NBEO Part 3 PEPS 2026
Clinical Skills Study Guide & Exam Preparation
Grade A+
Corneal Foreign Body - Treatment - 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 - 1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education - 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 - NaFl, Lid eversion
RCE/EBMD - Treatment - 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 - 1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education - 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 - 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 - Debridement of any loose epithelium, Moxifloxacin 0.5% qid x1
week, Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
Chemical Burn - FU - 1 day
Chemical Burn - Education - 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 - RNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen), Red cap, BP, Order urgent
MRI/MRV and LP with CSF analysis
IIH - Treatment - 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 - 3-4 weeks
,IIH - Education - 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 - 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 - Refer to PCP for management of BP/BS/Cholesterol
NAION - FU - 1-2 months
NAION - Education - 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 - RNFL OCT, VF (altitudinal or central), Pupils (APD), Red cap (reduced),
Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment - Refer to ER for blood work and IV methylprednisolone, Switch to oral
steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU - 3-4 wks
, AAION - Education - 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 - RNFL OCT, VF (central or arcuate), Pupils (APD), Red cap (reduced),
EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment - Refer for imaging, and oral steroids if within the first 1 -2 weeks of
onset. Refer to neurology for MS management.
Optic Neuritis - FU - 3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education - 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 - FAF (+), B-scan (hyper-reflective), VF (generalized depression), RNFL OCT
ONH Drusen - Treatment - Observation
ONH Drusen - FU - q 6-12 mo
Clinical Skills Study Guide & Exam Preparation
Grade A+
Corneal Foreign Body - Treatment - 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 - 1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education - 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 - NaFl, Lid eversion
RCE/EBMD - Treatment - 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 - 1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education - 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 - 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 - Debridement of any loose epithelium, Moxifloxacin 0.5% qid x1
week, Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
Chemical Burn - FU - 1 day
Chemical Burn - Education - 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 - RNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen), Red cap, BP, Order urgent
MRI/MRV and LP with CSF analysis
IIH - Treatment - 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 - 3-4 weeks
,IIH - Education - 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 - 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 - Refer to PCP for management of BP/BS/Cholesterol
NAION - FU - 1-2 months
NAION - Education - 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 - RNFL OCT, VF (altitudinal or central), Pupils (APD), Red cap (reduced),
Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment - Refer to ER for blood work and IV methylprednisolone, Switch to oral
steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU - 3-4 wks
, AAION - Education - 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 - RNFL OCT, VF (central or arcuate), Pupils (APD), Red cap (reduced),
EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment - Refer for imaging, and oral steroids if within the first 1 -2 weeks of
onset. Refer to neurology for MS management.
Optic Neuritis - FU - 3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education - 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 - FAF (+), B-scan (hyper-reflective), VF (generalized depression), RNFL OCT
ONH Drusen - Treatment - Observation
ONH Drusen - FU - q 6-12 mo
