NBEO PART 3 REVIEW EXAMS UPDATED
QUESTIONS AND ANSWERS SURE A+
✔✔CHRPE - Tx - ✔✔Monitor yearly; Urgent colonoscopy and refer to gastroenterologist
for FAP (Familial adenomatous polyposis) dx if bilateral CHRPE clusters
✔✔CHRPE - FU - ✔✔1 year
✔✔CHRPE - Education - ✔✔You have a CHRPE, which is a pigmented area of the
retina and a benign finding that you were likely born with. We'll continue to monitor it
yearly.
✔✔Nevus - Testing - ✔✔Fundus photo, Red-free photo (less visible), FAF (-), OCT
(drusen, RPE alterations), B-scan (high reflectivity)
✔✔Nevus - Treatment - ✔✔Monitor for progression and record size, Rcmnd UV
protection. If melanoma suspected, refer to ocular oncology
✔✔Nevus - FU - ✔✔If high risk, 3mo, 6 mo, 1 yr. Otherwise 1 year
✔✔Nevus - Education - ✔✔You have a freckle in the back of your eye that you were
likely born with or developed during puberty. This freckle is benign and not concerning.
Very rarely, these may progress to melanoma, so it is important that we monitor you
,annually to make sure there is no change in size/shape/color. UV protection can help
protect the back of the eye and deter progression.
✔✔Nevus vs. Melanoma - ✔✔Nevus - slate gray/brown, flat, 1-5 mm diameter, <2mm
deep, drusen, hypo pigmented halo, asymptomatic. Melanoma - <3mm to ONH, >6mm
diameter, >2mm depth, no drusen, lack of halo, flashes/floaters, subretinal fluid,
overlying orange pigment/lipofuscin
✔✔Choroidal Rupture - Testing - ✔✔Fundus photo, OCT, IVFA
✔✔Choroidal Rupture - Treatment - ✔✔Monitor for resolution; Monitor for CNV
✔✔Choroidal Rupture - FU - ✔✔1-2 weeks to check for resolution. 6-12 mo to check for
CNV
✔✔Choroidal Rupture - Education - ✔✔Due to blunt trauma, you have experienced a
rupture of the choroid, a deep layer in the back of the eye. This can lead to visual
disturbances until it heals. Down the line, this rupture can put you at risk for developing
a CNV, which is leaky blood vessels in the back of the eye. I'd like to see you in 2
weeks to make sure it's healed, and then in 6 months to make sure no complications
develop from this.
✔✔Commotio Retinae - Testing - ✔✔Fundus photo
✔✔Commotio Retinae - Treatment - ✔✔Monitor for resolution
✔✔Commotio Retinae - FU - ✔✔2-4 weeks
✔✔Commotio Retinae - Education - ✔✔Due to a coup/counter-coup injury, there is
some swelling in the back of the eye. The retina appears white where the retinal cells
are swollen, but this should not have a lasting impact on your vision. I'd like to see you
back in 2-4 weeks to make sure it's resolving properly.
✔✔Blepharospasm - Testing - ✔✔NaFL, TBUT, MRI if twitching persists during sleep
✔✔Blepharospasm - Treatment - ✔✔PFATs or gels, Refer to oculoplastics for botox
injections
✔✔Blepharospasm - FU - ✔✔1 year
✔✔Blepharospasm - Education - ✔✔You are experiencing blepharospasm, which is an
uncontrollable twitching of both eyelids. It may also be associated with twitching of the
lower face. This is a benign but annoying condition that can cause visual impairment if
severe enough. I'm going to recommend frequent PFATs to keep the cornea hydrated,
, as well as refer you for Botox injections to lessen the twitching. You can FU with me in 1
year or sooner if it worsens.
✔✔FES - Testing - ✔✔NaFl, TBUT, Lid eversion
✔✔FES - Treatment - ✔✔Lid taping or sleeping mask at night, PFATs and ointment
before bed, Avoid eye rubbing, Olopatadine 0.2% if itchy eyes. Refer for OSA
evaluation.
✔✔FES - FU - ✔✔5-7 days
✔✔FES - Education - ✔✔You are experiencing floppy eyelid syndrome, a condition in
which your eyelids have extra elasticity. This can cause them to flip in the middle of the
night when rubbing against your pillow, leading to dry eye. I'd recommend that you
begin using PFATs during the day and an ointment before bed as well as a sleeping
mask to protect your eyes while you sleep. I'd also like to refer for a sleep apnea
evaluation, as this is very commonly associated with FES. I'd like to FU in 5-7 days to
check on the dryness.
✔✔Blepharitis - Testing - ✔✔MG expression, Meibography, NaFl, Lash epilation (if
collarettes)
✔✔Blepharitis - Treatment - ✔✔Lid scrubs bid, hot compresses for 10-15 min qd,
PFATs, hypochlorous acid spray, omega-3 diet, XDEMVY bid for 6 weeks if demodex
✔✔Blepharitis - FU - ✔✔FU 2-4 weeks, 6 weeks for XDEMVY
✔✔Blepharitis - Treatment - ✔✔You have blepharitis, which is inflammation of the
eyelids. It an be due to oil/debris buildup, poor oil gland function, or demodex (explain
cause). To reduce irritation and itching, I recommend lid scrubs 1-2x per day, a warming
mask at night, PFATs, and hypochlorous acid spray (which is both antimicrobial and
anti-inflammatory). If due to demodex, suggest XDEMVY. I'd like to see you in 2-4
weeks to make sure you're healing properly.
✔✔Chalazion - Testing - ✔✔NaFl, A-seg photo, Eyelid eversion
✔✔Chalazion - Treatment - ✔✔Warm compresses with lid massage bid-qid, Lid scrubs,
PFATs
✔✔Chalazion - FU - ✔✔2-3 weeks
✔✔Chalazion - Education - ✔✔You have a chalazion which is a clogged oil gland in
your eyelid. The best way to treat these is with continuous heat for 15 minutes with a
warming mask, ideally multiple times per day. You can also massage the bump after the
mask, which can help to release some of the oil. You should also continue to use the
QUESTIONS AND ANSWERS SURE A+
✔✔CHRPE - Tx - ✔✔Monitor yearly; Urgent colonoscopy and refer to gastroenterologist
for FAP (Familial adenomatous polyposis) dx if bilateral CHRPE clusters
✔✔CHRPE - FU - ✔✔1 year
✔✔CHRPE - Education - ✔✔You have a CHRPE, which is a pigmented area of the
retina and a benign finding that you were likely born with. We'll continue to monitor it
yearly.
✔✔Nevus - Testing - ✔✔Fundus photo, Red-free photo (less visible), FAF (-), OCT
(drusen, RPE alterations), B-scan (high reflectivity)
✔✔Nevus - Treatment - ✔✔Monitor for progression and record size, Rcmnd UV
protection. If melanoma suspected, refer to ocular oncology
✔✔Nevus - FU - ✔✔If high risk, 3mo, 6 mo, 1 yr. Otherwise 1 year
✔✔Nevus - Education - ✔✔You have a freckle in the back of your eye that you were
likely born with or developed during puberty. This freckle is benign and not concerning.
Very rarely, these may progress to melanoma, so it is important that we monitor you
,annually to make sure there is no change in size/shape/color. UV protection can help
protect the back of the eye and deter progression.
✔✔Nevus vs. Melanoma - ✔✔Nevus - slate gray/brown, flat, 1-5 mm diameter, <2mm
deep, drusen, hypo pigmented halo, asymptomatic. Melanoma - <3mm to ONH, >6mm
diameter, >2mm depth, no drusen, lack of halo, flashes/floaters, subretinal fluid,
overlying orange pigment/lipofuscin
✔✔Choroidal Rupture - Testing - ✔✔Fundus photo, OCT, IVFA
✔✔Choroidal Rupture - Treatment - ✔✔Monitor for resolution; Monitor for CNV
✔✔Choroidal Rupture - FU - ✔✔1-2 weeks to check for resolution. 6-12 mo to check for
CNV
✔✔Choroidal Rupture - Education - ✔✔Due to blunt trauma, you have experienced a
rupture of the choroid, a deep layer in the back of the eye. This can lead to visual
disturbances until it heals. Down the line, this rupture can put you at risk for developing
a CNV, which is leaky blood vessels in the back of the eye. I'd like to see you in 2
weeks to make sure it's healed, and then in 6 months to make sure no complications
develop from this.
✔✔Commotio Retinae - Testing - ✔✔Fundus photo
✔✔Commotio Retinae - Treatment - ✔✔Monitor for resolution
✔✔Commotio Retinae - FU - ✔✔2-4 weeks
✔✔Commotio Retinae - Education - ✔✔Due to a coup/counter-coup injury, there is
some swelling in the back of the eye. The retina appears white where the retinal cells
are swollen, but this should not have a lasting impact on your vision. I'd like to see you
back in 2-4 weeks to make sure it's resolving properly.
✔✔Blepharospasm - Testing - ✔✔NaFL, TBUT, MRI if twitching persists during sleep
✔✔Blepharospasm - Treatment - ✔✔PFATs or gels, Refer to oculoplastics for botox
injections
✔✔Blepharospasm - FU - ✔✔1 year
✔✔Blepharospasm - Education - ✔✔You are experiencing blepharospasm, which is an
uncontrollable twitching of both eyelids. It may also be associated with twitching of the
lower face. This is a benign but annoying condition that can cause visual impairment if
severe enough. I'm going to recommend frequent PFATs to keep the cornea hydrated,
, as well as refer you for Botox injections to lessen the twitching. You can FU with me in 1
year or sooner if it worsens.
✔✔FES - Testing - ✔✔NaFl, TBUT, Lid eversion
✔✔FES - Treatment - ✔✔Lid taping or sleeping mask at night, PFATs and ointment
before bed, Avoid eye rubbing, Olopatadine 0.2% if itchy eyes. Refer for OSA
evaluation.
✔✔FES - FU - ✔✔5-7 days
✔✔FES - Education - ✔✔You are experiencing floppy eyelid syndrome, a condition in
which your eyelids have extra elasticity. This can cause them to flip in the middle of the
night when rubbing against your pillow, leading to dry eye. I'd recommend that you
begin using PFATs during the day and an ointment before bed as well as a sleeping
mask to protect your eyes while you sleep. I'd also like to refer for a sleep apnea
evaluation, as this is very commonly associated with FES. I'd like to FU in 5-7 days to
check on the dryness.
✔✔Blepharitis - Testing - ✔✔MG expression, Meibography, NaFl, Lash epilation (if
collarettes)
✔✔Blepharitis - Treatment - ✔✔Lid scrubs bid, hot compresses for 10-15 min qd,
PFATs, hypochlorous acid spray, omega-3 diet, XDEMVY bid for 6 weeks if demodex
✔✔Blepharitis - FU - ✔✔FU 2-4 weeks, 6 weeks for XDEMVY
✔✔Blepharitis - Treatment - ✔✔You have blepharitis, which is inflammation of the
eyelids. It an be due to oil/debris buildup, poor oil gland function, or demodex (explain
cause). To reduce irritation and itching, I recommend lid scrubs 1-2x per day, a warming
mask at night, PFATs, and hypochlorous acid spray (which is both antimicrobial and
anti-inflammatory). If due to demodex, suggest XDEMVY. I'd like to see you in 2-4
weeks to make sure you're healing properly.
✔✔Chalazion - Testing - ✔✔NaFl, A-seg photo, Eyelid eversion
✔✔Chalazion - Treatment - ✔✔Warm compresses with lid massage bid-qid, Lid scrubs,
PFATs
✔✔Chalazion - FU - ✔✔2-3 weeks
✔✔Chalazion - Education - ✔✔You have a chalazion which is a clogged oil gland in
your eyelid. The best way to treat these is with continuous heat for 15 minutes with a
warming mask, ideally multiple times per day. You can also massage the bump after the
mask, which can help to release some of the oil. You should also continue to use the
