Ophthalmic Surgical Assistant Exam 2026/2027
Actual Exam - Complete Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Total Questions: 130
Section Distribution:
• Section 1: Intra-operative Assistance (32 questions) — 25%
• Section 2: Ocular Anatomy and Physiology (26 questions) — 20%
• Section 3: Surgical Instrumentation (20 questions) — 15%
• Section 4: Pre-operative Procedures (20 questions) — 15%
• Section 5: Post-operative Care (20 questions) — 15%
• Section 6: Sterile Technique and Infection Control (12 questions) — 10%
SECTION 1: INTRA-OPERATIVE ASSISTANCE
(32 Questions — Scenario-Based Surgical Support)
Q1: During phacoemulsification cataract surgery, the surgeon is about to perform capsulorhexis
and requests an instrument to create a continuous circular tear in the anterior capsule. Which
instrument should the surgical assistant pass to the surgeon?
A. Keratome
B. Cystotome or bent needle
C. Phaco handpiece
D. Lens loop
Correct Answer: B [CORRECT]
Rationale: Capsulorhexis requires a sharp instrument to create and control a circular tear in the
anterior capsule. Option B is correct because a cystotome (or a bent needle on a syringe) is
,specifically designed for this purpose, allowing precise control of the tear direction. Option A
(keratome) is incorrect; it is used for creating the initial corneal incision. Option C (phaco
handpiece) is incorrect; it is used later for emulsifying the lens nucleus. Option D (lens loop) is
incorrect; it is used for delivering the lens nucleus in extracapsular cataract extraction (ECCE),
not for capsulorhexis.
Q2: The surgeon performing vitrectomy requests assistance maintaining visualization. The
surgical assistant notices the cornea is becoming cloudy. What is the most appropriate
immediate action?
A. Apply balanced salt solution (BSS) to the corneal surface
B. Increase the infusion pressure significantly
C. Request the surgeon stop the procedure immediately
D. Apply viscous coupling gel to the contact lens
Correct Answer: A [CORRECT]
Rationale: Corneal clarity is essential for visualization during vitrectomy. Option A is correct
because applying BSS maintains corneal hydration and clarity, which is a routine supportive
action during prolonged procedures. Option B is incorrect; increasing infusion pressure could
cause complications such as suprachoroidal hemorrhage. Option C is incorrect; corneal clouding
is manageable without stopping the procedure. Option D is incorrect; while coupling gel may be
used with certain contact lenses, it does not address corneal dehydration.
Q3: During femtosecond laser-assisted cataract surgery (FLACS), the patient interface has been
docked successfully. The surgical assistant notices the patient is moving their head. What is the
most critical action?
A. Continue the procedure as the laser will auto-compensate
B. Alert the surgeon immediately to abort the laser treatment
C. Administer additional topical anesthesia
D. Increase verbal reassurance without interrupting
Correct Answer: B [CORRECT]
Rationale: Patient movement during femtosecond laser treatment can result in incomplete or
misaligned capsulotomy, corneal incisions, or lens fragmentation patterns. Option B is correct
because immediate communication with the surgeon is essential to prevent complications; the
laser should be aborted until patient stability is achieved. Option A is incorrect; modern lasers
,have tracking but significant head movement exceeds safety parameters. Option C is incorrect;
while anesthesia may help, the immediate priority is stopping the procedure. Option D is
incorrect; continuing without intervention risks serious complications.
Q4: The surgeon performing trabeculectomy requests the surgical assistant to prepare the
antimetabolite for intraoperative use. Which medication is most commonly used and requires
careful handling due to its cytotoxic properties?
A. Balanced salt solution (BSS)
B. Mitomycin-C (MMC)
C. Tropicamide 1%
D. Lidocaine 2%
Correct Answer: B [CORRECT]
Rationale: Antimetabolites are used in glaucoma filtration surgery to prevent excessive scarring
and improve surgical success. Option B is correct because Mitomycin-C (MMC) is the most
commonly used antimetabolite in trabeculectomy; it requires careful handling with gloves and
dedicated instruments due to its cytotoxic properties. Option A (BSS) is incorrect; it is an
irrigating solution with no antimetabolite properties. Option C (tropicamide) is incorrect; it is a
mydriatic agent for pupil dilation. Option D (lidocaine) is incorrect; it is a local anesthetic.
Q5: During phacoemulsification, sudden shallowing of the anterior chamber occurs with iris
prolapse through the main incision. What is the most likely cause the surgical assistant should
recognize?
A. Adequate viscoelastic in the anterior chamber
B. Positive posterior pressure or expulsive hemorrhage
C. Proper wound construction
D. Normal surgical progression
Correct Answer: B [CORRECT]
Rationale: Sudden anterior chamber shallowing with iris prolapse indicates a serious
intraoperative complication. Option B is correct because positive posterior pressure (from
retrobulbar hemorrhage, patient straining, or expulsive suprachoroidal hemorrhage) pushes
ocular contents forward, causing chamber collapse and iris prolapse. Option A is incorrect;
adequate viscoelastic would maintain chamber depth. Option C is incorrect; proper wound
, construction would prevent prolapse. Option D is incorrect; this is not normal progression and
requires immediate intervention.
Q6: The surgeon requests an intraocular lens (IOL) for implantation. The surgical assistant
should verify all of the following EXCEPT:
A. IOL power matches the surgical plan
B. IOL model corresponds to surgeon preference
C. IOL expiration date is valid
D. Patient's insurance coverage for the specific IOL
Correct Answer: D [CORRECT]
Rationale: IOL verification is a critical patient safety step. Options A, B, and C are all correct
verification steps—power must match calculations, model must match surgeon's selection, and
expiration must be valid. Option D is correct as the exception because insurance verification is
an administrative function performed preoperatively, not an intraoperative responsibility of the
surgical assistant. The surgical assistant focuses on clinical and technical aspects during surgery.
Q7: During strabismus surgery, the surgeon is isolating the lateral rectus muscle. The surgical
assistant should anticipate the need for which instrument?
A. Phaco handpiece
B. Muscle hook
C. A-scan probe
D. Cystotome
Correct Answer: B [CORRECT]
Rationale: Strabismus surgery requires specialized instruments for extraocular muscle
manipulation. Option B is correct because muscle hooks are specifically designed to isolate,
elevate, and manipulate extraocular muscles during strabismus procedures. Option A (phaco
handpiece) is incorrect; it is used in cataract surgery. Option C (A-scan probe) is incorrect; it is
used for preoperative biometry. Option D (cystotome) is incorrect; it is used for capsulorhexis in
cataract surgery.
Q8: The surgeon performing pars plana vitrectomy (PPV) notes vitreous hemorrhage obscuring
the view. Which of the following should the surgical assistant have readily available?
Actual Exam - Complete Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Total Questions: 130
Section Distribution:
• Section 1: Intra-operative Assistance (32 questions) — 25%
• Section 2: Ocular Anatomy and Physiology (26 questions) — 20%
• Section 3: Surgical Instrumentation (20 questions) — 15%
• Section 4: Pre-operative Procedures (20 questions) — 15%
• Section 5: Post-operative Care (20 questions) — 15%
• Section 6: Sterile Technique and Infection Control (12 questions) — 10%
SECTION 1: INTRA-OPERATIVE ASSISTANCE
(32 Questions — Scenario-Based Surgical Support)
Q1: During phacoemulsification cataract surgery, the surgeon is about to perform capsulorhexis
and requests an instrument to create a continuous circular tear in the anterior capsule. Which
instrument should the surgical assistant pass to the surgeon?
A. Keratome
B. Cystotome or bent needle
C. Phaco handpiece
D. Lens loop
Correct Answer: B [CORRECT]
Rationale: Capsulorhexis requires a sharp instrument to create and control a circular tear in the
anterior capsule. Option B is correct because a cystotome (or a bent needle on a syringe) is
,specifically designed for this purpose, allowing precise control of the tear direction. Option A
(keratome) is incorrect; it is used for creating the initial corneal incision. Option C (phaco
handpiece) is incorrect; it is used later for emulsifying the lens nucleus. Option D (lens loop) is
incorrect; it is used for delivering the lens nucleus in extracapsular cataract extraction (ECCE),
not for capsulorhexis.
Q2: The surgeon performing vitrectomy requests assistance maintaining visualization. The
surgical assistant notices the cornea is becoming cloudy. What is the most appropriate
immediate action?
A. Apply balanced salt solution (BSS) to the corneal surface
B. Increase the infusion pressure significantly
C. Request the surgeon stop the procedure immediately
D. Apply viscous coupling gel to the contact lens
Correct Answer: A [CORRECT]
Rationale: Corneal clarity is essential for visualization during vitrectomy. Option A is correct
because applying BSS maintains corneal hydration and clarity, which is a routine supportive
action during prolonged procedures. Option B is incorrect; increasing infusion pressure could
cause complications such as suprachoroidal hemorrhage. Option C is incorrect; corneal clouding
is manageable without stopping the procedure. Option D is incorrect; while coupling gel may be
used with certain contact lenses, it does not address corneal dehydration.
Q3: During femtosecond laser-assisted cataract surgery (FLACS), the patient interface has been
docked successfully. The surgical assistant notices the patient is moving their head. What is the
most critical action?
A. Continue the procedure as the laser will auto-compensate
B. Alert the surgeon immediately to abort the laser treatment
C. Administer additional topical anesthesia
D. Increase verbal reassurance without interrupting
Correct Answer: B [CORRECT]
Rationale: Patient movement during femtosecond laser treatment can result in incomplete or
misaligned capsulotomy, corneal incisions, or lens fragmentation patterns. Option B is correct
because immediate communication with the surgeon is essential to prevent complications; the
laser should be aborted until patient stability is achieved. Option A is incorrect; modern lasers
,have tracking but significant head movement exceeds safety parameters. Option C is incorrect;
while anesthesia may help, the immediate priority is stopping the procedure. Option D is
incorrect; continuing without intervention risks serious complications.
Q4: The surgeon performing trabeculectomy requests the surgical assistant to prepare the
antimetabolite for intraoperative use. Which medication is most commonly used and requires
careful handling due to its cytotoxic properties?
A. Balanced salt solution (BSS)
B. Mitomycin-C (MMC)
C. Tropicamide 1%
D. Lidocaine 2%
Correct Answer: B [CORRECT]
Rationale: Antimetabolites are used in glaucoma filtration surgery to prevent excessive scarring
and improve surgical success. Option B is correct because Mitomycin-C (MMC) is the most
commonly used antimetabolite in trabeculectomy; it requires careful handling with gloves and
dedicated instruments due to its cytotoxic properties. Option A (BSS) is incorrect; it is an
irrigating solution with no antimetabolite properties. Option C (tropicamide) is incorrect; it is a
mydriatic agent for pupil dilation. Option D (lidocaine) is incorrect; it is a local anesthetic.
Q5: During phacoemulsification, sudden shallowing of the anterior chamber occurs with iris
prolapse through the main incision. What is the most likely cause the surgical assistant should
recognize?
A. Adequate viscoelastic in the anterior chamber
B. Positive posterior pressure or expulsive hemorrhage
C. Proper wound construction
D. Normal surgical progression
Correct Answer: B [CORRECT]
Rationale: Sudden anterior chamber shallowing with iris prolapse indicates a serious
intraoperative complication. Option B is correct because positive posterior pressure (from
retrobulbar hemorrhage, patient straining, or expulsive suprachoroidal hemorrhage) pushes
ocular contents forward, causing chamber collapse and iris prolapse. Option A is incorrect;
adequate viscoelastic would maintain chamber depth. Option C is incorrect; proper wound
, construction would prevent prolapse. Option D is incorrect; this is not normal progression and
requires immediate intervention.
Q6: The surgeon requests an intraocular lens (IOL) for implantation. The surgical assistant
should verify all of the following EXCEPT:
A. IOL power matches the surgical plan
B. IOL model corresponds to surgeon preference
C. IOL expiration date is valid
D. Patient's insurance coverage for the specific IOL
Correct Answer: D [CORRECT]
Rationale: IOL verification is a critical patient safety step. Options A, B, and C are all correct
verification steps—power must match calculations, model must match surgeon's selection, and
expiration must be valid. Option D is correct as the exception because insurance verification is
an administrative function performed preoperatively, not an intraoperative responsibility of the
surgical assistant. The surgical assistant focuses on clinical and technical aspects during surgery.
Q7: During strabismus surgery, the surgeon is isolating the lateral rectus muscle. The surgical
assistant should anticipate the need for which instrument?
A. Phaco handpiece
B. Muscle hook
C. A-scan probe
D. Cystotome
Correct Answer: B [CORRECT]
Rationale: Strabismus surgery requires specialized instruments for extraocular muscle
manipulation. Option B is correct because muscle hooks are specifically designed to isolate,
elevate, and manipulate extraocular muscles during strabismus procedures. Option A (phaco
handpiece) is incorrect; it is used in cataract surgery. Option C (A-scan probe) is incorrect; it is
used for preoperative biometry. Option D (cystotome) is incorrect; it is used for capsulorhexis in
cataract surgery.
Q8: The surgeon performing pars plana vitrectomy (PPV) notes vitreous hemorrhage obscuring
the view. Which of the following should the surgical assistant have readily available?
