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Year 1/2 > Cognition & Senses 2: Lacrimal/Nasolacrimal > Flashcards

Cognition & Senses 2: Lacrimal/Nasolacrimal Flashcards

1
Q

what 2 glands PRODUCE TEARS?

TEARS are made up of what 2 components?

A
  1. ORBITAL LACRIMAL GLAND
  2. GLAND of the THIRD EYELID

TEARS are…
1. AQUEOUS
2. LIPID from MEIBOMIAN GLANDS

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2
Q

why is LIPID in tears?

A

to PREVENT IT FROM EVAPORATING OFF OF THE SURFACE OF THE EYE

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3
Q

what is the FUNCTION of the PRE-CORNEAL TEAR FILM?

this is VITAL for ___ ACTIVITY

A

to give NUTRITION to the CORNEA (clear portion of eye) because it is AVASCULAR and WOULD NOT HAVE NUTRITION OTHERWISE

this is VITAL for OPTICAL ACTIVITY

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4
Q

what is one potential consequence of LOSING THE AQUEOUS portion of TEARS?

A

more at risk of INFECTION and can cause BACTERIAL KERATITIS

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5
Q

KERATOCONJUNCTIVITIS SICCA (KCS)

“aka?”

= definition?

commonality in dogs?

important HISTORY finding that can indicate it?

EARLY vs. LATE dz presentation?

A

aka “DRY EYE DZ”

= AQUEOUS TEAR deficiency causing INFLAMMATION of CONJUNCTIVA & CORNEA

commonality in dogs? = MOST COMMON OCULAR DZ IN DOGS

in HISTORY = can see MUCOPURULENT DISCHARGE from INFLAMMATION due to RECURRENT INFECTION from LOSS OF ANTIMICROBIAL AQUEOUS

EARLY dz = CONJUNCTIVITIS, REDNESS & DISCHARGE

LATE dz = CORNEAL CHANGES & DRYNESS

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6
Q

ID DZ & why

A

KERATOCONJUNCTIVITIS SICCA

the eye is RED because CONJUNCTIVA COVERS THE WHOLE THING and IS INFLAMED

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7
Q

PRIMARY cause of KCS?

SECONDARY cause of KCS?

A

PRIMARY = usually BREED-ASSOCIATED; usually TOY BREEDS such as SHIH TZUS

SECONDARY = IMMUNE-MEDIATED, often SPECIFIC to LACRIMAL GLAND

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8
Q

what LARGE BREED DOG can get KCS & why?

A

GERMAN SHEPHERD DOGS because they are LIKELY TO HAVE IMMUNE DYSFUNCTION

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9
Q

FIVE LESS COMMON causes of KCS?

A
  1. NEUROGENIC from LOSS of PARASYMPATHETIC INNERVATION to LACRIMAL GLAND
  2. GLAND of THIRD EYELID SURGERY (cherry eye)
  3. CONGENITAL
  4. DRUG-INDUCED (SULFONAMIDES, TOPICAL ATROPINE)
  5. INFECTIOUS DZ (CANINE DISTEMPER)
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10
Q

if a dog comes in with CONJUNCTIVITIS & REDUCED TEAR PRODUCTION, what DZ do we suspect?

A

CANINE DISTEMPER

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11
Q

5 clinical signs of KCS?

2 clinical signs of CHRONIC KCS?

A

5 clinical signs?
1. OCULAR PAIN
2. DRY & LUSTERLESS CORNEA
3. THICK MUCOID DISCHARGE
4. REDNESS
5. PHOTOPHOBIA

2 clinical signs of CHRONIC KCS?
1. CORNEAL PIGMENTATION
2. REDUCED VISION

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12
Q

2 reasons we see REDNESS in the eye in KCS?

A
  1. CONJUNCTIVAL HYPEREMIA
  2. CORNEAL VASCULARIZATION
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13
Q

DIAGNOSIS of KCS…

via WHAT test/parameter?

what 2 things does it measure?

A

via SCHIRMER TEAR TEST

if tear production BELOW 15 mmHg, then KCS!

2 things it measures… (AQUEOUS)
1. TEAR PRODUCTION from LACRIMAL GLAND
2. TEAR PRODUCTION from THIRD EYELID GLAND

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14
Q

TRUE/FALSE

IMMUNE-MEDIATED KCS is UNCOMMON IN CATS but COMMON IN DOGS

A

FALSE

CATS DO NOT GET IMMUNE-MEDIATED KCS

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15
Q

TREATMENT for IMMUNE-MEDIATED KCS…

we should INITIALLY treat the…

3 things we can do for tx? & give examples for second

A

we should INITIALLY treat the UNDERLYING CAUSE

3 tx?
1. REPLACE tears with ARTIFICIAL TEARS (many brands)

  1. STIMULATE PRODUCTION of tears via CALCINEURIN INHIBITORS for 3-4 WEEKS
    –> CYCLOSPORINE/TACROLIMUS
    –> MOST COMMONLY USE OPTIMMUNE (contains cyclosporine) which is VERY EFFECTIVE
  2. address any INFLAMMATION/INFECTION
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16
Q

PILOCARPINE…

WHEN is this given? (3)

how does it work?

A

given when..
1. DO NOT RESPOND TO OPTIMMUNE
2. DO NOT RESPOND TO HIGH DOSE CYCLOSPORINE
3. DO NOT RESPOND TO TACROLIMUS

how does it work? = DIRECTLY STIMULATE LACRIMAL GLAND to see if we can REPLACE TEARS

17
Q

PROGNOSIS for KCS…

generally?

if left UNTREATED… (3)

once the patient is STABLE (____ ____), what should we do for tx? what is the frequency?

A

is GENERALLY GOOD when TREATED WITH CALCINEURIN INHIBITORS

if left UNTREATED…
1. SCARRING
2. PIGMENTATION
3. BLINDNESS

once patient is STABLE (making tears), usually can DISCONTINUE ALL MEDS except LIFELONG CYCLOSPORINE BID

18
Q

if patients with KCS DO NOT RESPOND TO ANY MEDICAL TREATMENT but owners DO NOT WANT ENUCLEATION, what TREATMENT should be done? (3 words)

= how is it done?

this is a ___ PROCEDURE because…

A

PAROTID DUCT TRANSPOSITION

= MOVE PAROTID SALIVARY GLAND’S DUCT and TURN IT TOWARDS EYE, then SUTURE IT to the CONJUNCTIVAL FORNIX to allow for SALIVA TO ENTER EYE and LUBRICATE IT

this is a SALVAGE PROCEDURE because IT IS NOT IDEAL, and saliva can either cause TOO MUCH TEARING or PRECIPITATE FORMATION IN EYE

19
Q

QUALITATIVE tear film disorders…

= definition?

two clinical signs?

what confounding finding might we find on diagnostics? what can this tell us?

A

= when the LIPID from MEIBOMIAN GLANDS & GOBLET CELLS in the CONJUNCTIVA is ABNORMAL & DYSFUNCTIONAL causing LOSS OF TEAR FILM STABILITY

clinical signs?
1. DESSICATION
2. INFLAMMATION of CONJUNCTIVA & CORNEA

diagnostics show NORMAL SCHIRMER TEAR TEST even though SIGNS RESEMBLE KCS; this can ACTUALLY BE DIAGNOSTIC FOR QUALITATIVE TEAR FILM DISORDER

20
Q

2 DIAGNOSTICS & what we EXPECT for QUALITATIVE TEAR FILM disorders?

also describe what they are/what they’re looking for

A
  1. TEAR FILM BREAK UP TIME = put FLUORESCIN dye on eye and SEE HOW LONG IT TAKES FOR SURFACE TENSION to cause CLUMPS
    –> if it TAKES TOO LONG then ABNORMAL LIPID PORTION or GOBLET CELL PRODUCTION
  2. CONJUNCTIVAL BIOPSY to look for ABNORMAL GOBLET CELLS
21
Q

it IS POSSIBLE to have BOTH QUANTITATIVE & QUALITATIVE tear film disorders in WHAT species?

A

CATS

22
Q

difference between MEIBOMIANITIS vs. CHALAZION?

A

CHALAZION = ONE INFLAMED MEIBOMIAN GLAND

MEIBOMIANITIS = MULTIPLE INFLAMED MEIBOMIAN GLANDS

23
Q

ID CLINICAL SIGN

A

MEIBOMIANITIS

24
Q

what is the TREATMENT for MEIBOMIANITIS? (2)

why might we use CYCLOSPORINE?

A
  1. treat UNDERLYING CAUSE, often ATOPY/SKIN DISEASE
  2. OCULAR LUBRICANTS

CYCLOSPORINE used for ANTI-INFLAMMATION, but NOT CONCERNED WITH MAKING MORE TEARS

25
Q

what is the MOST COMMON cause of CHRONIC CONJUNCTIVITIS in the CAT? why?

what does this then CAUSE in the eye? (2)

treatment? (2)

A

FELINE HERPESVIRUS
–> why? because it CAUSES CONJUNCTIVAL GOBLET CELLS DYSFUNCTION

in the eye, causes…
1. QUALITATIVE TEAR FILM DEFICIENCY
2. DRYNESS of CORNEA

treatment?
1. treat UNDERLYING DZ (herpesvirus)
2. TOPICAL EYE LUBRICANT

26
Q

why can it be HARD to read results of a SCHIRMER TEAR TEST on a CAT?

instead, what CAN we use this test for in cats?

A

cats are often STRESSED at the vet, so HIGH SYMPATHETIC TONE –> FALSE LOW READING ON STT

INSTEAD, we should look to see IF TEAR PRODUCTION VARIES BETWEEN EYES

27
Q

what are the 2 things we should DISTINGUISH between in TEAR DRAINAGE ABNORMALITIES?

A
  1. EPIPHORA (tear overflow bc tears cannot drain)
  2. EXCESS LACRIMATION (tearing too much)
28
Q

EXCESS LACRIMATION…

is usually caused by ___ ____ ____, which includes these possibilities… (4)

unilateral vs. bilateral?

A

is usually caused by OCULAR SURFACE IRRITATION, which includes these possibilities…
1. TRICHIASIS
2. DISTICHIA
3. ENTROPION
4. CORNEAL ULCER

can be UNILATERAL or BILATERAL

29
Q

EPIPHORA…

= definition

unilateral vs. bilateral?

suggests ____ ____ ____, which can be caused by WHAT 4 THINGS?

what results do we expect on STT?

A

= TEAR OVERFLOW

usually UNILATERAL

suggested NASOLACRIMAL DUCT OBSTRUCTION, which can be caused by…
1. CONGENITAL issues
2. FOREIGN BODIES (grass awns)
3. TRAUMA/laceration of duct
4. NEOPLASIA/tumors pressing on duct

on STT, expect NORMAL

30
Q

JONE’S TEST…

= what does it test for?

steps? (3)

A

= tests for EPIPHORA caused by NASOLACRIMAL DUCT OBSTRUCTION

steps?
1. put FLUORESCIN in BOTH EYES
2. put SALINE IN BOTH EYES
3. look for DYE COMING OUT THROUGH NOSE

31
Q

what TEST is this? what is it TESTING FOR?

A

TEST = JONE’S TEST

tests for NASOLACRIMAL DUCT OBSTRUCTION

32
Q

if we see DYE IN THE MOUTH on a JONE’S TEST, what does this tell you?

what test can be MORE SPECIFIC? what do we look for?

A

THIS CAN STILL BE NORMAL as sometimes tear ducts can open into mouth!

the NASOLACRIMAL DUCT FLUSH can be MORE SPECIFIC to see if we INJECT FLUID INTO TEAR DUCT if it will COME OUT THROUGH NOSE

33
Q

ID DIAGNOSTIC & WHEN we do it

A

NASOLACRIMAL DUCT FLUSH

we do this when JONE’S TEST shows DYE COMING THROUGH MOUTH or if we suspect NEGATIVE RESULT from NASOLACRIMAL DUCT SPASM; we can CONFIRM if there’s an OBSTRUCTION OR NOT

34
Q

PHYSIOLOGIC EPIPHORA

= what is it?

what TYPE of dogs are likely to have this?

what 2 diagnostics can we do? which is most definitive/what results do we expect?

A

= dogs have TRICHIASIS due to a CARUNCLE in CORNER OF EYE allows for WICKING OF TEARS OVER THE LID and BLOCKS NASOLACRIMAL DUCT

likely in WHITE FLUFFY DOGS

2 diagnostics…
1. JONES TEST can or cannot be negative, UNSURE
2. NASOLACRIMAL DUCT FLUSH will show FLUID OUT THROUGH NOSE

35
Q

what is the NASAL PUNCTA?

A

TEAR DUCT

36
Q

what BREED of dog is PRONE TO PUNCTAL (tear duct) ABNORMALITIES?

A

COCKER SPANIEL

37
Q

what DISEASE in CATS can cause STENOSIS of the NASOLACRIMAL DUCT SYSTEM?

why?

how do they usually present?

A

FELINE HERPESVIRUS-1

because CHRONIC INFLAMMATION

presents as an OTHERWISE HEALTHY CAT with CHRONIC UNILATERAL TEARING

38
Q

DACRYOPS…

= definition?

etiology?

commonality?

A

= CYST of the LACRIMAL GLAND or ANYWHERE ALONG NASOLACRIMAL DUCT SYSTEM that allows TEARS TO ACCUMULATE

etiology = CONGENITAL

commonality? = UNCOMMON

39
Q

ID LESION & DEFINE

A

DACRYOPS (lacrimal gland or somewhere along nasolacrimal duct has a CYST that causes TEARS TO ACCUMULATE)

Year 1/2 (139 decks)

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