Is eye health high yield on the PEBC exam?

Yes. The red eye, dry eye, conjunctivitis, and glaucoma are common, and many of these are minor ailments within a pharmacist's scope to assess and treat. The exact mix is randomized from one sitting to the next, but eye health is consistently worth preparation.

What ophthalmology topics should I focus on for the PEBC?

Focus on red-eye assessment and the referral red flags, allergic and viral conjunctivitis, dry eye, glaucoma drug classes and counselling, and eye-drop administration technique. The self-care versus refer decision is a frequent target.

Which references should I use for ophthalmology on the PEBC?

Use the Canadian Ophthalmological Society guidance for eye disease such as glaucoma, and your provincial minor-ailments framework for the self-care presentations like allergic conjunctivitis and dry eye.

How should I study ophthalmology for the PEBC?

Learn the red-flag referral criteria for the red eye, the glaucoma drug classes and their counselling, and proper eye-drop technique.

PEBC Ophthalmology Practice Questions

Eye health is a practical area on the PEBC exam, and much of it sits within pharmacist scope. The red eye, conjunctivitis, dry eye, and glaucoma all show up, and most questions test whether you can treat a minor presentation, counsel on it, and recognize the red flags that need urgent referral.

The questions below are a sample across those areas. The explanations work through all four options and land on the red flag or counselling detail that separates the right call from the tempting one.

Written and reviewed against current Canadian guidelines and references.

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All 4

options explained

full clinical case

How to approach a PEBC ophthalmology question

1For the red eye, the key skill is separating a minor self-care presentation (allergic or viral conjunctivitis, dry eye) from a red flag that needs urgent referral: significant pain, vision loss, or photophobia.
2For glaucoma, know the topical drug classes and the counselling on adherence and administration, including nasolacrimal occlusion to limit systemic absorption.
3For dry eye and allergic conjunctivitis, match the product to the severity and the symptom.
4Know eye-drop administration technique and contact-lens counselling, which are common question targets.
5Anchor serious eye disease on the Canadian Ophthalmological Society guidance, and treat the rest as minor ailments with clear referral criteria.

Practice questions

Tap an answer to see why each option is right or wrong.

Question 1Eye Health

Which red-eye history element most directly separates bacterial from viral or allergic patterns?

Incorrect · Answer: A

PEBC Yield: Low-Meddiagnosis-classificationdrug-selectioncounsellingmonitoring

A) (Correct)

Correct. Purulent discharge with morning crusting most directly points to bacterial conjunctivitis.

Watery discharge with recent URTI is more consistent with viral conjunctivitis.

Watery discharge with severe itching is more consistent with allergic conjunctivitis.

Mucoid discharge with allergen exposure is more allergic-pattern than bacterial-pattern.

Question 2Glaucoma

Which feature most specifically points toward angle-closure risk rather than primary open-angle risk?

Incorrect · Answer: C

PEBC Yield: Low-Meddiagnosis-classificationdrug-selectionmonitoringcounselling

This is a close glaucoma detail, but it does not match the exact angle-closure anatomical risk factor. The tested detail is Shallow anterior chamber.

C) (Correct)

Correct. A shallow anterior chamber is an anatomical angle-closure risk factor.

This is a close glaucoma detail, but it does not match the exact angle-closure anatomical risk factor. The tested detail is Shallow anterior chamber.

Question 3Eye Health

Which interval best matches using an eye drop before an eye ointment?

Question 4Eye Health

Which nonpharmacologic step is most specific for bacterial conjunctivitis with crusting?

Incorrect · Answer: A

PEBC Yield: Low-Mednon-pharmacologicalcounsellingdiagnosis-classificationdrug-selection

A) (Correct)

Correct. Bacterial conjunctivitis crusting is managed with warm compresses 2-3 times daily for 5-10 minutes followed by gentle massage.

Once-daily prolonged warming without massage does not match the recommended bacterial-crusting approach.

Cool compresses fit allergic or viral discomfort rather than bacterial crusting.

One to 2 minutes is shorter than the recommended warm-compress duration.

Question 5Cataract Surgery Post-Op

Which drug should generally be avoided for postoperative IOP control in a patient with asthma?

Incorrect · Answer: C

PEBC Yield: Lowcontraindication-checkdrug-selectionadr-recognitionmonitoring

Tempting because brimonidine has systemic alpha effects. It is wrong here because asthma specifically points away from beta-blocker eye drops.

Tempting because apraclonidine has cardiovascular cautions. It is wrong here because asthma is the key beta-blocker concern.

C) (Correct)

Correct -- ophthalmic beta-blockers such as timolol can precipitate systemic beta-blockade effects and should be avoided in asthma or obstructive lung disease.

Tempting because carbonic anhydrase inhibitors are glaucoma agents. It is wrong here because timolol is the asthma concern.

Question 6Cataract Surgery Post-Op

Which adverse effect is most associated with ophthalmic corticosteroids after cataract surgery?

Incorrect · Answer: C

PEBC Yield: Lowadr-recognitionmonitoringdrug-selectioncounselling

Tempting because corneal precipitate is a distinctive ophthalmic adverse effect. It is wrong here because it is linked with ciprofloxacin.

Tempting because some ophthalmic agents can have systemic effects. It is wrong here because tachycardia fits dilators and cycloplegics.

C) (Correct)

Correct -- ophthalmic corticosteroids can elevate intraocular pressure and can mask signs of infection.

Tempting because medication safety can include cardiac effects. It is wrong here because QT prolongation is not the corticosteroid eye-drop effect tested.

Question 7Eye Health

Which description is NOT typical of anterior blepharitis?

Incorrect · Answer: D

PEBC Yield: Low-Meddiagnosis-classificationdrug-selectioncounsellingmonitoring

Outer eyelid edge involvement is typical of anterior blepharitis.

Scaly lid margins are typical of anterior blepharitis.

A seborrheic bacterial pattern is typical of anterior blepharitis.

D) (Correct)

Correct. Foamy tear film at the inner lid edge is typical of posterior blepharitis, not anterior blepharitis.

Question 8Glaucoma

Which finding is NOT consistent with ocular hypertension alone?

Incorrect · Answer: D

PEBC Yield: Low-Meddiagnosis-classificationmonitoringdrug-selectioncounselling

This is a close glaucoma detail, but it does not match the exact ocular hypertension versus glaucoma boundary. The tested detail is Optic disc cupping.

D) (Correct)

Correct. Ocular hypertension has elevated IOP with normal fields and optic discs; optic disc cupping suggests glaucomatous damage.

Question 9Glaucoma

Which oral methazolamide dose range is listed for glaucoma?

Incorrect · Answer: D

PEBC Yield: Low-Meddispensingdose-adjustmentdrug-selectionmonitoring

This is a plausible glaucoma detail, but it does not match the exact methazolamide oral dose range. The tested detail is 50 to 100 mg BID to TID PO.

D) (Correct)

Correct. Methazolamide is dosed 50 to 100 mg BID to TID PO.

Question 10Cataract Surgery Post-Op

Which diabetes medication may be held the day before and day of cataract surgery due to lactic acidosis risk?

Incorrect · Answer: C

PEBC Yield: Lowcounsellingcontraindication-checkmonitoringdrug-selection

Tempting because insulin may be modified due to hypoglycemia risk. It is wrong here because the lactic acidosis rationale points to metformin.

Tempting because sulfonylureas may be held due to hypoglycemia risk. It is wrong here because the lactic acidosis concern is metformin.

C) (Correct)

Correct -- metformin may be held the day before and day of surgery due to lactic acidosis risk.

Tempting because meglitinides may be modified due to hypoglycemia risk. It is wrong here because metformin is the lactic-acidosis medication.

Want the full bank?

These are a sample. The full bank adds full-length cases and timed mock exams.

Sample full case

One patient with several linked questions, the format the real exam uses for case clusters.

PG is a 62-year-old male newly diagnosed with primary open-angle glaucoma (IOP 28 mmHg right, 26 mmHg left; optic disc cupping on fundoscopy; Humphrey visual field shows early arcuate defect). He has well-controlled moderate persistent ASTHMA on salbutamol 100 mcg MDI PRN and fluticasone 125 mcg MDI bid; a documented SULFA ALLERGY (rash and urticaria to TMP-SMX as a young adult); and no other medications. The ophthalmologist asks the pharmacist for drug-selection input before starting therapy.

Question 1Glaucoma

Given PG's comorbidities and allergies, which of the following is the most appropriate FIRST-LINE topical therapy for primary open-angle glaucoma in this patient?

Incorrect · Answer: D

PEBC Yield: Highdrug-selectioncontraindication-checkmulti-comorbidityintraclass-differentiation

Alpha-2 agonists (brimonidine) are useful second- or third-line options but have systemic adverse effects (fatigue, dry mouth, hypotension in susceptible patients) and cross the blood-brain barrier, with neonatal/pediatric contraindications. They are not the first-line choice in the Canadian treatment algorithm; prostaglandin analogues are. Would be correct as an adjunct or alternative when the prostaglandin class is not tolerated.

Dorzolamide and brinzolamide are topical sulfonamides and carry a labelled caution/contraindication in patients with sulfa allergy. PG's sulfa allergy makes the CAI class inappropriate as first-line without allergy clarification. Would be correct only after sulfa allergy has been formally evaluated and found non-cross-reactive, which is not the case here.

Topical timolol (and other non-selective beta-blockers) is contraindicated or strongly cautioned in patients with reactive airway disease because systemic absorption via nasolacrimal drainage can provoke bronchospasm. PG's asthma (controlled on salbutamol + fluticasone) makes topical beta-blockers inappropriate as first-line. Would be correct only in a patient without reactive airway disease.

D) (Correct)

Correct. Prostaglandin analogues (latanoprost, travoprost, bimatoprost, tafluprost) are the guideline-recommended FIRST-LINE topical therapy for primary open-angle glaucoma because of once-daily dosing, excellent IOP-lowering efficacy (~25-33%), low systemic adverse effect profile, and no sulfa component. They are appropriate in patients with asthma (no bronchoconstriction risk, unlike topical beta-blockers) and sulfa allergy (no cross-reactivity, unlike carbonic anhydrase inhibitors). Common local effects include iris and eyelash changes, periocular pigmentation, and hyperemia. This is the PEBC-keyed first-line glaucoma answer.

Question 2Glaucoma

Which of the following topical glaucoma drug classes should be avoided (or used only with explicit allergy clarification) specifically because of PG's documented sulfa allergy?

Incorrect · Answer: D

PEBC Yield: Highcontraindication-checkallergy-assessmentintraclass-differentiationsafety-referral

Alpha-2 agonists (brimonidine, apraclonidine) are not sulfonamides. They have a distinct pharmacophore and no sulfa cross-reactivity. Would not be correct in a sulfa-allergy scenario.

Topical beta-blockers are not sulfonamides; the cautions here relate to bronchospasm in asthma/COPD and to systemic absorption effects (bradycardia, heart block, hypoglycemia masking), not to sulfa allergy. Would be correct for PG's asthma but not for his sulfa allergy.

Prostaglandin analogues are not sulfonamides and have no cross-reactivity with sulfa allergy. They are safe to use in PG. Would not be correct in any sulfa-allergy contraindication context.

D) (Correct)

Correct. Topical carbonic anhydrase inhibitors (dorzolamide, brinzolamide) and the oral CAI acetazolamide contain a sulfonamide moiety. Labelled cautions in Canadian product monographs advise avoidance in patients with documented sulfa hypersensitivity because of the potential for allergic cross-reactivity. Clinically, the cross-reactivity risk for non-antibiotic sulfonamides is lower than historically taught, but the standard-of-care response to a documented sulfa allergy is to avoid topical CAIs unless the allergy is further characterized. This is the PEBC-keyed sulfa-allergy glaucoma answer.

Question 3Glaucoma

Which of the following counselling points will MOST effectively INCREASE ocular absorption of his new latanoprost 0.005% eye drop?

Incorrect · Answer: D

PEBC Yield: Low-Medcounsellingadministration-techniqueabsorptionadherence

Multiple drops instilled at once simply overflow the tear film; the conjunctival sac holds only ~7-10 microlitres while a drop is ~30-50 microlitres. Excess spills over and is absorbed systemically (through the nasal mucosa) or lost, which does not improve ocular absorption and increases side effects. Would not be correct in any counselling scenario.

A cold compress has no established role in glaucoma eye-drop administration and can cause reflex tearing that washes out the drop. Would not be correct in any absorption-enhancement scenario.

Rapid blinking pumps the drop toward the puncta and increases nasolacrimal drainage, which DECREASES corneal contact time and ocular absorption. It also increases systemic absorption via the nasal mucosa. Would be the opposite of the desired effect.

D) (Correct)

Correct. Keeping the eyelids gently closed for 1-3 minutes after instillation allows longer corneal contact, reduces blinking-driven pumping into the lacrimal system, and increases ocular bioavailability. Combined with nasolacrimal-duct occlusion (finger pressure at the medial canthus) and leaving 5-10 minutes between different eye-drop products, this is the standard technique to maximize ocular and minimize systemic exposure. This is the PEBC-keyed absorption-technique answer.

Question 4Glaucoma

Which of the following is the MOST EFFECTIVE single counselling technique to DECREASE systemic absorption of an ophthalmic eye drop (important for drugs like topical beta-blockers where systemic side effects matter)?

Incorrect · Answer: B

PEBC Yield: Low-Medcounsellingadministration-techniquesystemic-exposuresafety-surveillance

Repeating a drop immediately increases the delivered dose and can increase systemic exposure; it does not reduce nasolacrimal drainage. If a dose truly misses the eye, technique should be reassessed rather than routinely doubling drops.

B) (Correct)

Correct. Gentle pressure over the inner corner of the eye compresses the nasolacrimal duct and reduces drainage into the nasal mucosa, where systemic absorption is rapid. Holding pressure for 1-2 minutes after instillation is the practical patient-facing version of punctal occlusion.

A cold drop may help some patients feel that the drop entered the eye, but refrigeration does not meaningfully reduce systemic absorption through the nasolacrimal duct.

Blinking moves fluid toward the puncta and can increase drainage into the nasolacrimal system. It is not the best technique for reducing systemic absorption.

Full-length cases like this, across every PEBC domain, live in the question bank.

Frequently asked questions

Is eye health high yield on the PEBC exam?: Yes. The red eye, dry eye, conjunctivitis, and glaucoma are common, and many of these are minor ailments within a pharmacist's scope to assess and treat. The exact mix is randomized from one sitting to the next, but eye health is consistently worth preparation.
What ophthalmology topics should I focus on for the PEBC?: Focus on red-eye assessment and the referral red flags, allergic and viral conjunctivitis, dry eye, glaucoma drug classes and counselling, and eye-drop administration technique. The self-care versus refer decision is a frequent target.
Which references should I use for ophthalmology on the PEBC?: Use the Canadian Ophthalmological Society guidance for eye disease such as glaucoma, and your provincial minor-ailments framework for the self-care presentations like allergic conjunctivitis and dry eye.
How should I study ophthalmology for the PEBC?: Learn the red-flag referral criteria for the red eye, the glaucoma drug classes and their counselling, and proper eye-drop technique.