Neuro-ophthalmology and pupils: macular star in neuroretinitis: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro-ophthalmology and pupils: macular star in neuroretinitis

Sample item

A young adult has painless blurring with optic disc swelling. As the oedema resolves over two weeks, a star-shaped figure forms around the fovea. Which best explains the star?

AHaemorrhage tracking along the nerve fibre layerBCystoid fluid in the inner nuclear layer from tractionCLipid exudate from the leaking disc in Henle's outer plexiform layerDSubretinal exudate from a choroidal neovascular membrane

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Lipid exudate from the leaking disc in Henle's outer plexiform layer

In neuroretinitis, leakage from disc vessels deposits fluid and lipid in the outer plexiform layer (Henle's layer), which radiates obliquely around the fovea and forms the macular star. It usually appears as the disc oedema resolves.

Option by option

A. Haemorrhage tracking along the nerve fibre layer
Nerve fibre layer haemorrhage is flame-shaped and not star-shaped.
B. Cystoid fluid in the inner nuclear layer from traction
Inner nuclear layer cystoid fluid forms a petaloid macular oedema pattern.
C. Lipid exudate from the leaking disc in Henle's outer plexiform layer (correct)
Correct. Lipid exudate in Henle's layer produces the star.
D. Subretinal exudate from a choroidal neovascular membrane
A choroidal neovascular membrane gives a grey-green lesion with subretinal blood.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, Lipid exudate from the leaking disc in Henle's outer plexiform layer. In neuroretinitis, leakage from disc vessels deposits fluid and lipid in the outer plexiform layer (Henle's layer), which radiates obliquely around the fovea and forms the macular star.

Why is "Haemorrhage tracking along the nerve fibre layer" not the answer?

Nerve fibre layer haemorrhage is flame-shaped and not star-shaped.

Why is "Cystoid fluid in the inner nuclear layer from traction" not the answer?

Inner nuclear layer cystoid fluid forms a petaloid macular oedema pattern.

Why is "Subretinal exudate from a choroidal neovascular membrane" not the answer?

A choroidal neovascular membrane gives a grey-green lesion with subretinal blood.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: macular star in neuroretinitis in Ophthalmology. It usually appears as the disc oedema resolves.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro-ophthalmology and pupils: macular star in neuroretinitis?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.