FRCS Glasgow part 3 experience. The Images are taken from internet and not exact images. Reading experience helps you to prepare better and be ready for the exam day. Feel free to contact me if any other information is required. FRCS is about problem solving rather than theoretical knowledge.

1. Dr. Ritesh Verma FRCS
dr_ritesh_verma@dmch.edu, +91-9914432104
Exam FRCS Glasgow Part 3, Sept 2022- New Delhi, India.
I had appeared in FICO exams during my residency (2016-2019) and cleared FICO advanced in Apr-
May 2019. I then started working as a senior resident in retina unit for 1.5 years and was only
focussed on retina. After that I moved to a corporate institute where most my work was phaco
refractive with very little academics. I joined medical college in Jan 2021 then went for training in
oculoplastic surgery. I finished my training in Orbit and Oculoplasty in Dec 2021 and joined back as
Assistant professor in a Medical college from Jan 2022. I was not eligible for FRCS part 3 till June
2022 as per 6-year experience requirement. I was randomly going through the website and registered
for the exam in May. Only after I paid my fee, I started taking the exam very seriously because I was
not prepared.
I had my clinics and OR till 4 pm in the afternoon followed by undergraduate and post graduate
teaching classes. I started to study in my clinics and made sure to teach and revise whatever I read the
last day to the postgraduate students. I felt confident in my clinics and there was a clear positive
change in my decision making and surgical skills as well. I never thought of opportunities or fame
associated with the exam and I was very clear that the sole purpose of giving this exam is to be a
better clinician.
As I had read AAO for my FICO and residency exams I started revising AAO from May. Did
glaucoma, retina, neuro-ophthal and it took a lot of time as it was already August and I had a lot of
subjects to revise. I joined MVUPGO on august 14, only 40 days before my exam. Prof Muthu guided
me to revise kanski and then I finished my remaining subjects from kanski and started revising from
chapter 1. I had to put in some extra hours as I had to finish general medicine as well. My wife is a
physician so I stared discussing respiratory and cardiac cases with her and trust me it takes time to get
a holistic approach from a physician perspective. This general medicine part is the most important
aspect of RCS exams as it is correctly said that “ we are doctors first, ophthalmologist second and
refractive surgeon the third”.
Gen medicine- I did revise a few topics from my notes I made during MBBS. Kept a separate day for
ECG and chest xrays.
I reached the exam centre 1 day prior and revised some important topics. Slept early and had light
breakfast on the day of OSCE exam.
OSCE exam experience- You have a very limited time at 1 station. There are a standard set of
questions from each topic and they expect some specific terms in each answer. One thing I could have

2. improved was to remember important associations like CMV and OSSN with HIV, Thymoma with
myasthenia. Even though I knew these but was not able to recall them in the exam. In the hindsight I
feel that I should have made a table for the important systemic associations.
Important points- 1. Even if you think you don’t like the examiner point of view in a question, stay
humble and accept whatever the examiner is saying. The aim is to pass the exam and not to prove
your point at that time. Don’t lose time.
2. If you think you did something right but the examiner was not expecting it then give a strong
reason for example one of the patients in the neuro clinical station had 7th
nerve palsy, I did palpebral
fissure height and the examiner looked unhappy and asked me why I did that. I answered that there is
mild eyelid retraction because of the loss of orbicularis tone and he smiled.
3. Stay focused and avoid unnecessary interaction during the exam days.
4. Study to be a better clinician. Do and say whatever you will do in a real patient scenario.
5. Practise comprehensive OPD and diagnose cases in each specialty. Try focussing on tests you are
likely to perform in exam.
Station1- posterior segment
1- Corneal injury in farmer sharp object- describe image-
Told that corneal infiltrates with corneal infiltrates? Corneal ulcer with hypopyon
There was no vascularisation
I thought it was corneal ulcer then the examiner eventually got me to foreign body
Case of iofb
How will you manage, investigations, endoph management
Causative organisms
Fortified antibiotics which and when
Hammer nail chisel injury why is different form fungal
Orbital foreign body
What to see on slit lamp

3. Investigations
Although examiner was trying to ask about foreign body, the picture confused with corneal
ulcer. He tried to prompt sterile hypopyon with foreign body?
What are the iris changes?
2- Cmv retinitis
Describe- necrotic retina with hemorhages in the st quadrant
DD- CMV, PORN, ARN, BEhcet
Management of cmv- Iv ganciclovir and Intravitreal ganciclovir
Forgot to mention about aids
Drugs used
Complications
Management of complications- use of silicone oil vs laser
3- CRVO- bad picture- optic disc swelling

4. Describe, risk factors
Management
Young vs old
Crao
Systemic investigations- why esr, forgot to tell blood glucose even though told in risk factors
Types of vein occlusion
Would you invstigate if the patient is hypertensive? Told yes cardiac evauation in older
patients?
features of crao
Prognosticate
Clinical exam
4- No history- clinical picture showing bulls eye with drusens
Told armd
Said this is a young patient
Told flecks- albipunctatus, stargardts, autosomal recessive, abca gene
Lipofuscin deposits, puter retinal pathology
Investigation- oct findings
Fa/faf findings- hyper
Genetics
Genetic counselling
5- POAG- Investigations, drugs, indications for surgery, MIGS

5. Station 2- Gen medicine-
1. Tuberculosis – Ocular manifestations- Told uveitis, choroid tubercles, abscess, orbital
involvement proptosis, skin lesions
What else? Cranial nerve palsies if cns involvement- which nerve- 6th
nerve
What else? Vasculitis- eales present as vitreous hemorrhage
Investigations- told montoux, cbc, esr chest xray
What will you do if patient had sputum- told zn stain- acid fast bacilli and culture
Treatment- which drugs hrzes
Complications with treatment- lft/rft/optic nerve
How long is the ethambutol given – 2 months in intensive phase
How will you monitor ocular side effects
Systemic manifestations of tb?
Time for cbnaat
2. Seizures-
A patient waiting in opd collapses abnormal movements you suspect seizure what will you
do- check vitals, move to safe place, clear motuth secretions
What are the causes of seizures- VITAMIN
Emergency treatment- observe, midazolam, phenytoin, phenobarb, valproate
Drugs used-
Investagions- electrolytes, abg, cbs, esr, glucose
3. Picture- anisocoria with mild ptosis
Ptosis examin third nerve? Abberent regen
What are differentials- adie, 3rd
nerve and horner
How to diff adies- pupil- direct, consensual, convergence
Clinical tests
How will you investigate
Why convergence- adie slow to dilate

6. Pharmacological tests- cocaine, apracloni and amphetamine
What do you order- mri brain and neck
4. Esotropia-
3-year-old child- convergence strabismus
Causes- early onset/infantile/sensory/accommodative
Partially accommodative/ fully
Investigations- Which refraction- wet- latent hypermetropia
Why check posterior pole- rule out sensory eso
Management- glasses- surgery
5. Neurofibromatosis
Ocular features
Ocular complications
How does glioma present
Eyelid features
Cranial nerve palsies
Systemic Complications?
6. Can’t remember
Station3- Anterior segment
1. Rose Bengal stain in exposed cornea- describe

7. Types of dry eye- evaporative vs aq def
Tests- tbut- schemer- values for both
Step wise approach- lifestyle, bak free when? antiinflammatory
Wht else- BCL, amg, tarso
2. Band shaped keratopathy
Causes- old age, silicone oil, inflammation- JRA
Management
Corneal debridement
Which laser- excimer? Femto
How to chelate- edta
Complications
Pkp, bcl
3. Ossn

8. Describe- papillomatous growth on nasal quadrant
What will you do- stain to check extent, topical therapy vs excision
Types
Pathology- squamous, adeno
Intraoperative- cryo double freeze thaw, draw on filter paper
Topical drugs- mmc, inf, 5-fu
When to give
Could have mentioned aids
4. Chemical injury
Emergency treatment hydroxide
How to proceed- irrigate, fornix sweep
Litmus- ph, number- more than 7
Amg
Long term complications- scar, dry eye, symblephra, corneal vascularisation, perforation
Roper hall
Slit lamp- limbal ischemia extent
Treatment- steroid antibiotic, vitamin c
Could have mentioned serum drops and tarso, sclera/ syblephra ring
5. Papilloma

9. Describe- lower lid could be malignant bcc vs papilloma
Cause- hpv, sunexposure, virus
Which virus- HPV
Treatment- excise
Malignant vs bening differentiate- vascularity, mg orifices, surrounding damage
How will you manage- excise patho, direct reconstruction
Wait for 1 minute
6. Ectropion
types- involutonal, cicatricial, mechanical
cause of involutional- laxity
s/s- fbs, watering, inferior corneal ulcer
management- LTS, lid shortening
7th
nerve palsy- observe
Will epiphora resolve- no if orbicularis pump fails
Bcl if required, lubricants,
Day 2 clinical exam

10. Woke up at 6:45AM. Had breakfast immediately, and got ready by 8, no reading on the same day. I
thought a lot and decided that I will answer what I do in my patients and not try to remember the book
because that’s what I did in osce and later thought that I said too much in bookish language rather
than real scenario.
Reached the hospital after struggling with cab. Had to wait for 1 hour prior to start of exam.
Station: neuro and motility
Case1 – right eye esotropia. 5-8 year old girl. Gave instructions to keep her head still and follow the
target.
Mentioned head posture.no scars. Commented on the lids. Did hb test
Mentioned findings right eso
Did versions, convergences, saccades and pursuits. Did multiple times hozt movement.
Did cover and uncover. Mentioned findings correctly
Examiner said to summarize- said my findings thought there is mild restriction in right eye?
He said to demonstrate.
Asked differentials- ? DRS, right 6 the nerve palsy, congenital/ infantile esotropia.
Case2- examine face and eyelid.
Mentioned head posture, lids and no scar. Did Hirshberg. No deviation
Lids left eye was not blinking. Said that blink rate is decreased on left side, face is flat and
expressionless on left side, angle of mouth is round on the left side,
Checked vph and mrd1 as there was eyelid retraction.
Did eye closure, forehead wrinkles, whistle, smile test.
Diagnosed left facial palsy. Lower motor neuron
Young patient.
Asked why you did vph and mrd. Cause of retratction- answered due to decreased orbicularis tone.
Causes- bells, ramsay hunt.
Asked to look for cause

11. Checked the neck- a large vertical scar.
Asked why- parotid surgery
Discussed lmn vs umn palsy
Discussed management options- lubricants, taping, gels
If ulcer then tarsorappy, non healing ulcer- bcl and amg.
Said if it will work?-I said that may work with tarso.
Station2- oculoplasty and lids-
Case1- young girl left eye phthisis.
Examine and mention findings.
Ptosis in the left with enophthalmos.
Left eye corneal scar with membrane in the pupillary area.
Right eye normal
Commented on the eyebrows, adnexa and no scars.
How would check for enophthalmos?
I answered hertels, not available then what will you do?
Nafziger view, worms eye view, palpate the rim and measure with a scale, rim to cornea
What will you do for this patient?
Answered that I will try to improve the visual acuity if possible.
Said the vision is no pl.
I said that I will offer cometic correction.
How?- eviscerate/enucleate with implant and then customised prosthesis.
What before surgery can you offer- I said high convex lens and photochromatic glasses.
Case2- old lady with right eye corneal scar and left eye ptosis
Asked to examine and tell

12. Checked hirschberhg and motility, saw a prosthesis in left eye.
Commented on the size and fit
What can you do for this patient?
Told about asking the history. If any document of implant? Would check the surface conjunctiva for
any cyst or granuloma, would check the motility of the implant.
Can get ct scan to see if there is an implant. Check for fractures,
Check the cop for weight and fit.
Check the fornices
Management?
Woud try to fit a new cop, if fornices inadequate then first make fornices and the cop.
If any fracture then repair fracture before prosthesis
Case 3- young boy with congenital ptosis both eyes
Examine- mentioned face position, scar and drooping and eyebrow elevation
Did Hirshberg , mrd( what is mrd) vph and lagophthalmos
Mentioned no lid crease, did lps action
Asked to check corneal sensations- said no
What else can you check- did bells
How will you counsel this patient- surgery with risk of exposure
Management plan- discussed frontalis sling- silicone vs facia lata
Complications of sling surgery- mentioned all
How would you prevent exposure, mentioned frost suture, lubricants and eye gels at night and can
tape at night
what are advantages of silicone sling- easy, no need for second surgery
how would you manage Marcus gun jaw- quantify eyelid synkinesis- mild, mod severe
if mild the direct surgery, if severe then levator disinsertion then sling

13. Station3- anterior segment-
Case1- slit lamp examination
Old lady – examine the anterior segment of the left eye
Sat on the slit lamp, checked the eye piece and saw that it was altered, (nobody in my batch did that?
Discussed afterwards- was told so many times this)
Reduced the magnification, did diffuse exam, commented on the lids, conjunctiva
Ac depth by von hericks. Saw tube in the anterior chamber superiorly
Iol in place with non reacting pupil, posterior synichae
Iol pitting and yag capsulotomy done already
Commented on the tube and the drainage implnt in the superior temporal quadrant
What are the potential complications? Mentioned immediate post op ac shallowing, tube corneal
touch and endothelial damage, tube migration, exposure and scleral necrosis, tube blockage by iris or
vitreous
What will you do to prevent the exposure? And is the implant exposed in this?
Case2- anterior segment slit lamp evaluation of the left eye of the patient
Mentioned normal lids, normal conjunctiva
Central corneal scar present, deep scar- leucomatous as nothing visible through this scar
Commented on the anterior chamber depth- vh grade 4, iris normal and no cataract
Measured the size of the corneal opacity
Discuss differential diagnosis- told post corneal ulcer, trauma, corneal dystrophy
What else? I said I would like to examine the other eye.
What do you want to see- transplant, corneal opacities in the other eye
What else this could be? I asked to examine again, did examination in high magnification
Answered this is post corneal hydrops patient- diagnosed keratoconus
What else would you find? Did munson sign

14. Mentioned prominent corneal nerves and stromal folds
How would you manage- pkp vs dalk
When dalk? If dm has healed high chances of pkp
Other eye management- if progressive keratoconus- then I would advise c3r
If other eye non progressive- then refraction, glasses, rigid lenses, pkp
Station 4- posterior segment
Examine the posterior segment of the right eye with 90d. asked to use my own lens. Said that’s great
Again I checked the eye piece it was not on 0, corrected that and the ipd
Describe- I described the disc- vertically oval and tilted disc, could be disc hypoplasia
What else- a whitish lesion sparing the disc and fovea, inferior to the disc, vessels dipping inside the
defect
Diagnosis- choroidal coloboma.
Can you comment on the type? I said 2 (Incorrect)
Checked the superior, temporal, nasal and inferior half
What would be the visual status of the patient?
I said that the macula is not involved so visual acuity will be good, but I would like to exainte the
anterior segment also
What could be the type of refractive error in this patient> I answered myopia? Not sure about this
What else could be cause of poor visual acuity in this patient?
Answered- strabismus and amblyopia either refractive of strabismic
Asked to move on the next patient
Case2- middle aged lady- asked to examine with the IDO
Did the focussing of the thumb thing first and adjusted the ipd.
Examine the left eye- mentioned media optic disc palor, margins sharp, attenuation of vessels in all
the quadrants

15. Checked all the quadrants
Mentioned pigments in all quadrants and involvement of macula
Check the other eye and comment on the disc
Said that disc is pale and macular pigmentation is present
Diagnosis- retinitis pigmentosa
What test will you do- mentioned visual acuity, refraction
How can you help the patient- do refraction, can plan cataract surgery
What ophthalmological tests will you do- slit lamp, oct
Why oct- if cme then Diamox and reduce cme
What else? Mentioned erg will show decreased photopic and scotopic response
What treatment can you give – I mentioned low vision aids
Said not management treatment- I said I will check serum vitamin levels, if low only the give vit a.
controversial use.
Case3- check the posterior segment in both eyes and comment
Media was hazy because of pco
Small disc horizontally oval, cannot comment on cd ratio, large peripapillary atropht, vessels
attenuated, other eye same
What do you think?
Optic nerve hypoplasia as the disc size is small
What else? I said optic atrophy, he was happy
Mentioned could be glaucoma or retinal disorder.
‘Representative images taken from the internet
Please feel free to contact me if you require any additional information.
All the best.