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NBEO Part 3 Conditions/Treatment – Questions With Fully Explained Solutions

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NBEO Part 3 Conditions/Treatment – Questions With Fully Explained Solutions

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NBEO Part 3 Conditions/Treatment – Questions
With Fully Explained Solutions

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Bacterial conjunctivitis Ancillary Testing: Anterior segment photos,
Preauricular Gland Palpation, Corneal culture with
differential


Plan:
Moxifloxacin 0.5% Ophthalmic Solution (adults)
1 gtt QID for 7 days,
Ocusoft lid scrubs BID for 1 week
(Kids Erythromycin Ophthalmic Ointment 1cm ribbon
into affected eye QID for 1 week)
RTC in 1 week to reassess status or sooner if
condition worsens


Education: Patient educated they have a condition
called bacterial conjunctivitis, which is a bacterial
infection of the eye better known as pink eye. They
were educated that they will be started on an
antibacterial drop they will used QID for 7 days and
lid scrubs to clean the eyelid margins BID for 7 days.
They were educated on the importance of hygiene
and to avoid touching their eyes and face and to
avoid sharing items such as towels. RTC in 1 week or
sooner if symptoms worsen or they do not note
improvement within 2-3 days.

,Optic Neuritis Ancillary Testing: Fundus photos, ONH OCT,
EOMs/Red Cap Desaturation, MRI of brain/orbits
with and without contrast


Plan:
Urgent referral to emergency room for treatment
with IV steroids (Methlyprednisone). Referral for
neuroimaging including MRI of brain/orbit with and
without contrast to rule out white matter lesions/MS.
RTC after discharge from hospital to reassess vision
and perform DFE/ONH OCT.


Education:
Patient educated they have optic neuritis which is an
inflammation of the optic nerve, the tether cord that
connects the eye to the brain. The inflammation can
be treated with IV steroids in the hospital to bring
down the swelling and to preserve the vision. With
proper treatment most people recover good vision
over time. This condition is linked closely to a
condtion called multiple sclerosis which is a
demyleninating disorder of the central nervous
system and testing will also be performed to rule out
this conditoon. RTC after discharge from ER to
reassess vision.

,Anterior Uveitis Plan:
Pred Forte 1% Ophthalmic Suspension 1gtt every 2
hours for first 24 hours (shake before instillation)
Cyclopentolate ophthalmic solution 1% BID
RTC in 24 hours to reassess and determine if tapering
can begin, otherwise RTC daily until improvement
noted, then slow taper can begin to QID, BID, QD
over course of several weeks. IOP check at each visit
to assess for steroid induced IOP elevation.


(First time occuring monitor, 2nd occasion referral for
PCP for systemic workup including CBC, ESR, CRP,
HLA-B27, RF, ANA, Chest X-Ray, PPD, urinaylsis.


Education:
Patient educated they have a condition called
anterior uveitis which is an inflammation of the front
structures of the eye. In 70-80% of the time, this
conditon is idiopathic meaning there is no definitive
factor that caused it but in about 30% of cases
especially when this has happened more than once it
can be a sign of an underlying inflammatory
condition and this would warrant blood work and
other testing. The steroid drop was explained to the
patient and the importance of slowly tapering and
following up regularly to prevent rebound
inflammation. Patient expressed understandign of
today's plan.

, Herpes Zoster Keratitis Plan: Valcylcovir 1000mg po TID for 7 days,
Preservative-free artificial tears 1 gtt OU QID for
additional comfort. Consider oral NSAID for pain
relief. Patient educated on condition and will RTC in 1
day to reassess anterior segment health and daily
until resolved pseudodendrite.


Education: Patient educated they have a condition
called herpes zoster opthalmicus which is essentially
a case of shingles in the eye. Shingles is caused by
the same virus that causes chicken pox and lays
dormant in the nervous system until triggered later in
life. if the virus shares the same nerve as the eye the
eye will be affected. RTC in 1 day. patient expressed
understanding of today's plan

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