Ophtho Flashcards
Exam 2 (150 cards)
1
Q
4 primary layers of the Adnexa
A
skin
orbicularis oculi m.
meibomian glands
palpebral conjunctiva
2
Q
Orbicularis oculi muscle (purpose/ uses)
A
closed eyelids
responsible for blepharospasm
invervated by CN VII
surgical holding layer
3
Q
Meibomian glands (purpose/ uses)
A
lipid layer tear film
distichiasis, ectopic cilia
duct is surgical landmark
4
Q
palpebral conjunctiva (purpose/ uses)
A
goblet cells produce mucous for tear film
source of tissue for surgery
5
Q
Superior palpebral levator muscle
A
open upper eyelid
innervated by CN III
6
Q
Müller’s muscle
A
smooth muscle
sympathetic innervation
maintains palpebral fissure opening
7
Q
Functions of the Adnexa
A
- general eye protection
- spread tear film and prevent evaporation
- produce portions of tear film
- contains portions of tear drainage system
8
Q
What is blepharospasm
A
involuntary tight closure of the eyelid
9
Q
General signs of disease of the Adnexa
A
redness
swelling
blepharospasm
10
Q
Entropion
A
- rolling in of eyelid margin
- can be congenital, spastic, or cicatricial (from scar tissue)
- dogs most common (also sheep and pot-bellied pigs)
11
Q
Entropion (clinical signs)
A
- larger dogs, lateral aspect lower lid
- belpharospasm
- epiphora (wetness along lower, lateral eyelid margin
- corneal vessels, melanosis, esp ventrolaterally
12
Q
Entropion (Causes)
A
- inherited
- spastic
- Cictricial
- Fat deposition (pigs)
13
Q
Entropion (Diagnosis)
A
- signalment
- clinical signs
14
Q
Entropion (treatment)
A
- Adolescents (lubrication, tacking)
Adults (surgical repair via Hotz-Celsus or “smile”)
15
Q
Chronic epiphora syndrome
A
- underlying problem medial entropion, lower lid
- > malposition lacrimal punctum
- > “crimping” canaliculus
- > Trichiasis
16
Q
Chronic epiphora syndrome (Signs)
A
- chronic tear staining from medial canthus
- secondary moist dermatitis (brachycephalics)
17
Q
Chronic epiphora syndrome (Cause)
A
- Entropion medial aspect lower lid
- breed related (chich, poodles)
18
Q
Chronic epiphora syndrome (treatment)
A
- benign neglect
- Hotz-Celsus or “smile” surgery
19
Q
Ectropion
A
- majority dogs, breed related ( cockers , bloodhounds, giant breeds)
- age-related
20
Q
Ectropion
A
- loss of contact lower eyelid with eye
- leads to secondary corneal problems
- > blepharospasm
- > epiphora
- > corneal vessels
- > corneal melanosis
- > corneal ulceration
21
Q
Ectropion (Causes)
A
- inherited
- age related
22
Q
Ectropion (treatment)
A
- often not necessary
- lubricating ointments
- antibiotics or steroid ointments
- wedge resection
23
Q
Meibomian Adenoma (Signs)
A
- papilloma-like projection from margin
- swelling affected gland
- upper lid more common
- variable size
- blepharospasm if ulcer
- met very rare
24
Q
Meibomian Adenoma (Cause, Diagnosis)
A
Cause: Age-related
Diagnosis: Signalment, Signs, Biopsy
25
Meibomian Adenoma (treatment)
- curettage and cryotherapy
| - wedge resection
26
Most common Adnexa Neoplasias (canine)
- meibomian adenoma
- papilloma
- melanoma
- 2ary lymphoma
27
Most common Adnexa Neoplasias (feline)
- squamous cell carcinoma
- fibrosarcoma
- mast cell tumor
- basal cell carcinoma
- 2ary lymphoma
28
Feline squamous cell carcinoma (Signs)
- ulcerative lesions
- lower lid
- white or light pigmentation
- met late
29
Feline squamous cell carcinoma (Cause)
- lack of eyelid pigmentation
| - UV exposure
30
Feline squamous cell carcinoma (treatment)
- radiotherapy =)
- surgical excision
- cryotherapy
31
Distichiasis
- meibomian glands modified hair follicles
- undifferentiated gland produces cilia
- cilia emerges form meibomian gland duct
32
Distichiasis (signs)
- difficult to see without magnification
- fine hairs emerging from eyelid margin
- usually does not cause disease
33
Distichiasis (cause)
- inherited
| - developmental
34
Distichiasis (treatment)
- manual epilation initially to confirm dx
| - cryotherapy
35
Ectopic cilia
- similar to distichiasis, cilium from meibomian glands
| - cilium protrudes through palpebral conjunctiva
36
Ectopic cilia (signs)
- 8-12 months of age
- marked blepharospasm, epiphora
- vertically linear superficial corneal ulcer
- raised papilla, 12 o'clock position on upper lid
37
Ectopic Cilia (cause)
- inherited
| - developmental
38
Ectopic Cilia (Treatment)
- excision
| - cryotherapy
39
Trichiasis
- hair from normal site in contact with ocular surface
| - most frequent in dogs (bracycephalics + long facial hair breeds)
40
Trichiasis (signs)
- periocular hair touching ocular surface
- medial canthus, nasal folds
- usually do not cause irritation
- often "wick" tears onto face
41
Trichiasis (Cause, Diagnosis)
Cause: breed related, conformational
Diagnosis: signalment, clinical signs
42
Trichiasis (treatment)
- usually not indicated
- cryotherapy
- lid surgery
43
Traumatic Injuries (treatment)
- minimal debridement
- 2 layer closure for lacerations (orbicularis oculi muscle is holding; skin needs careful alignment of margins)
- reconstruction of inferior NL system
- systemic, topical antibiotics
44
Bacterial blepharitis
- overgrowth surface bacterial flora
- ascends into eyelid via meibomian ducts
- Staph and Strep spp.
- Staph toxins exacerbate
45
Bacterial blepharitis (signs)
- severe eyelid swelling
- blepharospasm
- excoriation
- alopecia
- mucopurulent discharge
- granuloma formation
- bilateral and recurrent (Dogs)
46
Bacterial Blepharitis (Cause and Dx)
Cause: infection from ascending bacteria, fight wounds
Dx: clinical signs, biopsy, culture and sensitivity
47
Bacterial Blepharitis (treatment)
- topical antibiotic/ steroid (Neomycin and Polymyxin + dexamethasone)
- oral antibiotics (cephalexin)
- oral prednisone
- warm compress
- autogenous vaccines
48
Chalazion
- obstructed meibomian duct
- accumulation secretion
- rupture of gland
- granulomatous reaction
49
Chalazion (signs)
- nodular swelling within lid
- no inflammation
- no pain
- yellow/ white appearance through palpebral conjunctiva
50
Chalazion (Cause)
- obstruction of meibomian gland duct
| - age-related
51
Chalazion (treatment)
- curettage of gland
| - topical antibiotic/ steroid
52
Eyelid Agenesis (signs)
- absence lateral 1/2 to 2/3 upper eyelid
- trichiasis
- always bilateral, but not symmetric
- may have exposure keratitis
53
Eyelid Agenesis (Cause)
- heritable or developmental
54
Eyelid Agenesis (treatment)
- topical ointments
- cryotherapy
- blepharoplastic procedures
55
Neonatal ophthalmia
- ankyloblepharon normal for cats and dogs 10-14 days
- infection under eyelids before opening
- Staph, strep, herpesvirus
56
Neonatal ophthalmia (signs)
- inflamed, distended eyelids
- purlent discharge
- conjunctival hyperemia, chemosis
- +/- corneal ulceration
57
Neonatal Ophthalmia (treatment)
- open lids (digital manipulation, blunt probe)
- flush dilute betadine solution
- topical antibiotics
58
4 Primary layers of the cornea
- epithelium
- stroma
- Descemet's membrane
- endothelium
59
Corneal epithelium
- 5-10 cells thick
- constant turnover
- hydrophobic
- mechanical barrier
60
Corneal Stroma
- 90% thickness
- hydrophilic
- location of clinical signs
- sensory innervation from CN V
61
Corneal Descemet's membrane
- basement membrane endothelium
- elastic, last barrier to perforation
- hydrophobic
62
Corneal endothelium
- Na/K pump removes fluid
63
5 factors that affect corneal transparency
1. avascular
2. relatively dehydrated
3. orderly arrangement stromal fibrils
4. lack of pigment
5. non-keratinized epithelium
64
Corneal source of nutrition
- tear film for anterior
| - aqueous fluid for posterior
65
Corneal functions
- transmission of light
- refraction of light
- fibrous layer for protection
66
Corneal ulcers (normal healing)
- sliding (migration)
- formation of new basement membrane
- dividing (mitosis)
67
Uncomplicated corneal ulcer (signs)
- epithelium only, no stromal loss
- heals in ~7 days
- no change in stromal character
- no extensive vascularization
- miosis due to reflex uveitis
68
Uncomplicated corneal ulcer (management)
- topical steroid contraindicated
- topic broad spectrum abx
- topical atropine, q24hr
69
Complicated corneal ulcer (signs)
- increasing depth, non-specific
- stromal infiltrate, specific
- change in stromal character (melting)
- corneal vascularization, non-specific
- hasn't healed in 7-10 days, non-specific
- loose peripheral epithelium, specific
70
Complicated corneal ulcer (common causes)
- infection
- foreign bodies
- exposure
- entropion
- ectopic cilia
71
Signs of infected ulcer (complicated)
- all signs of complication possible
| - stromal infiltrate, melting specific
72
Diagnosis of infected ulcer
- cytology
| - culture and sensitivity
73
Treatment of infected ulcer
- referral
- vigorous abx (q2hr)
- topical serum
- E-collar
- warm compress
74
Signs of exposure ulcer (complicated)
- most frequent w/ brachycephalics
- centrally loacated
- round, firm edges
75
Treatment of exposure ulcer
- frequent abx ointment
- +/- topical atropine
- consider tarsorrhaphy
76
Signs of ersistent ulcer syndrome or SCCED
- middle-aged or older
- superficial
- redundant epithelium around periphery
77
Treatment of persistent ulcer syndrome
- corneal debridement
- grid keratotomy or diamond burr (dogs only)
- meidcal tx as uncomlicated
78
Chronic superficial keratitis
- immune-mediated
- breed related (GSD)
- environmental (UV light)
- referred to as 'pannus'
79
Chronic superficial keratitis (signs)
- Acute/ Active (fibrovascular invasion, ventrolateral thickening, 3rd eyelid thickening)
- Chronic (corneal melanosis, blindness)
80
Chronic superficial keratitis (cause)
- genetics/ UV lights --> stromal protein alteration --> loss of immunotolerance --> inflammatory response
81
Chronic superficial keratitis (treatment)
- topical steroids
- topical cyclosporine
- maybe seasonal, often lifelong)
82
Exposure Keratitis
- usually dogs
- incomplete blinking
- eyelids 'gap' open while sleeping
- senile change
- cats w/ eeylid agenesis
secondary to eyelid injury
83
Exposure Keratitis (signs)
- corneal vessels, melanosis medially
| - may lead to ulcers
84
Exposure Keratitis (Cause)
- conformation
- developmental
- Age related
- Eyelid inuury
85
Exposure Keratitis (treatment)
- if ulcer --> refer
- surgery for agenesis or lid problem
- abx/ steroid ointment QID until keratitis controlled, then reduce
- topical lube long term
86
Corneal Degeneration (Signs)
- crystalline to chalky deposits composed of lipids of Ca salts
- superficial w/in cornea
- older patients
87
Corneal Degeneration (Cause)
- aberrant healing response
| - 2ary to trauma, irritation, inflammation
88
Corneal Degeneration (Treatment)
- topical abx treatment
| - chemical keratectomy
89
Corneal Dystrophy (Signs)
- crystalline 'ground glass' deposits
- under corneal epithelium
- bilateral, not symmetric
- no pain, inflammation, vision change
- early age onset (1-2 years)
90
Corneal Dystrophy (cause)
- heritable
91
Corneal Dystrophy (treatment)
- not indicated
92
Feline Herpesvirus (Signs)
- blepharospasm, epiphora
- conjunctival hyperemia
- chemosis
- corneal vessels
- linear (dendritic) ulcers [pathopneumonic]
- focal, pinpoint cellular infiltrate
93
Feline Herpesvirus (Treatment)
- suppression of signs, not cure
- topical antivirals (cidofovir)
- oral antivirals (famciclovir)
- topical steroids contraindicated
94
Corneal Sequestrum (unique to what species)
- cats
95
Corneal Sequestrum (signs)
- dark brown plaque, represents necrotic stroma
- not melanin
- painful, can lead to rupture
96
Corneal Sequestrum (cause)
- herpesvirus
| - chronic exposure
97
Corneal Sequestrum (treatment)
- slough
| - keratectomy
98
Eosinophilic Keratitis (signs)
- cats and some horses
- fibrovascular infiltrate
- 'caseous' islands
99
Eosinophilic Keratitis (Cause)
- herpesvirus
100
Eosinophilic Keratitis (treatment)
- topical steroids
- topical antivirals
- megesterol acetate
101
Corneal Neoplasia - Canine
Primary - Limbal melanoma, hemangiosarcoma/carcinoma
| Secondary - Lymphoma
102
Corneal Neoplasia - Feline
Primary - Limbal melanoma/ melanocytoma
| [ Lymphoma and SCC very rare]
103
Limbal Melanoma (signs)
- dark mass, centered on limbus
- extends both ways
- unilateral
104
Corneal Dermoid (treatment)
- keratectomy
| - reconstruct lateral canthus
105
Corneal Dermoid (what is it)
- normal tissue in abnormal location
106
Parts of the tear film
- Lipid Layer (meibomian)
- Aqueous Layer (lacrimal and 3rd eyelid gland)
- Mucous Layer (goblet cells)
107
Lacrimal Drainage Apparatus
- lacrimal puncta
- canaliculi
- nasolacrimal duct
- nasal punctum
108
Functions of the lacrimal system
- provides nutrition to occular surface
- removes metabolites, waste, debris
- provide lubrication to occular surface
109
A patient has presents with mucoid ocular discharge, what is the first thing you will do before any other diagnostics?
- Shirmer Tear Test
110
Lacrimal System Diagnostics
- Shirmer Tear Test
- Fluorescine Dye Passage
- Nasolacrimal (NL) flush
111
Two causes of discharge
- overproduction
| - lack of drainage
112
Keratoconjunctivitis sicca (signs)
- mucoid discharge
- blepharospasm
- conjunctival hyperemia
- 360 corneal vessels
- corneal melansosis
113
Keratoconjunctivitis sicca (causes)
- immune-mediate (most common)
- drugs (TMS, atropine, anesthesia)
- ioatrogenic (removal of 3rd eyelid)
- trauma to lacrimal nerve
114
Keratoconjunctivitis sicca (Diagnosis)
- signs + STT
115
Keratonconjunctivitis sicca (treatment)
- topical cyclosporine
| - topical antibiotic/ steroid
116
Developmental Drainage Obstruction (signs)
- dogs have epiphora from birth
- fluorescine dye passage poor or negative
- NL flush nothing from inferior punctum
- horses have chronic purulent discharge
117
Developmental Drainage Obstruction (treatment)
- in dogs -- incise conjunctiva over imperforate punctum
- topical abx/ steroid combination
- in horses, cannulate
118
Foreign Body Obstruction (signs)
- blepharospasm
- mucupurulent discharge
- medial canthal swelling
- (-) fluorescin dye passage
119
Foreign Body Obstruction (Treatment)
- vigorous flushing +/- anesthesia
- dislodge/ retrieve fb
- cannulate NL system
- Abx/ steroids
120
Inflammatory Obstruction (Causes)
- descending infection w/ stagnant tear drainage
121
Inflammatory Obstruction (signs)
- mucopurulent discharge
- no medial canthal swelling
- (-) fluorescin dye passage
- NL flush easy, mucoid plug
122
Inflammatory Obstruction (Treatment)
- NL flush (+/- betadine)
| - abx/ steroid
123
Functions of the anterior uvea
- regulate light entry
- accomodation
- produce aqueous
124
Anterior Uveitis (active - signs)
- Aqueous flare
- miosis
- hypopyon or hyphema
- keratic precipitates
- iris bombé
- corneal edema
- episcleral injection
- corneal vessels
- dec IOP initially
125
Anterior Uveitis (inactive- signs)
- corneal scarring
- posterior synechia
- iridial scarring
- cataracts
- glaucoma, buphthalmos
126
Anterior Uveitis (pathogenesis)
- damage to anterior uvea --> release mediators inflammation --> increase vascular permeability -> breakdown BAB --> leakage of protein, fibrin, cells into aqueous
127
Anteriur Uveitis (treatment)
- topical steroid, NSAIDS, atropine
128
Anterior Uveal Neoplasia (top 3)
1* - melanoma, ciliary body adenoma/ carcinoma
| 2* - Lymphoma
129
Treatment of Anterior Uveal Neoplasia
- enucleation
130
Uveal cysts (signs)
- 3 locations (posterior surface or iris/cb, pupillary margin, free floating in AC)
- +/- transillumination
131
Uveal Cysts (cause)
- idiopathic
| - 2* to inflammation
132
Uveal cysts (treatment)
- not necessary
133
Iris Atrophy (signs)
- scalloping at pupil margin
- moth eaten appearance to iris stroma
- slow PLRs
- anisocoria
- dyscoria
134
Iris Atrophy (treatment)
- not indicated
135
Persistent pupillary membrane (signs)
- originate @ collarette region of iris (iris-iris, iris-ant lens, iris-post. cornea)
136
Persistent pupillary membrane (cause)
- heritable in certain breeds
| - developmental defect
137
Persistent pupillary membrane (treatment)
- usually not indicated
| - iris > lens cataract surgery
138
Glaucoma (progression)
- peracute onset pressure spike
- initially unilateral
- fellow eye affected 6-12 months
139
Glaucoma (primary mechanism)
- decreased outflow of aqueous humor
140
Glaucoma (signs - chronic)
- buphthalmos
- corneal striae, fibrosis
- lens (sub)luxation
- mydriasis
- 'cupped' optic disk
- tapetal hyper-reflectivity
- retinal vascular attenuation
141
Glaucoma (cause)
- iridocorneal angle increasingly compromised first few yers of life
- drainage angle collapsed
- IOP spikes
142
Causes of 2* Glaucoma
- Anterior Uveitis (#1 cause)
- lens luxation/ subluxation
- intraocular neoplasia
143
Glaucoma (treatment)
- Mannitol (acute decrease in IOP by pulling fluid out of vitreous humor)
- Methazolamide (oral carbonic anhydrase inhibitor -- not really used)
- Topical Meds [Xalatan (topical prostaglandin -> miosis), Dorzolamide (CA inhibitor will dec production), Timadol Maleate (B-blocker)]
144
3 structural elements of the lens
- lens capsule (barrier function)
- lens epithelium (multiple through life)
- lens fiber cells (transparent d/t orderly arrangement)
145
Reasons for lens transparency
- absence of blood vessels
- lack of pigmentation
- orderly arrangements of lens fiber cells
146
Cataracts (4 classifications)
1. incipient - focal, no intereference w/ vision
2. incomplete - diffuse, + tapetal reflection
3. complete - vision loss
4. resorbing - crystalline, wrinkled ALC, deep AC, some degree of lens-induced uveitis
147
Cataracts (causes)
- disruption in lens-cell fibers
- -> inherited
- -> diabetes mellitus
- -> anterior uveitis (most common in cats/horses)
- -> senility (usually do not progress to vision impairment)
- -> trauma
148
Cataracts (treatment)
- surgery
149
Lens Sub-Luxation (signs)
- shalow or uneqal ant. chambers
- anisocoria
- aphakic crescent
- vitreous strands through pupil
- iridodonesis
- glaucoma
150
Anterior Uveitis (causes)
- infectious
- immune-mediated
- neoplastic
- metabolic (systemic hypertension)
- traumatic (blunt or perforating)
- idiotpathic (#1 cause)
