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Opthalmology > The Wet Eye > Flashcards

The Wet Eye Flashcards

1
Q

What does epiphora indicate?

A

wet face d/t tearing, does NOT indicate cause

  • lack of drainage
  • irritation -> reflex tearing
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2
Q

Which direction does blinking occour in?

A

lateral-medial brings tears to medial canthus

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3
Q

Outline the nasolacrimal system

A
  • inferior and superior puncta medially
  • lead to canaliculus on each side
  • connect to lacrimal sac
  • continue as nasolacrimal duct (INTEROSSEOUS part)
  • potential additional duct openings (can -> drainage into throat not nose)
  • ends in nasal punctum lateral nasal wall
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4
Q

How doesthe nasolacrimal system of rabbits differ to other smallies?

A
  • single, large ppunctum lower lid
  • nasolacrimal duct interosseous is tortuous and follows tooth roots (1* maxillary incisor) -> blockage with tooth prblems
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5
Q

How does the nasolacrimal system of horses differ to smallies?

A
  • large, visable nasal punctum
  • cannulation of this is possible
  • retrograde flushing of NLD
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6
Q

What does a delayed or absence of fluorescin in the Jones test indicate?

A
  • potential blockage

- indication to FLUSH and find out more

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7
Q

What can damage of the NLD with a canula dispose to?

A

stricture

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8
Q

What could be used instead of a nasolacrimal cannula to flush ducts?

A
  • small IV caqtheter`
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9
Q

Risks of flushing the nasolacrimal duct?

A
  • damage and stricture-
  • pain (always use topical anaesthetic proxymetacaine, do not force fluid, pulsate it)
  • aspiration of fluid (tilt head down, or inflate cuff if under GA)
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10
Q

Potential causes of blockage -> epiphora?

A 
> imperforate punctum (congenital) 
- uni or bilateral 
- upper +- lower puncta
- may also affect caniliculi (malformation or aplasia) 
> closed puncta (2* to inflame/trauma) 
- eg. cat flu/herpes when young
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11
Q

ID and Tx of puncta blockage?

A
  • cannulate other punctum ipsilaterally
  • pulsate fluid and look for pulsating bulge in conjunctiva
  • cut if located, and place large 3-0/4-0 non absorbable suture cannulation for 14d to avoid closure
    > if cannulation not possible consider further dx
    = Dacryocystorhinography xray study with contrast
  • CT with contrast
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12
Q

ID and TX NLD blockage?

A 
> much more difficult as interosseous 
- bulging under skin near medial canthus
- mucous production 
- surgical exploration 
- foreign material
- imagine
> cannulate with suture again
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13
Q

3 main sources of pain irritants -> epiphora?

A
  1. ocular surface (eyelids, TE - poss infection/trauma; conjunctiva, cornea - more common and severe, d/t hairs, eyelid, nerves exposed with ulcers, FBs)
  2. intraocular structures
  3. retrobulbar area
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14
Q

Potential causes of 1* eyelid /TE problems

A

> trauma
inflam/immune/infectious (bacterial/mycotic/parasitic)
- leishmania
- part of systemic derm eg. pemphigus
- Hordoleum (stye) internal meibomian gland infection or external glands of Moll and Zeiss infection
- Chalazion (non painful blockage of sebaceous gland -> granuloma formation around exuded material cuasing 2* trauma to cornea)
- staphylococcal blepharitis (young/adult dogs, hypesenstivity + self harm - skin ulcers, abscesses)
- FB

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15
Q

What is the tx of staphylococcal blepharaiitis?

A
  • clean debride and lance
  • protective collar
  • Abx, cephalopsporin oral and Fucithalmic topically)
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16
Q

Are long term topical local anaesthetics indicated following FB removal from under the TE?

A

No

  • remove pain sensation will v tear production
  • proxymetacaine is cytotoxic with prolonged use and will prevent ulcers healing
17
Q

What should be used to suture a TE trauma?

A
  • 6-0 vicryl
  • round bodied needle
  • knots to the superficial side!
18
Q

What type of forceps are use dto handle delicate tissue?

A
  • Von Graeffe
19
Q

Treatement of chery eye?

A
  • prolapsed gland of TE
  • produces 30% tear film so DO NOT REMOVE, also breeds pdf cherry eye pdf KCS too
  • reposition using Morgans pocket technique
  • if this fails anchoring techniques though these limit movement of TE so last resort
20
Q

Which dogs is follicular conjunctivitis seen more commonly? Cuases?

A
  • young dogs
  • allergic response to environmental allergens
  • bulbar side more obvious
  • seen in horses with dust/flies
21
Q

Prognosis or tx of follicular conjunctivitis?

A
  • will rsolve spontaneously
  • lubricant
  • if persisting >6 months give topical steroids short term
  • sodium chromoglycate (MC stabiliser, must be given before onset)
22
Q

What 1* infectious agents cause conjunctivitis?

A 
> Clamydophila 
- young cats
- uni/bilateral 
- v hypeaemic
- Doxycyline BID for a month 
- Always Tx if suspected, can do swabs but stat tx before results if all other causes r/o. 
> FHV1
- more of a corneal problem
- affect conjunctiva 2*
23
Q

Which 1* infectious agents cause conjunctivitis in large animals?

A 
> IBR
- adults: URT, red nose, ocular discharge and redness
- in utero -> ocular development problems 
> Moraxella bovis (Pink EYe) 
- typically seasonal
- fomites
- very hyperaemic conjunctivitis 
> listeria monocytongenes (Silage Eye) 
- typically seasonal
- fomites
24
Q

Which infiltrative diseases can cause 1* eyelid/TE irritation?

A

> LPI (dogs)
- aka pannus, CSK [chronic superficial keratitis], corneal LPI
- may affect cornea only, cornea and TE or TE only [plasmoma]
EK (Cats)
- easinophilic keratitis and keratoconjunctivitis
- similar pathophysiology but more eosinophils less lymphocytes

25
Q

Tx of trichiasis, distichiasis andectopic cilium?

A
  • trichiasis: remove hair or prominent feature
  • distichiasis: electrolysis for multiple, wedge resection for single
  • ectopic cilium: wedge resection
26
Q

How does neoplasia of the eyelid differ betweenspecies?

A 
> dogs
- commonly benign
- meibomian gland adenoma and papilloma
- MCT have less aggressive biological behaviour in the eyelid
> cats variable, mostly malignant
- SCC
- melanoma
- MCTs
> horses/catle, most malignant
- sarcoid
- SCC potensh v serious 
- melanoma
27
Q

How may tension on a wedge resection wound be minimised?

A

House resection - cut wedge edges parallel instead of V shaped

28
Q

How are wedge resections closed?

A
  • internal tarsal plate suture

- figure of 8 suture

29
Q

What conformational problems may affect the eyelid? `

A 
> upper eyelid agenisis in cats 
- lateral upper eyelid missing (eyelid coloboma) 
- leads to trichiasis
- requires reconstruction 
> entropion
> ectropion
30
Q

What is the entropion chart?

A

Awaiting email response!

31
Q

How may entropion be repaired?

A

Celsus-Hotz or Hotz-Celsus repair

  • remove wedge from under eye
  • suture with 6-0 absorbable material
  • Rile of Bisection (start at either end then half distance until it is all closed)
32
Q

What ethics are asscoaited with conformational issues?

A
  • inform owners for showing
  • breeding?
  • repair only for medical reasons not looks
33
Q

What intraocular sources may -> epiphora? How?

A

> glaucoma, uveitis, others
prolonged/intense corneal stimulation cuasing reflex uveitis
- spasm of ciliary and iridial musculature
- miosis and photophobia

34
Q

What is the tx of iris spasm?

A

Atropine relaxes ciliary body for ~ week

35
Q

What type of retrobulbar disease may cause epiphora?

A
  • abscessation/cellulitis (painful)
  • salivery gland dz (variably painful)
  • neoplasia (rarely painful)
36
Q

What is reflec uveitis?

A
  • chronic corneal pain d/t ulcer -> psasm of iris and ciliary body

Opthalmology (14 decks)

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