NBEO PART 1 ACTUAL EXAM QUESTIONS WITH
ANSWERS 2025/2026 GRADED A+|verified 100%
correct|
A common cause of epiphora in infants is caused by a small membrane that covers
over which of the following structures?
The lacrimal gland
The canaliculus
The valve of Hasner
The puncta - ANSWER -It is common for mothers of young infants to note that
one eye (or both eyes) of her infant constantly tears in conjunction with the
presence of mucopurulent discharge. This epiphora results from a blockage of the
nasolacrimal passageway caused by a membrane covering the valve of Hasner. The
majority of blockages will self-resolve without intervention (80-90% of infants)
within the first 12 months of life. Treatment may include massage of the
nasolacrimal sac several times a day in an effort to rupture the membrane.
An 81-year old female reports that her eye has been watering more frequently over
the past month; you decide to administer the primary Jones dye test (Jones I). After
5 minutes, the application of a cotton-tipped applicator to the inferior turbinate
reveals the presence of dye in the area. Taking this into consideration, what is the
MOST likely cause of the patient's epiphora complaint?
Dysfunction of the valve of Hasner
Partial nasolacrimal duct obstruction
Punctal stenosis
Hypersecretion of tears
Complete nasolacrimal duct obstruction - ANSWER -The primary Jones dye test
can be utilized to determine the patency of the nasolacrimal system. 1-2 drops of
fluorescein are instilled into the inferior fornix of the eyes while the patient is in an
upright position and blinking her eyes normally. After a period of 5 to 10 minutes,
a cotton-tipped applicator is used to swab the undersurface of the inferior turbinate
on each side of the nasal passage.
,When the primary Jones dye test is positive (dye is recovered from the inferior
turbinate of the nose), practitioners may conclude that the system is patent and that
no significant blockage of the nasolacrimal drainage structure is likely. However,
minor stenosis or physiologic dysfunctions cannot be completely ruled out.
Patients who have a positive result on the Jones I test are more likely to experience
symptoms of epiphora that are secondary to primary oversecretion of tears, rather
than a dysfunction in lacrimal drainage (as in the above question).
When the primary Jones dye test is negative, the probability of an obstruction or
dysfunction in lacrimal drainage is much greater; however, this test alone is not
sufficient to document this conclusion. The secondary Jones dye test is then
necessary to determine the severity and location of the obstruction.
Oral acyclovir is most effective for patients presenting with eyelid findings
associated with herpes zoster if administered within which of the following periods
following the onset of the disease?
10-12 hours
72 hours
4-5 days
24 hours
7-10 days - ANSWER -Oral acyclovir is the mainstay of therapy for patients
diagnosed with herpes zoster ophthalmicus. This systemic treatment is maximally
beneficial if it is initiated within 72 hours from the onset of the disease (usually the
appearance of eyelid lesions). The use of oral acyclovir typically results in quick
resolution of skin vesicles, decreases the amount of pain the patient experiences,
and reduces the duration of viral shedding and appearance of new lesions.
Acyclovir has also been shown to significantly reduce the incidence of ocular
findings such as episcleritis, keratitis, and iritis. The recommended dosage is
800mg orally 5 times per day for 7-10 days.
Numerous reports have suggested that increased tear film osmolarity is a key
consequence in dry eye. Although osmolarity is not easily measured in the clinical
setting, tear osmolarity increases in most dry eye sub-types due to which of the
following processes?
The lipid layer is altered in most dry eye states, leading to ion pairing
,Decreased capillary exchange leads to ionic bonding
Patients with dry eye tend to blink less than normals, leading to increased
evaporation
Reactive oxygen species are increased in the tears of most dry eye sub-types; this
increases osmolarity
In aqueous tear deficiency, the lacrimal gland produces more ionic species
Loss of tear stability induces an increased evaporation rate, leading to increased
osmolarity - ANSWER -Tear instability leads to greater evaporation and higher
osmolarity through a mechanism of concentration of the remaining tears, since
only the aqueous tear portion evaporates rather than the ionic species. Several
studies have indicated that normal tear osmolarity is less than or equal to 300
Osm/L, with values exceeding 308 Osm/L indicating increased osmolarity. As a
single measure, tear osmolarity has recently been found to correlate the best (r
squared 0.55) to dry eye severity of several clinical tests in a large, multi-center
study (Sullivan et al., IOVS 51:6125-6130, 2010).
Many skin anomalies may mimic malignant lesions. Which of the following skin
conditions has the HIGHEST risk of becoming malignant?
Cutaneous horn
Papilloma
Actinic keratosis
Seborrhoeic keratosis - ANSWER -Actinic keratosis is a precursor to squamous
cell carcinoma and appears as scaly, dry skin that does not heal. People with skin
that is of lighter pigmentation along with excessive exposure to ultraviolet light
tend to be most at risk for development of this condition.
Papillomas may take on various forms and may be viral or non-viral in origin.
They can commonly be found on the eyelids or surrounding orbital skin. Viral
warts tend to grow at an accelerated rate while non-viral papillomas are fairly slow
to grow. Papillomas can mimic neoplastic growths so be sure to rule this out while
watching carefully for color change, ulceration, lash loss, bleeding, and
vascularization.
Cutaneous horns or tags are also benign and are likely a form of papilloma but
appear to involve more keratin. Treatment is similar to that of a papilloma.
, Seborrhoeic keratosis is more commonly seen in middle-aged and elderly persons.
This benign, epidermal growth is quite superficial and does not extend into the
dermis. It appears like a brown plaque that has been stuck onto someone's skin.
The borders are very distinct and there may be some elevation. The lesions may be
removed if the patient is concerned about cosmesis.
In addition to the meibomian glands which other accessory glands secrete oil?
Zeiss and Moll
Moll and Krause
Zeiss and Wolfring
Wolfring and Krause - ANSWER -The glands of Zeiss and Moll are accessory oil
glands located on the lid margins adjacent to the base of the lash follicles. The lipid
layer of the tear film is superficial and as such it is exposed to the environment
protecting the aqueous layer from evaporation.
The glands of Wolfring and Krause are located deep in the fornix of the eyelids
and serve to secrete a portion of the aqueous layer of the tear film.
Dacryoadenitis refers to an inflammation or infection of which of the following
ocular structures?
The nasolacrimal sac
The lacrimal sac
The lacrimal gland
The puncta - ANSWER -Dacryoadenitis describes inflammation of the lacrimal
gland, generally due to infection. The swelling is categorized as either chronic or
acute. Acute presentations appear more commonly as a unilateral swelling of the
upper eyelid, along with pain, excessive lacrimation, probable ipsilateral
lymphadenopathy, and potential proptosis. If the condition is bilateral it is likely
due to a systemic infection. Chronic dacryoadenitis is generally bilateral and
presents with hard masses that are palpable at the location of the lacrimal gland.
This form is often painless and caused by inflammatory diseases such as Grave's,
Sjogren's, or sarcoidosis. The chronic type warrants further investigation in order
to rule out a lacrimal gland tumor.
ANSWERS 2025/2026 GRADED A+|verified 100%
correct|
A common cause of epiphora in infants is caused by a small membrane that covers
over which of the following structures?
The lacrimal gland
The canaliculus
The valve of Hasner
The puncta - ANSWER -It is common for mothers of young infants to note that
one eye (or both eyes) of her infant constantly tears in conjunction with the
presence of mucopurulent discharge. This epiphora results from a blockage of the
nasolacrimal passageway caused by a membrane covering the valve of Hasner. The
majority of blockages will self-resolve without intervention (80-90% of infants)
within the first 12 months of life. Treatment may include massage of the
nasolacrimal sac several times a day in an effort to rupture the membrane.
An 81-year old female reports that her eye has been watering more frequently over
the past month; you decide to administer the primary Jones dye test (Jones I). After
5 minutes, the application of a cotton-tipped applicator to the inferior turbinate
reveals the presence of dye in the area. Taking this into consideration, what is the
MOST likely cause of the patient's epiphora complaint?
Dysfunction of the valve of Hasner
Partial nasolacrimal duct obstruction
Punctal stenosis
Hypersecretion of tears
Complete nasolacrimal duct obstruction - ANSWER -The primary Jones dye test
can be utilized to determine the patency of the nasolacrimal system. 1-2 drops of
fluorescein are instilled into the inferior fornix of the eyes while the patient is in an
upright position and blinking her eyes normally. After a period of 5 to 10 minutes,
a cotton-tipped applicator is used to swab the undersurface of the inferior turbinate
on each side of the nasal passage.
,When the primary Jones dye test is positive (dye is recovered from the inferior
turbinate of the nose), practitioners may conclude that the system is patent and that
no significant blockage of the nasolacrimal drainage structure is likely. However,
minor stenosis or physiologic dysfunctions cannot be completely ruled out.
Patients who have a positive result on the Jones I test are more likely to experience
symptoms of epiphora that are secondary to primary oversecretion of tears, rather
than a dysfunction in lacrimal drainage (as in the above question).
When the primary Jones dye test is negative, the probability of an obstruction or
dysfunction in lacrimal drainage is much greater; however, this test alone is not
sufficient to document this conclusion. The secondary Jones dye test is then
necessary to determine the severity and location of the obstruction.
Oral acyclovir is most effective for patients presenting with eyelid findings
associated with herpes zoster if administered within which of the following periods
following the onset of the disease?
10-12 hours
72 hours
4-5 days
24 hours
7-10 days - ANSWER -Oral acyclovir is the mainstay of therapy for patients
diagnosed with herpes zoster ophthalmicus. This systemic treatment is maximally
beneficial if it is initiated within 72 hours from the onset of the disease (usually the
appearance of eyelid lesions). The use of oral acyclovir typically results in quick
resolution of skin vesicles, decreases the amount of pain the patient experiences,
and reduces the duration of viral shedding and appearance of new lesions.
Acyclovir has also been shown to significantly reduce the incidence of ocular
findings such as episcleritis, keratitis, and iritis. The recommended dosage is
800mg orally 5 times per day for 7-10 days.
Numerous reports have suggested that increased tear film osmolarity is a key
consequence in dry eye. Although osmolarity is not easily measured in the clinical
setting, tear osmolarity increases in most dry eye sub-types due to which of the
following processes?
The lipid layer is altered in most dry eye states, leading to ion pairing
,Decreased capillary exchange leads to ionic bonding
Patients with dry eye tend to blink less than normals, leading to increased
evaporation
Reactive oxygen species are increased in the tears of most dry eye sub-types; this
increases osmolarity
In aqueous tear deficiency, the lacrimal gland produces more ionic species
Loss of tear stability induces an increased evaporation rate, leading to increased
osmolarity - ANSWER -Tear instability leads to greater evaporation and higher
osmolarity through a mechanism of concentration of the remaining tears, since
only the aqueous tear portion evaporates rather than the ionic species. Several
studies have indicated that normal tear osmolarity is less than or equal to 300
Osm/L, with values exceeding 308 Osm/L indicating increased osmolarity. As a
single measure, tear osmolarity has recently been found to correlate the best (r
squared 0.55) to dry eye severity of several clinical tests in a large, multi-center
study (Sullivan et al., IOVS 51:6125-6130, 2010).
Many skin anomalies may mimic malignant lesions. Which of the following skin
conditions has the HIGHEST risk of becoming malignant?
Cutaneous horn
Papilloma
Actinic keratosis
Seborrhoeic keratosis - ANSWER -Actinic keratosis is a precursor to squamous
cell carcinoma and appears as scaly, dry skin that does not heal. People with skin
that is of lighter pigmentation along with excessive exposure to ultraviolet light
tend to be most at risk for development of this condition.
Papillomas may take on various forms and may be viral or non-viral in origin.
They can commonly be found on the eyelids or surrounding orbital skin. Viral
warts tend to grow at an accelerated rate while non-viral papillomas are fairly slow
to grow. Papillomas can mimic neoplastic growths so be sure to rule this out while
watching carefully for color change, ulceration, lash loss, bleeding, and
vascularization.
Cutaneous horns or tags are also benign and are likely a form of papilloma but
appear to involve more keratin. Treatment is similar to that of a papilloma.
, Seborrhoeic keratosis is more commonly seen in middle-aged and elderly persons.
This benign, epidermal growth is quite superficial and does not extend into the
dermis. It appears like a brown plaque that has been stuck onto someone's skin.
The borders are very distinct and there may be some elevation. The lesions may be
removed if the patient is concerned about cosmesis.
In addition to the meibomian glands which other accessory glands secrete oil?
Zeiss and Moll
Moll and Krause
Zeiss and Wolfring
Wolfring and Krause - ANSWER -The glands of Zeiss and Moll are accessory oil
glands located on the lid margins adjacent to the base of the lash follicles. The lipid
layer of the tear film is superficial and as such it is exposed to the environment
protecting the aqueous layer from evaporation.
The glands of Wolfring and Krause are located deep in the fornix of the eyelids
and serve to secrete a portion of the aqueous layer of the tear film.
Dacryoadenitis refers to an inflammation or infection of which of the following
ocular structures?
The nasolacrimal sac
The lacrimal sac
The lacrimal gland
The puncta - ANSWER -Dacryoadenitis describes inflammation of the lacrimal
gland, generally due to infection. The swelling is categorized as either chronic or
acute. Acute presentations appear more commonly as a unilateral swelling of the
upper eyelid, along with pain, excessive lacrimation, probable ipsilateral
lymphadenopathy, and potential proptosis. If the condition is bilateral it is likely
due to a systemic infection. Chronic dacryoadenitis is generally bilateral and
presents with hard masses that are palpable at the location of the lacrimal gland.
This form is often painless and caused by inflammatory diseases such as Grave's,
Sjogren's, or sarcoidosis. The chronic type warrants further investigation in order
to rule out a lacrimal gland tumor.
