NBEO Part 3 - PEPS || 100% Correct Answers.
Corneal Foreign Body - Testing correct answers NaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment correct answers Remove foreign body with cotton-tipped
applicator, or instill Proparacaine and remove with instrument, remove rust ring with Alger
brush, place BCL if large epithelial defect, Moxifloxacin 0.5% qid x1 wk, Ketorolac 0.5% qid if
pain, frequent PFATs
Corneal Foreign Body - FU correct answers 1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education correct answers You have a piece of metal in your that we
have removed. We placed a bandage lens on your eye to help your cornea heal, so you need to
return tomorrow so that we can remove it. We've given you an antibiotic to use 4x per day, and
we also rcmnd using PFATs 6-8x throughout the next several days. In the future, it is important
to remember to wear safety glasses when working with metal.
RCE/EBMD - Testing correct answers NaFl, Lid eversion
RCE/EBMD - Treatment correct answers Propraracaine and debride 1-2mm beyond lesion, Place
BCL if not a previous CL wearer, Moxifloxacin 0.5% qid x1 wk, Nacl 5% soln qid x2 wk then
taper to qhs for 3 months, frequent PFATs
RCE/EBMD - FU correct answers 1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education correct answers You have a condition called EBMD, in which the top
layer of your cornea does not adhere well to the bottom layers. Sometimes, this can lead to the
top layer of the cornea being ripped off, leaving a large abrasion. (OR - Because of a past trauma
to your eye, the top layer of your cornea has difficulty staying adhered to the bottom layers). We
removed some of the top layer of your cornea so that it can heal properly, and placed a bandage
lens to speed up the healing process. We also gave you an antibiotic to prevent any infection
while this heals, and a drop that helps to dehydrate the cornea. This drop can help to prevent this
from happening again, but may need to be continued for the next few months. If this recurs, you
should return to our office.
Chemical Burn - Testing correct answers Irrigation for 15 mins, lid eversion and
irrigation/swabbing of fornices, Testing PH with litmus paper after 5 minutes (normal is 7-7.4),
NaFl
Chemical Burn - Treatment correct answers Debridement of any loose epithelium, Moxifloxacin
0.5% qid x1 week, Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
Chemical Burn - FU correct answers 1 day
Chemical Burn - Education correct answers You have gotten a chemical into your eye which has
burned a layer of your cornea. I've removed all of the loose corneal tissue to help the corneal heal
,better. I have given you an antibiotic drop to prevent any infection, as well as a steroid to help
with swelling and inflammation. You should use PFATs 6-8x per day while this heals. I'd like to
see you tomorrow to make sure your eye is healing well. In the future, it is important to use
safety eye wear while dealing with dangerous chemicals.
IIH - Testing correct answers RNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen), Red cap,
BP, Order urgent MRI/MRV and LP with CSF analysis
IIH - Treatment correct answers MRI & MRV of brain and orbit ASAP, LP if MRI/MRV
normal, and oral CAIs. Refer to PCP/OBGYN to discuss weight loss and d/c of birth control.
IIH - FU correct answers 3-4 weeks
IIH - Education correct answers You have IIH, which is a condition in which there is increased
pressure inside the brain. This also puts pressure on the optic nerve, causing it to swell and
leading to visual changes, headaches and nausea. This increased pressure may be due to being
overweight, or due to your birth control. First, it is important that we rule out any other causes of
increased pressure in the brain, so I am referring you for an urgent MRI and LP. I am also
referring you back to your PCP who can offer different treatments to help bring down the
pressure and may recommend you d/c your birth control. I'd like to see you back in about a
month to make sure your nerve swelling is returning to normal.
NAION - Testing correct answers RNFL OCT, VF (altitudinal or central), Pupils (APD), Red
cap (reduced), ESR/CRP/CBC with diff (r/o GCA), BP, EOM (r/o neuritis)
NAION - Treatment correct answers Refer to PCP for management of BP/BS/Cholesterol
NAION - FU correct answers 1-2 months
NAION - Education correct answers You have a condition called NAION, in which blood supply
to your optic nerve has been cut off. This is often due to systemic issues like uncontrolled high
BP, BS, or cholesterol. First, I want to refer you urgently for blood work to make sure that this
was not caused by inflammation in the body. I also want to refer you to your PCP to help get
your BP/BS under control as there is a risk of this happening to the other eye as well. Up to 40%
of patients show mild improvement in vision over 3 to 6 months in some studies. I'd like to see
you back in 1-2 months after you've seen your PCP.
AAION - Testing correct answers RNFL OCT, VF (altitudinal or central), Pupils (APD), Red
cap (reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment correct answers Refer to ER for blood work and IV methylprednisolone,
Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU correct answers 3-4 wks
, AAION - Education correct answers You have AAION/GCA. This condition leads to
inflammation of the medium and large blood vessels in the body, leading to your fever,
headaches, and jaw pain. This inflammation is also affecting the blood supply to your optic
nerve, leading to vision loss. Unfortunately, there is only a small chance the vision loss you are
experiencing will return. The primary goal is to prevent this from happening in the other eye. I
am referring you for urgent blood work, as well as steroids at the hospital. They will likely keep
you on steroids for 6-12 months after this to keep inflammation in your body low. I'd like to see
you back in about a month.
Optic Neuritis - Testing correct answers RNFL OCT, VF (central or arcuate), Pupils (APD), Red
cap (reduced), EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment correct answers Refer for imaging, and oral steroids if within the first
1 -2 weeks of onset. Refer to neurology for MS management.
Optic Neuritis - FU correct answers 3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education correct answers You have a condition called optic neuritis. This
means that the optic nerve connecting your eye to your brain is swollen, leading to your blurry
vision. Your vision will return after the swelling has gone down. However, this kind of swelling
is often associated with MS. MS is an autoimmune disease in which your body's own immune
system attacks your tissues and nervous system. It's important that we refer you for an MRI and
to a neurologist to help make that diagnosis. I'd like to see you back in 1 month, and we'll check
your vision every 3-6 months from here on out.
ONH Drusen - Testing correct answers FAF (+), B-scan (hyper-reflective), VF (generalized
depression), RNFL OCT
ONH Drusen - Treatment correct answers Observation
ONH Drusen - FU correct answers q 6-12 mo
ONH Drusen - Education correct answers You have ONH drusen, which are calcified deposits
within the optic nerve. Usually these are benign and will have no effect on your vision. Rarely,
they can start to compress the nerve tissue and lead to loss of vision. I'd like to see you every 6-
12 months to check on your visual field to make sure that they are not impacting your vision.
There is no treatment for this condition.
Horner Syndrome - Testing correct answers Pupil sizing, Near testing (no LND/ normal), MRD 1
(2mm ptosis), Old photos, 1% Apraclonidine testing (dilates Horner pupil), RTC 1 day for 1%
Hydroxyamphetamine testing (dilates if pre-ganglionic), Order chest CT (Pancoast tumor),
MRI/MRA of brain/neck (carotid artery dissection [esp if neck pain]), CBC w/ diff
Horner Syndrome - Treatment correct answers Refer for neuroimaging
Horner Syndrome - FU correct answers FU after imaging
Corneal Foreign Body - Testing correct answers NaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment correct answers Remove foreign body with cotton-tipped
applicator, or instill Proparacaine and remove with instrument, remove rust ring with Alger
brush, place BCL if large epithelial defect, Moxifloxacin 0.5% qid x1 wk, Ketorolac 0.5% qid if
pain, frequent PFATs
Corneal Foreign Body - FU correct answers 1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education correct answers You have a piece of metal in your that we
have removed. We placed a bandage lens on your eye to help your cornea heal, so you need to
return tomorrow so that we can remove it. We've given you an antibiotic to use 4x per day, and
we also rcmnd using PFATs 6-8x throughout the next several days. In the future, it is important
to remember to wear safety glasses when working with metal.
RCE/EBMD - Testing correct answers NaFl, Lid eversion
RCE/EBMD - Treatment correct answers Propraracaine and debride 1-2mm beyond lesion, Place
BCL if not a previous CL wearer, Moxifloxacin 0.5% qid x1 wk, Nacl 5% soln qid x2 wk then
taper to qhs for 3 months, frequent PFATs
RCE/EBMD - FU correct answers 1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education correct answers You have a condition called EBMD, in which the top
layer of your cornea does not adhere well to the bottom layers. Sometimes, this can lead to the
top layer of the cornea being ripped off, leaving a large abrasion. (OR - Because of a past trauma
to your eye, the top layer of your cornea has difficulty staying adhered to the bottom layers). We
removed some of the top layer of your cornea so that it can heal properly, and placed a bandage
lens to speed up the healing process. We also gave you an antibiotic to prevent any infection
while this heals, and a drop that helps to dehydrate the cornea. This drop can help to prevent this
from happening again, but may need to be continued for the next few months. If this recurs, you
should return to our office.
Chemical Burn - Testing correct answers Irrigation for 15 mins, lid eversion and
irrigation/swabbing of fornices, Testing PH with litmus paper after 5 minutes (normal is 7-7.4),
NaFl
Chemical Burn - Treatment correct answers Debridement of any loose epithelium, Moxifloxacin
0.5% qid x1 week, Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
Chemical Burn - FU correct answers 1 day
Chemical Burn - Education correct answers You have gotten a chemical into your eye which has
burned a layer of your cornea. I've removed all of the loose corneal tissue to help the corneal heal
,better. I have given you an antibiotic drop to prevent any infection, as well as a steroid to help
with swelling and inflammation. You should use PFATs 6-8x per day while this heals. I'd like to
see you tomorrow to make sure your eye is healing well. In the future, it is important to use
safety eye wear while dealing with dangerous chemicals.
IIH - Testing correct answers RNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen), Red cap,
BP, Order urgent MRI/MRV and LP with CSF analysis
IIH - Treatment correct answers MRI & MRV of brain and orbit ASAP, LP if MRI/MRV
normal, and oral CAIs. Refer to PCP/OBGYN to discuss weight loss and d/c of birth control.
IIH - FU correct answers 3-4 weeks
IIH - Education correct answers You have IIH, which is a condition in which there is increased
pressure inside the brain. This also puts pressure on the optic nerve, causing it to swell and
leading to visual changes, headaches and nausea. This increased pressure may be due to being
overweight, or due to your birth control. First, it is important that we rule out any other causes of
increased pressure in the brain, so I am referring you for an urgent MRI and LP. I am also
referring you back to your PCP who can offer different treatments to help bring down the
pressure and may recommend you d/c your birth control. I'd like to see you back in about a
month to make sure your nerve swelling is returning to normal.
NAION - Testing correct answers RNFL OCT, VF (altitudinal or central), Pupils (APD), Red
cap (reduced), ESR/CRP/CBC with diff (r/o GCA), BP, EOM (r/o neuritis)
NAION - Treatment correct answers Refer to PCP for management of BP/BS/Cholesterol
NAION - FU correct answers 1-2 months
NAION - Education correct answers You have a condition called NAION, in which blood supply
to your optic nerve has been cut off. This is often due to systemic issues like uncontrolled high
BP, BS, or cholesterol. First, I want to refer you urgently for blood work to make sure that this
was not caused by inflammation in the body. I also want to refer you to your PCP to help get
your BP/BS under control as there is a risk of this happening to the other eye as well. Up to 40%
of patients show mild improvement in vision over 3 to 6 months in some studies. I'd like to see
you back in 1-2 months after you've seen your PCP.
AAION - Testing correct answers RNFL OCT, VF (altitudinal or central), Pupils (APD), Red
cap (reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment correct answers Refer to ER for blood work and IV methylprednisolone,
Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU correct answers 3-4 wks
, AAION - Education correct answers You have AAION/GCA. This condition leads to
inflammation of the medium and large blood vessels in the body, leading to your fever,
headaches, and jaw pain. This inflammation is also affecting the blood supply to your optic
nerve, leading to vision loss. Unfortunately, there is only a small chance the vision loss you are
experiencing will return. The primary goal is to prevent this from happening in the other eye. I
am referring you for urgent blood work, as well as steroids at the hospital. They will likely keep
you on steroids for 6-12 months after this to keep inflammation in your body low. I'd like to see
you back in about a month.
Optic Neuritis - Testing correct answers RNFL OCT, VF (central or arcuate), Pupils (APD), Red
cap (reduced), EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment correct answers Refer for imaging, and oral steroids if within the first
1 -2 weeks of onset. Refer to neurology for MS management.
Optic Neuritis - FU correct answers 3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education correct answers You have a condition called optic neuritis. This
means that the optic nerve connecting your eye to your brain is swollen, leading to your blurry
vision. Your vision will return after the swelling has gone down. However, this kind of swelling
is often associated with MS. MS is an autoimmune disease in which your body's own immune
system attacks your tissues and nervous system. It's important that we refer you for an MRI and
to a neurologist to help make that diagnosis. I'd like to see you back in 1 month, and we'll check
your vision every 3-6 months from here on out.
ONH Drusen - Testing correct answers FAF (+), B-scan (hyper-reflective), VF (generalized
depression), RNFL OCT
ONH Drusen - Treatment correct answers Observation
ONH Drusen - FU correct answers q 6-12 mo
ONH Drusen - Education correct answers You have ONH drusen, which are calcified deposits
within the optic nerve. Usually these are benign and will have no effect on your vision. Rarely,
they can start to compress the nerve tissue and lead to loss of vision. I'd like to see you every 6-
12 months to check on your visual field to make sure that they are not impacting your vision.
There is no treatment for this condition.
Horner Syndrome - Testing correct answers Pupil sizing, Near testing (no LND/ normal), MRD 1
(2mm ptosis), Old photos, 1% Apraclonidine testing (dilates Horner pupil), RTC 1 day for 1%
Hydroxyamphetamine testing (dilates if pre-ganglionic), Order chest CT (Pancoast tumor),
MRI/MRA of brain/neck (carotid artery dissection [esp if neck pain]), CBC w/ diff
Horner Syndrome - Treatment correct answers Refer for neuroimaging
Horner Syndrome - FU correct answers FU after imaging
