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Ophthalmology > A colour guide to the cornea > Flashcards

Flashcards in A colour guide to the cornea Deck (43):
1

What can chronic irritation cause?

- vascularisation
- pigment deposits
- scarring
(e.g. d/t dry eye, entropion, LPI (pannus) etc

2

What might white in a cornea represent?

* scar
- lipid
- calcium

3

How do you tell if a problem is active, ongoing or an old one that is no longer active?

- look for obvious BVs (in cornea) or eye discharge (tearing or mucus discharge)
- if eye is held open (if it appears to be comfortable)

4

Another name - corneal pannus

corneal lymphopcytic-plasmacytic infiltrate (LPI)

5

Are dry eye and LPI usually bilateral or unilateral?

bilateral

6

Will cytology of the corneal surface be useful if the lesion (corneal ulcer) is inactive?

No

7

Tx - inactive corneal ulcer

none

8

Tx - LPI of the cornea (corneal pannus)

- can recur (especially if patient taken off meds - topical ciclosporin and/or topical steroid) too abruptly or early and if there is exposure to sunlight --> maintain low frequency of a drop (once every other day) to keep CS under control

9

Describe pigment of feline limbus and conjunctiva

cats have little to no pigment in the limbus or conjunctiva and do not normally pigment their cornea the way dogs do.

10

What is a feline sequestra?

sequestra in cats form in response to chronic irritation, trauma or repeated, subtle microtrauma (small amount of medial canthal entropion, dry eye etc). Sometimes they appear spontaneously without an obvious cause wand we tend to suspect the latter is most likely

11

Ddx - sequestrum

there is often little room for doubt that the dx in a cat is a sequestrum although a FB and a response around it could also be considered

12

What might fluorescein reveal around a feline sequestrum plaque?

an ulcer around the sequestrum plaque and other possible ulcerative areas.

13

What predisposes sequestrum formation?

medial lower eyelid entropion

14

T/F: STT-1 in cats is rather variable

true - also cats rarely present with dry eye

15

Tx - feline sequestra

best treated with keratectomy for the removal of the entire sequestrum, this may be followed by corneal grafting (a conjunctival pedicle or a corneo-limbo-conjunctival transposition). REFER for this!

16

Where does eosinophilic keratitis (EK) usually occur?

normally in dorsolateral cornea

17

What might a yellowish hue be on an eye?

what is left of fluorescein

18

What suggests hairs are distichiasis?

their regular and orderly distribution and their position pointing directly at the cornea

19

When do distichiae cause a lot of irritation or none?

- long/medium soft coats (cocker spaniels) - no obvious irritation
- cats, short coats in dogs - lots of irritation and often keratitis
- many cases sit in between (including some cocker spaniels!)

20

T/F: some dogs can have distichiae and be asymptomatic but all cats are usually symptomatic

True

21

Ddx - keratitis in a young cat

- distichiasis (primary)
- other eyelid problems (upper eyelid agenesis and entropion)
- FHV-1
- sequestrum formation

22

T/F: distichiae are usually bilateral

True

23

What eyelid problem should you always check for in cats?

- upper eyelid agenesis (this develops dorso-laterally in cats and may be associated with distichiasis). The eyelid and edge and skin may be missing in that region since birth (agenesis) or it might be there but very hypoplastic. In such cases there will be trichiasis too.

24

Tx - distichiasis

- hair removal (e.g. electrolysis)
- supportive medical tx for the cornea (topical AB such as fucithalmic or chloramphenicol) and preservative free viscous tears such as Celluvisc 1% so cornea can heal naturally in a few days without further trouble).

25

What can continued irritation (d/t distichiasis) in cats lead to?

- ulcer
- sequestrum

26

T/F: an active process may be associated with a scar

True - but very rare. This happens when the active process is chronic and there has been time for a scar to develop. In such cases one can also find vascularisation. (e.g. chronic keratitis secondary to a poorly responsive dry eye - KCS)

27

What does corneal oedema result from?

overhydration of the corneal stroma, which is hydrophilic. The stroma is protected from overhydration by the endothelium anteriorly and the endothelium posteriorly. Overhydration can also happen secondary to vessel ingrowth into the cornea (new vessels are leaky as they frm) but oedema is only localised in such cases.

28

Ddx - corneal oedema

- ulcerative dz
- intraocular disease (primary/secondary glaucoma, uveitis)
- primary endothelial degeneration

29

Why do transillumination?

- to look into AC if possible
- see if lens is in the right place or if there are any signs of lens luxation as this can cause secondary glaucoma

30

Use - ocular US

to examine inside of eye

31

T/F: primary endothelial degeneration is usually non-symmetrical

True (b/w l and r eyes) but it is a bilateral problem

32

Tx principles - glaucoma

- primary: careful IOP management
- secondary: deal with the problem that lead to it

33

What needs to happen in lens luxation?

lens needs to be removed.

34

What colours do you need to assess the cornea for?

- white
- yellow
- red/pink
- blue
- black

35

What colour is corneal vascularisation and GT?

red/pink

36

What colour is a corneal abscess?

white

37

Describe corneal abscessation

doesn't really involve the devlopement of a pocket of pus per se but the heavy cellular infiltration of the corneal stroma. This may be infected with bacteria (and rarely depending on location, fungal organisms).

38

T/F: most corneal ulcers are secondary to something else

True

39

What might cause decompensation of corneal ulcer healing?

- infection

40

Ddx - corneal ulcer

- ulcerative dz secondary trauma, possibly d/t FB trapped under TE

41

Name an AB which has good coverage and corneal penetration

chloramphenicol

42

What might help avoid corneal melting?

serum eyedrops

43

How often should you re-examine a corneal ulcer?

- if worried, keep in hospital to observe 2 times a day or once a day, then every 3-4 days. then every 5-7 days.
- the worry is that the cornea may suddenly start melting and perforate