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ACVN - MEDICAL NURSING > Ophthalmology 1 > Flashcards

Ophthalmology 1 Flashcards

1
Q

What are the top 4 signs of eye pain?

A
  • blepharospasm
  • reduced palpebral fissure
  • ocular discharge/epiphora
  • hyperaemiaw
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2
Q

What is hyperaemia?

A

increased redness

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3
Q

What is blepharospasm/

A

increased blink rate

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4
Q

What would you see with reduced palpebral fissure?

A

blink/wink

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5
Q

What are the local signs of pain?

A
  • photophobia
  • misosis
  • third eyelid protrusion
  • head-shy
  • self-trauma/rubbing
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6
Q

What is photophobia?

A

avoiding light

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7
Q

What is miosis?

A

small pupil

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8
Q

What are systemic signs of eye pain/

A
  • reduced appetite
  • quiet/subdued
  • depressed
  • headache?
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9
Q

How would you triage a patient for pain?

A
  • systemic signs
  • brief description of ocular signs
  • onset
  • duration
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10
Q

How can a pain score be difficult?

A

the result will be affected by blepharospasm, squinting changes the patients facial expression

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11
Q

What does a patient have to score for additional analgesia on an ophthalmic pain score?

A

3 or above

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12
Q

How do you manage ophthalmic pain?

A
  • medical options - topical and systemic
  • surgery
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13
Q

How might you treat scratchy dry lids?

A

lubrication with HA drops

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14
Q

How might you treat acutely painful indolent ulcers?

A

bandage contact lens

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15
Q

How might you treat cramping spasm uveitis?

A

atropine/clycopentolate drops

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16
Q

How might you treat chronic searing ache of intractable glaucoma?

A

Enucleation

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17
Q

How might you treat dull ache orbital swelling?

A

NSAIDs +/- opioids

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18
Q

How might you treat an eye that cannot be opened to examine?

A

local anaesthetic, sedation or GA

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19
Q

How would you handle a blind patient to make them feel comfortable?

A
  • talk to them
  • go slowly
  • guide them
  • avoid bumps
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20
Q

How would you handle a patient who is blind of visually impaired for a clincial exam?

A
  • assess temperament
  • keep steady
  • keep calm
  • examine at the end of the table
  • reward and reassure
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21
Q

What types of cataract are there?

A

inherited or diabetic

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22
Q

What type of glaucoma is there?

A

primary inherited genetic defect or secondary to intraocular neoplasia, uveitis, lens luxation

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23
Q

How would you treat glaucoma?

A

medical management intially, surgical shunt implant, laser TSCP/EPC ultimately enucleation

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24
Q

What is SARDS?

A

sudden acquired retinal degeneration syndrome

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25
Q

How would you confirm SARDS?

A

electroretinogram

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26
Q

What toxins can cause vision loss?

A

ivermectin poisoning, enrofloxicin in cats

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27
Q

What is PRA?

A

progressive retinal atrophy

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28
Q

What happens with PRA?

A

night vision goes then day vision

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29
Q

What else can cause vision loss?

A

brain disease and trauma

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30
Q

How can you advise owners who have a blind dog?

A
  • facebook forums with other owners with blind pets
  • RSPCA tips
  • buster collars, guide leads, bump bars to prevent injury
  • doggles/rex-specs
  • sound/voice commands
  • behavioural modification training
  • lead walks offer more support - reverse guide dog
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31
Q

Why do we need to treat eye ulcers?

A
  • painful
  • infection risk
  • risk of keratomalacia ‘melting’
  • perforation - endophthamitis - glaucoma- phtthisis - blindness
32
Q

What is the cornea made of?

A

transparent stratified squamous epithelium

33
Q

What is the limbus?

A

transition zone, stem cells

34
Q

What is the scelera?

A

gibrous tunic, gives globe rigidity (white part of the eye)

35
Q

What percentage stromal loss is classed as fragile eye?

A

> 50%

36
Q

When is fragile eye extremely fragile?

A

is the loss has gone down to the descemet layer

37
Q

What can raise intracranial pressure and put the patient at risk of rupture?

A

barking, jugular blood samples, coughing/vomiting, pulling on collar, firm restraint

37
Q

How would you handle patients with fragile eye?

A
  • avoid pressure on neck or lids
  • increasing intraocular pressure causes increase in venous pressure
  • avoid stress
  • meds
  • keep eyes clean
  • schirmir tear test or intraocular pressure test or cytoloy?
37
Q

How would you treat spontaneous chronic corneal epithelial defect?

A

algar brush, grid superficial keratectomy

38
Q

Why should you never do a grid superficial keratectomy on a cat?

A

risk of corneal sequestrum formation

39
Q

How would you treat stromal ulcers and feline sequestrum?

A

medical or surgical graft
corneo-conjunctival transposition, biopsies collagen, amnion, tutopatch

40
Q

How would you treat melting ulcers?

A

intense medical initially +/- corneal cross linking or corneal graft surgery

41
Q

How would you treat descemotocoeles?

A

tectonic.structural support imerative, corneo-conjunctival transposition

42
Q

How would you treat perforation?

A

risk endophthalmitis, suture closed/patch/graft

43
Q

What considerations should you consider with inpatients?

A
  • low stress
  • smooth pre-surgical preparation
  • smooth recovery post-op
  • reversal or repeat of premedication
  • cats in separate wards
  • horses in dark stables
44
Q

What post-operative care should you provide to patients who have had eye surgery?

A
  • harness walks only
  • no jugular samples
  • buster/soft collar
  • recognise, monitor and treat pain
  • administer eye medication
  • keep wounds clean and dry
  • keep patient calm
45
Q

What trauma is an ocular emergency?

A
  • sharp trauma
  • blunt trauma such as RTA or run into wall
  • proptosis
  • penetrating foreign body
46
Q

What is proptosis?

A

eyelids are trapped behind globe so the eye will appear pushed forward

46
Q

What are the priorities with ocular emergencies?

A
  • cardiovascular stability
  • analgesia
  • ocular surface support (lubrication
  • prevent further trauma
  • buster collar to prevent self-trauma
  • stabilise - assess - plan - treat
46
Q

When do puppies develop a menace response?

A

8-12 weeks

47
Q

What can happen if a puppy obtains a cat claw injury?

A

corneal laceration, lens puncture or capsular tear

48
Q

What can a cat claw injury cause?

A

cataract formation, lens induced uveitis

49
Q

How would you treat a cat claw injury?

A

cataract surgery, corneal laceration repair and uveitis medically treated

50
Q

How does a non-traumatic glaucoma look?

A

blue cornea, red sclera and conjunctiva

51
Q

What does chronic glaucoma look like?

A

buphthalmic eye, stretched globe making it look enlarged

52
Q

What measurement is high intraocular pressure?

A

> 30mmHg

53
Q

What is normal intraocular pressure?

A

10-25mmHg

54
Q

What are the signs of retrobulbar mass?

A
  • pain on opening mouth
  • exophthalmic eye
  • excessive conjunctiva visible, especially 3rd eyelid
55
Q

What do lubricants do?

A

protect, soothe, support healing

56
Q

What are antibiotics used for?

A

treatment or prophylaxis

57
Q

What anti-inflammatories can be used?

A

NSAIDs or steroids

58
Q

What do mydriatics do?

A

dilate the pupil

59
Q

What do anti-glaucoma drugs do?

A

lower pressure

60
Q

What are immune modulator drops used for?

A

immune mediated disease

61
Q

What would local anaesthetic eye drops be used for?

A

diagnosis or pre-op

62
Q

What are serum eye drops made from?

A

fresh frozen plasma or serum

63
Q

How do you use serum eye drops?

A
  • defrost frozen plasma
  • place needle-free fluid spike on plasma bag
  • draw up 3mls of plasma using a syringe and transfer into bottles before placing the cap onto the bottles
  • once completed store bottles or syringes in the freezer
  • defrost in pocket for days of use then store in the fridge
64
Q

What are serum eye drops used for?

A

melting ulcers, or to prevent keratomlacia

65
Q

How long should you leave between each eye drop?

A

10 minutes

66
Q

How long should you leave between ointment and gel?

A

60 minutes

67
Q

What is the order of eye drops you should follow?

A
  1. watery aqueous drops
  2. suspensions
  3. gel
  4. ointment
68
Q

What is an example of an aqeous eye drop?

A

chloramphenicol 0/5%

69
Q

What is an example of a suspension eye drop?

A

pred forte

70
Q

What is an example of a gel eye drop?

A

clinitas

71
Q

What is an example of an ointment eye drop?

A

optimmune

72
Q

What are lubricants used for?

A
  • supporting healing ocular surface disease
  • nutrition of cornea through the tears
  • reduce evaporation
  • prevent ulceration perioperatively
  • replace missing tears in dry eye
  • comfort

ACVN - MEDICAL NURSING (22 decks)

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