Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IP 11 Ophthalmology > 6: cornea, sclera - giuliano > Flashcards

6: cornea, sclera - giuliano Flashcards

(60 cards)

Start Studying
1
Q

t/f

an appropriate Tx for ulcers are topical steroids

A

false

NEVER put steroids on a corneal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are 5 conditions that considered an ophthalmic emergency?

A 
keratitis [corneal ulcers]
uveitis [hyphema]
glaucoma [acute 1*, 2* to lens luxation]
orbital dz [proptosis]
adnexae [eyelid lacerations]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does a rose bengal stain evaluate for?

A

FHV-1

KCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what CrNn does palpebral reflex require?

A

CrN 5 and 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

important things to consider while describing corneal ulcers:

A 
size
depth
position relative to limbus
health of surrounding cornea
chrnoicity / cause
# of ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the significance of the position of the ulcer relative to the limbus?

A

if ulcer is deep, it needs neovascularization which comes from the limbus

so if near limbus, that is good

if positioned too centrally and far from the limbus, may recommend Sx instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

underlying causes of corneal ulcers:

A 
trauma (save for last)
FB
eyelid abnormalities 
infectious etiologies
neurologic defect
KCS***
congenital abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

underlying infectious causes of corneal ulcer in cats:

A

FHV-1

1* infection common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

underlying infectious causes of corneal ulcer in dogs:

A

1* infectious keratitis does not ‘typically’ occur

r/o all other causes 1st in dogs (KCS)

2* infection may result in progressive ulceration, stromal malacia, perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what neurologic deficits will be present w CrN 5 issue?

A

sensory deficit, neurotrophic keratitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what neurologic deficits will be present w CrN 7 issue?

A

lagophthalmos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

superficial corneal onset typical presentation?

A

acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what tissue layers are lost in superficial corneal ulcer?

what does this look like on fluoroscein stain?

A

epithelial tissue loss only
stroma intact

sharp distinct borders to stain
minimal corneal inflammatory response b/c acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is reflux uveitis?

A

axonal reflex mediated by CrN 5 w release of inflammatory mediators (PG)

cornea richly innervated so if nerve ending abrasion, signal sent back to uveal tract [PG mediated response] -> ciliary spasm and uveal tract spasm to close the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

simple corneal ulcer Tx:

A
  • find and remove underlying cause
  • px 2* infection - broad spectrum topical abx
  • tx refulx uveitis (atropine, oral NSAIDs)
  • px self trauma (e-collar)
  • NO topical corticosteroids
  • recheck 7 d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is SCCED?

A

spontaneous chronic corneal epithelial defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is an indolent ulcer?

A

SCCED - a superficial ulcer that should heal but does not heal

chronic or likely to become chronic

minimal corneal inflammatory effect - epithelium tries to cover the defect but cannot adhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what tissue is lost in an indolent ulcer?

what does the STT look like?

A

epithelial loss only - stroma intact

non-adherent epithelial “lip” - creates indistinct borders with stain - “halo” like effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tx of indolent ulcers?

A 
px 2* infection
promote healing - topical anesthetic, debride, perform grid keratotomy or diamond burr keratectomy
tx reflex uveitis
px self trauma
recheck 7-10 d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

for indolent ulcers, what is believed to be the problem that is preventing healing?

A

corneal anterior stromal problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

with just a dry q tip debridement, what % of indolent ulcers will heal?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how do you do a grid keratotomy?

what species is it appropriate for?

what % will heal?

A

make hash marks in superficial cornea - get through anterior stroma so epithelial cells have more healthy stroma to adhere

use 27 gauge needle***

85% heal

dogs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why is grid keratotomy NOT appropriate for cats and horses typically?

A

the MC cause for feline and equine is infectious - you will inoculate the deeper tissue w the bacT => BAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what abx for indolent ulcers?

A

oxytet
terramyciin

atropine - to effect - to dilate pupil

oral NsAID
oral analgesic (tramadol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
if the grid keratectomy does not repair the indolent ulcer, what should be done?
refer may need superficial keratectomy or 2nd grid keratotomy or corneal thermal cautery
26
what is a descemetocele?
a deep ulcer = complex ulcer = melting ulcer = deep stromal ulcer
27
what are the characteristics of a stromal ulcer?
- acute or chronic - epithelial AND stromal tissue loss - fluorescein stains walls and floor of ulcer - stroma frequently unhealthy: edema, inflammatory cells, "melting" or keratomalacia
28
what is appearance of deep corneal ulcer?
- severe corneal edema {blue} - variable depth of stromal loss - soft, melting corneal stroma - yellow-cream stromal infiltrates - corneal neovascularization - anterior uveitis {hypotony, miosis, equeous flare, hypopyon or fibrin in AC}
29
what are causes of deep ulcer?
- endogenous proteinases [WBCs, corneal epithelial cells, stromal fibroblasts] - 2* bacT infections [collagenase prod, B-hemolytic strep] - topical corticosteroids [local immune suppression, potentiation of collagenase activity]
30
what does the Seidel test evaluate for?
if concerned that patient might still be actively leaking put fluorescein stain on eye and do not dilute it, wait, then if positive, you will see the leak
31
dx of deep corneal ulcer:
corneal cytology and swab [under anesthesia] be careful and DO NOT touch eyelids swab margin of ulcer bed
32
deep ulcer Tx?
- find and remove underlying cause - Px / Tx 2* infection - assume already infected - Tx reflex uveitis - px corneal melting: serum - bandage - Sx? - e collar - recheck w/in 7 d
33
what does serum do to help ulcer heal?
anti collagenase activity
34
surgical options for deep ulcer tx:
conjunctival graft corneo-conjunctival transposition REFER
35
when should Sx be considered for deep ulcer?
greater than 1/2 stromal depth loss rapidly progressive or melting no neovascular response perforated and actively leaking
36
medical mgmt of deep ulcer?
- abx based on cytology and culture g + = cefazolin g - = fluoroquinolone - use solutions - NOT ointments
37
what is the function of proteinase inhibitors in deep ulcer Tx?
inhibit endogenous and BacT collagenases px melting or Tx ongoing stromal melting
38
when should atropine be used?
initially - to maintain pupillary dilation => Px synechia [iris adhering to other tissue] cycloplegia for ciliary M spasm assoc w reflex uveitis stabilize blood-eye barrier via dec vasc permeability
39
when is systemic therapy appropriate to Tx deep ulcers?
appropriate for deep ulcers analgesic systemic anti inflammatory systemic abx - if perforation possible and to px ascending infection
40
Sx Tx of deep ulcer?
conjunctival graft [pedicle] corneal graft ophthalmic tissue glue
41
t/f | a conjunctival graft will restore vision completely in a patient with a deep ulcer
false will restore functional vision but not complete vision
42
what is a corneal facet?
chronic ulcer hx: deep ulcer that healed intact epithelium, healthy tissue but still thin and is a defect - an area of weakness
43
how long does debridement take?
hours
44
how long does epithelial flattening and migration take?
hours
45
how long does epithelial mitosis take?
days
46
how long does basement mem deposition take?
days to weeks
47
how long does stromal collagen deposition take?
days to weeks
48
how long does stromal collagen remodeling take?
months
49
what are 3 reasons an ulcer will NOT heal in 7-10 days?
- original cause still present - it has become infected - it is an indolent ulcer
50
what is the sclera?
white of the eye part of the outer fibrous tunic
51
what are the specialized areas of the sclera?
limbus intrascleral venous plexus equatorial extra ocular muscle insertions lamina cribrosa
52
what is the lamina cribrosa?
exit of optic nerve - it is the axons of ganglia cells
53
MC scleral dzz?
coloboma neoplasia immune med disorders trauma
54
what is a sclera coloboma?
a hole in the scleral tissue
55
ddx for brown pigment in the sclera?
melanoma | benign melanocytoma
56
what can you visualize with gonioscopy?
the irido corneal angle
57
what is NGE? etiology?
episcleritis and episclerokeratoconjunctivitis => nodular granulomatous immune mediated
58
NGE MC seen in what species and breed?
collies and collie crosses
59
Tx of NGE?
top and sys steroids top cyclosporine sys tetracycline sys azathiopirne
60
what is predominate cell type present in NGE?
macrophages

IP 11 Ophthalmology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions