NBEO - National Board of Examiners in Optometry Anterior Segment Disease Questions and Answers — Questions and Answers
Question 1: A 28-year-old female presents with a painful, red, light-sensitive left eye for the past two days. Slit lamp examination reveals circumlimbal injection, 2+ anterior chamber cells, fine keratic precipitates (KPs) on the endothelium, and a miotic pupil. Intraocular pressure is normal. What is the MOST appropriate initial treatment plan?
- Topical antibiotic and a warm compress
- Topical corticosteroid and a cycloplegic agent (Correct answer)
- Oral antiviral medication and artificial tears
- Topical NSAID and referral for blood work
Correct answer: Topical corticosteroid and a cycloplegic agent
The patient's signs and symptoms—unilateral pain, photophobia, circumlimbal injection, anterior chamber cells, and KPs—are classic for acute anterior uveitis. The standard of care is to control inflammation with a topical corticosteroid (e.g., prednisolone acetate) and manage pain and prevent posterior synechiae with a cycloplegic agent (e.g., homatropine or cyclopentolate).
Question 2: A 45-year-old male contact lens wearer complains of severe unilateral eye pain, photophobia, and watery discharge that began this morning. Slit lamp examination with fluorescein dye reveals a branching, linear epithelial defect with distinct terminal bulbs. Which of the following is the most likely diagnosis?
- Acanthamoeba keratitis
- Fungal keratitis
- Pseudomonal ulcer
- Herpes Simplex Virus (HSV) dendritic keratitis (Correct answer)
Correct answer: Herpes Simplex Virus (HSV) dendritic keratitis
A dendritic (branching) ulcer with terminal bulbs is pathognomonic for Herpes Simplex Virus (HSV) epithelial keratitis. This classic presentation helps differentiate it from other forms of infectious keratitis.
Question 3: A 19-year-old patient reports needing frequent updates to their glasses prescription over the last two years. They complain of distorted vision and significant glare at night. Retinoscopy reveals a 'scissoring' reflex, and keratometry shows steep corneal curvatures with significant astigmatism. Which of the following is the MOST likely underlying condition?
- Pellucid marginal degeneration
- Keratoconus (Correct answer)
- Corneal warpage from contact lens wear
- Fuchs' endothelial dystrophy
Correct answer: Keratoconus
The combination of progressive myopic and astigmatic refractive error, distorted vision, glare, a scissoring reflex on retinoscopy, and steep keratometry readings are all classic early signs of keratoconus.
Question 4: A 72-year-old patient is found to have white, flaky material on the pupillary margin and anterior lens capsule of the right eye during a routine exam. Gonioscopy reveals a hyperpigmented trabecular meshwork. This patient is at a significantly increased risk for developing which of the following conditions?
- Angle-closure glaucoma
- Uveitic glaucoma
- Secondary open-angle glaucoma (Correct answer)
- Neovascular glaucoma
Correct answer: Secondary open-angle glaucoma
The clinical signs describe pseudoexfoliation syndrome (PEX), a systemic condition where abnormal fibrillar material is deposited on various ocular structures. This material and associated pigment can clog the trabecular meshwork, leading to increased intraocular pressure and a high risk of developing secondary open-angle glaucoma (pseudoexfoliation glaucoma).
Question 5: Which of the following clinical findings is most useful for differentiating allergic conjunctivitis from viral conjunctivitis?
- Presence of watery discharge
- Bilateral eye redness (hyperemia)
- Patient complaint of significant itching (Correct answer)
- Follicular response on the palpebral conjunctiva
Correct answer: Patient complaint of significant itching
While both allergic and viral conjunctivitis can present with watery discharge, redness, and follicles, intense itching (pruritus) is the hallmark symptom of allergic conjunctivitis and is typically much more pronounced than in viral cases.
Question 6: A 55-year-old patient presents with chronic symptoms of burning, grittiness, and fluctuating vision. Examination reveals telangiectatic vessels on the eyelid margins, inspissated meibomian glands with frothy tear film, and a rapid tear break-up time. What is the MOST appropriate initial management strategy for this condition?
- Long-term topical antibiotic therapy
- A short course of a potent topical steroid
- Prescription of oral acetazolamide
- Instruction on warm compresses, lid massage, and eyelid hygiene (Correct answer)
Correct answer: Instruction on warm compresses, lid massage, and eyelid hygiene
The patient's signs and symptoms are characteristic of posterior blepharitis, or meibomian gland dysfunction (MGD). The cornerstone and first-line treatment for MGD is patient education on implementing a daily routine of warm compresses to melt the solidified meibum, followed by gentle lid massage and cleansing of the lid margins.
NBEO - National Board of Examiners in Optometry Anterior Segment Disease Questions and Answers
A 28-year-old female presents with a painful, red, light-sensitive left eye for the past two days.
Slit lamp examination reveals circumlimbal injection, 2+ anterior chamber cells, fine keratic precipitates (KPs) on the endothelium, and a miotic pupil.
Intraocular pressure is normal.
What is the MOST appropriate initial treatment plan?