NBEO Part 4 PEPS PDF – Clinical Skills
Study Guide
Corneal Foreign Body - Testing - correct answersNaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment - correct answersRemove 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 - correct answers1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education - correct answersYou 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 - correct answersNaFl, Lid eversion
RCE/EBMD - Treatment - correct answersPropraracaine 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 - correct answers1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education - correct answersYou 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 - correct answersIrrigation 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 - correct answersDebridement of any loose epithelium,
Moxifloxacin 0.5% qid x1 week, Prednisolone Acetate 1% qid x1 week then taper,
frequent PFATs
,Chemical Burn - FU - correct answers1 day
Chemical Burn - Education - correct answersYou 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 - correct answersRNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen),
Red cap, BP, Order urgent MRI/MRV and LP with CSF analysis
IIH - Treatment - correct answersMRI & 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 - correct answers3-4 weeks
IIH - Education - correct answersYou 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 - correct answersRNFL 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 - correct answersRefer to PCP for management of
BP/BS/Cholesterol
NAION - FU - correct answers1-2 months
NAION - Education - correct answersYou 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 - correct answersRNFL OCT, VF (altitudinal or central), Pupils (APD),
Red cap (reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment - correct answersRefer to ER for blood work and IV
methylprednisolone, Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU - correct answers3-4 wks
AAION - Education - correct answersYou 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 - correct answersRNFL OCT, VF (central or arcuate), Pupils
(APD), Red cap (reduced), EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment - correct answersRefer for imaging, and oral steroids if within
the first 1 -2 weeks of onset. Refer to neurology for MS management.
Optic Neuritis - FU - correct answers3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education - correct answersYou 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 - correct answersFAF (+), B-scan (hyper-reflective), VF
(generalized depression), RNFL OCT
ONH Drusen - Treatment - correct answersObservation
ONH Drusen - FU - correct answersq 6-12 mo
ONH Drusen - Education - correct answersYou have ONH drusen, which are calcified
deposits within the optic nerve. Usually these are benign and will have no effect on your
vision. Rarely, they can start to compress the nerve tissue and lead to loss of vision. I'd
Study Guide
Corneal Foreign Body - Testing - correct answersNaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment - correct answersRemove 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 - correct answers1 day if BCL, otherwise 1 wk
Corneal Foreign Body - Education - correct answersYou 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 - correct answersNaFl, Lid eversion
RCE/EBMD - Treatment - correct answersPropraracaine 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 - correct answers1 day for BCL, Otherwise 3-4 weeks
RCE/EBMD - Education - correct answersYou 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 - correct answersIrrigation 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 - correct answersDebridement of any loose epithelium,
Moxifloxacin 0.5% qid x1 week, Prednisolone Acetate 1% qid x1 week then taper,
frequent PFATs
,Chemical Burn - FU - correct answers1 day
Chemical Burn - Education - correct answersYou 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 - correct answersRNFL OCT, VF (enlarged BS), FAF (r/o ONH drusen),
Red cap, BP, Order urgent MRI/MRV and LP with CSF analysis
IIH - Treatment - correct answersMRI & 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 - correct answers3-4 weeks
IIH - Education - correct answersYou 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 - correct answersRNFL 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 - correct answersRefer to PCP for management of
BP/BS/Cholesterol
NAION - FU - correct answers1-2 months
NAION - Education - correct answersYou 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 - correct answersRNFL OCT, VF (altitudinal or central), Pupils (APD),
Red cap (reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
AAION - Treatment - correct answersRefer to ER for blood work and IV
methylprednisolone, Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
AAION - FU - correct answers3-4 wks
AAION - Education - correct answersYou 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 - correct answersRNFL OCT, VF (central or arcuate), Pupils
(APD), Red cap (reduced), EOM (pain), Urgent MRI and LP
Optic Neuritis - Treatment - correct answersRefer for imaging, and oral steroids if within
the first 1 -2 weeks of onset. Refer to neurology for MS management.
Optic Neuritis - FU - correct answers3-4 weeks. After that, q 3-6 mo
Optic Neuritis - Education - correct answersYou 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 - correct answersFAF (+), B-scan (hyper-reflective), VF
(generalized depression), RNFL OCT
ONH Drusen - Treatment - correct answersObservation
ONH Drusen - FU - correct answersq 6-12 mo
ONH Drusen - Education - correct answersYou have ONH drusen, which are calcified
deposits within the optic nerve. Usually these are benign and will have no effect on your
vision. Rarely, they can start to compress the nerve tissue and lead to loss of vision. I'd
