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Year 1/2 > Cognition & Senses 2: Cornea > Flashcards

Cognition & Senses 2: Cornea Flashcards

1
Q

name RED & BLACK circles?

what’s BETWEEN them?

A

RED = LENS

BLACK = CORNEA

BETWEEN = ANTERIOR CHAMBER filled with AQUEOUS HUMOR

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1
Q

what is the FUNCTION of the cornea? (2)

A
  1. REFRACT LIGHT = capture IMAGE on the RETINA & send it to the BRAIN via OPTIC NERVE
  2. BARRIER to MICROORGANISMS
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2
Q

the CORNEA is MOSTLY MADE OF ____ ARRANGED ____

blood vessels?

how THICK is it?

A

REGULARLY ARRANGED COLLAGEN

MOSTLY AVASCULAR

it’s ~0.65 mm THICK

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3
Q

what NOURISHES the CORNEA?

A

nourishment = PRE-CORNEAL TEAR FILM & LIPIDS

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4
Q

what makes the cornea TRANSPARENT? (two)

A
  1. REGULARLY ARRANGED COLLAGEN with NO BLOOD VESSELS
  2. MOST DEHYDRATED STRUCTURE in body, so LIQUID FROM TEARS/AQUEOUS HUMOR PASSIVELY FLOWING IN will be PUMPED OUT BY Na/K pumps on the CORNEAL ENDOTHELIAL LAYER
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5
Q

what happens if the Na/K ENDOTHELIAL pump in the CORNEA is DYSFUNCTIONAL?

A

FLUID OVERLOAD & CORNEAL EDEMA

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6
Q

ID what LESION this is & WHY

A

CORNEAL EDEMA

why? = the PUPIL & IRIS ARE OBSCURED, so we cannot see anything else, meaning that SOMETHING HAS COMPROMISED THE CORNEAL ENDOTHELIUM or EPITHELIUM

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7
Q

ID LESION & WHY

A

KERATITIS

why? = this is a result of BLOOD VESSELS & INFLAMMATORY INFILTRATES

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8
Q

ID LESION & LOCATION

what does it tell you in the DOG?

A

CORNEAL PIGMENT in the ANTERIOR CHAMBER

in the DOG, tells you CHRONIC CORNEAL INFLAMAMTION

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9
Q

ID LESION

tends to be present in ___-STAGE _____ DZ

A

CORNEAL MINERALIZATION (from LIPID or Ca)

tends to be present in END-STAGE CUSHING’S DZ

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10
Q

CORNEAL ENDOTHELIAL DECOMPENSATION…

= definition

3 appearance traits for eye?

A

= the CORNEAL ENDOTHELIAL CELLS DO NOT WORK, causing the Na/K PUMP to NOT WORK, causing DIFFUSE CORNEAL EDEMA

appearance?
1. DIFFUSE CORNEAL EDEMA ‘BLUE’
2. COBBLESTONE APPERANCE
3. CORNEAL THICKENING

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11
Q

ID DZ (3 words)

how can you tell what caused this?

A

CORNEAL ENDOTHELIAL DECOMPENSATION

AGE-RELATED CORNEAL DZ if it’s BLUE EYES that are BILATERALLY SYMMETRICAL

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12
Q

CAUSES of CORNEAL ENDOTHELIAL DZ…

primary? (2)
–>which one is MOST COMMON?
–> which one occurs in MIDDLE-AGED animals?

secondary? (1)
–> & give 2 examples

A

primary?
1. most commonly AGE-RELATED DEGENERATION of ENDOTHELIUM

  1. CORNEAL ENDOTHELIAL DYSTROPHY based on BREED, occurs in MIDDLE-AGED animals

secondary? = INTRAOCULAR DZ –> ex = uveitis or glaucoma

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13
Q

ID DZ

A

BILATERAL UVEITIS

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14
Q

AGE-RELATED ENDOTHELIAL DEGENERATION…

= occurs when…

onset?

painful?

unilateral vs. bilateral? why?

A

= occurs when ENDOTHELIAL CELL DENSITY DECREASES with AGE

usually SLOWLY PROGRESSIVE

often DOESN’T BECOME PAINFUL UNTIL LATE STAGES

ALWAYS BILATERAL because CORNEAL ENDOTHELIAL CELLS ARE THE SAME AGE IN BOTH EYES

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15
Q

CORNEAL ENDOTHELIAL DYSTROPHY…

= what is it?

3 predisposed breeds?

unilateral vs. bilateral? severity?

diagnosis? (three)

A

= IMPAIRED, ABNORMAL DEVELOPMENT of the CORNEA

3 breeds?
1. BOSTON
2. CHIHUAHUA
3. DACHSHUND

if YOUNGER ONSET, then UNILATERAL and EVENTUALLY BILATERAL —> ASYMMETRICAL SEVERITY IS COMMON

diagnosis?
1. CLINICAL SIGNS
–> DIFFUSE CORNEA that’s BLUE & THICKENED

  1. SIGNALMENT (breed?)
  2. RULE OUT UNDERLYING DZ (UVEITIS & GLAUCOMA)
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16
Q

ID DZ

A

CORNEAL ENDOTHELIAL DYSTROPHY

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17
Q

BULLOUS KERATOPATHY…

= definition

what 3 things can happen to the patient’s eyes as a result?

A

= when CORNEAL EDEMA is CHRONIC, and eventually forms BLISTERS or BULLA on the SURFACE OF THE EYE (cornea)

3 things…
1. the BULLA/blisters can RUPTURE & cause CORNEAL ULCERS
2. OCULAR PAIN
3. VISION IMPAIRMENT

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18
Q

ID DZ

A

ADVANCED, CHRONIC CORNEAL EDEMA causing BULLOUS KERATOPATHY

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19
Q

TREATMENT for CORNEAL EDEMA…

depends on…

we usually ONLY TREAT when…

medical tx? (1) how often?

A

depends on UNDERLYING DZ

we usually only treat when the edema is…
1. MARKED
2. or there’s PROGRESSIVE BULLA

medical tx?
= put MURO 128 (salt solution) on CORNEAL EPITHELIUM to PULL FLUID OUT OF THE EYE to REDUCE BLISTERS
–> BID to TID

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20
Q

RHO-KINASE INHIBITORS…

used normally for WHAT in people?

what can they do in dogs?

why is this not CLINICALLY very useful?

A

used normally to treat GLAUCOMA in people

in DOGS, can REPAIR or ENCOURAGE CORNEAL EPITHELIAL CELLS to IMPROVE FUNCTION in response to CORNEAL EDEMA

not very useful because only causes TRANSIENT relief

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21
Q

SURGICAL tx for CORNEAL EDEMA? (2)

prognosis?

helps to control ____ but DOES NOT help….

A

SURGICAL tx?
1. THERMOKERATOPLASTY = makes BURNS in cornea and TRIES TO ELIMINATE ULCERS

  1. GUNDERSEN FLAP = with a blade, remove ANTERIOR STROMA and CREATE A THIN MEMBRANE OF CONJUNCTIVA via a GRAFT to PULL OVER CORNEA

prognosis = GUARDED

helps to control PAIN but DOES NOT HELP VISION as TRANSPARENCY IS LOST

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22
Q

KERATITIS…

= definition

2 sub-categories?

what is a HALLMARK of this DZ?
–> is this always seen?

A

= CORNEAL INFLAMMATION

2 subs?
1. ULCERATIVE
2. NON-ULCERATIVE

VASCULARIZATION is a HALLMARK OF CORNEAL INFLAMMATION
–> NOT always seen GROSSLY bc vessels can be DEEP

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23
Q

DURATION & LESION?

A

CHRONIC KERATITIS

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24
Q

DURATION & LESION?

A

ACUTE KERATITIS

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25
Q

CORNEAL ULCER…

aka?

= definition?

commonality?

A

aka ULCERATIVE KERATITIS

= LOSS of CORNEAL EPITHELIUM +/- STROMA

common in DOGS & CATS

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26
Q

ID LESION & potential DISEASE that caused it

A

LESION = CORNEAL ULCER (ulcerative keratitis)

DZ = FHV-1 can cause this SPONTANEOUSLY

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27
Q

how can you tell if a corneal ulcer is SUPERFICIAL or DEEP?

A

SUPERFICIAL = ulcer is SMOOTH

DEEP = ulcer is INDENTED

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28
Q

CAUSES of CORNEAL ULCERS…

A
  1. EXTERNAL TRAUMA
  2. TEAR FILM ABNORMALITIES
  3. NEURON DAMAGE to CORNEA (CN V, OPHTHALMIC BRANCH)
  4. INFECTION
  5. EYELID DZ
29
Q

what NEURON INNERVATES the CORNEA?

A

CN V, OPHTHALMIC BRANCH of TRIGEMINAL NERVE

30
Q

CLINICAL SIGNS of CORNEAL ULCERS… (list five)

A
  1. PAIN –> have EXPOSED CN V NERVE ENDINGS from REMOVED EPITHELIUM
  2. INFLAMMATION
  3. OCULAR DISCHARGE
  4. EDEMA
  5. STROMAL LOSS ‘DIVOT’
31
Q

IRIDOCYCLOSPASM…

= definition

causes WHAT 2 things?

usually secondary to WHAT?

A

= when NERVE ENDINGS of CN V are AGITATED, causes SPASM of CILIARY BODY MUSCLE & IRIS MUSCLE

causes…
1. PUPIL TO GET SMALL
2. OVERALL PAIN

usually secondary to CORNEAL ULCER

32
Q

ID LESION

A

CORNEAL ULCER

also can see CORNEAL EDEMA & INFLAMMATION

33
Q

if we can SEE BLOOD VESSELS in the eye with a CORNEAL ULCER, what does this indicate?

A

indicates that the ulcer is LIKELY CHRONIC

34
Q

DESCEMETOCELE..

= definition

what does this indicate?

A

= if a CORNEAL ULCER is DEEP ENOUGH, then HOLE IN THE CORNEA will be DEEP ENOUGH TO BASEMENT MEMBRANE or DESCEMET’S MEMBRANE

this indicates that you’re MINUTES AWAY FROM CORNEAL PERFORATION

35
Q

ID LESION

what does this mean??

A

DESCEMETOCELE

this means THE CORNEA IS ABOUT TO PERFORATE!

36
Q

once CORNEAL EPITHELIUM is DAMAGED, what disease is possible/how does it occur?

what does the cornea LOOK LIKE?

what are 2 common etiologic agents?

A

BACTERIAL INFECTION can occur when they COLONIZE ON STROMA prior to the EPITHELIUM HEALING

CORNEA can look SOFT & MELTED

2 common agents? = SKIN FLORA
1. STREP
2. STAPH

37
Q

ID DZ

A

CORNEAL INFECTION

38
Q

DIAGNOSIS of CORNEAL ULCER?

how does it work?

what DZ would NOT STAIN even though it’s a problem?

A

via POSITIVE FLUORESCIN DYE STAIN

the CORNEAL STROMA will TAKE UP THE DYE because the STROMA is HYDROPHILIC, while if EPITHELIUM was intact it’d be HYDROPHOBIC (not take up any stain)

a DESCEMETOCELE will NOT STAIN bc THE DESCEMET’S MEMBRANE IS ALSO HYDROPHOBIC

39
Q

TREATMENT for CORNEAL ULCERS…

depends on what 3 things?

SUPERFICIAL ulcers (5)?

DEEP ulcer treatment depends on… (3)

A

depends on…
1. DEPTH of the ULCER
2. INFECTION presence or not
3. APPROPRIATE HEALING RESPONSE from the cornea

SUPERFICIAL ulcers?
1. give E-COLLAR

  1. generally heal RAPIDLY by EPITHELIALIZATION in 5-7 DAYS
  2. BROAD-SPECTRUM ANTIBIOTICS to PREVENT INFECTION TID
  3. TOPICAL ATROPINE for PAIN
  4. RECHECK in 1-WEEK

DEEP ulcers tx depends on..
1. treatment DEPENDS on HOW FAR AWAY THE NEWLY CREATED BLOOD VESSELS ARE from the ULCER (grows 1 mm/DAY)

  1. CORNEAL INTEGRITY is COMPROMISED or not
  2. INFECTION PRESENT
40
Q

ATROPINE…

why is it an IRIDOCYCLOPLEGIC drug?

what will the PUPILS do?

how does it work?

A

IRIDOCYCLOPLEGIC = stops the SPASMING of the CILIARY BODY, which is associated with IRITOCYCLOSPASM

will cause the PUPILS TO DILATE

how does it work? = PREVENTS spasm of ciliary body muscle & pupil muscle and STOPS PAIN

41
Q

how should we ADMINISTER CORTICOSTEROIDS or NSAIDs for CORNEAL ULCERS?

why? (2)

A

we should administer CORTICOSTEROIDS or NSAIDs ORALLY

why? because if we do TOPICAL…
1. it can DELAY CORNEAL HEALING

  1. and PREVENT COLLAGENASE ACTIVITY
42
Q

INDOLENT CORNEAL ULCER…

= definition

etiology?

commonality?

2 signalments?

2 clinical signs in EYE? (1 is +/-)

A

= SUPERFICIAL CORNEAL ULCER which FAILS TO HEAL IN APPROPRIATE TIME

etiology? = usually due to UNDERLYING CORNEAL DEFECT with the BASEMENT MEMBRANE

commonality? = COMMON IN DOGS

2 signalments?
1. GERIATRIC DOGS
2. BOXER BREEDS

clinical signs in EYE?
1. VISIBLE LIPS of COREAL EPITHELIUM from it SLOUGHING OFF (lighter stain)
2. +/- BLOOD VESSELS in CORNEA

43
Q

how do CORNEAL ULCERS usually heal?

A

need VASCULARIZATION & COLLAGEN DEPOSITION done by COLLAGENASES, which are produced by CORNEAL EPITHELIAL CELLS & NEUTROPHILS

44
Q

TREATMENT for INDOLENT CORNEAL ULCER (SUPERFICIAL)?

what is the TIME RANGE in which this should work?

what TOOL do we usually use?

prognosis?

if this DOES NOT WORK, then do what?

A

tx = CORNEAL DEBRIDEMENT to REMOVE LOOSE EPITHELIAL EDGES & promote EPITHELIALIZATION/VASCULARIZATION

this should work in 7-10 DAYS

tool? = DIAMOND BURR

prognosis = GENERALLY GOOD, MAJORITY HEAL

if this DOES NOT WORK, then a BANDAGE CONTACT LENS can help KEEP EPITHELIUM ADHERED TO EYE & PROMOTE HEALING, but can also cause scarring

45
Q

if we suspect an INFECTED CORNEAL ULCER, what DIAGNOSTIC should we do?

what tx/frequency for SEVERE cases?

A

DIAGNOSTIC = C&S for ANTIBIOTIC PRESCRIPTION

tx = FLUOROQUINOLONES if UNSURE ABOUT SAFETY OF PERFORMING CULTURE, can give EVERY 2 HOURS FOR SEVERE CASES

46
Q

MAIN MEDICAL TREATMENT for CORNEAL ULCERS?
–> what does it do?

if NOT IMPROVING/GETTING WORSE after 48 hours, what should we consider?

A

MAIN MED = ANTI-COLLAGENASE, has SERUM that has NATURAL ANTIPROTEASE/ANTICOLLAGENASES to PREVENT CORNEA MELTING from ulcer

if NOT IMPROVING or GETTING WORSE after 48 hours = SURGERY

47
Q

SURGICAL REPAIR for CORNEAL ULCERS…

usually done using ___ ____

3 steps?

1 advantage?

1 disadvantage?

we DO NOT perform this surgery UNLESS we believe…

A

usually done using CONJUNCTIVAL GRAFTS

steps?
1. make LIP OF CORNEA
2. move it OFF SCLERA
3. flap up CONJUNCTIVAL GRAFT to MAKE A SEAL

advantage = BRING BLOOD SUPPLY DIRECTLY TO AREA to cause HEALING and THICKENING OF CORNEA

disadvantage = DECREASES TRANSPARENCY of CORNEA

we DO NOT perform this surgery UNLESS we believe that WE CAN PRESERVE THE ANIMAL’S VISION

48
Q

PANNUS

aka? (3 words)

common in WHAT BREED?

what ENVIRONMENTAL FACTOR makes it WORSE?

pain?

what do we see on a FLUORESCIN STAIN?

A

aka CHRONIC SUPERFICIAL KERATITIS

common in GSD

exposure to UV LIGHT MAKES IT WORSE

usually starts as NON-PAINFUL

on FLUORESCIN STAIN, DOES NOT TAKE UP DYE

49
Q

ID LESION (2 names)

note: this lesion DID NOT TAKE UP FLUORESCIN STAIN

A

LESION = CHRONIC SUPERFICIAL KERATITIS or PANNUS

50
Q

ID LESION (2 names)

A

PANNUS or CHRONIC SUPERFICIAL KERATITIS

51
Q

ID LEFT AND RIGHT BUBBLE

A

LEFT = PANNUS or CHRONIC SUPERFICIAL KERATITIS

RIGHT = PLASMOMA from ACCUMULATION OF PLASMA CELLS in CORNER OF EYE

52
Q

3 STRONG SIGNS for PANNUS?

A
  1. VENTROLATERAL PROGRESSIVE signs
  2. BREED PREDILECTION (GSD)
  3. NO FLUORESCIN DYE TAKE-UP
53
Q

TREATMENT for PANNUS? medication & duration?

frequency?

A

mostly TOPICAL CORTICOSTEROIDS like CALCINEURIN INHIBITORS for 4-6 WEEKS

frequency can be up to 4 times DAILY initially, then try to reduce to TWICE DAILY

54
Q

PROGNOSIS for PANNUS?

if UNTREATED…

A

often MANAGED but NOT CURED, so OK

if UNTREATED, can lead to BLINDNESS

55
Q

PIGMENTARY KERATITIS>..

= definition

2 predisposed breeds? due to ____ _____

treatment options? (3)

A

= when MELANIN is DEPOSITED INTO CORNEA as a NON-SPECIFIC RESPONSE to CHRONIC, NON-ULCERATIVE CORNEAL INFLAMMATION

2 predisposed breeds? due to POOR CONFORMATION
1. PUGS
2. PEKINGESE

treatment?
1. OCULAR LUBRICATION
2. CLOSE DOWN MEDIAL CANTHUS (to stop lagophthalmos)
3. TACROLIMUS

56
Q

CORNEAL MINERALIZATION…

= definition

usually NON-____

DOGS vs. CATS?

MOST COMMON presentation?–> how does it look?
–> etiology?
–> pain/tx?

A

= LIPID or CALCIUM DEPOSITION in CORNEA

usually NON-ULCERATIVE

DOGS > CATS

most COMMON = CORNEAL DYSTROPHY
–> milky WHITE, BILATERAL
–> CONGENITAL
–> NO PAIN/TX

57
Q

ID LESION

A

CORNEAL MINERALIZATION

58
Q

TRUE/FALSE

CORNEAL DYSTROPHY causes an IRREVERSIBLE CHANGE to the cornea

A

TRUE

59
Q

CORNEAL LIPIDOSIS..

appearance? (two)

2 causes?

usually NON-___

reversible?

A

appearance?
1. WHITE, CRYSTALLINE LOOK
2. can be DIFFUSE or UNILATERAL

causes?
1. TOPICAL CORTICOSTEROIDS
2. SYSTEMIC DZ

usually NON-PAINFUL

THIS IS REVERSIBLE

60
Q

CORNEAL DEGENERATION…

= definition

potential signalment?

appearance?

tx? (3)

A

= result of CHRONIC CORNEAL DISEASE/ULCER, so even if it’s FINISHED HEALING it DEPOSITS CALCIUM

can potentially also be the result of GERIATRIC DOGS

appearance = HAPHAZARD, WHITE CRYSTALLINE CHANGE

tx?
1. TOPICAL LUBRICATION
2. TREAT CORNEAL ULCERS IF THEY OCCUR
3. use DIAMOND BURR to BREAK DOWN MINERALIZATION

61
Q

if you see BLOOD VESSELS/INFLAMMATION with CORNEAL MINERALIZATION what medication SHOULD WE NOT USE/WHY?

A

we SHOULD NOT USE ANTI-INFLAMMATORIES because CALCIUM or LIPID will be MORE LIKELY TO SLOUGH OUT OF CORNEA

62
Q

how does FELINE HERPESVIRUS cause CORNEAL ___?

how LONG does it take for these to heal?

A

ULCERS

the virus will LYSE CORNEAL EPITHELIAL CELLS & cause SUPERFICIAL CORNEAL ULCERS

these ulcers can take MONTHS to heal

63
Q

ID LESION & potential DZ

A

LESION = SUPERFICIAL CORNEAL ULCER

DZ = FHV-1

64
Q

TRUE/FALSE

we can treat INDOLENT CORNEAL ULCER in the SAME WAY in a DOG and a CAT

A

FALSE, CATS need to have FHV-1 TREATED PRIMARILY, and CANNOT USE OTHER METHODS

65
Q

2 CLINICAL SIGNS of FHV-1 in the CORNEA

A
  1. DENDRITIC ULCERS in the CORNEA (breaks in epithelium)
  2. GEOGRAPHIC/NON-HEALING ulcer
66
Q

ID LESION & DZ

A

DENDRITIC CORNEAL ULCER

likely FHV-1

67
Q

STROMAL DZ..

= definition

often caused by WHAT?

treatment?
–> MOSTLY?
& 2 more!

PROGNOSIS focuses on ____ rather than ____

A

= NON-ULCERATIVE KERATITIS that causes SCARRING, PAIN & IMMUNE-SUPPRESSION

often caused by OCULAR FHV-1

treatment?
–> MOSTLY supportive care!
1. TETRACYCLINE ANTIBIOTICS
2. ARTIFICIAL TEARS

PROGNOSIS focuses on MANAGEMENT rather than CURE

68
Q

ID DZ

what should we expect on CYTOLOGY that’s DIAGNOSTIC?

painful?

treatment? & duration? (2)

A

EOSINOPHILIC KERATITIS

on CYTOLOGY, expect to see EOSINOPHILS, and EVEN ONE IS DIAGNOSTIC!

USUALLY NOT PAINFUL

treatment?
1. TOPICAL ANTIVIRALS usually LIFELONG
2. CORTICOSTEROIDS shorter term

69
Q

CORNEAL SEQUESTRUM…

= how does this occur IATROGENICALLY?

give a breed PREDISPOSITION? (3 & overall)

A

IATROGENIC = if you DIAMOND BURR or DEBRIDE A CAT TOO VIOLENTLY with a NON-HEALING CORNEAL ULCER, causing a REGION OF NECROSIS

breeds?
1. BRITISH SHORTHAIRS
2. BURMESE
3. PERSIANS
–> overall, CATS WITH LAGOPHTHALMOS causing CHRONIC INFLAMMATION & NON-HEALING ULCERS

70
Q

ID LESION

A

CORNEAL SEQUESTRUM

Year 1/2 (139 decks)

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