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Small animal med > Ophtho > Flashcards

Ophtho Flashcards

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1
Q

4 components of 3rd eyelid

A
  • cartilage
  • lacrimal glands
  • lymphoid nodule
  • conjunctiva
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2
Q

Muscle closing eyelid

- CN innervation

A
  • obicularis m.

- CN 7

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3
Q

M. opening eyelid

- CN innervation

A
  • levator palpebral superioris

- CN 2

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4
Q

3 layers of tear film, their composition, made by what?

A
  • meibum: lipid from meibomia gland
  • aqueous: water from lacrimal gland
  • mucin: glycoprptein from conjunctival
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5
Q

3 layers of cornea

A
  • epi
  • stroma
  • endothelium –> incl descemet
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6
Q

Corneal epi

  • histo epi type
  • water affinity
  • function
A
  • non-keratinized strat epi
  • lpophilic
  • mech barrier
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7
Q

Corneal stromal

  • histo
  • water affinity
  • innervated by
A
  • collagen fiber
  • hydrophilic
  • CN5
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8
Q

3 parts parts of uvea

- function

A
  • iris: controls pupil opening
  • ciliary: aqueous humour prod
  • choroid: supplies nutrients to retina
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9
Q

3 chambers

A
  • anterior
  • prosterior
  • vitreal
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10
Q

Eye dev sequence roughly

A

Optic vesicle grows out –> optic cup –> hyaloid vascular system –> lens placode invagination –> optic fissure closes –> formation of vitreal and anterior chambers

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11
Q

What is persistent pupillary membrane formed from

A
  • reminent of part of iris and hyaloid vascular system that was suppose to degrate in embryogenesis
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12
Q

How does cataracts form from embryogenesis

A
  • as lens placode invaginates, forms nucleus of lense –> if issue, get cataracts
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13
Q

Microphthalmia

  • what
  • cause
  • tx
A
  • small ocular globe
  • congenital
  • if severe enucleate
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14
Q

Congenital strabismus cause

A

Muscle or innervation issue

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15
Q

Congenital exophthalmos

  • breed
  • cause
  • sequalae
  • tx
A
  • brachys
  • shallow orbit
  • can’t blink well
  • canthoplasty (ie lengthening of the palpebral fissure of the eyelids by cutting through the external canthus.)
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16
Q

Extraocular (eosinophilic) myositis

  • sign
  • dx
  • tx
A
  • bilat exophthalmos, painful mastication if eosinophilic, m. atrophy
  • m. biopsy
  • corticosteroid
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17
Q

Neoplasia in orbit

  • sign
  • malignancy
  • dx
  • tx
A
  • progressive exophthalmia, no pain opening mouth
  • often malignant
  • CT, MRI
  • sx, +/- radiation
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18
Q

Enophthalmia

  • what
  • 4 main types of cause
A
  • eye abn sunken into orbit

1) loss of orbital tissue: dehydration, cachexia, m loss, etc.
2) trauma: fracture
3) Horners
4) ocular pain: e.g. corneal ulcer, uveitis

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19
Q

3 eye removing sx and what happens in them

A

1) enucleation: remove eye globe
2) exenteration: remove globe and orbital content
3) evisceration: remove globe contents but leave sclera

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20
Q

2 approaches to enucleation

A

1) tran-conjunctival: lateral canthotomy –> dissect away conjunctiva –> cut from m. and optic n. –> take globe out –> remove 3rd eyelid –> close
2) trans-palpebral: suture eyelids closed –> dissect away globe –> cut m. and nerve –> close

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21
Q

Evisceration step

A
  • incise conjunctiva and sclera –> remove intraocular content –> replace with silicone prosthesis –> close
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22
Q

When do you do orbitotomy

A
  • to explore orbit

- referral proceedure

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23
Q

Define:

  • distichiasis
  • ectopic cilia
  • triachiasis
A
  • hair growing from meibomian gland touching cornea
  • hair growing from meibomian gland exits at palpebral conjunctiva and rubs against cornea
  • hair growing form normal position touching cornea
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24
Q

Entropion

  • what
  • sequelae
  • tx
A
  • eyelids roll in
  • hair rubs against cornea
  • tacking suture if temp, surgery
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25
Ectropion - what - sequelae - tx
- eyelids rolling outwards - conjunctivitis - sx
26
Blepharitis - what - causes
- inflammation of eyelids | - chalazion, hordoleum, cellulitis, allergy, parasites, immune-med
27
What is cherry eye? What does it look like? tx?
- prolapsed glands of 3rd eyelid - pink ovoid mass in corner of eye - sx
28
Everted cartilage of 3rd eye lid - cause - tx
- genetic | - remove bent stem
29
Follicular conjuntivitis of 3rd eyelid - signs - tx
- lympoid hyperplasia, conjuncitivitis, mucupurulent d/c | - debride follicles, abx and steroid drops
30
Keratoconjunctivitis sicca - what - pathophys - cause - dx - tx
- dessication of cornea - lack of nutrients and moistured from lack of good tear film --> vessels gorw in --> melanocytes - immune-mediated, genetic, neurogenic, infectious, drug (e.g. opiod, TMS), gen anaesth - Schirmer tear test - tear stimulant (cyclosporin, tacrolimus, pilocarpine), tear supp, parotid duct transposition
31
Normal value for Schirmer tear test
15-25mm/min
32
Epiphora - what - cause
- excessive tearing | - irritation, improper drainage from NL-duct system
33
2 ways NL system fails to cause epiphora - cause - dx - tx
1) imperforated puncta - congenital - sx 2) obstruction of duct - infection, chronic swelling of medial lower canthus - CT skull - sx
34
Definition of chemosis
Pouching out of conjuncita from edema
35
Conjunctivitis - signs - causes - dx - tx
- dilated blood vessels in conj., chemosis, ocular d/c - KCS, corneal ulcer, infection, intraocular dz - culture, biopsy --> often not done though? - broad spec abx
36
Conjunctival haemorrhage - what - cause - tx
- blood btw conj and sclera - trauma, coagulopathy, high BP - tx underlying cause, support, resolves by self
37
Conjunctival dermoid - what - cause - tx
- skin cells on conjunctiva, may grow hair - congenital - excision
38
Scleritis - what - cause - breed - tx
- inflammation of sclera - immune-med, uveritis - corticosteroid, cyclosporine --> aim to aim
39
Most common mass on sclera - dx - tx
- nodular granulomatous episcleritis - biopsy - tetracycline/niacinamide
40
Corneal ulcer (aka ulcerative keratitis) - what happens - cause - signs
- no epi, stromal loss - trauma, infection, KCS - painful
41
3 types of corneal ulcers and what makes them that type
1) Simple - superficial, only epi - no infection, vascularization, or pigmentation 2) Complex - depth beyond epi, infected, corneal edema, vascularization if chronic, +/- melting 3) Recurrent - chronic, superficial (only epi), not infected, loose epi edges - stromal hylaine membrane forms --> epi can't anchor to heal
42
How does corneal epi heal? What about cornea? What if hit endothelium
- Epi detach from anchor --> migrate and thing out over lesion --> proliferate - keratocyte proliferate --> become fibroblasts --> form collage bundles; can scar is collagen not organized - endothelial cells spread and enlarge - -> corneal edema if defect too large
43
Tx for the 3 diff types of ulcers
- in gen: recheck in 24-48h to ensure protocol working - Topical steroids and NSAIDS contra-indicated!!!** 1) Simple: fix initial cuase, abx (-cidal) QID, +/- atropine for pain, E-collar, - recheck 3-5d 2) Complex: - debride, flush, topical abx, serum if melting, atropine, systemic NSAID, - recheck 24h - sx: keratectomy, conj graft, enucleation 3) Recurrent: - corneal debridement, grid kertotomy - abx, atropine, +/- analgesia, +/- systemic NSAD, +/- contact lens - recheck 7d
44
Pigmentary keratitis - what - cause - dx - tx
- melanocytes in epi - chronic irritation, KCS, pug predisposed - Shimir tear test, fluorescein stain - remove insult, lub, steroids, cyclosporine
45
Chronic superficial keratitis - breed - sign - cause - dx - tx
``` - GSD, Grey hounds- neovascularization, pigmentation - immune-mediated - cytology (see plasma cells) - steroid, cyclosporine, no cure ```
46
Ddx corneal dystrophy vs degeneration
- dystrophy: inherited, bilat, pri dz, issue in central cornea, no vasc or blindness - degeneration: acquire, unilat, secondary dx, can occur anywhere on cornea, yes vasc, +.- ulcer
47
Endothelial dystrophy - pathophys - tx
- abn endothelial cells --> corneal edema --> form bubbles = epi bullae formation --> chornic ulcer - hypertonic saline, thermkeratoplasty, conj graft, corneal transplant
48
What could a corneal mass be | - tx
- congenital - hair - pigment - hemangioma - keratectomy --> corneal ulcer --> heal
49
What makes aqueous humor? Where does it drain?
- ciliary body | - iridocorneal angle
50
Glaucoma - what - pathophys
- incr intraocular pressure | - imparied drainage --> incr pressure --> ischemia and hypoxia --> cell death incl of n.
51
Causes of glaucoma | - which breed predisposed to each type
- congenital --> any - primary: irido-corneal angle close/narrow, goniodysgenesis (angle abn) --> Cocker, Boston, Basset - secondary to other dx (e.g. lens lux, uveitis, formation of membranes over angle, neoplasia)
52
What are 2 diseases of irido-corneal membrane
- pre-iridofibrovascular membrane --> from retinal detachement --> incr VEGF --> membrane formation - corneal endothelial overgrowth - membranes are granulation that migrated to angle?
53
Clinical signs of acute glaucome and chronic glaucoma
- acute: red eye, conjunctivits, corneal edema, dilated fixed pupil - chronic: buphthalmia, exposure keratitis, corneal striae, fixed dilated pupil, retinal atrophy, blind eye
54
What is corneal striae
- white lines from desment's membrane breaking
55
Dx for glaucoma
- PLR to check for blindness - flourescein stain - IOP
56
Medical tx for glaucoma - drug options - primary - w/ uveitis
- osmotic diuretics, carbonic anhydrase inhibitor, prostaglandin analouge, B-antagonist - post. ana + CAI + B-blocker - + mannitol if corneal edema - CAI + B-blocker + corticosteroids
57
Lens luxation - breed - 2 positions - tx
- terrier 1) anterior lens lux: sx extraction, enucleation if blind 2) prosterior: topical prostalglandin, topical corticosteroid
58
What is aqueocentesis
- pulling aq humor out via needle | - contraversial tx for glaucoma
59
What can be given in concern of reperfusion injury in glaucoma tx
Calcium channel blocker
60
What are some contra-indications to glaucoma tx drugs
- osmotic diuretic: diabetes, cardio, renal - B-blocker: cardio, asthma - prostaglandin: uveitis (as is an inflammatory molecule), lens lux if anterior,
61
Sx tx for glaucoma
- enucleation - evisceration - chemical ablation w/ gentamicin - laser photocoagulation of ciliary body - anterior chamber shunt
62
Prognosis for glaucoma
- congenital can only extend eye life | - good secondary if cause early
63
Uveal cyst - 2 location - what - breed
- posterior iris, ciliary body - fluid trapped btw 2 layers of iris - golden
64
Persistent pupillary membrane - what - can go btw iris and?
- iris tissue that whould have disintegrated in embryo dev | - iris, cornea, lens
65
Iris coloboma - what - cause - tx
- hole in iris - congenital - no tx
66
Iris atrophy - what - breed
- dev or degenerative (old age) hole in iris | - small breed
67
Uveitis - what - pathophys - signs
- inflammation of uvea - inflamm compromises retinal-blood barrier --> more inflamm - pain, red eye, miosis, corneal edema, aq flare
68
Aqueous flare - what is it - what can fill it - causes - dx - tx - sequelae
- lit beam scattered from stuff in in aq humor - WBC (hyphema), RBC (hypopion), keratitic precipitate - infection, immune-mediated, breed predisposition, neoplasia, idiopathic - low IOP, BW, xray, US - anti-inflammatory (cort., NSAID), atropine - cataracts, synechiae, glaucoma, lens lux, retinal detachment
69
Phacolytic vs phaclastic
- phacolytic: lens protein leak out of lens into ant chamber | - phacoclastic: lens rupture
70
3 Common neoplasia of uvea - malignancy - where on uvea - tx
1) melanocytoma - benign - iris and ciliary body - laser, enucleation 2) Adenoma - resect, laser, enucleate 3) lymphosarcoma - malignant (2nd) - chemo
71
What lens shape and zonule positions for near vs distant vision
- near: sphere, relaxed z | - far: ovoid, tense
72
Where does lens get it's nutrients
Aqueous humor
73
What is microphakia? Cause?
Small lens | Congenital
74
5 Stages of cataracts and descriptions
1) incipient/punctate - small focal areas where fibres misaligned - +ve tapetal reflect. 2) Immature/incomplete - cataract more generalied - protein leaking --> will induce inflamm - +ve tapetal 3) mature/ complete/ generalized - generalized cataract - leak protein - no tapetal reflect. 4) hypermature - generalized - lost vol from protein leak - may see white dots on lens - no tapetal reflect. 5) morgagnian - resportion of lens - +/-tapetal reflect
75
What is cataracts
Opacity of lens
76
4 components of lens
- capsule - cortex - nucleus - equator - incipient cataract can be any of these places
77
Causes of cataracts
- congenital - genetic: lab, golden - nutrition: low arginine - diabetes - trauma - uveitis
78
Med tx of cataracts
- managelens-induced uveitis: cort or NSAID
79
Things to do pre-op cataract sx? Sx procedures Post off care?
- stabilize patient and eye - ERG: check vision working - US eye: ensure no other issues - Phacoemulsification, (ie break up lens and suck up), IOL - monitor IOP - wean off drugs
80
Nuclear sclerosis - what - cause
- nucleus of len gets condensed | - normal aging
81
Lens lux causes
- primary: congenital, genetic (terriers) | - secondary: uveitis, trauma, chronic glaucoma
82
3 positions of lens lux and sequlae
- sublux - prosterior --> cataracts from lack of nutrients - anterior --> glaucoma --> thus emergency!
83
Lens lux tx options
- sx extract - trans-corneal reduction if anterior - prostalglandin for miosis - enucleation - fix underlying issue too (e.g. uveitis, glaucoma, etc.)
84
Eyelid agenesis in cats - cause - tx
- congenital, genetic | - sx: rotational flap, cryotherapy
85
Ophthalmia neonatorum - what - tx
- inflammatory dz of eyelids in which neonate's eyelids bulge before even opening, often has mucopurulent dc - irrigate conjunctiva, topical abx, lube
86
Parasites causing blepharitis | - tx
- demodex - Ntoedres - ivermectin, lime sulfur
87
lipogranulomarous conjunctivitis - what - cause - dx - tx
- white mass on conjuctiva from impacted mebomian glands - actinic radiation, ointment - biopsy - excision
88
Feline herpes virus - signs - dx - tx - sequelae
- dendritic ulcers which can merge to geographic ulcers, occasionally stromal keratitis - cytology, IFA, PCR - topical abx, antiviral (famciclovir, syst, trifluridine topical), lysine, lube - symblepharon = adhesion and scarring btw conjunctiva and cornea/3rd eyelid
89
Tx for Chlamydophila cause of conjuncitivitis Tx for mycoplasma cause
- topical and systemic tetracycline | - topical tetracycline
90
Corneal sequestrum - pathophys - tx
- corneal ulcer --> dev black scab when healing --> may slough off - topical abx, sx
91
Eosinophilic keratitis (cats) - what - cause - dx - tx
- eosino infiltrate in cornea - herpes virus? - cytology: see eosinophil - control herpesvirus
92
Bullous keratopathy - pathophys - tx
- "focal ball" of corneal edema | - hypertonic saline, conjunctival graft, 3rd eyelid
93
Common causes of cataracts in cats
- congenital | - chronic uveitis
94
Nutritional retinal degeneration (cats) - cause - signs - tx
- taurine def - granular tapetum, hyper-reflective lesion on tapetum, loss of retinal vasculature - taurine supp
95
hypertensive retinopathy - what happens - tx
- retinal detachment from high systemic BP | - amlodipine
96
Baytril toxicity in cats - dose - signs - tx
- >5mg/kg/d - acute blindness, retinal atrophy - stop baytril
97
Common neoplasias in eye of cats
- SCC - Iris melanoma - traumatic intraocular mass
98
Normal variations of fundu
- pigment islands in tapetum - abscence of tapetum - parital or sub - albunotic fundus - hyper-reflective area around optic nerve head - blue tapetum in puppies
99
3 common congenital issues with retina in collies
- choroidal hypoplasia - optic n. coloboma - retinal detachment
100
Retinal dysplasia - pathophys - cause - tx
- malformation of retinal layers --> folds or rosettes - inherited, toxic, infection - none
101
Progressive retinal degeneration/atrophy - signs - dx
- progressive loss of vision, starting with night | - fundic exam (tapetal hyperfrlec, decr arteries), ERD, genetic test
102
Sudden acquired retinal degen syndrome - sign - dx - tx
- acute hx of blindness - PLR normal, fundus normal, ERG - none
103
Retinal detachment - what - cause - sign - dx - tx
- photoreceptor detachses from retinal pig epi - exudate (e.g. infect, BP), tear, traction bands from fibrous tissue - blindness, dilated pupil - BW, look for underlying dz - tx underlying cause, sx
104
2 things toxic to retina, how, and tx
- ivermectin: retinal edema, fluids | - Baytril (cat): retinal degen, stop baytril
105
Optic n. coloboma - what - cause - sequlae
- hole in optic n. - congenital - retinal detachment, blindness
106
Optic n. neuritis - cause - sign - dx - tx
- inflamm., (G)ME - blind (no PLR nor menance) - MRI. CSF - systemic anti-inflamm.
107
3 main components that need to be functional for vision
1) ocular globe (esp transparency of cornea, lens, chamber; retina) 2) optic n. 3) brain
108
What is used mostly in night vs day vision? What's the fancy word for night and day vision?
- night = scotopic --> cones | - day = photopic --> cones
109
what is hyperopia vs myopia
- hyper = far sighted | - myopia = near
110
Patient prep for ophtho sx
- clip - scrub - povidone-iodine solution - avoid -OH and H2O2 and chlorohex
111
Position for eyelid vs orbital sx
- eyelid: sternal | - orbital: lateral
112
Post-op things we want after eye sx
- slow wake-up | - analgesia (opioid, NSAID), E-collar, harness walk
113
Orbital abscess - common hx - signs - dx - tx
- dentistry recently - exophthalmia, prolapsed 3rd eyelid, retrophulsion of globe, painful opening mouth - PLR, flouro stain, oral exam, eye US - abx, NSAID, sx drain?
114
Proptosis - what - dx - tx - recheck - prognosis
- eye out of socket - check PLR and fluoro stain - tarsrrhaphy (suture eyelids closed), abx - 1-2d - good with +ve direct PLR, worse with everything else
115
orbital FB - dx - tx
- ocular US, CT | - incise around FB to take out as whole, topical and systemic abx, systemic NSAID
116
Lid laceration dx and tx
- check cornea okay with fluoro stain | - prep area (povidine-iodine), suture close, abx, systemic NSAID
117
Corneal FB
- incise around FB to take out as whole, topical abx, systemic NSAID
118
Corneal ulcer - ensure to check what in eye exam?
under 3rd eye lid
119
Corneal laceration - dx - tx
- Seidel's test | - small defect can suture, large likely enucleate
120
Chemical keratitis - sign - tx - check
- corneal ulcer, miosis, pain - flush!, tx ulcer/uveitis - 3d
121
Hyphema - what - dx - tx
- blood in anterior chamber - PLR, IOP, fluoro, ocular US - tx underlying cause, corticosteroid
122
Lens lux prognosis better with?
normal IOP
123
Glaucoma an emergency?
YES
124
Causes of acute blindness and their dx
- glaucoma: IOP - retinal detachment: IOP - sudden acquired retinal degen - retinal toxicity: ivermectin, baytril - optic neuritis - cortical blindness (ie from brain cortex): other neuro signs

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