patient’s next appointment.
- Process a patient’s insurance claim.
Answer: Alert a prescriber who is ordering a non-selective beta-blocker eye drop for a patient with a documented history of severe asthma.
50. The most important principle for a pharmacist to remember regarding ophthalmic care is that:
- The eye is a delicate and unique organ, and maintaining patient safety is the highest priority.
- All red eyes are caused by bacterial infections.
- Over-the-counter products are always safe for any eye condition.
- Counseling on administration technique is not necessary.
Answer: The eye is a delicate and unique organ, and maintaining patient safety is the highest priority.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com