4: conjunctiva - giuliano Flashcards Preview

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Flashcards in 4: conjunctiva - giuliano Deck (75):
1

what is the conjunctiva?

pink, fleshy structure that coats and lines part of the globe

2

what are the regions of the conjunctiva?

palpebral conjunctiva
bulbar conjunctiva
fornix
Nictitans: anterior and posterior surface

3

where is the palpebral conjunctiva loc?

under the eyelid, facing the globe

4

where is bulbar conjunctiva?

the conjunctiva that projects on to the surface of the globe

5

what is the fornix of the conjunctiva?

the space where the conjunctiva folds over itself, loc superior and inferior to the bulbar conjunctiva

6

what is the fxn of the conjunctiva?

- glove movement [low friction]
- physical barrier [mucus of goblet cells]
- immunologic barrier [conjunctival associated lymphoid tissue, M cells]

7

what is work up for conjunctival dz?

MODB - minimum ophthalmic data base

8

what are things to r/o when considering conjunctival dz?

- tear deficiency
- corneal dz
- intraocular dz

9

what additional diagnostics might be conducted for conjunctival dz?

- cytology
- culture
- biopsy
- NL flush
- rose bengal stain

10

c/s of conjunctival dz?

epiphora
chemosis
hyperemia
tissue proliferation
mucopurulent exudate
emphysema
hemorrhage
pruritis

11

what is epiphora?

tearing - inc in serous discharge

12

what causes epiphora?

- inc prod: pain, irritation
- dec outflow: NL obstruction

13

what is chemosis?

conjunctival edema

14

what causes chemosis?

- allergic rxn
- trauma
- infectious agents
- tumors [rare]

15

what infectious agents cause chemosis?

chlamydophila felis

16

what infectious agents causes hyperemia?

herpes

17

what is hyperemia?

redness

18

what 2 types of hyperemia that are important to distinguish within the eye?

conjunctival vs scleral hyperemia

19

what does conjunctival hyperemia look like?

what kind of dz does this suggest is in the eye?

superficial
tortorous vessels, branching
move with conjunctiva
blanch with the epithelium

SUPERFICIAL DZ

20

what does scleral hyperemia look like?

what kind of dz does this suggest is in the eye?

deeper red
straighter
less branching
immobile
blanch slowly

DEEP DZ, FROM W/IN THE EYE

21

what is mucopurulent exudate?

excess mucus with WBCs

22

what are causes of mucopurulent exudate?

- KCS [dry eye]
- bacT infections
- viral infections

23

what is emphysema of the eye?

entry of air into the periorbita from surrounding tissues

swelling and crepitus of conjunctiva

24

what causes emphysema of the eye?

trauma to sinus or tracheostomy

25

what is the term for hemorrhage inside the eye?

hyphema

26

what is the definition of hemorrhage in the eye?

extravasation of blood w/in the conjunctiva

27

what causes hemorrhage in the eye?

trauma: strangulation, CSF tap / SAH

often a manifestation of systemic dz:
septicemia
vasculitis
coagulopathies

28

what are 2 categories of tissue proliferation w/in the eye?

follicle formation or swelling/mass

29

what are 2 reasons for follicle formation w/in the eye?

lymphoid follicles [normal or abnormal location]

allergies

30

what are causes of mass or swelling in the eye?

neoplasia
immune mediated
granuloma
congenital
gland prolapse

31

what are some causes of pruritus of the eye?

itching
2* lesions: alopecia, erythema, stained/matted hair [MC region or periocular]

32

cats and cows 1* get what type of conjunctivitis?

infectious - bacT and viral

33

what species MC get non infectious conjunctivitis?

canine and horse

34

what is common cause of canine conjunctivitis?

pannus
KCS*** (2* conjunctivitis)
entropion
FB

2* infections may occur

35

what is common cause of equine conjunctivitis?

immune mediated
keratitis
uveitis

36

conjunctivitis tx goals?

make diagnosis
remove all exudates/cleanse the eye
maintain surface moisture
control 1* / 2* infections
reduce inflammation

37

what are signs of feline conjunctivitis allergic reactions?

chemosis
epiphora
anaphylaxis possible

38

feline conjunctivitis allergic reaction dx?

etiology?

hx!
administration of triple antibiotic (poly-bac, TAB) - suspected neomycin

39

what is Tx of feline conjunctivitis allergic reactions?

discontinue therapy
+/- anti inflammatory therapy

40

what is the MC etiology of feline conjunctivitis?

herpes - viral infection


41

in addition to the risk of an allergic reaction, why is it typically not appropriate to administer TAB or poly-bac that contains neomycin?

it does not treat the MC etiology of conjunctivitis => herpes virus infection

and it does not treat the more common bacT causes either...

42

what bacT infections in cats are common causes of conjunctivitis?

chlamydophila felis
mycoplasma

43

c/s of feline conjunctivitis caused by chlamydophila felis?
dx?
tx?

chemosis
sneezing
nasal discharge

dx: cytology, PCR

tx: tetracyclines***, azithromycin [oral]

44

c/s of feline conjunctivitis caused by mycoplasma spp?

dx?

tx?

conjunctivitis
90% cats normal

dx: cytology

tx: tetracyclines
topical oxytet
oral doxy or mino

45

c/s of feline conjunctivitis caused by FHV-1?

dx?

tx?

hyperemia***
sneezing and nasal discharge - MC in kittens
keratitis

dx: serology, cytology, PCR, IFA, virus isolation

tx: oral L-lysine and anti viral agents

46

t/f

anti viral agents are created among species. acyclovir and valcyclovir, common human anti viral agents, are safe to use in cats

false

they can kill cats - DO NOT USE THEM

47

what is most classic lesion you will see in a cat infected with FHV-1?

dentritic corneal lesions - branching ulcers or erosions

48

what is the major oral anti viral drug given to tx FHV-1 infections?

famciclovir

49

what are two issues with topical anti viral drugs, such as cidofovir?

must be given often - b/c anti virals are static, NOT cidal

also, they sting - cats are very sensitive

50

how would a clinician describe FHV-1 latency?

a period of time when a patient does not show any c/s of viral infection

51

besides stress induced outbreaks, what will reactivate FHV-1 infection?

pharmacologic stress: corticosteroids [or epinephrine]

52

how do FHV-1 establish latency?

by traveling down the sensory Nn from the site of replication - lies dormant in the sensory ganglia

53

what type of transport does virus utilize in sensory neurons?

retrograde transport

54

how does stress bring FHV-1 out of latency?

causes viral rep at site of latency w subsequent transport of the virus in the sensory Nn

virus travels to target tissue, replicates, causes clin dz

55

how does lysine tx inhibit viral replication?

the virus incorporates lysine into its genome, instead or arginine, but then it cannot replicate properly

arginine cannot be removed from diet b/c it is necessary for life but influxes of lysine inc proportion of lysine in the genome

56

t/f

lysine offers a cure to viral infection

false

dec duration and severity of clin dz - is NOT a cure

57

what is symblepharon?

adherence of conjunctiva to cornea or itself

58

what are 3 FHV-1 related conditions?

symblepharon
eosinophilic keratoconjunctivitis
corneal sequestrum

59

what is common presentation of corneal sequestrum?

necrotic cornea - looks like a burn in the cornea

60

corneal sequestrum tx?

keratectomy

61

what is c/s of calcivirus in cats?

ocular discharge - minimal conjunctivitis, no keratitis
oral ulceration ****
ptyalism (excess salivation)
nasal discharge
sneezing

62

what is the common signalment of canine conjunctivitis caused by allergy?

c/s?

large breed dogs

follicles, periocular erthema, chemosis, skin/ears affected

63

what is the pathogenesis of allergic canine conjunctivitis?

dx?

direct contact
inhalation
ingestion

cytology: lymphocytes and plasma cells

64

Tx of canine allergic conjunctivitis?

flush out allergens w sterile eye wash
corticosteroids: topical, systemic
cyclosporine
allergy meds: mast cell stabilizers, anti histamines, eosinophil inhibitors

65

c/s of canine conjunctivitis caused by KCS?

dx?

conjunctivitis
keratitis
mucopurulent discharge

dx: schirmer tear test

66

etiology of canine conjunctivitis caused by trauma/irritation?

tx?

FB
entroption
ectroption
direct trauma: strangulation, head trauma, CSF tap
masses (dermoids)


tx: remove 1* cause
anti inflammatory medication

67

t/f

trauma should always be at the top of your differential list

false

trauma is unlikely - so unless it was witnessed, it should be on the bottom of the list

68

canine viral conjunctivitis common etiologies?

canine distemper #1
adenovirus
herpesvirus

69

what are early and chronic signs of distemper?

early: serous discharge, conjunctival hyperemia, systemic dz

chronic: KCS [viral adenitis], mucopurulent rhinitis

70

what are some non neoplastic types of conjunctival masses?

dermoids
nodular granulomatous episcleritis
cysts
granulation tissue
parasites

71

what type of granulation tissue is MC present in cats?
horses?

cats: lipogranuloma
horses: habronemiasis

72

what kind of parasite commonly affects the eyes?

oncocerca

73

common conjunctival masses that are neoplastic?

- melanoma, melanocytoma
- SCC
- adenoma, adenocarcinoma
- HSA, hemangioma
- papilloma
- LSA

74

what is the leading presentation of cats with systemic LSA?

ocular findings
uveitis

75

clinical approach to conjunctival masses?

dx: clin presentation, cytology, biopsy

tx: tailored to condition