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Question 1

Treatment options for entropion

Answer 1

1. Vertical mattress sutures/staples
2. Hot celsus technique
3. Excise lateral canthal ligament (+ hot celsus)

Question 2

Entropion pathology

Answer 2

LOWER LAT Lid margin rolls in -> pain + irritation of cornea -> globe reiteration -> lid turns in more (-VE FEEDBACK)

Question 3

What is the most common form of neeoplasia of the eyelid?

Answer 3

Tarsal gland adenoma (warty cauliflower appearance)

Question 4

What causes atonic entropion and trichiasis?

Answer 4

Loss of tone in skin of upper eyelid + excessive head skin -> drooping upper eyelid -> hairs impinge on cornea

Question 5

How would you treat atonic entropion + trichiasis?

Answer 5

STADES PROCEDURE: excise skin adj to upper eyelid

Question 6

What is hot celsus technique vs stades procedure? When would each be indicated?

Answer 6

HOT CELSUS = excise wedge parallel to lower lid (entropion), STADES = excise parallel to upper lid (atonic entropion + trichiasis)

Question 7

Define trichiasis

Answer 7

Facial folds -> cause hair to rub on ocular surface

Question 8

Define distichiasis

Answer 8

Abnormally positioned cilia @ lid margin (close to tarsal gland opening)

Question 9

How would you treat distichiasis?

Answer 9

Refer for electrolysis/cryosurgery

Question 10

Ectropion pathology

Answer 10

LOWER lid turns out -> gap between lid + cornea _> exposure conjunctivitis

Question 11

How would you treat a conjunctival cilia?

Answer 11

Excise wedge of tissue containing cilium +/- cryosurgery to prevent recurrence.

Question 12

Treatment of ectropion

Answer 12

Usually cosmetic but can wedge excision bordering lat canthus

Question 13

Define lagophthalmos

Answer 13

Bug eyed brachycephalic dogs with macropalpebral fissures-> pushes globe out -> chronic keratitis + progressive pigmentary infiltration

Question 14

How is lagophthalmos treated?

Answer 14

Nasal canthoplasty + section medial lig

Question 15

Define blepharitis + forms of progression

Answer 15

= inflame of eyelid tarsal glands
Meibomianitis = inflam of tarsal glands
Chalazon = obstruction of tarsal gland secretion -> gland rupture -> firm spherical yellow lipogranulomas

Question 16

What would a dorsal vertically orientated ulcer indicate?

Answer 16

Conjunctival cilia

Question 17

List 5 causes of 3rd eyelid protrusion

Answer 17

1. Reduction in globe contents eg. cachexia, dehydration, masticatory m. atrophy
2. Reduction in globe size
3. Orbital mass lesion eg. abscess, tumour
4. Altered nervous control eg. Horners’ syndrome, tetanus
5. Retracted globe eg. anything causing ocular pain

Question 18

Draw the normal and cherry eye position of the nictitans gland

Answer 18

Refer to notes

Question 19

Why should third eyelid not be removed and what is the only indication for doing so?

Answer 19

Responsible for approx 1/3 of tear volume. Neoplasia only indication

Question 20

What are the treatment options for prolapsed nictitans gland?

Answer 20

1. Excise gland - high risk of p/op dry eye
2. Anterior anchoring technique: suture anchors gland to orbital rim -> prevents norm movement of 3rd eyelid
3. Pocket technique: crescent shaped incisions dorsal + ventral to gland on inside surface, appose opposite edges to create pocket around gland, tie knot on outside (so doesn’t abrade cornea)

Question 21

What is the pathology + treatment of a scrolled 3rd eyelid?

Answer 21

Cartilage kinks and folds outwards-> entire 3rd eyelid no longer contacts cornea. Treat by excising kinked portion of cartilage from deep surface of membrane.

Question 22

What are the clinical signs of nictitans plasmacytic conjunctivitis, which dogs are most likely to get it?

Answer 22

GSD, Belgian Shepherds, collie types

• bilat thickening + depigmentation of 3rd eyelid
• pink/red fleshy infiltrate
• irreg. surface

Question 23

What is nictitans plasmacytic conjunctivitis?

Answer 23

Plasma cell +lymphocytic infiltration (immune mediated), often assoc with chronic superficial keratitis

Question 24

How would you treat a reddened conjunctiva with purulent ocular discharge + slightly increased tear production?

Answer 24

= bacterial conjunctivitis, fusidic acid

Question 25

What is the normal reference range for dogs and cats on the Schirmer I Tear Test?

Answer 25

D: approx 21mm (>15mm) C: approx 17mm IN 1 MINUTE

Question 26

What is the cause of bacterial conjunctivitis and how is it treated?

Answer 26

Often gram =ve bacteria eg. Staph following primary (rare) infection or secondary to eyelid masses, foreign bodies or irregularities. Treated with fusidic acid 1-2x/d.

Question 27

What is the pathology + signalment of keratoconjunctivitis sicca?

Answer 27

AKA: dry eye. due to lack of aqueous portion of tear film deficiency, commonly because of bilateral immune-mediated destruction of lacrimal tissue, also can be caused by endocrinopathies, some drugs e.g.. sulfadiazine, viral adenines. Westies + Spaniels = common

Question 28

What are the clinical signs of dry eye?

Answer 28

- conjunctivitis - neovascularisation + pigmented cornea - lacklustre cornea - mucopurulent discharge

Question 29

How is dry eye treated?

Answer 29

1. Tear replacement- lubricating gel 4-6x/d 2. Tear stimulants eg. topical 0.2% cyclosporine ('optimmune') 3. Parotid duct transposition

Question 30

Define 'epiphora'

Answer 30

Excess tear production due to drainage problem

Question 31

How is epiphora diagnosed?

Answer 31

1. Directly observe: normal puncta openings? FB? any medial canthal abnormalities e.g.. ectropion 2. Fluoroscein in lacrimal puncta- should be seen out of nose within 4 mins 3. Nasolacrimal cannulation (w/ topical anaesthesia + sedation) 4. Dacryocystorhinography (flush w/ contrast)

Question 32

Define dacryocystitis

Answer 32

Inflammation of lacrimal sac often due to FB e.g.. grass seed

Question 33

A German Shepherd with a rough red fleshy infiltrate in its ventro-lateral cornea presents. What is the pathology and treatment?

Answer 33

Chronic superficial keratoconjunctivitis ('pannus'). Cyclosporine treatment.

Question 34

What is the pathology and appearance of corneal dystrophy?

Answer 34

Primary bilat inherited disorder where cholesterol/f.a./phosopholipids deposit. Well demarcated, w/ central/paracentral grey crystalline opacities, no pain.

Question 35

Older dog, steamy, blue stromal oedema-> cause?

Answer 35

Corneal endothelial degeneration

Question 36

Describe the clinical signs of corneal ulceration?

Answer 36

- pain - conjunctival hyperaemia - corneal oedema (milky) - irregular surface contour - neovascularisation of cornea - secondary anterior uveitis

Question 37

How would you approach a corneal ulcer case?

Answer 37

1. Schirmer I Tear Test (unless lacrimating/deep) 2. Fluoroscein + blue light (taken up by exposed stroma) 3. Observe + draw diagrams of surface area, site (central/peripheral), edges (obvious/underrun/gelatinous), depth (superficial, deep, full thickness) 4. Look for underlying cause 5. Look for potential complications eg. brachycephalic, steroids

Question 38

What are the potential causes of corneal ulceration?

Answer 38

- external trauma (common) - hair/lash trauma - infection (secondary to trauma, FeHV) - exposure keratopathy - tear film abnormalities - spontaneous chronic corneal epithelial defect (SCCED)

Question 39

Define superficial chronic corneal epithelial defects

Answer 39

AKA: Boxer ulcers | edges of ulcer don't adhere to underlying stroma

Question 40

Define descemetocoele

Answer 40

Descemetes membrane bulges out due to loss of stromal support (clear centre as no stroma left to be oedematous)

Question 41

How would you treat superficial and midstromal ulcers?

Answer 41

Topical broad spec antibiotics

Question 42

How would you treat superficial under run ulcers?

Answer 42

1. Topical anaesthesia to cornea 2. Debride by pushing back ulcer w/ sterile dry cotton swab 3. Augment healing by diamond burr/superficial grid/punctate keratotomy 4. soft corneal bandage lens 5. recheck every 7-14d until -ve fluoroscein