NBEO Part 2 2025/2026 Updated | Real Exam
Practice Questions & Case Review
What is a Microhyphema?
RBC's suspended in the anterior chamber without accumulation at the inferior angle
What does a Vossius ring look like?
Pigment ring on the anterior lens capsule
Describe how a Vossius ring is formed:
Blunt trauma causes the back of the iris to hit the anterior lens capsule, leaving behind a ring of
pigment
When a patient has a Hyphema, how do you manage their IOP?
Elevate their head during sleep (approx 30 degrees) to make the RBC's settle in the inferior angle
(and leave the rest of the angle open)
When a patient presents with an idiopathic hyphema, what should you always ask about during
history?
Use of blood thinners
Which orbital bone is the most likely to break in a blowout fracture?
Maxillary bone
Hallmark clinical signs of a blowout fracture:
Crepitus on palpation of medial orbital area or crepitus after nose-blowing
Enophthalmos
Diplopia
Step-off of the orbital rim
Infraorbital hypoesthesia
What causes the infraorbital hypoesthesia after a blowout fracture?
Entrapment of the infraorbital nerve (branch of V2)
Prognosis for commotio retinae:
Usually resolves without sequelae in 24-48 hrs
What is Commotio retinae?
"Bruised" retina- disruption of RPE and photoreceptor outer segments after trauma
,Commotio retinae that occurs in the macula is called:
Berlin's edema
In iridodialysis, what structure detaches from what?
Iris root detaches from ciliary body
What is Iridodialysis?
Peripheral iris hole where iris root has become detached after trama
What causes Purtscher's retinopathy?
Chest or neck compression (traumatic choking)
Acute pancreatitis
Clinical findings of Purtscher's retinopathy:
Diffuse retinal hemorrhages, exudates, CWS
Choroidal rupture secondary to trauma is most likely to occur in which location?
Temporal posterior pole
Which type of chemical burn has a worse prognosis: Acid or base?
Base
Which type of chemical burn is more common: Acid or base?
Base- 2x as common
Which chemical is the most common cause of alkali burns on the ocular surface?
Calcium hydroxide (Lye)
Is limbal blanching more common in an acid or base chemical burn?
Base
After a hyphema, gonioscopy should not be performed for at least how long to avoid rebleeds?
1 month
What is an 8-ball Hyphema?
Black hyphema filling 100% of the anterior chamber
Potential complication of Choroidal rupture secondary to trauma:
CNVM development (CHBALA)
,Conditions that can cause CNVM:
CHBALA:
Choroidal rupture
Histoplasmosis
Best's vitelliform
ARMD
Lacquer Cracks
Angioid streaks
What causes prolapse of orbital fat (dermatochalaisis) with age?
Weakening of the orbital septum
Etiologies of Preseptal Cellulitis:
Acute hordeolum
Dacryocystitis
Upper respiratory infection or middle ear infection
Skin puncture wounds
Etiologies of Orbital Cellulitis:
Sinus infection (especially ethmoid)
Dacryoadenitis, dacryocystitis
Progression of preseptal cellulitis
Orbital fracture
Dental infection
Most common bacteria that cause orbital cellulitis- adults & children:
Staph aureus in adults
Haemophilus influenzae in kids
Signs/sx of Orbital cellulitis:
APD
Proptosis
Diplopia
EOM restriction
Fever
Eyelid edema & redness
Potential complications of Orbital cellulitis:
Cavernous sinus thrombosis
Brain abscess
, Meningitis
Mucormycosis (diabetics & immunocompromised)
What is Mucormycosis?
Fungal infection that causes orbital cellulitis in diabetics & immunocompromised pts- hallmark
sign is "black eschar" in mouth and nose
What is the strongest risk factor for development of thyroid eye disease?
Cigarette smoking
What is the order of muscle involvement in thyroid eye disease?
IM SLO:
IR, MR, SR, LR, Obliques
Thyroid eye disease occurs in ___________% of patients with Graves' disease.
30-70%
The lid retraction in thyroid eye disease is due to contraction of which lid muscle?
Muller's muscle
Grading system/progression of thyroid-related Ophthalmopathy:
NO SPECS
No signs or sx
Only signs, no sx (lid retraction)
Soft tissue involvement
Proptosis
EOM involvement
Corneal involvement
Sight loss (due to optic nerve compression)
What is Von Graefe's sign?
Thyroid eye dz sign- Upper eyelid lag during downgaze
What is Kocher's sign?
Thyroid eye dz sign- globe lag compared to lid movement when looking up
What is Dalrymple's sign?
Thyroid eye dz sign- Lid retraction resulting in a staring appearance
Normal Exophthalmometry range for Caucasians:
Practice Questions & Case Review
What is a Microhyphema?
RBC's suspended in the anterior chamber without accumulation at the inferior angle
What does a Vossius ring look like?
Pigment ring on the anterior lens capsule
Describe how a Vossius ring is formed:
Blunt trauma causes the back of the iris to hit the anterior lens capsule, leaving behind a ring of
pigment
When a patient has a Hyphema, how do you manage their IOP?
Elevate their head during sleep (approx 30 degrees) to make the RBC's settle in the inferior angle
(and leave the rest of the angle open)
When a patient presents with an idiopathic hyphema, what should you always ask about during
history?
Use of blood thinners
Which orbital bone is the most likely to break in a blowout fracture?
Maxillary bone
Hallmark clinical signs of a blowout fracture:
Crepitus on palpation of medial orbital area or crepitus after nose-blowing
Enophthalmos
Diplopia
Step-off of the orbital rim
Infraorbital hypoesthesia
What causes the infraorbital hypoesthesia after a blowout fracture?
Entrapment of the infraorbital nerve (branch of V2)
Prognosis for commotio retinae:
Usually resolves without sequelae in 24-48 hrs
What is Commotio retinae?
"Bruised" retina- disruption of RPE and photoreceptor outer segments after trauma
,Commotio retinae that occurs in the macula is called:
Berlin's edema
In iridodialysis, what structure detaches from what?
Iris root detaches from ciliary body
What is Iridodialysis?
Peripheral iris hole where iris root has become detached after trama
What causes Purtscher's retinopathy?
Chest or neck compression (traumatic choking)
Acute pancreatitis
Clinical findings of Purtscher's retinopathy:
Diffuse retinal hemorrhages, exudates, CWS
Choroidal rupture secondary to trauma is most likely to occur in which location?
Temporal posterior pole
Which type of chemical burn has a worse prognosis: Acid or base?
Base
Which type of chemical burn is more common: Acid or base?
Base- 2x as common
Which chemical is the most common cause of alkali burns on the ocular surface?
Calcium hydroxide (Lye)
Is limbal blanching more common in an acid or base chemical burn?
Base
After a hyphema, gonioscopy should not be performed for at least how long to avoid rebleeds?
1 month
What is an 8-ball Hyphema?
Black hyphema filling 100% of the anterior chamber
Potential complication of Choroidal rupture secondary to trauma:
CNVM development (CHBALA)
,Conditions that can cause CNVM:
CHBALA:
Choroidal rupture
Histoplasmosis
Best's vitelliform
ARMD
Lacquer Cracks
Angioid streaks
What causes prolapse of orbital fat (dermatochalaisis) with age?
Weakening of the orbital septum
Etiologies of Preseptal Cellulitis:
Acute hordeolum
Dacryocystitis
Upper respiratory infection or middle ear infection
Skin puncture wounds
Etiologies of Orbital Cellulitis:
Sinus infection (especially ethmoid)
Dacryoadenitis, dacryocystitis
Progression of preseptal cellulitis
Orbital fracture
Dental infection
Most common bacteria that cause orbital cellulitis- adults & children:
Staph aureus in adults
Haemophilus influenzae in kids
Signs/sx of Orbital cellulitis:
APD
Proptosis
Diplopia
EOM restriction
Fever
Eyelid edema & redness
Potential complications of Orbital cellulitis:
Cavernous sinus thrombosis
Brain abscess
, Meningitis
Mucormycosis (diabetics & immunocompromised)
What is Mucormycosis?
Fungal infection that causes orbital cellulitis in diabetics & immunocompromised pts- hallmark
sign is "black eschar" in mouth and nose
What is the strongest risk factor for development of thyroid eye disease?
Cigarette smoking
What is the order of muscle involvement in thyroid eye disease?
IM SLO:
IR, MR, SR, LR, Obliques
Thyroid eye disease occurs in ___________% of patients with Graves' disease.
30-70%
The lid retraction in thyroid eye disease is due to contraction of which lid muscle?
Muller's muscle
Grading system/progression of thyroid-related Ophthalmopathy:
NO SPECS
No signs or sx
Only signs, no sx (lid retraction)
Soft tissue involvement
Proptosis
EOM involvement
Corneal involvement
Sight loss (due to optic nerve compression)
What is Von Graefe's sign?
Thyroid eye dz sign- Upper eyelid lag during downgaze
What is Kocher's sign?
Thyroid eye dz sign- globe lag compared to lid movement when looking up
What is Dalrymple's sign?
Thyroid eye dz sign- Lid retraction resulting in a staring appearance
Normal Exophthalmometry range for Caucasians:
