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Sensing & Seeing > Cornea & Sclera 1,2 & 3 & Eye exam/ Diagnostics > Flashcards

Cornea & Sclera 1,2 & 3 & Eye exam/ Diagnostics Flashcards

1
Q

What is the normal state for the corneal stroma?

A

avascular

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2
Q

What accounts for about 90% of thickness and is arranged in a lamellar collagen arangment?

A

Corneal stroma

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3
Q

What is the function of the corneal endothelium?

A

Pump fluid out of the cornea

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4
Q

What is the normal state for the cornea to be in?

A

Dehydrated

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5
Q

Vascularization in corneal pathology? (2)

A

Superficial disease= branching blood vessels
Intraocular disease= more vessels that are deeper in the cornea

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6
Q

What are 2 specific congenital corneal disorders?

A

Corneal dermoid
Persistent Pupillary Membrane

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7
Q

Corneal Dermoid (5)

A

1) Usually arises from the limbus
2) Embryologic defect
3) misplaced skin containinng hair follicles
4)Irritating and cosmetic
5) Doesn’t regrow after surgery

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8
Q

Persistent Pupillary Membrane (PPMs) (4)

A

1) absorption of the pupillary membrane is incomplete as a fetus and shred or strands remain
2) Arise from the surface of the iris
3) No significant change in iris mobility
4) Nothing to be done about it

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9
Q

What is corneal ulceration?

A

Full thickness loss of epithelium

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10
Q

What are the clinical signs/findings associated with corneal ulceration? (4)

A

1) Blepharospasm/epiphora
2) Corneal edema (localized)
3) Conjunctival hyperemia/chemosis
4) Variable ocular discharge

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11
Q

What are the specific causes of delayed corneal healing? (6)

A

1) corneal fixation
2) unresolved source of corneal abrasion
3) Keratoconjunctivitis sicca
4) Exposure keratitis
5) Neurotrophic keratitis
6) SCCED

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12
Q

What are the risk factors for ulcer progression? (5)

A

1) Is tear production normal?
2) Can/does animal blink normally?
3) Brachycephalic breed/conformation exophthalmos?
4) Adnexal abnormalities?
5) Does ulcer appear infected?

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13
Q

What complications are associated with Corneal Ulceration? (4)

A

1) Secondary infections
2) Stromal collagenolysis
3) Uveitis
4) Corneal perforation

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14
Q

What are the descriptive classification of corneal ulcers? (3)

A

1) Superficial
2) Stromal (mid or deep)
3) Descemetocoele

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15
Q

How do all ulcers start?

A

As acute superficial ulcers that will heal

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16
Q

What is the defining feature of a mid-stromal ulcer?

A

Maybe some scaring but visual and will heal

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17
Q

What is the defining feature of a deep-stromal ulcer?

A

More scaring than a mid- stromal ulcer but still visual and will heal

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18
Q

What is the defining feature of a descemetocoele?

A

Translucent center in the cornea, not going to heal/fill in will require surgery

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19
Q

What is a chronic superficial ulcer?

A

A superficial ulcer that is not healing appropriatly

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20
Q

What are the diagnostics performed to determine if it is a corneal ulcer? (5)

A

1) search for underlying cause
2) Schirmer tear test
3) Corneal culture
4) corneal cytology
5) Fluorescien stain

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21
Q

What are the goal of therapy for a corneal ulcer? (4)

A

1) Prevent/control infection
2) Prevent/control collagenolysis
3) Increase patient comfort
4) Promote healing

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22
Q

What are the indication for surgical therapy involving a corneal ulcer? (4)

A

1) SCCED (spontaneous chronic corneal epithelial defect)
2) Progressive corneal ulceration
3) Deep stromal ulceration or descemetocoele
4) Keratomalacia (melting ulcer)

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23
Q

Conjunctival flaps (4)

A

1) Mechanical support
2) Immediate blood supply
3) Source of fibroblasts
4) Source of epithelial cells

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24
Q

What is the clinical appearence of SCCED (spontaneous chronic corneal epithelial defect)? (6)

A

1) Superficial, non-healing ulceration
2) No identifiable underlying cause
3) Non-infected
4) Loose epithelial lip surrounding ulcer
5) Variable vascularization
6) Variable ocular discomfort

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25
Q

What is the treatment options for SCCED? (4)

A

1) Keratotomy
2) Manage as a superficial ulcer until healed
3) +/- 3rd eyelid flap
4) +/- contact lens

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26
Q

What sort of treatment should not be done for SCCED?

A

Corneal debridement is NOT recommended

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27
Q

What is the classic early corneal ulceration lesion associated with feline herpesvirus (FHV-1) keratitis?

A

Dendritic ulcers/erosion
Rose bengal ulceration

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28
Q

Canine herpesvirus corneal ulceration? (3)

A

1) Ubiquitous infection, but rare cuase of corneal disease
2) Dendritic ulcers or non-ulcerative inflammatory disease
3) commonly seen in immunosuppressed dogs

29
Q

Infectious Bovine Keratoconjunctivitis (IBK) (4)

A

1) Moraxella bovis
2) most common bovine ocular disease
3) highly contagious organism w/ significant economic impact
4) mechanical vector (face fly) or direct contact

30
Q

What are the ocular lesions associated with IBK? (5)

A

1) Corneal ulceration; maybe severe leading to proliferation
2) Conjunctivitis
3) Blephrospasm
4) Photophobia
5) epiphora/mucopurulent discharge

31
Q

Corneal Foreign body (3)

A

1) Removal mandatory
2) Potential for perforation
3) surgical intervention in select cases

32
Q

Corneal Abscess (5)

A

1) uncommon
2) intrastromal cellular accumulation
3) infected vs. sterile
4) must vascularize to heal
5) cannot drain it

33
Q

Pigmentary Keratitis (3)

A

1) NOT a specific disease
2) a result of underlying condition causing chronic irritation
3) most common/ severe in brachycephalic dogs

34
Q

Immune-mediated keratitis (4)

A

1) Idiopathic condition
2) Typically characterized by vascularization, edema, variable inflammatory cell infiltrate
3) Responsive to topical immunosupressive medication
4) Long term treatment usually required

35
Q

Chronic Superficial Keratitis (Pannus) (3)

A

1) German Shepherds and crosses
2) Exposure to UV radiation
3) Clinical signs bilateral

36
Q

What are the clinical signs for Chronic Superficial Keratitis (Pannus)? (3)

A

Bilateral
1) Corneal vascularization/pigmentation (from lateral limbus)
2) Conjunctival hyperemia
3) Nictitan thickening/depigmentation (Plasmoma)-not always present

37
Q

4 classifications of Equine IMMK

A

1) Epithelial
2) Superficial Stroma
3) Mid- stromal
4) Endothelial: no blood vessels, edema

38
Q

Causes of Lipid Keratopathy (3)

A

1) Lipid dystrophy (bilateral: Inhereited/breed related
2) Lipid Degeneration: antecedent or active corneal/scleral disease
3) Lipid Keratopathy due to systemic lipid metabolism abnormalities

39
Q

Corneal Mineralization/ Calcification Keratopathy appearance/ clinical findings (2)

A

1) Typically a benign condition
2) Ulceration over densely mineralized tissue

40
Q

What are the causes of Corneal Mineralization/ Calcification Keratopathy? (3)

A

1) Age-related degenerative condition
2) Secondary to systemic calcium/phosphorous imbalance
3) Seen in horses w/ chronic ERU (band keratopathy)

41
Q

Endothelial Dystrophy/ Degeneration (5)

A

1) Abnormal corneal endothelial development
2) Compounded by age-related endothelial deneration
3) Progressively severe corneal edema
4)corneal bullae formation/rupture
5) Corneal ulceration

42
Q

Feline Corneal Sequestrum clinical findings (3)

A

1) Painful
2) Focal brown/black corneal discoloration
3) Variable corneal vascularization

43
Q

Feline Corneal Sequestrum etiology/pathology (3)

A

1) Chronic corneal ulceration
2) FHV-1
3) breed predisposition

44
Q

Neoplastic Cornoscleral Masses (3)

A

1) Primary corneal neoplasms are rare
2) Corneoscleral/corneoconjuncatival neoplasms are more common
3) Melanocytoma, Squamous cell carcinoma, hemangioma

45
Q

Non-neoplastic Cornosclereal Masses (2)

A

1) Inflammatory- episclerokeratitis
2) Epithelial inclusion cyst

46
Q

Episcleritis (4)

A

1) Sectorial scleral thickening
2) No corneal encroachment
3) Unilateral or bilateral
4) Self-limiting

47
Q

Nodular Granulomatous Episclerokeratitis (5)

A

1) Immune-mediated inflammatory condition
2) only seen in dogs
3) Non painful, raised cornoscleral mass
4) Responds to immunosuppressive medication
5) Surgical excision alone generally not helpful

48
Q

Diffuse Scleritis (4)

A

1) Usually bilateral
2) Painful condition
3) Secondary corneal, uveal & retinal disease common
4) Systemic immunosuppressive medication required to control

49
Q

“Oblique Illumination” (2)

A

1) Application of light @ various angles
2) Highlight subtle corneal opacities, determining depth, contours of ocular structures etc.

50
Q

“Coaxial Illumination” (2)

A

1) light angled with observer’s line of sight
2) effective means of highlighting light obstruction opacities in eye

51
Q

Anterior Segment Magnification tools (4)

A

1) Head loupe (optivisor)
2) Direct ophthalmoscope
3) Otoscope without cone (2-3x magnification)
4) Slit lamp biomicroscope

52
Q

Distant Direct Ophthalmoscopy (4)

A

1) coaxial illumination technique
2) set at 0 diopters
3) work at arms length from patient
4) nuclear sclerosis vs. cataract

53
Q

Direct ophthalmoscope for magnified ocular surface structure exam (3)

A

1) set diopter setting at 15-20 D
2) move in towards area of interest until lesion comes into focus
3) limitation is small surface area that can be visualized in this manner

54
Q

Fundus Exam (2)

A

1) determine cause of vision loss
2) searching for evidence of systemic disease that may affect the retina

55
Q

Fundus Exam Technique (5)

A

1) Set lens power to 0 D
2) while looking through the ophthalmoscope, lean in towards patient until retina is in focus
3) adjust diopter focus wheel as needed
4) typically need to be within 2-3 cm from cornea
5) at this distance, fundus is typically in focus somewhere between +2D & -2D on focus wheel

56
Q

Direct Ophthalmoscopy Technique (2)

A

1) Use right eye to examine patient’s right eye and use left eye to examine patient’s left eye
2) Easiest to perform in dilated eyes

57
Q

Direct Ophthalmoscopy Image (5)

A

1) Highly magnified
2) Best opportunity to see fine detail
3) difficult to evaluate entirety of fundus: especially in peripheral fundus
4) hard to isolate/localize lesions due to eye movements
5) Image is an anatomic orientation

58
Q

Monocular Indirect Ophthalmoscopy (3)

A

1) Employs hand held light source
2) Finoff transilluminator held adjacent to observers eye
3) Direct ophthalmoscope

59
Q

Binocular Indirect Ophthalmoscopy (3)

A

1) Employs specialized headset
2) allows for stereoscopic image
3) frees both hands for manipulating lens & patient

60
Q

Basic technique for indirect ophthalmoscopy (3)

A

1) low level of illumination
2) obtain a tapetal reflection
3) position indirect lens into path of light in front of patient’s eye to obtain fundic image

61
Q

Image for indirect ophthalmoscopy (3)

A

1) wide field of view
2) Virtual image
3) upside down and reversed

62
Q

Lens alignment for indirect ophthalmoscopy (2)

A

1) Lens should be held perpendicular to light beam
2) must maintain this alignment when looking at different areas of retina

63
Q

General tips for all forms of ophthalmoscopy (4)

A

1) retina is best view in a dark room
2) use lowest practical light intensity
3) appropriate restraint is very helpful
4) pharmacologic dilation whenever possible

64
Q

When is dilation contraindicated in an ophthalmoscopy exam?

A

If there is concern about glaucoma or lens instability

65
Q

Schirmer tear test (4)

A

1) measures tear production)
2) insert in lower eyelid (lateral) up to notch on strip
3) leave in place 1 minute
4) read immediately following removal: measures in mm/min

66
Q

Application Method Topical Fluorescein stain (2)

A

1) directly touching pre-moistened strip to conjunctiva
2) create fluorescein solution in syringe & apply drop to ocular surface

67
Q

Primary diagnostic use for Topical Fluorescein stain (2)

A

1) corneal ulcer detection
2) evaluating nasolacrimal duct patency

68
Q

Tonometry (4)

A

1) Measures IOP
2) Measured in mmHg
3) Topical anesthetic for Tonopen & Schiotz NOT Tonovet
4) Always measure both eyes

Sensing & Seeing (15 decks)

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