Clinical Skills at the Highest Level Allowed in New Mexico
What "highest level" means
The ceiling on your practice is set by statute and Board rule, not by residency training, CE certificates, or hospital privileges. In New Mexico that ceiling is high: full pharmaceutical management with topical and oral agents, medical management of glaucoma, and minor surgical procedures of the anterior segment and adnexa. Anything above that ceiling-intraocular surgery and any procedure the rule does not authorize-is outside scope no matter how well you were trained.
Pharmaceutical management
- Topical anesthetics are for diagnostic and procedural use only; never dispense them for home instillation.
- Steroids need a taper plan, an IOP check, and a documented indication; a red eye on a steroid with no follow-up is a classic complaint.
- Oral agents-doxycycline for meibomian disease and rosacea, antivirals for herpes zoster ophthalmicus or HSV keratitis-require allergy, pregnancy, and interaction review.
- For glaucoma, obtain gonioscopy and a baseline nerve and field record before treating, then set and document a target IOP.
Procedures at the ceiling
Slit-lamp removal of corneal and conjunctival foreign bodies, rust-ring burring, epilation for trichiasis, punctal occlusion, chalazion management, and co-management of post-operative patients. Each needs documented informed consent, an anesthesia plan, and post-procedure instructions.
Referral thresholds
Penetrating or ruptured globe, intraocular foreign body, hyphema, retinal detachment, acute angle closure, endophthalmitis, orbital cellulitis, and suspected giant cell arteritis leave the ceiling immediately; refer same-day and document the conversation.
Worked example
A 32-year-old grinding metal without glasses has a peripheral corneal opacity with a rust ring. You anesthetize, perform a Seidel test (negative), evert the lid, and document acuity, pupil, and IOP. Because the mechanism is high-velocity metal, you image for an intraocular foreign body before burring. You then remove the rust ring, place a bandage lens or antibiotic ointment, and recheck at 24 hours.
Traps
Sending a topical anesthetic home for pain; skipping Seidel in a "simple" foreign body; using a steroid without scheduling an IOP check; forgetting that the injury mechanism, not the appearance, drives imaging.