4: conjunctiva - giuliano Flashcards

(75 cards)

1
Q

what is the conjunctiva?

A

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

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2
Q

what are the regions of the conjunctiva?

A

palpebral conjunctiva
bulbar conjunctiva
fornix
Nictitans: anterior and posterior surface

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3
Q

where is the palpebral conjunctiva loc?

A

under the eyelid, facing the globe

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4
Q

where is bulbar conjunctiva?

A

the conjunctiva that projects on to the surface of the globe

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5
Q

what is the fornix of the conjunctiva?

A

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

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6
Q

what is the fxn of the conjunctiva?

A
  • glove movement [low friction]
  • physical barrier [mucus of goblet cells]
  • immunologic barrier [conjunctival associated lymphoid tissue, M cells]
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7
Q

what is work up for conjunctival dz?

A

MODB - minimum ophthalmic data base

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8
Q

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

A
  • tear deficiency
  • corneal dz
  • intraocular dz
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9
Q

what additional diagnostics might be conducted for conjunctival dz?

A
  • cytology
  • culture
  • biopsy
  • NL flush
  • rose bengal stain
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10
Q

c/s of conjunctival dz?

A
epiphora
chemosis 
hyperemia
tissue proliferation
mucopurulent exudate
emphysema
hemorrhage
pruritis
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11
Q

what is epiphora?

A

tearing - inc in serous discharge

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12
Q

what causes epiphora?

A
  • inc prod: pain, irritation

- dec outflow: NL obstruction

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13
Q

what is chemosis?

A

conjunctival edema

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14
Q

what causes chemosis?

A
  • allergic rxn
  • trauma
  • infectious agents
  • tumors [rare]
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15
Q

what infectious agents cause chemosis?

A

chlamydophila felis

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16
Q

what infectious agents causes hyperemia?

A

herpes

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17
Q

what is hyperemia?

A

redness

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18
Q

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

A

conjunctival vs scleral hyperemia

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19
Q

what does conjunctival hyperemia look like?

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

A

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

SUPERFICIAL DZ

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20
Q

what does scleral hyperemia look like?

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

A
deeper red
straighter
less branching
immobile 
blanch slowly

DEEP DZ, FROM W/IN THE EYE

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21
Q

what is mucopurulent exudate?

A

excess mucus with WBCs

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22
Q

what are causes of mucopurulent exudate?

A
  • KCS [dry eye]
  • bacT infections
  • viral infections
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23
Q

what is emphysema of the eye?

A

entry of air into the periorbita from surrounding tissues

swelling and crepitus of conjunctiva

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24
Q

what causes emphysema of the eye?

A

trauma to sinus or tracheostomy

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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