Ophthalmology Flashcards Preview

RUSVM Small Animal Medicine II 2017 > Ophthalmology > Flashcards

Flashcards in Ophthalmology Deck (368):
1

OS

Left Eye

2

OD

Right Eye

3

OU

Both Eyes

4

What does the cotton ball test assess?

Vision - needed to track the cotton ball

5

Phototopic Maze Test

Tests vision in bright and navigating

6

Scotopic Maze

Tests navigating the maze in dim light

7

What cranial nerves are assessed with the Palpebral reflex?

CN V (afferent)
CN VII (efferent)

8

What cranial nerves are assessed with the Menace response?

CN II (afferent)
CN VII (efferent)

9

What cranial nerves are assessed with the Pupillary light reflex?

CN II (afferent)
CN III (efferent)

10

What cranial nerves are assessed with the Dazzle Reflex?

CN II (afferent)
CN VII (efferent)

11

What cranial nerves are assessed with the Oculocephalic reflex?

Intact CN II
peripheral and central vestibular components
CN III
CN IV
Cn VI

12

What cranial nerves are assessed with the Corneal reflex?

CN V (afferent)
CN VI and VII (efferent)

13

What are the guidelines for a normal Schirmer Tear Test for a dog?

greater than 15mm wetting/minute

14

What are the three common uses of Fluorescein stain?

Diagnosis and characterization of corneal ulceration
Demonstration of nasolacrimal patency (Jones Test)
Demonstration of corneal performation (Seidel Test)

15

What does the Jones Test assess?

Demonstration of nasolacrimal patency

16

What does the Seidel Test assess?

Demonstration of corneal perforation

17

What does a positive Jones Test demonstrate?

nasolacrimal patency

18

What does Tonometry measure?

intraocular pressure in mmHg

19

What is a normal reading for Tonometry for cats and dogs?

10-20mmHg

20

What is the diagnosis for a Tonometry reading of greater than 25mmHg with vision loss?

Glaucoma

21

What is the diagnosis for low intraocular pressures?

Uveitis

22

Adnexa

everything that supports the eyeball

23

Specular Reflection

Mirror-like feature of the eye

24

What does a disturbance of the Specular reflection mean?

Irregularity of the ocular surface

25

Boney orbit

a part of the adnexa, the conical boney structure that contains the eyeball and periorbital cone

26

Periorbital cone

Supportive cone like structure that contains the eyeball, extraocular muscles, fat, vessels, nerves, and fascia that reside within the orbit

27

Orbital Ligament

ligamentous structure that forms the lateral boundary of the boney orbit in cats and dogs

28

Exopthalmus

Abnormal protrusion of the eye from the orbit. The position is abnormal. The globe size is normal

29

Buphthalmos

"cow eye" but refers to the abnormal enlargement of the eyeball

30

What causes Buphthalmos?

glaucoma

31

Enophthalmos

Abnormal recession of the eye within the orbit

32

Strabismus

deviation of one or both eyes, so that both eyes are not directed at the same object

33

Horner's Syndrome

sympathetic denervation to the eye and ocular adnexa.

34

What are the clinical signs of Horner's Syndrome?

Enophthalmos
Ptosis
Miosis
Protrusion of the third eyelid

35

Microphthalmos

a congenitally small and malformed globe

36

Phthisis bulbi

an acquired shrunken globe, most often from severe or chronic inflammation

37

Proptosis

Anterior displacement of the globe such that the eyelids are caught behind the equator of the globe

38

What can induce orbital or periorbital disease?

Dental disease especially from the carnassial tooth

39

What can cause displacement of the globe?

Inflammation of the Zygomatic salivary gland

40

What can cause temporary or permanent blindness in cats?

The use of Mouth Gags

41

What is different about orbital anatomy of the dog and cat?

Open orbit with an orbital ligament

42

What is different about orbital anatomy in ruminants and horses?

Closed orbit

43

What are the clinical signs associated with Exophthalmos?

Third eyelid protrusion
Facial swelling
Soft palate bulging
Pain opening mouth
Fever

44

What is the most common cause of exophthalmos?

Orbital volume imbalance

45

What is a non-painful cause of Exophthalmos?

Orbital neoplasia

46

What causes acute onset painful Exophthalmos in working dogs and stick chewers?

Orbital Cellulitis

47

What can causes Lateral deviation in orbital disease?

Tumor involving the third eyelid

48

Strabismus

deviation of one or both eyes, so that both eyes are not directed at the same object

49

What are the treatments for Orbital Neoplasia?

Globe sparing:
Radiation
Surgical exploration
Chemotherapy

Globe removal:
Enucleation
Exenteration

50

Exenteration

removal of the eye and all orbital contents

51

What are the treatment approaches for Orbital cellulitis?

NSAIDs
Antibiotics
Surgical exploration and/or drainage

52

What are the common clinical signs of Enophthalmos?

Facial muscular loss (unilateral or bilateral)
Third eyelid protrusion
Entropion

53

What are the three common mechanisms of Enophthalmos?

Orbital volume imbalances
Active globe retraction
Passive glove retraction

54

What are the common causes of Enophthalmos?

Dehydration
Emaciation or cachexia
Myopathies
Space occupying lesions anterior to the globe
Ocular pain
Horner's Syndrome

55

What are the congenital Strabismus?

Divergent strabismus in brachycephalic dogs
Convergent strabismus in Siamese Cats
Ventrolateral divergent strabismus in Hydrocephalus

56

What are the acquired causes of Strabismus?

Mechanical or nervous dysfunction of any rectus muscle
Imbalance of orbital volume

57

What are the two considerations in the prognosis of Proptosis?

Vision?
Globe retention?

58

Tarsus

The fibrocartilagenous layer of the eyelid that contains the meibomonian glands. This is the holding layer for surgical eyelid closure

59

Meibomian glands

These are glands within the tarsal layer of the eyelid that produce lipid, or sebum, to the tear film, This is the outermost, or most external layer of the three-layered tear film

60

Lateral canthus

the lateral, or temporal convergence of the upper and lower eyelids

61

Medial canthus

the medial, or nasal convergence of the upper and lower eyelids

62

Palpebral fissure

the area outlined by the upper and lower eyelid margins

63

Ptosis

drooping of the eyelids (most often evident by upper eyelid drooping) cause by sympathetic denervation to the eyelid.

64

Lagophthalmos

incomplete eyelid closure/coverage of the eyeball

65

Eyelid margin

identified by the"grey line" of Meibomian gland orifices. This is an important landmark to identify when closing the eyelid surgically

66

Entropian

rolling in the eyelid margin such that hairs are touching the ocular surface

67

Ectropion

the outward rolling of the eyelids. Animal will often develop exposure keratitis or conjunctivitis due to the poor ability of the eyelids to completely close over the ocular surface

68

Blepharospasm

Spasm of the orbicularis oculi muscle resulting in eyelid closure.
AKA squinting

69

Tarsorrhaphy

A surgical procedure in which the eyelids are sutured together. This can be temporary or permanent, and can be partial (closing only a portion of the eyelid) or complete (closing the entire eyelid)

70

Trichiasis

Hairs growing from normal skin reach the corneal and /or conjunctival surface. Technically speaking, entropion causes trichiasis, however, trichiasis is most often used to describe hairs from the nasal folds (nasal fold trichiasis) that are directed toward the eye in brachycephalic dog breeds.

71

Distichia

cilia (eyelashes) which emerge from Meibomian (tarsal) glands.

72

Ectopic cilia

cilic (eyelashes) protruding through the palpebral conjunctiva. These hairs typically cause severe, intermittent pain and often cause corneal ulceration. They most commonly arise from the 12 o'clock eyelid position

73

What muscle closes the eyelids like a zipper?

Orbicularis oculi

74

What Cranial nerve innervates the Orbicularis oculi?

CN VII

75

What is caused by dysfunction of the CN VII?

Lagophthalmos

76

What muscle is innervated by the CNIII to open the upper eyelid?

Levator palpebrae superioris

77

What nerve innervates the Levator palpebrae superioris?

CN III

78

What is caused by dysfunction of the CNIII?

ptosis

79

What muscle opens the upper eyelid due to the sympathetic nervous system?

Muller's muscle

80

What is caused by dysfunction of the Muller's muscle?

ptosis

81

What layer supports the Meibomian glands?

tarsus layer

82

Anatomic entropion

the eyelids are not appropriately conformed to the eye and its presence is unrelated to ocular pain

83

Blepharospasm associated entropian

ocular pain stimulates active glove retraction and an altered eyelid to eye relatioship

84

What are the hereditary causes of Anatomic entropion?

Abnormal canthus in brachycephalic dogs
Abnormal palpebral fissure in Hounds and giant breeds
Excessive facial folds in Shar Pei

85

What are the acquired causes of Anatomic entropion?

Enophthalmos
Blepharospasm that alters anatomy

86

What should you consider with Anatomic Entropion caused by Blepharospasm?

Chronic corneal ulceration
Dry eye
Conjunctivitis

87

How do you differentiate anatomic and blepharospasm entropion?

Take away the ocular pain that induces blepharospasm

88

What is a common cause of Entropion in foals?

Septic dehydration

89

What is a temporary treatment for Entropion?

Viscous lubrication
Eyelid tacking
Partial temporary tarsorrhapy

90

What is a permanent treatment for Entropion?

Modified Hotz-Celsus - rolls out the eyelid

91

What is a common cause of Ectropion?

Iatrogenic: aggressive entropion correction
Hereditary: Hounds and giant breeds

92

What are 4 common causes of Lagophthalmos?

Breed variation
Exophthalmos
Buphthalmos
CN V or CN VII dysfunction

93

What is caused by secondary eye exposure from Lagophthalmos?

Keratoconjunctivitis

94

How do you treat Lagophthalmos temporarily?

Lubrication or temporary tarsorrhaphy

95

How do you treat Lagophthalmos permanently?

permanent partial tarsorrhaphy or canthoplasty

96

What nerve innervates the eyelid for sensory?

CN V (maxillary or ophthalmic branches

97

What nerves innervate the 3 muscles of the eyelid?

CN III (Open)
CN VII (close)

98

What causes an abnormal palpebral reflex?

CN V
CN VII

99

What are the clinical signs of Horner's Syndrome?

Miosis
Enophthalmos
Protrusion of the third eyelid
Ptosis

100

What causes the clinical signs of Horner's Syndrome?

Disruption of innervation to the Muller's Muscle, Iris dilator, or Periorbital cone

101

What are the common causes of Horner's Syndrome?

Otitis
Nasopharyngeal polyps
Iatrogenic: venipuncture or feeding
Idiopathic

102

How do you diagnose Horner's Syndrome?

Dilute phenylephrine (0.1%). 1 drop to both eyes

103

What three conditions cause irritation to the cornea or conjunctiva?

Trichiasis
Distichiasis
Ectopic Cilia

104

What breeds are commonly affected by Trichiasis?

Brachycephalic

105

What is the treatment for Trichiasis?

Lubrication
Facial fold resection

106

In what breeds would you find Distichia?

Cockers
Poodles
Sheepdogs

107

What is the treatment for Distichia?

Cryotherapy and plucking of the hairs

108

What breed is Ectopic cilia common in?

Brachycephalic breeds

109

How do you treat Ectopic cilia?

Cryotherapy with hairs sharply excised

110

What type of tumor is Canine eyelid tumors?

benign

111

What type of tumor is feline eyelid tumors?

malignant

112

What is the most common eyelid tumor in dogs?

Meibomian gland adenoma

113

What are the surgical considerations for removing Canine eyelid tumors?

Irritation to the ocular surface?
Size
Location

114

How do you treat Canine eyelid tumors?

Debulk and cryotherapy
Complete excision

115

What are the 4 key concepts to closure of eyelid margin defects?

1. Limited debridement
2/ Closure must be perfect
3. Avoid full thickness suture bites
4. The tarsus is holding layer

116

What is important about the figure 8 suture pattern used to correct eyelid margin defects?

Knot and suture are directed away from the cornea

117

What is the purpose of the third eyelid cartilage?

Gives the third eyelid shape and structure
Performs a squeegee like function
Supports the gland of the third eyelid

118

What is caused by Prolapse of the third eyelid?

Chronic conjunctivitis
Keratoconjunctivitis sicca

119

What is the treatment for prolapse of the third eyelid?

Morgan pocket technique
Orbital tacking

120

Conjunctival fornix

The area where palpebral conjunctiva meets bulbar conjunctiva

121

Palpebral and Bulbar conjunctiva

Conjunctiva that lines the inner surface of the eyelid and the anterior aspect of the globe respectively

122

Epiphora

Abnormal overproduction of tears. This is common response to ocular irritation

123

Conjunctival lymphoid follicles

a response to non-specific antigenic stimulation. Presence of these follicles anywhere but the bulbar surface of the third eyelid is considered abnormal and consistent with a diagnosis of conjunctivitis

124

Goblet cells

These are present in conjunctival epithelium and have produce the innermost mucus layer of the three-layered tear film. Patients with conjunctivitis will often overproduce mucus, conventionally referred as mucus discharge

125

Mucoid discharge

a very common clinical sign with conjunctivitis

126

Mucopurulent discharge

most commonly found in cases of keratoconjunctivitis sicca (KCS), due to loss of the aqueous portion of the tear film which then causes mucus overproduction, bacterial overgrowth and subsequent white blood cell recruitment. This is a classic feature of KCS and will be very important to remember

127

Conjunctival hyperemia

describe congestion of the superficial vessels of the conjunctiva. Predominance of this finding suggests superficial disease. For instance, tear film disorders (KCS), primary conjunctivitis, eyelid disorders causing secondary conjunctivitis, a response to superficial cornea ulceration etc.

128

Episcleral injection

congestion of deep conjunctival vessels known as episcleral vessels. Predominance of this clinical signs suggests deeper disease processes. For instance uveitis, glaucoma, and deep/complicated corneal ulceration

129

Keratitis

Inflammation of the cornea. Clinical signs include corneal neovascularization (Most common), corneal pigmentation, corneal fibrosis, corneal ulceration and white blood cell infiltration

130

Symblepharon

Permanent adhesion between the conjunctiva and the cornea

131

Ghost vessels

non-perfused corneal blood vessels. These blood vessel tracks provide evidence of previous keratitis

132

Chemosis

edema of the conjunctiva

133

What are the clinical signs of Allergic Conjunctivitis?

Blepharospasm
Epiphora
Mucoid discharge
Hyperemia
Lymphoid follicles

134

What is the treatment for Allergic Conjunctivitis?

Steroid: Neomycin-Polymixin - Dexamethasone
NSAID: Diclofenac
T-cell inhibitor: Cyclosporine

135

What is the function of tear film?

Nourish
Cleanse
Protect

136

What secretes the Oil/Lipid layer of the tear film?

Meibomian gland

137

What secretes the Aqueous layer of tear film?

Lacrimal and gland of the third eyelid

138

What secretes the Mucinous layer of the tear film?

Conjunctival goblet cells

139

What is the most common cause of Keratoconjunctivitis sicca?

Immune-mediated destruction

140

What are the causes of Keratoconjunctivitis sicca?

Immune mediated destruction
Excision of the gland of the third eyelid
Drugs
Trauma
Neurogenic
Infectious

141

Xeromycteria

Dry nose

142

With what test do you diagnose Quantitative KCS?

Schirmer tear test

143

What is the most common cause of conjunctivitis in dogs?

Bacterial

144

What are the two categories of KCS?

Qualitative
Quantitative

145

What virus causes KCS?

Canine Distemper Virus

146

Qualitative KCS

Lipid or mucin deficiency

147

What are the clinical signs of Keratoconjunctivitis sicca?

Keratitis:
Superficial corneal neovascularization
Corneal fibrosis
Superficial corneal pigmentation
Corneal ulceration
White blood cell infiltration
Hyperemia

Conjunctivitis:
Mucopurulent discharge

148

What is the treatment for Keratoconjunctivits sicca?

Topical cyclosporine

149

Cyclosporine

T-cell inhibitor
Immunomodulator
Suppresses further destruction of lacrimal tissue
Directly stimulates tear production
Anti-inflammatory effects: reduces vessels, clears fibrosis and clears pigment

150

What are the objectives of KCS treatment:

Replace the tears
Stimulate more tears
Anti-inflammatory therapy

151

What is the pathophysiology of Neurogenic KCS?

Loss of parasympathetic innervation to the lacrimal gland and ipsilateral nostril

152

What are the causes of Neurogenic KCS?

Trauma
Severe otitis interna
Neoplastic
Idiopathic

153

What is the surgical therapy for KCS?

Parotid duct transposition

154

What are the most common causes of Feline conjunctivitis?

Feline Herpesvirus keratoconjunctivitis
Chlamydial conjuncitivitis
Mycoplasma conjunctivitis
Calicivirus conjunctivitis

155

What is the most common cause of feline conjunctivitis and feline keratitis?

Feline herpesvirus keratoconjunctivitis

156

What are the 2 forms of Feline herpesvirus keratoconjunctivitis?

Primary
Recrudescence

157

Recrudescent disease

Latent FHV-1 virus becomes reactivated due to environmental stress

158

What are the Clinical signs of FHV-1?

Blepharospasm
Epiphora
mucoid discharge
Hyperemia
Conjunctival and corneal epithelial ulceration
Symblepharon

159

Symblepharon

permanent adhesion between the conjunctiva and the cornea

160

What is the pathognomic lesion for FHV-1?

Dendritic corneal ulceration

161

If you observe a cat with conjunctivitis and evidence of present or historic keratitis what is the diagnosis?

FHV-1

162

What is the treatment for FHV-1?

Topical cidofovir
Oral Famciclovir
Supportive Care: Erythromycin

163

What is the second most common cause of conjunctivitis in FHV-1?

Chlamydial conjunctivitis

164

What are the clinical signs of Chlamydial conjunctivitis?

Blepharospasm
epiphora
mucoid or mucopurulent discharge
hyperemia
Chemosis

165

Chemosis

conjunctival edema

166

How do you diagnose Chlamydial conjunctivitis?

Cytology: Intracytoplasmic inclusion bodies

167

Facet

Loss of corneal stroma with intact overlying epithelium. This occurs because epithelialization progresses more rapidly than stromal healing

168

Cornea edema

The only "blue" opacity. Corneal edema often appears heterogenous or fluffy. There are only two common sources of corneal edema: Epithelial disruption or Endothelial disruption

169

Superficial corneal neovascularization

This vessel pattern occurs in response to superficial disease processes. These vessels are tree-like in their appearance, can often be seen crossing the limbus, and can coalesce to form raised granulation tissue

170

Deep corneal neovascularization

This vessel pattern occurs in response to deep disease processes. These vessels are usually straight, cannot be seen crossing the limbus and do not extend as far across the cornea as superficial vessels

171

Ciliary flush (Ciliary neovascularization)

360 degree deep corneal neovascularization that is pathognomonic for uveitis. Ciliary refers to the ciliary body, implying that these vessels arrive in the cornea from an intraocular or deep origin

172

White blood cell corneal infiltration

this falls within our "white" category of corneal opacity and is a sign of active inflammation (keratitis). White blood cell infiltration is often painful and signals infection. Presence typically signifies an ocular emergency. These infiltrates can have a yellow or green appearance and are most commonly observed in equine stromal abscesses and cases of corneal melting "keratomalacia".

173

Corneal fibrosis

AKA corneal scarring. This results from stromal collagen contracture and appears as a dull, wispy white. You might see ghost vessels present from past active keratitis. This is non-painful

174

Corneal dystrophy or degeneration

Dystrophy most often involves corneal lipid and appears glittery/shiny. Degeneration most often involves calcium and appears gritty or chalky

175

Feline corneal sequestrum

This condition results from chronic corneal irritation and/or ulceration

176

What is the most common cause of corneal ulceration in cats?

Feline herpesvirus

177

Keratic precipitates

These are cellular adhesions to the endothelium and are pathognomic for uveitis. They have a classic appearance that can be easily recognized. You will see tiny dots from the mid-portion of the cornea that becomes larger and denser in the ventral cornea

178

Limbus

junction between cornea and sclera

179

Blue corneal opacity

edema

180

What are the two possible causes of edema?

Epithelial barrier disruption
Endothelial barrier/pump disruption

181

What does the degree of edema depend on?

Geographic size of the ulcer
Depth of the ulcer
If reflex uveitis is present or not

182

What is caused by Endothelial barrier/pump generalized reduction in function?

Glaucoma
Uveitis

183

What is a Red Corneal opacity?

Corneal neovascularization

184

What are two important sources of corneal neovascularization?

Superficial neovascualrization
Deep neovascularization

185

What do you see with superficial neovascularization?

Granulation tissue
Ghost vessels

186

What causes superficial neovascularization?

Superficial stimuli such as KCS, eyelid conformation, hair abnormalities, or superficial corneal ulcers

187

How much growth of superficial neovascularization occurs per day?

1mm

188

How long does it take for the insult to start growing superficial neovascularization?

3 days

189

Ghost vessels

Non-perfused empty vessels

190

What occurs with deep stimuli from uveitis or deep corneal inflammation/ulceration ?

Deep neovascularization

191

White with yellow or green hue opacity

White blood cell infiltration

192

White with gray or wispy features

Fibrosis

193

Crystalline or chalky white

Mineral or lipid
Dystrophy
Degeneration

194

What does white blood cell infiltrate signal?

Corneal infection

195

Crystalline White opacity

Lipid degeneration

196

Chalky white opacity

Calcific degeneration

197

What is a common cause of corneal opacity in dogs?

Corneal dystrophy with lipid

198

Brown or Black corneal opacities

Pigment
Feline Corneal sequestrum

199

What can cause Chronic superficial corneal ulceration in feline?

Feline Herpes Virus

200

Tan or Greasy Punctate

Keratic Precipitates

201

What causes Keratic precipitates?

Cellular and fibrinous adhesions to the endothelial surface

202

What is the source of Keratic Precipitates?

Uveitis

203

Superficial corneal ulceration

loss of the corneal epithelium without any loss of corneal stroma

204

Simple or Uncomplicated Corneal Ulcer

A superficial corneal ulcer that heals according to the expected time frame of less than 7 days

205

Complex or complicated corneal ulcers

any ulcer that does not heal within the expected time frame

206

Indolent ulceration or spontaneous chronic corneal epithelial Defect or Boxer ulcer

a canine specific form of complex corneal ulceration in which the epithelium fails to adhere to the stroma

207

Reflex uveitis

The trigeminal nerve and certain cytokines cause direct stimulation of the ciliary body, inducing spasm, pain, and disruption of the blood ocular barrier

208

Descemetocele

A corneal ulcer that has reached the depth of Descemet's membrane. This has a classic staining pattern that you should be familiar with

209

Keratomalacia

Softening of the cornea due to collagenolysis from infection and the ocular inflammatory response

210

Collagenolysis

Enzymatic destruction of the corneal stroma that signals infection, Bacteria, most often Pseudomonas trigger collagenolysis. The body's ocular inflammatory response from white blood cells also cause similar destruction

211

Iris prolapse

one of the only rule outs for a brown, raised, corneal opacity. This iris will rush forward to plug a corneal perforation in certain circumstances

212

Sequestrum

A devitalized portion of feline corneal stroma that pigments amber to black. The cause for the pigment is unknown, though this condition often forms following chronic or recurrent corneal ulceration

213

Pannus or Chronic Superficial Keratitis

An autoimmune condition that is inherited in German Shepards and Greyhounds. This condition forms progressive pigment and granulation tissue across corneal and conjunctival epithelium. It is painless, though binding if left untreated. Ultraviolet light is thought to exacerbate this problem

214

Pigmentary Keratitis

Most commonly seen in a pug. This is a condition that involves superficial corneal pigment migration from the limbus. Its presence suggests that superficial inflammation is present

215

What is the most common cause of a Deep Stromal Corneal Ulcer?

Infection

216

What are brachycephalic risk factors for corneal ulcers?

Ocular prominence
Decreased corneal sensitivity
Adnexal abnormalities
Tear film abnormalities

217

Why do you not use Steroids in ulcerative keratitis treatment?

Delayed healing
Enhanced corneal destruction

218

What are the superficial corneal ulceration categories?

Simple
Complicated

219

Simple Corneal Ulcer

A superficial corneal ulcer that heals in 7 days or less

220

Causes of Superficial corneal ulceration?

Irritants
Infection
Trauma

221

What is the treatment of simple/uncomplicated superficial corneal ulceration?

E-collar
Broad spectrum topical antibiotics 3-4x/day
Atropine

222

Complicated/Complex Superficial corneal ulcer

An ulcer that does not heal appropriately
1. Indolent ulcer
2. Persistent irritant
3. Infection

223

How do you treat Indolent ulceration?

Debridement

224

What are the three possible causes of Complex/complicated ulcer?

Feline herpesvirus
Bacterial
Fungal

225

What is the identifying feature of stromal ulceration?

Inappropriate level of reflex uveitis

226

Clinical signs of Stromal ulcer

Miosis
Aqueous flare
Diffuse corneal edema
Hypopyon or hyphema

227

How do you diagnose Deep stromal corneal ulceration?

Fluorescein
Topical anesthesia
Cytology
Aerobic culture

228

Treatment for deep stromal corneal ulceration

E-collar
Antibacterial therapy
Anti-collagenase therapy
Reflex uveitis and pain management

229

What are the three indications for parenteral antibiotics?

1. the ulcer has become vascularized
2. The corneal is close to perforation
3. Iatrogenic vascularization

230

How do you treat the Reflex uveitis and pain management?

Atropine
NSAIDs
Tramadol

231

Three guidelines for referral or surgical repair

1. The ulcer has 50% or greater stromal depth
2. The ulcer is failing aggressive medical therapy
3. Descemetocele or perforation

232

Uvea

The uvea has three components, the iris, cilliary body and choroid. The uvea is synonymous with the vascular tunic layer of the globe

233

Uveitis

Defined by a breakdown of the blood-ocular barrier

234

Anterior Uveitis

Inflammation of the iris and ciliary body.

235

Posterior uveitis

Inflammation fo the choroid or choroiditis. This is rarely observed independent of retinal inflammation and is thus the term "chorioretinitis"

236

Panuveitis

Inflammation of the all components of the uvea, the iris, ciliary body, and choroid

237

Endophthalmitis

Inflammation of all structures internal to the fibrous tunic of the eye

238

Panophthalmitis

Inflammation of all structures of the globe, including the fibrous tunic

239

Aqueous flare

a pathognomonic sign of anterior uveitis in which proteins and cells are suspended in the anterior chamber. This debris scatters light and can be visualized when a bright focused beam light is passed through it, like a headlights through fog. This optical phenomenon is known as the Tyndall effect. The presence of aqueous flare signals active inflammation

240

Keratic precipitates

Another pathognomonic sign of uveitis which consists of cellular debris that adheres to the corneal endothelium as a result of constantly cycling convection currents within the eye.

241

Ciliary flush

Pathognomonic for uveitis. This term refers to 360 degree deep corneal neovascularization. These vessels arise from the ciliary body and deep episcleral vessels

242

Fibrin

Pathognomonic for uveitis. Fibrin develops within the eye like it would anywhere else in the body. Fibrin is very good at adhering delicate structures to one another within the eye and is often responsible for synechia

243

Hypopyon

Pathognomonic for uveitis, hypopyon refers to white blood cells that have settled out dependently in the anterior chamber

244

Miosis

Constriction of the pupil. When you see inappropriate miosis, uveitis should be on your list

245

Dyscoria

An abnormally shaped iris. Most commonly observed with posterior synechia

246

Synechia

Adhesion of the iris to the lens or to the cornea

247

Iris bombe

360 degree posterior synechia. Aqueous humor becomes entrapped within the posterior chamber which causes the iris to bulge forward

248

Hyphema

Blood that settles within the anterior chamber. Common with uveitis and indicative of a large breakdown in the blood ocular barrier. Note that hypertension and coagulopathies can also cause hyphema

249

Hypotony

Decreased intraocular pressure. Hypotony is consistent with acute uveitis

250

Cycloplegia

paralysis of the ciliary body. Induced by atropine and useful at alleviating pain from uveitis

251

What are the three components of the uvea?

Iris
Ciliary body
Choroid

252

What is the purpose of the Blood ocular barrier?

Still allows for selective nutrition of avascular intraocular structures
Prevents free passage of cells or proteins into the anterior chamber
Allows clear media for vision

253

What are the two components of the Blood ocular barrier?

Blood aqueous barrier
Blood retinal barrier

254

What makes up the Blood aqueous barrier?

Iris blood vessels
Ciliary body

255

What makes up the Blood-retinal barrier?

Retinal blood vessels
Retinal pigmented epithelium

256

What is responsible for the inflammation in uveitis?

Prostaglandins

257

What cause ocular pain?

Spasm of the ciliary body

258

What are the clinical signs of ciliary body spasm?

Blepharospasm
Epiphora
Photophobia
Hiding
Aggressive behaviors

259

What are the differentials for Miosis?

Bright light
Horner's syndrome
Brain trauma
Drugs
Uveitis

260

Tyndall Effect

light scatter through a turbid environment

261

What causes Dyscoria?

Posterior Synechia

262

What tests should you perform with Hyphema present?

Blood pressure
Platelet count
Coagulation panel

263

What are long term sequelae for chronic uveitis?

Cataract
Secondary lens luxation
Secondary glaucoma
Retinal detachment
Phthisis bulbi

264

What is the most common cause of blindness from uveitis?

secondary glaucoma

265

Exogenous causes of canine uveitis

Blunt or perforating trauma
corneal ulceration

266

Endogenous causes of canine uveitis

Lens induced
Infectious
Neoplastic
Metabolic
Auto-immune

267

What is the most common primary canine neoplasma of the eye?

Melanocytoma

268

What are the clinical characteristics of Uveal cysts?

Spherical
Transilluminate
Benign
Can be free floating

269

What is the most common feline uveal tumor?

Feline diffuse Iris Melanoma

270

What characteristics of the tumor aid in diagnosis of Feline diffuse Iris Melanoma?

Rapid progression
Texture is velvety
Dyscoria due to invasion of iris musculature
Pigmented cells floating in the anterior chamber

271

What is the metabolic cause of endogenous uveitis in cats?

Hypertension from renal disease or hyperthyroid

272

Treatment for Uveitis

Topical steroids
Topical NSAIDs
Systemic steroids
Systemic NSAIDs
Topical atropine
Systemic antimicrobials

273

Nuclear sclerosis

The hardening of the lens that occurs naturally in animals
The hardening scatters light such that the lens appears cloudy

274

Cataract

Any opacity of the lens or lens capsule that interferes with vision and fundus is not visible through cataract

275

Parallax

Utilizing the appearance of one object relative to another to determine depth

276

Lens Zonules

Small collagen fibrils arising from the ciliary body that attach to the equator of the lens securing the lens position within the eye

277

Intumescent Cataract

Common cataract in diabetic patients in which the cataract progression is driven by osmotic effect as a result of entrapped sorbitol and fructose within the lens capsule

278

Phacoemulsification

This is the modern technique for cataract surgery in which the lens is broke up using ultrasound energy and aspiration

279

Aldose reductase

enzyme that converts glucose to sorbitol and fructose which become trapped within the lens capsule, causing an osmotic pulling effect/ The lens swells creating an intumescent cataract

280

Lens luxation

complete detachment of the lens from the lens zonules. The lens typically shifts anteriorly or posteriorly following luxation

281

Lens subluxation

partial detachment of the lens from the lens zonules. The lens typically shifts side to side with subluxation revealing an aphakic crescent

282

Aphakic crescent

Phakic refers to lens. Aphakic is therefore without a lens. A lens subluxation displays a crescent shaped area in which the lens is visibly displaced

283

Iridonesis

Movement of the iris that occurs secondary to lens instability

284

Phacodonesis

Movement of the lens that occurs secondary to lens instability

285

What is the appearance of Nuclear Sclerosis?

Bluish-gray pearly haze

286

What is the treatment for Nuclear Sclerosis?

No treatment required

287

What causes Cataracts?

Inherited
Chronic uveitis
Metabolic
Trauma
Nutritional
Toxic
Senile degeneration

288

What is the most frequent cause of cataracts in Cats and horses?

Chronic uveitis

289

What is the pathophysiology of Inflammatory Cataracts?

Mediators of inflammation diffusing into and altering lens structure or metabolism, changes in aqueous humor production and synechiae

290

What is the most common cause of Metabolic Cataracts in dogs?

Diabetes Mellitus

291

What is the pathophysiology of Diabetic cataracts?

Normal glucose metabolism is shunted to an alternate pathway due to high levels of Aldose Reductase

292

What causes Progressive retinal atrophy?

degenerating photo receptors releasing toxic substances into the vitreous

293

What is the most common clinical signs of Progressive retinal atrophy?

Night Blindness

294

What are the two types of Lens-Induced Uveitis?

Phacoclastic
Phacolytic

295

Phacoclastic Lens Induced Uveitis

Severe form associated with traumatic tears of the the lens capsule

296

Phacolytic Lens induced Uveitis

milder form of lens induced uveitis associated with leakage of lens proteins from a cataract that results from exposure of immunologically isolated lens protein to the immune system

297

How do you treat Phacolytic Lens induced Uveitis?

Topical +/- systemic anti-inflammatory agents

298

What is the medical treatment for Cataracts?

Topical corticosteroids and NSAIDs

299

What is the surgical treatment for Cataracts?

Phacoemulsification

300

What is the reason for Lens Luxation?

loss of zonular ligament support

301

What is the primary etiology of Lens Luxation?

Inherited disorder common in canine terrier breeds
Abnormal degeneration of zonular ligaments

302

What is the secondary etiology of Lens Luxation?

Chronic uveitis
Trauma
Chronic glaucoma

303

What is the most common cause of Lens Luxation in cats?

Chronic Uveitis

304

What are some easily identifiable clinical signs of Lens Luxation?

Aphakic crescent
Iridodonesis
Phacodeonesis
Focal corneal edema
Cataract

305

How do you treat Anterior Lens Luxation?

Medically stabilize by decreasing IOP: Mannitol
Carbonic Anhydrase
Surgical: Intracapsular lens extraction

306

What do you not use to treat Anterior Lens Luxation?

Miotics

307

How doyou prevent Anterior Lens luxation from a Subluxation?

Miotically trap the lens with Latanoprost
Anti-inflammatory therapy (NeoPolyDex)

308

Glaucoma

Vision loss that occurs due to elevated intraocular pressure and damage to the optic nerve and retina

309

Carbonic Anhydrase

An enzyme found in the ciliary body that aids in the production of aqueous humor. Therapeutic strategies to inhibit this enzyme "carbonic anhydrase inhibitors" are used commonly when treating glaucome

310

Optic Nerve cupping

The optic nerve is extremely sensitive to increased intraocular pressure. With glaucoma, the optic nerve will lose myelin and will be displaced posteriorly, displaying a cupped appearance

311

Buphthalmos

Enlargement of the globe.

312

What is the common cause of Buphthalmos?

Glaucoma

313

Haab's striae

Fractures of Descemet's membrane that occur secondary to buphthalmos and stretching of the globe. They can be seen as subtle white streaks coursing across the cornea

314

Goniodysgenesis

an abnormal iridocorneal angle conformation in which the angle is narrowed or closed. Sheets of abnormal tissue often coat the iridocorneal angle with goniodysgenesis

315

Gonioscopy

The use of a goniolens, applied to the surface of the eye which allows light to bend into the iridocorneal angle and facilitates examination

316

What are the two outflow options for Aqueous humor?

Iridocorneal angle
Uveoscleral

317

What enzyme is part of the active secretion of Aqueous humor?

Carbonic Anhydrase

318

What are the common clinical signs of Glaucoma?

Episcleral injection
Blepharospasm
Corneal edema
Mydriasis
Impaired vision

319

What are the chronic clinical signs of Glaucoma?

Optic disc cupping
Retinal degeneration
Blindness

320

How do you decide on Prognosis for vision due to glaucoma?

Duration of signs (greater than 24 hours)
Buphthalmos is present

321

If Bupthalmos is present what is the prognosis?

Blindness

322

What treatments should you consider if glaucoma is chronic and no vision is present?

Enucleation
Eviseration and prosthesis
Ciliary Body ablation

323

What is the normal Tonometric reading for the eye?

10-20 mmHg

324

If the pressure of the eye is greater than 25mmHg what is the diagnosis?

glaucoma

325

What are the three most common causes of Secondary glaucoma?

Uveitis
Neoplasia
Lens Luxation

326

What is an important feature of primary glaucoma?

Bilateral

327

What are the two outcomes to consider with treatment of glaucoma?

Vision
Comfort

328

What is the Emergency therapy for Glaucoma?

Latanoprost

329

What is Latanoprost used for?

Increases uveoscleral outflow

330

What is a contraindication for Latanoprost?

Anterior Lens Luxation

331

What is the second most effective therapy for glaucoma?

Dorzolamide

332

What does Dorzolamide do?

Decrease aqueous production

333

What is considered emergency therapy for glaucoma when Dorzolamide and Latanoprost have failed?

Intravenous Mannitol

334

What is the function of a Gonioimplant?

Increase aqueous outflow

335

What is the function of a Ciliary body ablation?

Decrease aqueous production

336

What is the function of Cyclodestruction?

Decrease the production of aqueous humor by destroying the ciliary body

337

What are the complications from Cyclodestruction?

Postoperative pressure spike
Cataract formation
inflammation

338

How long does it take for blindness to occur with glaucoma and no therapy?

6-12 months

339

How long does it take for blindness to occur with glaucoma and therapy?

3 years

340

What are the three options for end stage glaucoma treatment?

Enucleation
Evisceration and prothesis
Cilliary body ablation

341

What are the components of the fundus?

Sclera
Choroid
Tapetum
RPE
Neurosensory
Retina

342

RPE

Retinal Pigmented Epithelium

343

Atapetal

some species/individuals lack a tapetum

344

What causes Retinal Hemorrhage?

Anemia
Systemic hypertension
Hyperviscosity
Diabetes mellitus
Chorioretinits
Coagulopathy
Trauma
Retinal detachment

345

What does Pre-retinal hemorrhage resemble?

Keel boat

346

What does hemorrhage within nerve fiber layer resemble?

Flame-shaped

347

What does hemorrhage within the retina resemble?

Dot-blot

348

What does hemorrhage within the sub-retinal resemble?

Diffuse, irregular shape

349

What causes Retinal detachment?

Vitreous disease
Congenital malformations
Lens luxations
neoplasia
Intraocular inflammation: Chorioretinitis
Trauma
Vascular disease: Hypertension

350

What are the 2 types of retinal detachment?

Bullous
Rhegmatogenous

351

What is the sign of retinal detachment on the ultrasound?

"Seagull sign"

352

What is a common early sign of Feline hypertensive retinopathy?

Bullous Detachment

353

How do you treat Bullous detachment?

Treat underlying disease
Anti-hypertensive therapy

354

What is common with primary vitreous degeneration?

Rhegmatogenous Detachment

355

What is the treatment for Partial Retinal detachment?

Retinopexy

356

What is the treatment for Complete Retinal detachment?

Re-attachment surgery

357

What are the vascular changes seen with retinal detachment?

Attenuation (thinning)
Dilation
Hemorrhage
Exudation
Increased tortuosity: Hypertension and Hyperviscosity

358

What are the different Altered Tapetal Reflectivity?

Hyperreflective
Hyporeflective

359

What causes Hyperreflectivity of the Tapetum?

Retinal thinning

360

What causes Hyporeflectivity of the Tapetum?

Increased retinal thickness

361

What is Patchy depigmentation?

Non-specific response to inflammation/ injury/ degeneration

362

What are the clinical signs of Progressive Retinal Atrophy?

Narrowing and loss of retinal blood vessels
Tapetal hyper-reflectivity
Optic nerve atrophy
Non-tapetal pigmentary changes
Secondary cataract formation

363

What are the characteristics of Retinal degeneration?

Bilateral and Symmetrical
Sudden loss of vision
Acute photo receptor death
Dilated pupils

364

SARDS

Sudden Acquired retinal Degeneration Syndrome

365

How do you diagnose SARDS?

ERG

366

Feline central Retinal Degeneration

elliptical area of dorsalateral degeneration caused by Taurine deficiency

367

What can cause acute permanent loss of vision due to Retinal degeneration in cats?

Enrofloxacin

368

How do you treat Chorioretinitis?

Anti-microbial
Systemic NSAIDs or corticosteroids