Ophthalmology

Question 1

What is the correct confirmation for the eye?

Answer 1

No sclera visible
No protrusion of globe
Correctly positioned on the head

Question 2

What equipment will you need to preform and eye exam?

Answer 2

Optalmoscope 
Tonometer 
Schirmer tear test 
Pen torch 
20D condensing lens 
Consumables-flurescein, tropicamide(dilated pupils)

Question 3

What is a direct optalmoscope for and what light settings can you apply?

Answer 3

Look at ocular structures in detail
Have multiple filters and light settings for observing different structures
White light retro illumination
Red light differentiates blood vessels and pigments
Blue colbalt filter for flurescein staining

Question 4

What specific opthalmologists equipment can you use?

Answer 4

Slit lamp biomicroscope
Advanced tonometers
Lens gonioscopy

Question 5

What should you ask for in the history of an opthomology patient?

Answer 5

How long has it been going on 
Has it gotten worse 
Is is worse st night or in Bright light 
Any concurrent diesease 
Any trauma is it in both eyes 
Breed, species 
Coat colour 
Vaccination status 
Any other animals in the house

Question 6

What order should you carry out an opthalmological examinations?

Answer 6

History 
Distance exam 
Tear test conjunctival culture 
Acne a and anterior segment 
Intraoccular pressure measurements and pupil dilation 
Posterior segment exam 
Any additional techniques reauired

Question 7

What is involved when completing a distance exam for opthomology?

Answer 7

Face from above and direct any protrusion, squinting, symmetry ocular discharge
Eyelids-palpebral fissure, size colour swelling
Eyeballs- position, size, direction movements
Observation pupil static and dynamic
Use of direct optalmoscope retro illumination

Question 8

List the clinical signs that will present within an opthomology case

Answer 8

Discharge-euphiod muccoid mucopurulent haemorrhagic
Eyelids- palpebral fissure, colour swelling hair? Position of the eyelid margin
Gobble- abnormal position of visual axis (strabismus) abnormL position within the orbit Abnormal size
Retro illumination- abnormal reflection opacities

Question 9

What is involved when completing a neuro-opthalmicexamination?

Answer 9

Menace response (blink response) 
Tracking response 
Visual placing 
Look for strabismus Anisocoria Nystagmus 
Eyelid ptosis(drooping)

Question 10

How do you complete a schirmer eye test?

Answer 10

Place paper in the lower fornixeyelid ensuring it is inside the lid allow to stay there for one minute normal tear production is 15-25 MM

Question 11

How do you take a corneoconjunctival culture?

Answer 11

Cytobrush sterile cotton bud before diagnostic drops culture and sensitivity

Question 12

How do you test the tear quality?

Answer 12

Tear break up time use of flurorescein maintain lids open for and measure time takes for dark spots to appear after last blink normal duration is 20 seconds

Question 13

How do you preform and Adenexa and anterior segment exam?

Answer 13

Use direct opthalmoscope
Close examination examines conjunctiva cornea and anterior segment
Retro illumination shows opacities

Question 14

What is the jones test in ophthalmology?

Answer 14

Demonstrates the permeability of the mask-lacrimal duct system
Flurorescein applied in both eyes green then present at the nostrils 1 -5 minutes later

Question 15

What equipment can be used to test intraocculare pressure?

Answer 15

Tonometer schiotz tonometer
Apply general anaesthetic
Or an measurement 10-20 mmHg

Question 16

How can you dilate the pupil?

Answer 16

Administer one drop of tropicamide into each eye wait 20-30 minutes. If the eye is not dilated enough add another drop.

Question 17

How do you exam the posterior segment of the eye after dilation?

Answer 17

Monocular indirect ophthalmoscope

Direct ophthalmoscope using the lens

Question 18

List the three types of topical drugs and their properties

Answer 18

Ointment: can’t be used if corneal ulcer, increased duration, lubrication, hydration of the cornea,
Solution and suspension: quickly eliminated not convienient in large animals lea 5 min between applications
Always apply drops in the order of viscosity

Question 19

List lubricants used for the eyes

Answer 19

Clinadry mild dryness
Clinitas soothe: moderate dryness
Hycare gel moderate to severe dryness

Question 20

Which product is a lubricant that combines sodium hyaluronate?

Answer 20

Optixcare

Question 21

List the topical antibiotics used for eyes and their order of intentions?

Answer 21

First intention
Chloramphenicol 
Second intention 
Gentamycin 
Third intention 
Ofloxacin not good for cornea

Question 22

List the topical corticosteroids used for the eye

Answer 22

Prednisalone (predforte)

Maxitrol (dexmethasone)

Question 23

List the NSAIDs that can be used to treat eye infections

Answer 23

Ketorolac (acular)

Bromfenac (yellox)

Question 24

List the immunosuppressive drug used to treat KCS

Answer 24

Optimmune ciclospoin

Question 25

What would you use to treat a melting corneal ulcer?

Answer 25

Serum EDTA very frequent administration every hour

Question 26

How would you treat glaucoma?

Answer 26

Reduce the production and increase the drainage of the aqueous humour in the eye Carbonic anhydrase inhibitors Prostaglandin analogues

Question 27

Name the mydriatic agents used in opthomology and their function

Answer 27

Dilation of the pupil atropine days duration | Tropicamide duration 4-8 hours

Question 28

Discuss the tips fro applying eye drops and the nursing care required after eye surgery

Answer 28

``` Appropriate handling • Support the jaw when examining from a distance • Do not put pressure around the neck otherwise increase IOP (! Possible globe rupture in case of deep ulcer) • Corneal ulcer, post-op ocular surgery: buster collar on AT ALL TIME Good positioning for eye drops administration • Don’t open the eyelids for too long! Spread the tears every 10-15 sec ```

Question 29

What causes the red eye?

Answer 29

Inflammation (hyperaemia): e.g. conjunctivitis (non urgent to urgent) , uveitis (urgent) • Haemorrhages: trauma (non urgent to urgent), coagulopathy (urgent) • Vasodilation: e.g. conjunctival: Horner syndrome (non urgent), retrobulbar abscess (can be urgent) • Neovascularisation: e.g. associated with corneal ulcer (urgent)

Question 30

Clinical signs associated with position | of the globe in the orbit

Answer 30

Exophthalmos Abnormal protrusion of the eye Globe proptosis Enophthalmos Recession of the globe into the orbit. Sunken eyeball i.e. Claude Bernard Horner syndrome Strabismus Deviation of the visual axis compared to normal gaze

Question 31

Clinical signs associated with the position of the eyelids?

Answer 31

``` Blepharospasm Macropalpebral fissure Treatment: • Lubrication • Topical antibiotic • Surgical correction Oversized eyelids Ectropion Exposed conjunctiva Dryness, impaired eyelid function Entropion • Primary or secondary (trauma, eyelid surgery..) ```

Question 32

Clinical signs associated with the condition of the eyelid?

Answer 32

Conjunctivitis: Inflammation (hyperaemia) | Conjunctival Oedema: Chemosis

Question 33

The blue eye clinical signs

Answer 33

``` Due to lesion of the superficial layer of the cornea: epithelium or the most inner layer: endothelium Leads to water uptake in the cornea URGENT ```

Question 34

The white eye

Answer 34

Scar to previous ulcer, corneal surgery (conjunctival graft)

Question 35

The cloudy eye

Answer 35

White color: lipid keratopathy “Archus liposis” Lipid depositis associated with hyperlipidemia (triglycerides) and some systemic conditions: i.e. hypothyroidism, pancreatitis, diabetes mellitus

Question 36

What is a corneal ulceration?

Answer 36

``` Defect of the epithelial layer with most of the time involvement of the stroma (deeper layer) ```

Question 37

What is a cherry eye? How is it corrected and what is the postop care?

Answer 37

``` Prolapsed third eyelid Surgical correction Post-operative treatment • Buster collar • First line antibiotic 3 -4 times daily • Lubrication 3 times daily • Systemic anti-inflammatory drug ```

Question 38

What is keratoconjunctiva sicca, what are the clinical signs and how is it treated?

Answer 38

Causes: Thought to be an immune-mediated condition. • Other causes: e.g. iatrogenic: GA (temporary) ocular pain mucoid strings on the cornea, mucoid discharge dryness and inflammation of the conjunctiva and cornea decreased vision and progressive corneal disease Lubrication • Immunomodulating agent: topical cyclosporine A (0.2% - Optimune®) or tacrolimus. Usually given twice a day. Broad-spectrum topical antibiotic to prevent secondary bacterial infection. Moderate to severe meibomianitis: systemic broad-spectrum antibiotic • Topical or systemic anti-inflammatory treatment might be indicated. Surgical technique: Parotid duct transposition. The parotid duct if individualised and transposed to exit in the lower fornix of the lower eyelid.

Question 39

What is the treatment for an infected ulcer or a deep ulcer?

Answer 39

``` Medical therapy: • Antibiotherapy: topical: first to third line topical antibiotic (C/S): up to hourly • Serum: up to hourly • Lubrication, systemic NSAIDs, +/- atropine, Systemic large spectrum antibiotic (i.e. Cephalosporin) Hourly drops!! • Reconstructive corneal surgery Antiproteolytic drugs: EDTA, serum (hourly until proteolytic mechanism stopped), NAcetylcystein • +/- surgical treatment • Advanced treatment for refractory cases (i.e. cross linking) ```