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Flashcards in Opthalmology Deck (131)
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1
Q

where are the medial and lateral canthus of the eye located?

A

medial is the meeting point of the upper and lower eyelids on the medial aspect of the eye
the lateral canthus of the eye is on the lateral aspect

2
Q

what is the conjunctiva formed of?

A

connective tissue

3
Q

what is the iris of the eye formed of?

A

muscle

4
Q

where does the nasolacrimal duct open?

A

into nose and mouth

5
Q

what is the limbus of the eye?

A

area where cornea meets sclera

6
Q

what is the sclera?

A

tough protective outer covering of the eye

7
Q

what is the retina?

A

area at the back of the eye with photo-receptor cells

8
Q

what is the choroid of the eye?

A

vascular layer of the eye below the retina

9
Q

what shape should normal dog eyes be?

A

almond

10
Q

what is the palpebral fissure?

A

gap between eyelids

11
Q

where should sclera be seen in healthy eyes?

A

small amount medially and laterally

none D/V

12
Q

what equipment is required for an ophthalmic exam?

A
dark room
pen torch
direct ophthalmoscope
20D condensing lens
tonometer
consumables including Fluorescein, Schirmer tear test strips
13
Q

how should a patient be restrained for ophthalmic exam?

A

minimal is best
calm and confident
patient seated at the edge of the table or on floor against nurses legs if large
one hand over the back and round to the chest
one hand supporting under the chin to hold head horizontal

14
Q

how should fractious patients be managed for ophthalmic exam?

A

muzzled
towel
chemical restraint if necessary (will alter some ophthalmic parameters)

15
Q

how should blind/visually impaired patients be handled?

A

talk before you approach them
go slowly
guide them carefully while walking to prevent them walking into things

16
Q

how should patients with painful/fragile eyes or raised intraoccular pressure (IOP) be restrained?

A
no pressure on the neck
harness not lead
gentle handling
low stress
minimise barking
avoid temperature checks
sedation needed to place IV
smooth anaesthetic recovery
17
Q

where should the IV be placed in patients with painful/fragile eyes or riased IOP?

A

saphenous vein

18
Q

what are the steps involved in an ophthalmic exam?

A
history
distant examination and close examination
Schirmer tear test
(sample collection)
neuro-ophthalmic exam
close direct ophthalmoscopy
indirect ophthalmoscopy
19
Q

what should questioning about history in an ophthalmic patient be focused around?

A

overall health then narrow down to presenting complaint

20
Q

what questions should be involved in the history part of the ophthalmic exam?

A

signalment
general history
known illness or any other signs
previous occular conditions and any treatment
current occular complaint and any treatment
how good is animals vision (do they bump into things)

21
Q

what is involved in general history questioning during an ophthalmic exam?

A

vaccination
travel
other animals

22
Q

what is involved in the distance and close exam stage of the ophthalmic exam?

A
animals attitude
body condition
face
eyelids
eyeballs
observation of pupil
use of direct ophthalmoscope for retro-illumination
23
Q

what is assessed about the face during the distance and close exam stage of the ophthalmic exam?

A

symmetry

any occular discharge

24
Q

what is assessed about the eyelids during the distance and close exam stage of the ophthalmic exam?

A

palpebral fissure (size, does it close)
size of eyelids
colour
swelling

25
Q

what is assessed about the eyeballs during the distance and close exam stage of the ophthalmic exam?

A
position
size
direction
movements
retropulsion
26
Q

what is assessed about the pupil during the distance and close exam stage of the ophthalmic exam?

A

static - symmetry, size and shape

dynamic - PLR

27
Q

what is retro-illumination?

A

ophthalmoscope is shone at eye from a distance to look at tepetum and anything that may block the reflection from it

28
Q

why are the diagnostic tests performed early in the ophthalmic exam?

A

before the eye is irritated by the more invasive exams

29
Q

what is involved in the neuro-ophthalmic examination?

A

reflexes and tests of vision

30
Q

what are the reflexes tested during the neuro-ophthalmic exam?

A
PLR
dazzle reflex
menace response
tracking response
visual placing
maze test (bright and dim light)
31
Q

what are you looking for during PLR tests?

A

bilateral pupil contraction

32
Q

what is the dazzle reflex?

A

shining a bright light into the animals eye to look for eyes to close

33
Q

what is the tracking response?

A

animal should follow something that is dropped in front of them with their eyes (not food as may follow nose)

34
Q

what is the maze test?

A

obstacle placed in animals way and they have to navigate it to reach owner - if they knock into it it indicates their vision is affected

35
Q

what is close direct ophthalmoscopy used for?

A

magnification to look at detail of the ocular structures

36
Q

what is involved in indirect ophthalmoscopy?

A

ophthalmoscope used as light source with the condensing lens placed in front of the eye

37
Q

what is indirect ophthalmoscopy used for?

A

examination of retina

38
Q

what is needed for indirect ophthalmoscopy?

A

large pupil - may need midriatic agent e.g. atropine

39
Q

what are the common diagnostic tests used in ophthalmology?

A
Schirmer tear test
bacterial swab for cytology, culture and sensitivity
Fluorescein staining
intraoccular pressure measurement
gonioscopy
occular ultrasound
electroretinogram
CT and MRI
40
Q

what is involved in the Schirmer tear test?

A

paper placed over lower eyelid with the end touching the cornea
dye will move along paper as tear are absorbed

41
Q

what is the Schirmer tear test result for a normal dog?

A

15-25mm over 1 minute

42
Q

what are the main pieces of equipment used for IOP measurement?

A

Schoitz tonometer
Tonopen
Tonovet

43
Q

what must be used with Schiotz tonometer and the tonopen?

A

topical anaesthetic

44
Q

what is normal IOP?

A

10-25 mmHg

45
Q

what may high IOP indicate?

A

glaucoma

46
Q

what may low IOP indicate?

A

uveitis

47
Q

what is the indication for performing gonioscopy?

A

patients with a risk of developing inherited glaucoma

patient with confirmed glaucoma (raised IOP)

48
Q

what is applied prior to performing gonioscopy?

A

local anaesthetic

49
Q

what is tested on an electroretinogram?

A

function of the retina by monitoring electrical signals from cranial nerves

50
Q

what are CT and MRI used for in ophthalmology?

A

exophthalmos

51
Q

what are the main reasons for exophthalmos?

A

retrobulbar abscess
retrobulbar neoplasia
foreign body

52
Q

what is Fluorescein used for?

A

detection of ulcers

53
Q

what is the purpose of gonioscopy?

A

use a lens to view the drainage angle of aqueous humor from the eye

54
Q

what does OS stand for?

A

occular sinister - left eye

55
Q

what does occular sinister mean?

A

left eye

56
Q

what does occular dexter mean?

A

right eye

57
Q

what doe OD stand for?

A

occular dexter - right eye

58
Q

what does OU stand for?

A

occular uterque - both eyes

59
Q

what does occular uterque mean?

A

both eyes

60
Q

what is essential when giving eye drops?

A

do not touch surface of the eye with the nozzle or you finger

61
Q

describe the process of administering eye drops

A
  1. Ensure that you have the correct medication for the correct eye
  2. Clean any discharge
  3. Hold the bottle/tube between your thumb and first two fingers of your dominant hand
  4. With your other hand, support the chin and lift it upwards slightly, holding the muzzle gently if required
  5. Come from behind the head towards the eye
  6. Using your finger, gently lift the upper eyelid and squeeze the bottle to apply one drop of the medication
  7. Rest the hand that is holding the medication on your patient’s head (this will decrease the risk of accidental injury to the eye from the nozzle)
62
Q

what are the signs of occular pain?

A
increased blink rate
blepharospasm
increased lacrimation and overflow
redness
photophobia
rubbing
miosis
third eyelid protrusion
63
Q

what is suggested by third eyelid protrusion?

A

retraction of the globe due to pain

64
Q

how can animals with eyes removed be assessed for occular pain?

A

view response to contact with the head / eye area
look for flinching/moving away
look for other general pain signs e.g. depression

65
Q

what are the main types of topical medication used for ophthalmology?

A
lubricants
mydriatics
topical antibiotics
topical NSAIDs
carbonic anhydrase inhibitor
prostaglandin analogue
66
Q

what are lubricants used for in ophthalmology?

A
Provide a protective layer to the eye
Support patients with dry eye
Soothes eyes
Lubricant
Post op
67
Q

what are mydriatics used for in ophthalmology?

A

Short term pupil dilation for detailed ophthalmic exam
Long term muscle spasm release for uveitis
Comfort

68
Q

what are topical antibiotics used for in ophthalmology?

A

treatment and prevention of bacterial infection

69
Q

what are topical NSAIDs used for in ophthalmology?

A

Treat inflammation within the anterior portion of the eye

70
Q

what are carbonic anhydrase inhibitors used for in ophthalmology?

A

treatment of glaucoma

Reduce IOP by decreasing the production of aqueous humor and so reducing pressure in the eye

71
Q

what are prostaglandin analogues used for in ophthalmology?

A

Increase aqueous outflow to help with glaucoma

72
Q

what are common examples of ophthalmic lubricants?

A

Lubrithal

Optixcare

73
Q

what are common examples of ophthalmic mydriatics?

A

Tropicamide

Atropine

74
Q

what are common examples of ophthalmic topical antibiotics?

A

Isothal

Chloramphenicol

75
Q

what are common examples of topical NSAIDs?

A

Acular

76
Q

what are common examples of carbonic anhydrase inhibitors?

A

Trusopt

Cosopt

77
Q

what are common examples of prostaglandin analogues?

A

Latanoprost

Monoprost

78
Q

what should be done pre-anaesthesia for a ophthalmic procedure?

A

physical exam to assess for systemic issues and to assign ASA grading
pre-anaesthetic blood tests if indicated
eye drops needed?
IV catheter
what insulin requirements does the patient have if diabetic

79
Q

when should eye lubrication be used?

A

GA and sedation

any opioid use

80
Q

where can IV catheters be placed in ophthalmic surgery?

A

saphenous vein to reduce venous pressure increase which will affect IOP
IV placed after sedation

81
Q

when should clipping be performed for occular surgery?

A

yes for eyelid

no for corneal or intraoccular

82
Q

what should be used to prep the area for ophthalmic surgery?

A

povidone iodine solution

83
Q

what should never be used to prep for occular surgery?

A

scrub or tincture should never be used

84
Q

what dilution of iodine should be used for the globe?

A

1 part povidone iodine to 50 parts sterile saline

85
Q

what dilution of iodine should be used for the eyelids?

A

1 part povidine iodine to 10 parts sterile saline for the eyelids

86
Q

how should surgical prep for the eyelid be performed?

A

wear gloves
Apply copious amounts of lubricating gel to the eye(s) e.g. Lubrithal, Viscotears.
Use small, clean sharp clippers
Clip area required as close to the skin without causing irritation
Use gauze swabs and sterile saline to remove the gel and hair from the eye(s)
Prep the globe first with 1:50 povidone iodine solution
Then prep the eyelids (adnexa) with 1:10 povidone iodine solution
After 3 minutes, flush the globe with sterile saline to prevent corneal toxicity

87
Q

what is the role of the lubricating gel on the eyes during prep?

A

protects the eyes from hair

88
Q

why is it essential that clipper irritation is reduced in ophthalmic surgery?

A

will cause post-op irritation

89
Q

why does the povidine iodine need to be removed from the globe?

A

prevent corneal toxicity

90
Q

how should the eye be prepped for corneal or occular surgery?

A

wear gloves
prep the globe with 1:50 povidine iodine solution
after 3 minutes flush with sterile saline to prevent corneal toxicity

91
Q

how should theatre be set up for ophthalmic surgery?

A

damp dust all surfaces and equipment, mop the floor
set up arterial line, operating microscope, phacoemulsification machine (if cateract surgery)
ventilator set up if required
prepare kit and consumables

92
Q

why may neuromusular blocking agents be needed in ophthalmic surgery

A

prevents the eye rotating ventromedially under GA which facilitates surgery

93
Q

how should microsurgery instruments be cased for?

A

very delicate so handle with care

94
Q

how should microsurgical instruments be cleaned immediately after surgery?

A

remove any gross material with distilled water and soft nail brush / tooth brush
check instruments for damage
place in ultrasonic cleaner for 5-10 mins in neutral pH cleaning solution

95
Q

how should micro surgical instruments be placed in the ultrasonic cleaner?

A

on a finger mat, not touching each other to prevet damage

96
Q

how should microsurgical instruments be dried?

A

air dry not towel

97
Q

how should micro surgical instruments be autoclaved?

A

on micro surgical tray in silicone finger mat not touching

TST strip, double wrap

98
Q

what should you ensure has happened to micro surgical instruments before they are stored after autoclaving?

A

allow to dry throughly

99
Q

what is involved in the post op care of ophthalmic patients?

A
harness not collar and lead
no jugular samples
buster / soft collar
recognise and monitor main
analgesia
eye medication
keep wounds clean
keep patient calm to prevent raised IOP
100
Q

what effect does increased venous pressure have on IOP?

A

increase

101
Q

what is a complication associated with intraoccular surgery?

A

glaucoma

102
Q

what are some common ocular conditions seen commonly in practice?

A
exopthalmos
globe proptosis
entropion
keratoconjunctivitis sicca (KCS)
conjunctivitis
corneal ulcer
uveitis
cataract
retinal detatchment
103
Q

what is exophthalmos?

A

abnormal protrusion of the eyeball (rostrally)

104
Q

what can cause exophthalmos?

A

FB
abscess
neoplasia

105
Q

what is globe proptosis?

A

eyelids trapped behind globe and eye then pushed forwards out

106
Q

what advice should be given to owners of pets with globe proptosis?

A

keep eye moist and come in quickly

107
Q

what is entropion?

A

eyelids are inverted so skin of eyelid rubs on the cornea

108
Q

what are the reasons for entropion?

A

primary

secondary - trauma or eyelid surgery

109
Q

what is keratoconjunctivitis sicca (KCS)?

A

dry eye

110
Q

what causes keratoconjunctivitis sicca (KCS)?

A

inadequate tear production lets occular surface become very dry
thought to be immune mediated

111
Q

how is keratoconjunctivitis sicca (KCS) diagnosed?

A

assess tear production via Schirmer test

112
Q

how is keratoconjunctivitis sicca (KCS) treated?

A

topical medication to treat (optimmune and lubricants) for life

113
Q

what is conjunctivitis?

A

inflammation of conjunctiva

114
Q

what are the causes of conjunctivitis?

A

many

115
Q

what causes a corneal ulcer?

A

erosion of surface of cornea

116
Q

how are corneal ulcers diagnosed?

A

Fluorescein dye

117
Q

what is uveitis?

A

painful inflammation of the eye

118
Q

what is cataract?

A

opacity of the lens

119
Q

what is a hypermature cataract?

A

complete opacity of lens

120
Q

what is retinal detachment?

A

retina moves away from its attachment point at the back of the eye

121
Q

what are some of the main causes of retinal detachment?

A

systemic hypertension

CKD

122
Q

what are some of the signs of retinal detachment?

A

mydriasis

unresponsive to light

123
Q

what is normal IOP?

A

10-25 mmHg

124
Q

what causes glaucoma?

A

Eye pressure is to high as aqueous humour cannot drain out of normal drainage angle properly

125
Q

how does fluroscein show corneal ulcers?

A

Fluroscein only sticks to stroma of eye so will go green as epithelium will be gone and dye can stick

126
Q

what must be done after fluroscein has been used in the eye?

A

flush

127
Q

what is needed for culture and sensitivity tests on the eye?

A

sterile swab

128
Q

what are the punctae of the eye?

A

opening of nasolacrimal duct in eye

129
Q

what covers the sclera?

A

conjunctiva

130
Q

what is the role of the suspensory ligament of the eye?

A

attaches lens to cilliary body

131
Q

what is the role of the choroid?

A

supplies nutrients to retina

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