NBEO Part 3 - PEPS
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1. Corneal foreign body: Sx: Sudden onset pain, photophobia, watering, possible FB sensation.
signs and symptoms S: Conjunctival injection, FB embedded in cornea, may need fluores-
cein to see
2. Corneal Foreign Body - NaFl, Lid eversion, Retroillumination
Testing
3. Corneal Foreign Body Remove foreign body with cotton-tipped applicator, or instill Propara-
(metal and not) - Treat- caine and remove with instrument, remove rust ring with Alger brush,
ment in office and after place BCL if large epithelial defect, Moxifloxacin 0.5% qid x1 wk, prn:
oral NSAID and frequent PFATs
4. Corneal Foreign Body - 1 day if BCL, otherwise 1 wk
FU times
5. Metal FB pt. education You have a piece of metal in your eye 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.
6. Recurrent Epithelial Ero- Sx: Pain upon opening eyes, ripping or tearing sensation, tearing,
sion (RCE): Symptoms blurred vision, redness, photophobia
and signs S: subtle loose epithelium
7. Suspected RCE/EBMD - NaFl, Lid eversion
Testing
8. RCE - Treatment for sub- Erythromycin ointment QID, NaCl 5% QID until healed. Then NaCl QHS
tle loose epithelium and Genteal gel QHS x3-6 months
9.
, NBEO Part 3 - PEPS
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RCE - Treatment in office Propraracaine and debride 1-2mm beyond lesion, Place BCL if not a
and after for heaping ep- previous CL wearer, Moxifloxacin 0.5% qid x1 wk, Nacl 5% soln qid x2
ithelium wk then taper to qhs for 3 months, frequent PFATs
10. RCE -Recalcitrant treat- Do in office anterior stromal puncture
ment
11. RCE - FU times 1 day for BCL, Otherwise 3-4 weeks
12. RCE from previous trau- You have a condition called EBMD, in which the top layer of your cornea
ma or EBMD - Education 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.
13. Chemical Burn - workup Irrigation for 15 mins, lid eversion and irrigation/swabbing of fornices,
and testing Testing PH with litmus paper after 5 minutes (normal is 7-7.4), NaFl
14. Chemical Burn - Treat- Debridement of any loose epithelium, Moxifloxacin 0.5% qid x1 week,
ment Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
15. Chemical Burn - FU 1 day
16. Chemical Burn - Educa- You have gotten a chemical into your eye which has burned a layer of
tion your cornea. I've removed all of the loose tissue to help the corneal
heal better. I want you to use an antibiotic to prevent infection and an
anti-inflammatory to help with swelling and inflammation. You should
, NBEO Part 3 - PEPS
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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 glasses while using chemicals.
17. IIH: Symptoms and signs Sx: HA, transient vision loss, back pain, pulsatile tinnitus, nausea
S: Bilateral ON edema
18. Suspected IIH - Testing RNFL OCT (elevated nerves), VF (enlarged blind spot), Fluorescein
AutoFluorescence (FAF) (r/o ONH drusen), Red cap (decreased), BP,
Order urgent MRI/MRV and LP afterwards with CSF analysis
19. Confirmed IIH - Treat- Acetazolamide 250mg po BID. Refer to PCP/OBGYN to discuss weight
ment loss and changing birth control drug/method.
20. IIH - FU from initial dx 4 weeks
21. IIH - Education You most likely have Idiopathic Intracranial Hypertension or IIH, a con-
dition in which there is increased pressure inside the brain. The optic
nerve is being affected by this increased pressure, causing it to swell
and leading to visual changes, headaches and nausea. Two potential
causes of this increased pressure may be due to being overweight, or
the type of birth control you're using. It's important that we rule out
any other causes of increased pressure in the brain, so I am referring
you for an urgent MRI and lumbar puncture. I would also like you to
see 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 a month to check the health of your optic nerve.
22. Non-arteritic Ischemic Sx: sudden, painless, unilateral vision loss
optic neuropathy S: Unilateral ON edema (diffuse or segmental) that is hyperemic NOT
(NAION) -symptoms and pale, flame hemes, vessel obscuration
signs
, NBEO Part 3 - PEPS
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23. NAION - Testing and or- In office: RNFL OCT (elevation), VF (altitudinal or central), Pupils
ders (+RAPD), Red cap (reduced), BP (high), EOMs (r/o neuritis)
Order: ESR/CRP/platelet count (r/o GCA)
24. NAION - Treatment Refer to PCP for management of BP/BS/Cholesterol
25. NAION - FU 1-2 months
26. NAION - Education You have a condition called Non-Arteritic ischemic Optic Neuropathy
or 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 rule
out dangerous inflammation in the body. I also want to refer you to
your PCP to help get your BP/BS/cholesterol 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 one month after you've seen your PCP.
27. Arteritic Anterior Is- Sx: HA, scalp tingling, jaw claudication, temporal artery pain, sudden
chemic Optic Neuropa- acute unilateral vision loss
thy (AAION) -Symptoms S: Chalky white edematous ON, vessels are not obscured
and signs
28. Suspected AAION - Test- RNFL OCT, VF (altitudinal or central), Pupils (+RAPD), Red cap (re-
ing and orders duced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
-platelets (elevated. nl: ESR (age+10)/2 (F), CRP < 10)
29. AAION - Treatment Refer to ER for blood work and IV methylprednisolone, Switch to oral
steroids if (+) TA biopsy and cont for 6-12 months
30. AAION - FU 3-4 wks
31. AAION - Education You have Arteritic Anterior Ischemic Optic Neuropathy or AAION/GCA.
This condition leads to inflammation of the medium and large blood
Study online at https://quizlet.com/_j87w9q
1. Corneal foreign body: Sx: Sudden onset pain, photophobia, watering, possible FB sensation.
signs and symptoms S: Conjunctival injection, FB embedded in cornea, may need fluores-
cein to see
2. Corneal Foreign Body - NaFl, Lid eversion, Retroillumination
Testing
3. Corneal Foreign Body Remove foreign body with cotton-tipped applicator, or instill Propara-
(metal and not) - Treat- caine and remove with instrument, remove rust ring with Alger brush,
ment in office and after place BCL if large epithelial defect, Moxifloxacin 0.5% qid x1 wk, prn:
oral NSAID and frequent PFATs
4. Corneal Foreign Body - 1 day if BCL, otherwise 1 wk
FU times
5. Metal FB pt. education You have a piece of metal in your eye 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.
6. Recurrent Epithelial Ero- Sx: Pain upon opening eyes, ripping or tearing sensation, tearing,
sion (RCE): Symptoms blurred vision, redness, photophobia
and signs S: subtle loose epithelium
7. Suspected RCE/EBMD - NaFl, Lid eversion
Testing
8. RCE - Treatment for sub- Erythromycin ointment QID, NaCl 5% QID until healed. Then NaCl QHS
tle loose epithelium and Genteal gel QHS x3-6 months
9.
, NBEO Part 3 - PEPS
Study online at https://quizlet.com/_j87w9q
RCE - Treatment in office Propraracaine and debride 1-2mm beyond lesion, Place BCL if not a
and after for heaping ep- previous CL wearer, Moxifloxacin 0.5% qid x1 wk, Nacl 5% soln qid x2
ithelium wk then taper to qhs for 3 months, frequent PFATs
10. RCE -Recalcitrant treat- Do in office anterior stromal puncture
ment
11. RCE - FU times 1 day for BCL, Otherwise 3-4 weeks
12. RCE from previous trau- You have a condition called EBMD, in which the top layer of your cornea
ma or EBMD - Education 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.
13. Chemical Burn - workup Irrigation for 15 mins, lid eversion and irrigation/swabbing of fornices,
and testing Testing PH with litmus paper after 5 minutes (normal is 7-7.4), NaFl
14. Chemical Burn - Treat- Debridement of any loose epithelium, Moxifloxacin 0.5% qid x1 week,
ment Prednisolone Acetate 1% qid x1 week then taper, frequent PFATs
15. Chemical Burn - FU 1 day
16. Chemical Burn - Educa- You have gotten a chemical into your eye which has burned a layer of
tion your cornea. I've removed all of the loose tissue to help the corneal
heal better. I want you to use an antibiotic to prevent infection and an
anti-inflammatory to help with swelling and inflammation. You should
, NBEO Part 3 - PEPS
Study online at https://quizlet.com/_j87w9q
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 glasses while using chemicals.
17. IIH: Symptoms and signs Sx: HA, transient vision loss, back pain, pulsatile tinnitus, nausea
S: Bilateral ON edema
18. Suspected IIH - Testing RNFL OCT (elevated nerves), VF (enlarged blind spot), Fluorescein
AutoFluorescence (FAF) (r/o ONH drusen), Red cap (decreased), BP,
Order urgent MRI/MRV and LP afterwards with CSF analysis
19. Confirmed IIH - Treat- Acetazolamide 250mg po BID. Refer to PCP/OBGYN to discuss weight
ment loss and changing birth control drug/method.
20. IIH - FU from initial dx 4 weeks
21. IIH - Education You most likely have Idiopathic Intracranial Hypertension or IIH, a con-
dition in which there is increased pressure inside the brain. The optic
nerve is being affected by this increased pressure, causing it to swell
and leading to visual changes, headaches and nausea. Two potential
causes of this increased pressure may be due to being overweight, or
the type of birth control you're using. It's important that we rule out
any other causes of increased pressure in the brain, so I am referring
you for an urgent MRI and lumbar puncture. I would also like you to
see 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 a month to check the health of your optic nerve.
22. Non-arteritic Ischemic Sx: sudden, painless, unilateral vision loss
optic neuropathy S: Unilateral ON edema (diffuse or segmental) that is hyperemic NOT
(NAION) -symptoms and pale, flame hemes, vessel obscuration
signs
, NBEO Part 3 - PEPS
Study online at https://quizlet.com/_j87w9q
23. NAION - Testing and or- In office: RNFL OCT (elevation), VF (altitudinal or central), Pupils
ders (+RAPD), Red cap (reduced), BP (high), EOMs (r/o neuritis)
Order: ESR/CRP/platelet count (r/o GCA)
24. NAION - Treatment Refer to PCP for management of BP/BS/Cholesterol
25. NAION - FU 1-2 months
26. NAION - Education You have a condition called Non-Arteritic ischemic Optic Neuropathy
or 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 rule
out dangerous inflammation in the body. I also want to refer you to
your PCP to help get your BP/BS/cholesterol 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 one month after you've seen your PCP.
27. Arteritic Anterior Is- Sx: HA, scalp tingling, jaw claudication, temporal artery pain, sudden
chemic Optic Neuropa- acute unilateral vision loss
thy (AAION) -Symptoms S: Chalky white edematous ON, vessels are not obscured
and signs
28. Suspected AAION - Test- RNFL OCT, VF (altitudinal or central), Pupils (+RAPD), Red cap (re-
ing and orders duced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
-platelets (elevated. nl: ESR (age+10)/2 (F), CRP < 10)
29. AAION - Treatment Refer to ER for blood work and IV methylprednisolone, Switch to oral
steroids if (+) TA biopsy and cont for 6-12 months
30. AAION - FU 3-4 wks
31. AAION - Education You have Arteritic Anterior Ischemic Optic Neuropathy or AAION/GCA.
This condition leads to inflammation of the medium and large blood
