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Ophthalmology I shit Flashcards

eye shit

1
Q

Identify the lens zonules in a eye ?

A
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2
Q

Identify the tapetum, choroid, retina and sclera in the eyeball ?

A

Globe

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3
Q

Within the globe - what does the fibrous tunic, neural tunic and the vascular tunic comprise ?

A

Globe = eyeball

Fibrous tunic
- sclera and cornea
- collagen dense connective tissue

Vascular tunic
- iris, ciliary body and choroid
- this comprises the vascular unit

Neural tunic
- ciliary , epithelium and retina
- the retina is continuous with the optic nerve

Transparent media
- cornea, aqueous lens and vitreous

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4
Q

Describe the orbit of the eye and ocular cone ?

A

The eye
Orbit
The bony socket of the skull in which the eye and its adnexa live
+ contents of bony socket
+ extraconal orbital tissue

Orbital cone
- extraocular muscles+ blood vessels + nerves

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5
Q

Eye embryology; Describe the structures which the ectoderm gives rise to ?

A

Eye embryology ectoderm gives rise to

Neuroectoderm
- optic bud
- optic vessicle

Ocular epithelial tissues = lens

Ectoderm also develops into the lens placode

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6
Q

Describe the development of the neuroectoderm ?

A

Neuroectoderm (neural tube)
Develops into the optic nerve and the retina
- optic bud, optic vessicle

Differentiation
Optic vessicle forms the optic cup
- collapses
- from the ectoderm becomes the retina

Lens vessicle
- from ectoderm becomes the lens

Corneal epithelium
- modification of ectoderm derived skin
- lens placode

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7
Q

What structures develop from mesoderm in the eye ?

A

Mesoderm

The mesoderm develops into the ocular subepithelial connective tissue
- vitreal
- vasscular tissue
- primary vitreous

The anterior chamber forms via regression of the mesoderm
- pupillary membrane from mesoderm
- tunica vasculosa lentis derived from mesoderm
- secondary vitreous derived from mesoderm

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8
Q

Describe the Iridocorneal angle ?

A

Iridocorneal angle
- located between the cornea and iris
- structure responsible for the outflow of aqueous humour from the anterior chamber

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9
Q

What is abnormal about this eye ?
What leads to this abnormality ?

A
  1. Dermoid; patch of skin on the surface of the globe
  2. Failure of ectoderm modification from skin to corneal epithelium.
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10
Q
  1. What is abnormal about the eye ?
  2. What leads to this type of abnormality ?
A
  1. Persistant papillary membrane
    - abnormal iris type tissue in anterior chamber across the pupil.
    - membranes may run up the back of cornea causing fibrosis and opacification.
  2. Failure of complete regression of the anterior chamber mesoderm.
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11
Q

What is the adnexa ?

A

Adnexa

Accessory components of the eye
Lids - skin, muscle, senaceous glands, modified hairs and conjunctival linning
Conjunctiva - lines the lids, sclera and forms nictitans
Lacrimal appartus - tear glands and tear ducts.

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12
Q

Identify this disorder and its cause ?

A

Developmental condition = Simple entropion

The basic problem is the lid is too long
- rolled in lid margins (irritation as hair may contact cornea)
- may observe excessive lacrimation
- usually occurs on the lower lid

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13
Q

What is this condition and its cause ?

A

Ectropion developmental condition

Basically the lid is too long
- dose not cause as much irritation as entropion
- turned out lid margin, usually lower lid

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14
Q

Identify this condition and its causes ?

A

Trichiasis - developmental condition
Normal lid hairs growing in an abnormal direction and contacting the globe.

  • tends to affect upper lids
  • this occurs especially with age / southward migration of lid
  • medial canthus
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15
Q

Identify this condition and its cause ?

A

Macropalpebral fissure
(developmental condition)

  • excessive lid length
  • lower entropion / ectropion
  • upper trichiasis
  • a combination of conditions all occuring at the same time
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16
Q

Identify this condition and its cause ?

A

Brachycephalic lid disease
(developmental condition)

Poor medial canthus conformation and medial entropion/trichiasis
- secondary changes with age
- a combination of trichiasis and entropion
- in brachy dogs (the bone length is reduced) same amount of skin causing rolling
+ secondary changes may occur due to chronic irritation eg. pigmentation.

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17
Q

Identify this condition and its cause ?

A

Distichiasis
(developmental condition)

Abnormal hair developing from the lid margins

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18
Q

Identify this condition and describe its causes ?

A

Ectopic cilia
(developmental condition)

Abnormal hairs erupting through the conjunctival lid surface
- classic in young dogs (severe pain)
- must be treated and removed

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19
Q

Identify this condition and describe its causes ?

A

Pyoderma
(inflammatory condition of eyelids)

  • painful swelling of eye
  • overactivity of the immune system, bacterial infection
  • impetigo
  • papules, pastules red and raised - with a white pus centre
  • chronic exposure to moisture
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20
Q

Identify this condition and describe its causes ?

A

Allergy
(inflammation of eyelids)

  • redness, discharge and swelling
  • may be seasonal
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21
Q

Identify this condition and describe its causes ?

A

Meibomian adenitis
(immune mediated inflammation - eyelids)

  • lumpy swelling along lid margins
  • causes glands to become blocked via thick waxy secretions
  • sebacious gland of eyelids release oils onto the cornea
  • treat with a warm compress which may assist in removing discharge
  • blockage leads to reduced tear film stability and decreased lipid secretion
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22
Q

identify this condition and its cause ?

A

Meibomian adenoma
(neoplastic condition)

Meibomian gland (sebaceous gland of the eye) = produces oils for the surface of the cornea.

  • nodules protruding from the eyelid margin
  • common tumour of older dogs
  • treatment is via surgical removal
  • benign
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23
Q

Identify this condition and its causes ?

A

Neoplasm of the lid

Potentially
- sarcoma
- carcinoma
- mast cell tumours
- requires an incisional biopsy

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24
Q

Describe the surgical principles of eyelid surgery ?

A

Eyelid surgery
Correction for ectropion, entropion and tumours

  • 5.0 or 6.0 soft non absorbabable, polyglycolic acid suture
  • cresents to roll out lid margin
  • full thickness wedge 2-4 sides shorten lid or remove tumour
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25
Describe the three potential causes of conjunctivitis ?
Conjunctivitis Conjunctiva lines the inner surface of the eyelid and covers the first part of the eye. Conjunctivitis is inflammation of the conjunctiva. can be caused by - immune mediated / dry eye - allergy - infection / cat
26
Identify this condition and describe its cause ?
Conjunctivitis Dry eye Immune mediatedattacks the tear glands - increased mucin production - can be congenital in pups - gunky discharging eye - red inflammed - common in dogs with most cases being immune mediated Use a Schirmer tear test to identify - no tear production
27
Identify this condition and its cause ?
Conjunctivitis - allergy - second most common cause of conjunctivitis in dogs - often tied to atopic dermatitis Schirmer tear test - normal
28
Identify this condition and its cause ?
Conjunctivitis - infection - not common in dogs - number one rule out in cats, very common in multi cat house holds
29
Describe the Nictitans and the possible reasons for a third eyelid flap ?
The nictitans "third eyelid" Essentially a fold of conjunctiva with cartiliginous support in a T shape and tear gland. - can be used to cover the cornea - third eyelid flap "sutured" - deep ulcers for extra protection
30
What could result in elevation of the third eyelid ?
Elevation of the third eyelid Occurs with retraction of the globe into the orbit (pulled into the socket) - some dog breeds may retract for discomfort - cats Horners syndrome
31
Identify this condition and its causes ?
Cherry eye This is a prolapse (lacrimal gland of the third eyelid) - requires surgery for correction - if severe cases cartilage deformity may combine with gland prolapse
32
Describe the three layers of the tear film ?
The three layers of the tear film Lipid layer - reduce evaporation - produced by meibomian glands Aqueous layer - middle lacrimal gland Mucin layer - assist in sticking the tear film to the cornea (produced by goblet cells in the conjuntiva - dry eye = increased mucin production
33
Describe the tear glands of the eye and how they are drained ?
Tear glands Lacrimal glands, nictitans glands and other small glands The drainage of tear glands - lacrimal puntate (two openings which join) - lacrimal canaliculi - naso lacrimal duct (nasal punctum)
34
Identify this abnormality and its cause ?
Excessive tear overflow - punctal atresia - tear duct abnormally small / sealed - usually a lid conformational problem - acquired nasal lacrimal duct blockage - can be corrected surgically but is a cosmetic procedure.
35
Identify this abnormality and its cause ?
Dacryocystitits This is infection of the lacrimal sac. - pus discharge - yet globe appears healthy
36
What is the name of this condition and what secondary disease may result ? What simple diagnostic aids will help in assessment of this eye ?
Q1. Entropion - which could lead to corneal ulceration Q2 Topical anaesthesia Fluorescein stain
37
What is the treatment for this condition ?
Q1. Entropion corrective surgery with lid roll out and shortening.
38
Identify the five layers of the cornea ?
The five layers of the cornea 1. Tear film 2. Corneal epithelium 3. Corneal stroma 4. Descements membrane 5. Endothelium (mesoderm)
39
Identify this condition of the cornea and its potential causes ?
Corneal Oedema Corneal overhydration - this leads to increased collagen fibre spacing which interfers with light transmission - appears stippled blue/grey - opacity / cloudiness - in health the collagen spacing is very specific and results in minimal scattering of light - when spacing increases through increased water content there is a increased scattering of light. Cause - epithelial damage - endothelial compromise - vascular infiltrate
40
Identify this condition and its cause ?
Neovascularisation of the cornea This is an inflammatory response to infection / healing or is immune mediated - grow 1/2 mm per day
41
Identify this condition and its cause ?
Lipid infiltration of the cornea - stromal deep layer - may get crystals of cholesterol in the cornea, causing opacification - circular or swirly type pattern - axial central cornea
42
Identify this condition and its cause ?
Corneal calcification - tends to be irritating and uncomfatable - superficial to epithelium - dogs 14yrs and older
43
Identify this condition and its cause ?
Pigmentation of the cornea - usually indicates chronic aging change - irritation to the cornea - often seen in pugs
44
Identify this condition and its cause ?
Neoplasia corneal - conjuntiva tissue - infiltrating and growing into the cornea
45
Identify this condition ?
Corneal ulceration (epithelial erosion) - shallow but dye uptake - can still be painful due to nerve endings in the stroma - no crater effect / no indentation
46
Identify this condition ?
Corneal ulcer - stromal erosion - crater effect - melting ulcer - rapid deepening may be observed to release enzymes/ bacteria/ white cells generating keratosis - collagen analytic - very rapid
47
Identify this condition ?
Corneal ulcer - Descemetocoele basement membrane epithelium - observe cloudy edge - crystal clear centre (little tissue no stain take up) - stains around the edge stroma - oedematous + vascularisation
48
Identify this condition ?
Perforated corneal ulcer - eye will collapse - wrinkled up cornea and the aqueous rushes out
49
Identify this condition ?
Iris prolapse - the eyes puncture repair kit - iris heads up and plugs the gap - eyes attempt to reinflate and heal itself
50
What are the aetiologies of ulcerative keratitis ?
Aetiologies of ulcerative keratitis - simple trauma - secondary (dry eye, lid disease, foreign body etc) - indolent non healing SCCED - Infected (bacterial, fungal) - Immune mediated (as pictured below).
51
Describe the pathology which underlies SCCED ?
Ulcerative kertitis SCCED SCCED = Spontaneous, chronic, corneal, epithelial, defect - indolent non healing ulcer - breed and age related - boxer, staffy > 8yrs of age - epithelial defect - six months of treatment and still not heal is a strong sign
52
Describe your management strategies for ulcerative keratitis ?
Management strategies for ulcerative keratitis First point os to identify the cause Simple trauma - prevent infection (antibiotics and allow time to heal). Secondary - treat the primary disease and prevent infection - antibiotics NON healing ulcers (SCCED) - promote healing and prevent infection (topical antibiotics) - requires surgery Infected - treat infection and promote healing first Immune mediated - can utilise corticosteroids usually contraindicated.
53
Describe the varous types of non ulcerative keratitis ?
Non ulcerative keratitis Keratitis is inflammation of the cornea These are various types of non ulcerative keratitis Pannus Pigmentary keratitis Lipid infiltrate Calcification
54
Describe the consequence of corneal endothelial degeneration ?
Oedema infiltrate of fluid into the cornea
55
Identify this condition and describe its pathology ?
Pannus Non ulcerative kertitis/ inflammation of the cornea - chronic superficial keratitis - immune mediated condition almost exclusive to German Sheppards and occassionally grey hounds - there is a genetic component + immune mediated component and UV component
56
Identify this condition and describe its aetiology ?
Episcleritis / Scleritis Pink lumps on the eye - inflammatory - nodular granulomatous - poorly defined connective tissue between the collagen of the Sclera and conjunctival epithelium
57
Identify this condition ?
Neoplasia Haemangiosarcoma / haemangioma tumour within the cornea - common Nrth QLD - tumours on the surface of the globe - vasculature - sometimes on the surface of the nictitans
58
Identify this condition ?
Neoplasia on the cornea Limbal melanoma - pigmented cells of the limbus - junction of the sclera and cornea - surface of the eye - benign - easy treatment via freezing
59
Identify this condition ?
Neoplasia of the cornea Squamous cell carcinoma - arise from corneal epithelium - very common in horses - excision / freezing
60
Describe the surgical principles for the cornea ?
Cornea non healing ulcer - requires debridement - cotton bud debridement - diamond spur debridement - grid keratotomy - superficial keratotomy Support - nicitans flap - potential temporary tarsorrhaphy (suturing the lids together) Graft (specialist) - magnification and microinstrumentation
61
What corneal condition is likely present in this painful eye ? Describe simple diagnostic aides ? Describe treatment for this condition ?
Answer 1. Corneal ulcer 2. Topical anaesthesia and Fluorescein stain 3. Topical antibiotics and consider surgery - debridement - support - graft
62
Identify this condition and describe its features ?
Anterior uveitis Classification is based on the part of uvea involved - iris and ciliary body - miosis (pupil constriction) - bulbar hyperaemia (vasodilation in the eye) - 'Flare' Tyndall effect, increased protein and cells pick up of the particles through the anterior chamber. - keratic precipitates - hypopyon - iris neovascularisation - posterior synechiae (adhesions of the iris to the lens).
63
Describe the anatomy of the Uvea ?
Uvea = the vascular tunic of the eye comprising of Iris - controls light entry Ciliary body - nutrition + lens shape Choroid - nutrition for retina, absorbs light
64
What are the five classifications of uveitis ?
65
Identify and describe this condition ?
Congenital heterochromia iridis (Non inflammatory condition of the uvea) - incidental normal - eg one blue and one brown eye
66
Identify and describe this condition ?
Iris cyst (degeneration of the uvea). - spherical brown structure - may need to alter view 3D effect to identify - between lens and cornea, sitting in anterior chamber
67
Identify and describe this condition ?
Iris atrophy degeneration of the uvea - moth eaten appearance to iris, thread bear, thinning out - small older bred dogs
68
Identify this condition and describe its features ?
Posterior Uveitis (choroid and retina) Distinguishing features - perivascular exudate - subretinal exudate - exudative retinal detachment
69
Identify this condition and describe its features ?
Pan uveitis (both anterior and posterior segment)
70
Identify this condition and describe its features ?
Endophalmitis (pan uveitis and intraocular fluids) - spread to intraocular fuids (sclera and cornea)
71
Identify this condition and describe its features ?
Panophthalmitis (endothalmitis + the fibrous tunic) - fibrous tunic = sclera and cornea
72
What conditions could lead to secondary uveitis ?
Sequelae of Uveitis - glaucoma - pthisis bulbi (eye shrivels and ciliary body can not produce sufficient aqueous humour). - cataract - retinal damage
73
Describe the aetiologies of uveitis ?
74
Describe the general therapy principles for uveiitis ?
Therapy for uveitis 1. Treat any associated disease, neoplasia, ulcer, infectious agents 2. topical anitinflammatories with anterior uveitis 3. posterior antiinflammatories with posterior uveitis 4. mydriatic atropine to affect Avoid the use of corticosteroids with any systemic disease.
75
Identify and describe this condition ?
Uveal melanocytoma Primary tumour - uveal - benign - iris - heavily pigmented bulging mass formed on the surface of the iris
76
Identify this pathology ?
Ciliary body adenoma, adenocarcinoma Primary tumour - non pigmented coming off the ciliary body' - benign but may end up as a nucleation
77
Identify and describe this condition ?
Lymphoma Secondary tumour - tends to be bilateral - subtle thickening of tissue in both eyes with enlarged lymph nodes - ocular involvement is not a good prognostic for the animals recovery
78
Identify this pathology ?
Metastatic tumour Secondary tumour
79
Describe what is the posterior segment ?
80
What is the fundus ?
Fundus The part of the posterior segment which is visable with an opthalmoscope.
81
Identify this pathology ?
Optic nerve hypoplasia (congenital conditions) - reduced in size and lost its myelin - in health the optic nerve has a triangular shape due to the myelin
82
Identify this pathology ?
Collie eye anomaly congenital condition Abnormal choroid or retina tissue lateral to the optic nerve.
83
Identify this pathology ?
Retinal dysplasia (congenital condition) - strange folds in the retina may appear like worms
84
Identify this pathology ?
Exudative retinal detachment
85
Identify this pathology ?
Optic neuritis Inflammatory condition - Inflamed optic nerve - sort of fuzzy - swollen appearance
86
Identify this pathology ?
Asteroid hyalosis (degenerative condition) - speaks observed in vitreous - age related change / older dogs
87
Identify this pathology ?
Vitreal degeneration and rhegmatogenous retinal detachment. (degenerative disorder) - common in older dogs - certain breeds labs - moonscape effect
88
What is SARDS ?
SARDS Sudden acquired retinal degeneration syndrome - often the retina appears completely normal - will observe degeneral changes later on - middle age to older dogs - zero electrical response from retina - change observed within 7 days
89
What do you call this change in the anterior chamber of the eye ? What dose this change suggest ?
1. Hyopyon 2. Anterior uveitis
90
If you have a bilateral change as pictured what else should you be assessing in this patient ?
91
Define a cataract and its sequalae ?
Cataract An opacity or loss of transparency of the lens as a result of tissue breakdown and protein clumping degenerative. Sequaelae - congenital - hereditary 'primary' - secondary to uveitis, trauma, diabetes
92
Identify the five stages of the cataract ?
The five stages of the cataract incipient immature mature hypermature reasorbing
93
# [](http://) Identify and describe this pathology ?
Incipient cataract - small bubbles of degenerative change in the lens - < 10% of lens lost opacity - the majority of the tapedal reflex still present
94
Identify and describe this pathology ?
Immature cataract - many clumps of opaque material - retro illumination appear as black shadows - 50% of lens black shadows
95
Identify and describe this pathology ?
Mature cataract - the entire lens has lost its opacity - complete black out of tapedal reflex
96
Identify and describe this pathology ?
Resorbing cataract - rare - all the contents of the capsule dissolve with degeneration - left with crystals within the lens capsule - may regain vision and tapedal reflex
97
Identify this pathology ?
Primary Lens luxation aphasic cresent premature breakdown of collagen making up the lens zonule there is genetic testing available
98

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