NBEO Part 3 2025/2026 Updated Exact Exam|
Skills Exam Prep + Clinical Scenarios &
Answers
Corneal Foreign Body - Testing
NaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment
Proparacaine and remove foreign body with cotton-tipped applicator or appropriate instrument.
Remove rust ring with Alger brush. Measure epi defect created and place BCL if large w/
Moxifloxacin qid x1 wk.
Ketorolac qid if pain, PFATs qid
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
Cyclo TID and Bacitracin Ung QID until healed. Then ATs QID for 6mo
If Epith is heaped or not healing: Debridement 1-2mm past defect w/ Anesthetic and Cotton
swab. If not previous CL wearer, place BCL and use Moxifloxacin 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 qid x1 week, Pred 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
Ask if taking any of the "CATS" drugs
VF (enlarged BS)/most important for monitoring
FAF (r/o ONH drusen)
Red cap (Dyschromatopsia)
BP
Urgent MRI/MRV orbit and brain then LP (r/o systemic causes)
IIH - Treatment
MRI & MRV of brain and orbit ASAP
LP if MRI/MRV normal
,Oral CAIs (ie Acetazolomide)
if applies 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
- VF (asses for altitudinal or central defect)
- Red cap (asses for dyschromatopsia)
- ESR/CRP and CBC w/ diff (r/o GCA/AION)
- Blood pressure
- EOMs (r/o neuritis)
NAION - Treatment
Monitor
Refer to PCP for management of BP/BS/Cholesterol. If on BP meds, consult w/ PCP to not take
them at night
BP meds:
-pril "P for pril drugs lower Pressure"
- sartan drugs "Sartan stops the strain from pressure"
- amlodipine "loves dipping the pressure down"
- beta blockers "beta blockers block the pressure"
NAION - FU
1 month
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, Temporal Artery 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 months
AAION - FU
1 month
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
- Ask: Worse sx when hot ie shower/exercise
- EOM (pain w/ eye mvmts)
- Red cap (dyschromatopsia/ CV changes)
- MRI brain and orbits (r/o MS white matter lesions)
- VF (central or arcuate)
- Pupils (APD)
- Blood pressure
Dont forget 2/3 Retrobulbar so nerve will look fine!)
Optic Neuritis - Treatment
Refer for MRI to asses for MS, and IV steroids (as long as pt knows this will only speed
recovery but arrive at the same end point as if not using them)
Skills Exam Prep + Clinical Scenarios &
Answers
Corneal Foreign Body - Testing
NaFl, Lid eversion, Retroillumination
Corneal Foreign Body - Treatment
Proparacaine and remove foreign body with cotton-tipped applicator or appropriate instrument.
Remove rust ring with Alger brush. Measure epi defect created and place BCL if large w/
Moxifloxacin qid x1 wk.
Ketorolac qid if pain, PFATs qid
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
Cyclo TID and Bacitracin Ung QID until healed. Then ATs QID for 6mo
If Epith is heaped or not healing: Debridement 1-2mm past defect w/ Anesthetic and Cotton
swab. If not previous CL wearer, place BCL and use Moxifloxacin 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 qid x1 week, Pred 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
Ask if taking any of the "CATS" drugs
VF (enlarged BS)/most important for monitoring
FAF (r/o ONH drusen)
Red cap (Dyschromatopsia)
BP
Urgent MRI/MRV orbit and brain then LP (r/o systemic causes)
IIH - Treatment
MRI & MRV of brain and orbit ASAP
LP if MRI/MRV normal
,Oral CAIs (ie Acetazolomide)
if applies 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
- VF (asses for altitudinal or central defect)
- Red cap (asses for dyschromatopsia)
- ESR/CRP and CBC w/ diff (r/o GCA/AION)
- Blood pressure
- EOMs (r/o neuritis)
NAION - Treatment
Monitor
Refer to PCP for management of BP/BS/Cholesterol. If on BP meds, consult w/ PCP to not take
them at night
BP meds:
-pril "P for pril drugs lower Pressure"
- sartan drugs "Sartan stops the strain from pressure"
- amlodipine "loves dipping the pressure down"
- beta blockers "beta blockers block the pressure"
NAION - FU
1 month
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, Temporal Artery 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 months
AAION - FU
1 month
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
- Ask: Worse sx when hot ie shower/exercise
- EOM (pain w/ eye mvmts)
- Red cap (dyschromatopsia/ CV changes)
- MRI brain and orbits (r/o MS white matter lesions)
- VF (central or arcuate)
- Pupils (APD)
- Blood pressure
Dont forget 2/3 Retrobulbar so nerve will look fine!)
Optic Neuritis - Treatment
Refer for MRI to asses for MS, and IV steroids (as long as pt knows this will only speed
recovery but arrive at the same end point as if not using them)
