100+ Free NBEO TMOD Practice Questions

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A patient presents with floaters, flashes, and on fundus exam has Shafer sign (pigment cells in the anterior vitreous). What is your concern and next step?

Vitritis from uveitis; oral steroids

Posterior vitreous detachment with high suspicion for retinal break or detachment; perform careful dilated fundus exam with scleral depression and consider widefield imaging; refer to retina if break/detachment identified

Endophthalmitis; intravitreal antibiotics

Posterior vitreous detachment alone; reassure

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2026 Statistics

Key Facts: NBEO TMOD Exam

~120

Case-Based Items

Single session

Passing Scaled Score (0-99)

NBEO

$450

Standalone Exam Fee

NBEO published rates

FL, NC

States That Historically Required Separate TMOD

State boards

Year 4

Typically Taken

Fourth year of OD program

Image-rich

Case Format

Demographics, history, findings, images

NBEO TMOD is the standalone Treatment and Management of Ocular Disease exam required by states such as Florida and North Carolina in addition to Parts I, II, and III for full therapeutic licensure. It is a single-session image-intensive multiple-choice exam with approximately 120 items, scored 0-99 with a passing score of 75. Most candidates take it alongside Part II PAM in the fourth year of optometry school.

Sample NBEO TMOD Practice Questions

Try these sample questions to test your NBEO TMOD exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old soft contact lens wearer presents with a 2 mm round white corneal infiltrate, overlying epithelial defect, 2+ anterior chamber cells, and severe pain. Vision is 20/200. What is the most appropriate initial management?

A.Start prednisolone acetate 1% every 2 hours

B.Culture the ulcer and start a topical fluoroquinolone (e.g., moxifloxacin 0.5%) every 1 hour while awake

C.Patch the eye and re-evaluate in 24 hours

D.Begin topical antiviral therapy with trifluridine

Explanation: A vision-threatening central corneal ulcer in a contact lens wearer should be cultured (Gram stain, blood and chocolate agar, plus Sabouraud if fungal suspected) and treated empirically with a fortified or fourth-generation fluoroquinolone every 1 hour around the clock until improvement. Steroids are deferred until the organism is identified and the epithelium is healing.

2Which slit-lamp finding most strongly suggests Acanthamoeba keratitis over bacterial keratitis in a soft contact lens wearer with corneal infiltrate?

A.Mucopurulent discharge

B.Pain out of proportion to clinical findings with a ring infiltrate and radial perineuritis

C.Branching dendritic epithelial lesion with terminal bulbs

D.Diffuse punctate keratitis with no infiltrate

Explanation: Acanthamoeba keratitis classically presents with severe pain out of proportion to slit-lamp signs, a ring-shaped stromal infiltrate, and radial perineuritis (inflammation along corneal nerves). Risk factors include exposure to tap water, hot tubs, or improper lens disinfection. Diagnosis is confirmed by confocal microscopy or culture on non-nutrient agar with E. coli overlay.

3A 40-year-old presents with unilateral painful red eye, photophobia, and a corneal dendrite with terminal bulbs that stains with rose bengal. Corneal sensitivity is reduced. What is the most appropriate treatment?

A.Trifluridine 1% drops 9 times per day or oral acyclovir 400 mg 5 times daily

B.Topical prednisolone acetate 1% every 2 hours

C.Moxifloxacin 0.5% every 2 hours

D.Natamycin 5% every hour

Explanation: Classic herpes simplex virus (HSV) epithelial keratitis presents with a true dendrite (terminal bulbs, swollen borders) and reduced corneal sensation. First-line therapy is topical trifluridine 1% 9 times daily or oral acyclovir 400 mg five times daily (or valacyclovir 500 mg TID). Steroids alone are contraindicated in active epithelial disease because they promote viral replication.

4Which finding distinguishes herpes zoster ophthalmicus from herpes simplex keratitis?

A.Reduced corneal sensitivity

B.Vesicular skin rash following the V1 dermatome with Hutchinson sign (tip of nose involvement)

C.Stromal scarring

D.Iritis

Explanation: Herpes zoster ophthalmicus (HZO) presents with a unilateral vesicular dermatomal rash following the ophthalmic division of CN V (V1). Involvement of the tip of the nose (Hutchinson sign) indicates nasociliary nerve involvement and predicts higher risk of ocular complications. Both HSV and HZV can reduce corneal sensitivity, cause stromal disease, and produce iritis, but the dermatomal rash is unique to HZV.

5A 55-year-old presents with bilateral, chronic, itchy, irritated eyelid margins with crusting at the lashes and dilated meibomian gland orifices. What is the most appropriate first-line management?

A.Topical antibiotic monotherapy

B.Lid hygiene with warm compresses, lid massage, and microblepharoexfoliation; consider oral doxycycline 50-100 mg daily for posterior MGD

C.Topical steroid 4 times daily for 6 weeks

D.Punctal occlusion

Explanation: Mixed anterior and posterior blepharitis with meibomian gland dysfunction is managed primarily with lid hygiene (warm compresses, lid scrubs, microblepharoexfoliation) plus expression of the meibomian glands. Oral doxycycline 50-100 mg daily acts via anti-inflammatory and anti-lipase effects (not antibacterial dose) for posterior MGD. Topical antibiotics or short-pulse steroids are adjuncts for acute exacerbations.

6A patient with rheumatoid arthritis presents with deep boring eye pain that wakes them at night, with a violaceous hue to the sclera visible in daylight. What is the diagnosis and appropriate workup?

A.Episcleritis; reassure and use lubricants

B.Scleritis; obtain systemic workup (CBC, ANA, ANCA, RF, syphilis serology) and treat with oral NSAIDs or systemic steroids/immunosuppression

C.Conjunctivitis; topical antibiotic

D.Subconjunctival hemorrhage; observation

Explanation: Scleritis presents with deep boring pain that wakes patients at night and violaceous scleral injection that does not blanch with phenylephrine 2.5%. Up to 50% of patients have an associated systemic autoimmune or vasculitic disease; workup includes CBC, ANA, ANCA, RF, ACE, syphilis serology, chest imaging. Treatment is oral NSAIDs (e.g., indomethacin) first, then oral steroids and steroid-sparing immunosuppression.

7Phenylephrine 2.5% applied to a red eye blanches the conjunctival vessels and leaves the deeper episcleral vessels visible. What does this finding suggest?

A.Scleritis

B.Episcleritis (or differentiating between conjunctival and scleral injection)

C.Acute angle closure

D.Endophthalmitis

Explanation: Phenylephrine 2.5% blanches superficial conjunctival vessels but not the deeper episcleral plexus or scleral vessels. If the redness blanches, the inflammation is in the conjunctiva or episclera (episcleritis); if the redness persists with violaceous hue, scleritis is likely. This test is a quick chair-side method to differentiate scleritis from episcleritis.

8A 25-year-old with seasonal allergies presents with bilateral itchy red eyes, stringy mucus, and large cobblestone papillae on the upper tarsal conjunctiva. Vernal keratoconjunctivitis is suspected. What treatment is most appropriate?

A.Topical antibiotic 4 times daily

B.Mast cell stabilizer/antihistamine combination (e.g., olopatadine 0.2% daily) plus a brief course of topical loteprednol for severe flares

C.Topical antiviral 9 times daily

D.Oral acyclovir 800 mg 5 times daily

Explanation: Vernal and chronic allergic keratoconjunctivitis are treated first with dual-action mast cell stabilizer/antihistamine drops (olopatadine, ketotifen, alcaftadine, bepotastine). For severe disease, a short pulse of topical loteprednol or fluorometholone is used to break the inflammatory cycle. Loteprednol has lower IOP elevation risk than prednisolone acetate. Refractory cases may need topical cyclosporine or tacrolimus.

9A patient with newly diagnosed dry eye disease has a tear breakup time of 3 seconds and corneal staining. Schirmer testing is normal. Which subtype is most likely and what is appropriate first-line treatment?

A.Aqueous-deficient dry eye; punctal plugs

B.Evaporative dry eye (MGD-related); warm compresses, lid hygiene, and lipid-replacement artificial tears

C.Neuropathic dry eye; gabapentin

D.Sjogren syndrome; immediate oral steroids

Explanation: Short tear breakup time with normal Schirmer test suggests evaporative (MGD-related) dry eye where tear quality, not quantity, is the problem. First-line treatment includes lid hygiene, warm compresses, in-office meibomian gland expression or thermal pulsation, and lipid-based artificial tears. Aqueous-deficient subtype is supported by low Schirmer (<10 mm/5 min) and is the indication for punctal occlusion.

10Which medication is FDA-approved for the treatment of moderate-to-severe Demodex blepharitis?

A.Oral azithromycin

B.Lotilaner ophthalmic solution 0.25% (Xdemvy)

C.Cyclosporine 0.05% (Restasis)

D.Lifitegrast 5% (Xiidra)

Explanation: Lotilaner 0.25% (Xdemvy) is the first FDA-approved prescription drop for Demodex blepharitis. It is dosed BID for 6 weeks and works by paralyzing the mite via GABA-gated chloride channels. Cyclosporine and lifitegrast are approved for dry eye (not Demodex). Tea tree oil (terpinen-4-ol) lid scrubs are an over-the-counter adjunct.

About the NBEO TMOD Exam

The NBEO Treatment and Management of Ocular Disease (TMOD) exam is a case-based, image-rich multiple-choice exam required by several state boards for therapeutic optometry licensure. It tests pharmacology, glaucoma, anterior and posterior segment disease management, systemic disease with ocular manifestations, neuro-ophthalmic disease, and contact lens-related disease.

Questions

120 scored questions

Time Limit

Single session (approximately 4 hours)

Passing Score

Scaled score of 75 on a 0-99 scale

Exam Fee

$450 standalone (NBEO (National Board of Examiners in Optometry))

NBEO TMOD Exam Content Outline

25%

Anterior Segment Disease

Blepharitis, MGD, dry eye, conjunctivitis (bacterial, viral, allergic, GPC), corneal infection and inflammation, corneal dystrophies and degenerations, scleritis and episcleritis

20%

Glaucoma

Primary open-angle glaucoma, normal-tension glaucoma, primary angle closure, pigmentary, pseudoexfoliation, neovascular, uveitic; IOP-lowering medication classes; SLT, MIGS, trabeculectomy

20%

Posterior Segment Disease

Diabetic and hypertensive retinopathy, AMD wet/dry, retinal vein/artery occlusion, retinal detachment, posterior uveitis, hereditary retinal dystrophies, choroidal lesions

15%

Ocular Pharmacology

Topical and oral antibiotics, antivirals (acyclovir, valacyclovir, ganciclovir), antifungals, corticosteroid potency and side effects, NSAIDs, anti-VEGF, mydriatics, cycloplegics, anesthetics

10%

Systemic Disease and Ocular Manifestations

Diabetes, hypertension, thyroid eye disease, sarcoidosis, lupus, rheumatoid arthritis, syphilis, HIV/AIDS, hydroxychloroquine and tamoxifen toxicity

Neuro-ophthalmic Disease

Optic neuritis, ischemic optic neuropathies, papilledema, cranial nerve III/IV/VI palsies, Horner syndrome, Adie pupil, visual field localization

Contact Lens-Related Disease

Microbial keratitis (Pseudomonas, Acanthamoeba), contact lens-associated red eye (CLARE), GPC, corneal infiltrative events, hypoxic complications, solution toxicity

How to Pass the NBEO TMOD Exam

What You Need to Know

Passing score: Scaled score of 75 on a 0-99 scale
Exam length: 120 questions
Time limit: Single session (approximately 4 hours)
Exam fee: $450 standalone

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NBEO TMOD Study Tips from Top Performers

1Memorize glaucoma drug classes (PG analogs, beta-blockers, alpha-2 agonists, topical/oral CAIs, rho kinase inhibitors) with mechanism, dosing, and contraindications

2Build an anterior segment disease differential matrix: bacterial vs viral vs allergic vs GPC vs dry-eye conjunctivitis, with cell type, discharge, and follicle/papilla patterns

3Drill diabetic retinopathy staging (mild/moderate/severe NPDR vs PDR) and the DRCR.net thresholds for anti-VEGF, panretinal photocoagulation, and focal laser

4Know AMD: dry vs wet, AREDS2 supplement formula (lutein, zeaxanthin, vitamins C/E, zinc, copper), and anti-VEGF agents (ranibizumab, aflibercept, bevacizumab, faricimab, brolucizumab)

5Learn the hydroxychloroquine retinal toxicity screening protocol: baseline within 1 year, then annual after 5 years (or sooner with risk factors), with 10-2 visual fields and SD-OCT plus FAF

6Master the corneal ulcer workup: scrape and culture before treatment for any central or vision-threatening ulcer, then fortified antibiotics or fluoroquinolone monotherapy depending on size and location

7Review the three-step test for cyclovertical muscle palsies (especially CN IV) and the Bielschowsky head-tilt test

8Memorize systemic medications with classic ocular side effects: ethambutol (optic neuropathy), amiodarone (vortex keratopathy), tamoxifen (crystalline retinopathy), topiramate (acute myopia and angle closure), bisphosphonates (uveitis/scleritis)

Frequently Asked Questions

What is the NBEO TMOD exam?

TMOD (Treatment and Management of Ocular Disease) is a standalone NBEO written multiple-choice exam focused on diagnosing and managing eye disease and the pharmacology used to treat it. It is required by Florida, North Carolina, and select other jurisdictions in addition to NBEO Parts I, II, and III for full therapeutic licensure. Most other states accept the TMOD score embedded within Part II PAM, but a separate sitting may be required depending on the state board.

How many questions are on the TMOD exam and how is it scored?

The standalone TMOD exam has approximately 120 case-based multiple-choice items administered in a single session. It is scored on a 0-99 scaled-score range, and a score of 75 is required to pass. The image-intensive case format presents demographics, history, exam findings, and ancillary tests, then asks several questions per case.

How much does the TMOD exam cost?

The standalone TMOD examination fee is $450 per NBEO published rates. Candidates who take TMOD as part of Part II PAM in the same sitting pay only the Part II PAM fee. Retake fees are charged separately for each attempt and the six-attempt lifetime cap applies.

How does TMOD differ from Part II PAM?

Part II PAM is the broader patient assessment and management exam, with roughly 350 items covering the full scope of optometric clinical care. TMOD is a focused subset of about 120 items concentrating only on disease diagnosis, pharmacology, and management. Candidates can sit TMOD on the same day embedded in Part II PAM, or take it as a standalone exam later if their state board specifically requires a separate TMOD score.

Which states require a separate TMOD exam?

Per published NBEO and state board guidance, Florida and North Carolina historically require a separate TMOD score for therapeutic licensure in addition to Parts I, II, and III. Most other states accept TMOD as embedded within Part II PAM. Always verify the current requirements with your specific state board of optometry before scheduling.

How should I study for TMOD?

TMOD is tightly focused on disease and pharmacology, so build your prep around the AAO Preferred Practice Patterns for glaucoma, AMD, diabetic retinopathy, dry eye, uveitis, and corneal disease. Drill drug classes (PG analogs, beta-blockers, alpha agonists, CAIs, fluoroquinolones, steroids, antivirals) with their mechanisms, contraindications, and side effects. Use image-based case banks because the live exam is image-intensive.

Can I take TMOD if my state already accepts the Part II TMOD subscore?

Yes, candidates may sit the standalone TMOD voluntarily for licensure portability if they plan to apply for licensure in a TMOD-requiring state in the future. NBEO maintains scores on file, and most state boards accept a passing standalone TMOD score regardless of when it was taken, subject to that state's recency requirements.