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cft ii > Exam 3 - Keratoconjunctivitis Sicca > Flashcards

Exam 3 - Keratoconjunctivitis Sicca Flashcards

1
Q

successful diagnosis & treatment of KCS depend on what 2 things?

A
  1. highly magnified view of ocular structures
  2. appreciation of depth within the eye paying special attention to the quality of the specular reflection
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2
Q

what is the ‘classic’ quantitative KCS?

A

dog presenting for ‘red eyes with film’

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3
Q

what is the ‘diversion’ KCS?

A

animal is presented for another issue causing KCS to be overlooked in the other eye!!!

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4
Q

what is the ‘nose’ presentation of KCS?

A

neurogenic KCS - animal presents for red eye & itching

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5
Q

what is the treatment failure patient of KCS?

A

refractory & absolute KCS

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6
Q

what is the ‘puzzle’ patient of KCS?

A

patient that has multifactorial qualitative KCS that presents for squinting & discharge

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7
Q

what ocular lesion is shown in this photo?

A

pigmentary keratitis

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8
Q

what makes up the 3 layers of the tear film?

A
  1. oil/lipid production through meibomian gland
  2. aqueous middle layer - lacrimal gland (65%) & 3rd eyelid gland (35%)
  3. mucinous, innermost, conjunctival goblet cells - connects the aqueous layer to the cornea
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9
Q

what is the function of the tear film of the eye?

A

to nourish, cleanse, & protect the ocular surface

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10
Q

what defines quantitative KCS? how is it diagnosed?

A

aqueous deficiency!!!!

diagnosed by schirmer tear test < 15 mm/min + clinical signs

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11
Q

T/F: quantitative KCS is the ONLY common cause of bacterial conjunctivitis in dogs

A

true

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12
Q

what does the schirmer tear test do?

A

quantifies the aqueous portion of the tear film

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13
Q

what are the guidelines for performing a schirmer tear test?

A

performed before any other drops or ointments!!!

performed before sedation or anesthesia

performed for 60 SECONDS

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14
Q

what is the normal test result for a schirmer tear test in a dog? what about a cat?

A

> 15 mm of wetting/min including basal & reflex tearing

unpredictable in cats!!!

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15
Q

what is the most common cause of quantitative KCS?

A

immune-mediated destruction

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16
Q

what causes neurogenic quantitative KCS?

A

loss of parasympathetic input to tears

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17
Q

apart from immune-mediated & neurogenic causes of KCS, what are some other causes of this condition?

A

trauma causing proptosis, congenital alacrima, iatrogenic (removal of the gland of the 3rd eyelid), drugs (sulfonamides & atropine), & infectious (canine distemper virus)

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18
Q

what signalment of animals are commonly affected by KCS?

A

toy breeds - yorkies, pomeranians

brachycephalic breeds - bulldogs, pugs, shih tzus

cocker spaniels

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19
Q

what is the common presenting complaint of animals with quantitative KCS?

A

mucoid discharge!!!!!!

red eyes & squinting

20
Q

what is seen in this photo that is evidence of keratitis?

A

superficial corneal neovascularization

21
Q

what is seen on ocular exam & schirmer tear testing that diagnoses quantitative KCS?

A

STT < 15 mm/min + evidence of keratitis & conjunctivitis

22
Q

what is seen in this photo that is evidence of conjunctivitis?

A

mucopurulent discharge

23
Q

what is seen in this photo that is evidence of conjunctivitis?

A

conjunctival hyperemia

24
Q

T/F: for patients with corneal ulceration, the ulcer is often infected & often requires emergent care

A

true

25
Q

what is seen in this photo that is evidence of keratitis?

A

superficial corneal pigment

26
Q

what is seen in this photo that is evidence of keratitis?

A

corneal ulceration

27
Q

what is seen in this photo that is evidence of keratitis?

A

corneal fibrosis & faint edema

28
Q

what lesion is seen here? what should you think is going on?

A

superficial corneal neovascularization

evidence of keratitis - think about early quantitative KCS

29
Q

where does superficial corneal neovascularization most often start?

A

dorsal limbus of the eye

30
Q

what are the 4 objectives of KCS treatment?

A
  1. replace the tears - lubricate the eye with artificial tears 2-6X a day
  2. temporary antibiotic therapy - need to clear the initial bacterial infection while the tear film recovers
  3. stimulate more tears - use of cyclosporine or tacrolimus indefinitely!!!!
  4. anti-inflammatory therapy - topical cyclosporine or similar
31
Q

how is neurogenic KCS diagnosed?

A

diagnosed by the presence of ipsilateral xeromycteria (dry nose)

unilateral disease that can resolve spontaneously - unpredictable, can take years

32
Q

T/F: neurogenic KCS typically disrupts motor function to CN VII

A

false - usually doesn’t

33
Q

what is the typical age of patients affected by neurogenic KCS?

A

average age of 9 years

presents with unilateral KCS with a dry nose

34
Q

what do you think is wrong with these two dogs?

A

unilateral quantitative KCS with dry nose - neurogenic KCS

35
Q

what is the mechanism of action of topical pilocarpine? how is topical 1% pilocarpine used?

A

indirect parasympathomimetic

patients with neurogenic KCS - 1 drop per 10 lbs given twice daily until the patient develops signs of toxicity!!!

36
Q

what are signs of toxicity associated with topical 1% pilocarpine?

A

vomiting, diarrhea, increased salivation, bronchiolar spasm, & pulmonary edema

37
Q

if you’re treating a KCS patient that you think may be refractory, and you see no improvement at 4-6 weeks of therapy, what should you do next?

A

increase concentration/frequency of cyclosporine - use COMPOUNDING

add additional tear stimulant - for example, tacrolimus

continue topical lubrication

introduce the idea of surgical options

recheck in another 4-6 weeks

38
Q

what are the two largest veterinary compounding pharmacies nationally that you can use for compounding cyclosporine?

A

stokes pharmacy

wedgewood pharmacy

39
Q

what is level 1 for treating a refractory KCS patient?

A

change optimmune (0.2% cyclosporine) to 2% cyclosporine OU BID until recheck

add on 0.3% tacrolimus OU BID

continue puralube OU QID until recheck

recheck in 4-6 weeks

40
Q

what is level 2 (max) for treating a refractory KCS patient?

A

2% cyclosporine OU TID until recheck

1% tacrolimus OU TID

discuss warnings in increasing the doses of cyclosporine/tacrolimus

pulse therapy topical antibiotics for 1 week to 1 month

continue puralube OU QID until recheck

recheck in 4-6 weeks

41
Q

what surgical therapy may be used for a refractory KCS patient that fails to recover tear production with persisting clinical signs?

A

parotid duct transposition

42
Q

what are some newer therapies/ideas being used for treating KCS?

A
  1. oral cyclosporine - 10 mg/kg
  2. subconjunctival cyclosporine implant
  3. buccal mucosal graft
43
Q

what is qualitative KCS?

A

lipid or mucin deficiency (something is going on with the goblet cells or meibomian glands)

44
Q

how is qualitative KCS diagnosed?

A

schirmer tear test >/= 15 mm/minute + clinical signs

45
Q

what are the acceptable first line therapies used for qualitative KCS?

A

topical cyclosporine twice daily for life!!!!

topical lubricant as needed

address underlying cause if possible

cft ii (28 decks)

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