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Year 4 small animal > Opthalmology > Flashcards

Opthalmology Flashcards

(103 cards)

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1
Q

Signalment

A

Breed
Age - older dog, intraocular neoplasia, cat systemic hypertension
Gender (pyometra uveitis)

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2
Q

History for ophthalmic exam

A

Vaccination, worming, diet
Other pets
Travel
General health
Medications
Previous eye issues
Uni/bilateral
Duration/progression
Ocular pain, appearance change, vision changes

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3
Q

presenting ocular complaints

A

ocular pain - blepharospasm, increased tearing
change in appearance - redness, discharge, swelling
decreased vision - day vs night, changes in unfamiliar surroundings

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4
Q

things to examine - ophthalmic

A

behaviour - do they seem visual/painful etc
symmetry - colour, nostrils, swelling, palpebral fissure size, third eyelid position
external anatomy, palpation, under eyelids, anterior surface, retropulsion
schirmer tear test
ocular reflexes

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5
Q

ocular reflexes

A

menace - vision
palpebral (before menace to check blink)
dazzle
pupillary light - really bright light
vestibulo-ocular
corneal sensation (if suspect of blinking/trigeminal disorder)

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6
Q

anterior assessment

A

pen torch +/- magnification
examine outside to inside
eyelids/lashes/nasolacrimal puncta
third eyelid
conjunctiva, sclera, limbus
anterior chamber
iris and pupil

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7
Q

distant direct ophthalmoscopy

A

essential
0 dioptre at arms length
tapetal reflex to highlight visual axis
compare pupil sizes, opacities

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8
Q

close direct

A

0 dioptres 2-3cm from eye
dilate pupil with tropicamide
small highly magnified field of vision - hard to examine whole fundus
line up eye, light source and condensing lense, curved side towards you

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9
Q

fluorescein staining

A

orange dye - turns green in alkaline conditions
stroma turns it green
indicated in most opthalamic assessments but towards end of assessment
strips are preferable to drops
always flush afterwards
stain should appear at nose in 3-5 mins (jones test)

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10
Q

conjunctival swabs/scrapes

A

sterile swabs
if bacteria suspected - charcoal medium
ocular surface disease - chlamydophila felis, feline herpes virus PCR

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11
Q

tonometry

A

end of exam
essential for reduced vision
red/blue eyes or corneal oedema
measures IOP 10-25mmHh normal in dog/cat, 15-20mmHg normal in rabbit
raised - suspect glaucoma
lowered - suspect uveitis
difference >8mmHg abnormal

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12
Q

split lamp - specialist

A

judge depth and localise lesions

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13
Q

electroretinography - specialise

A

assessment of retinal function

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14
Q

gonioscopy - specialist

A

assessment of iridocorneal drainage angle

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15
Q

imaging - specialist

A

ultrasound, ct, mri

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16
Q

corneal pathology

A

oedema - breach/dysfunctional barrier
vascularisation - promotes healing but increases scarring
pigmentation - non-specific response to corneal insult

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17
Q

wound healing

A

corneal epithelium self renews - movement up/centrally
proliferation from basal epithelium at limbus

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18
Q

superficial, epithelial only ulcers

A

cover defects in hours-days with proliferation, migration and adhesion

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19
Q

stromal healing

A

healing starts after re-epithelialisation
fibroblasts migrate in and lay down new collagen
requires vascularisation and results in scar tissue/remodelling

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20
Q

common causes of corneal ulceration

A

trauma
tear film production - KCS
adnaxal conditions - eyelids/eyelashes
primary corneal disease (SCCEDs - spontaneous chronic corneal epithelial defect)
infection
neurological disease

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21
Q

types of ulcer

A

superficial
SCCED
stromal
desmetocoele
infected/melting
perforated

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22
Q

clinical signs of ulceration

A

pain
conjunctival hyperaemia
ocular discharge
corneal oedema
reflex uveitis

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23
Q

superficial ulcer

A

epithelial loss only
acute
painful
sharp distinct borders
minimal inflammatory response
+/- reflex uveitis

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24
Q

SCCED - spontaneous chronic corneal epithelial defect

A

non-healing, indolent ulcer
any breed but boxers and corgis are common
> 7 years old
epithelium loss only, usually unilateral
no stromal involvement
lip of loose epithelium - grows across but cannot adhere to stroma

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25
stromal ulcer
epithelial and stromal loss acute/chronic fluorescein staining of walls and floor of ulcer can be superficial or deep anterior uveitis is common side effect visible crater
26
desmetocoele
acute/chronic complete stromal ulcer down to descemets membrane walls of ulcer common bottom does not stain revealed by flushing
27
melting corneal ulcers
keratomalacia present with acute closed painful eye with ++ gloopy discharge ill defined/ rounded/soft edges - look like melting away anterior uveitis can perforate within hours - ophthalmic emergency pathogensis - enzymes digest stroma - caused by cornea itself or bacterial infection steroids suppress and potentiate collagenase
28
treatment of simple superficial
chloramphenicol nsaids regular checks
29
SCCEDs treatment
debridement keratotomy/keratectomy chloramphenicol nsaids atropine contact lens as bandage
30
keratotomy
grid - hash with needle, bevel up parallel to surface diamond burr
31
complex corneal ulcer treatment
intensive treatment +/- infection C+S - enrofloxacin nsaids +/- opioids atropine to effect hospitalise/very close monitoring
32
melting treatment
apply serum 1-2 hourly for 24h then reduce n-acetylcysteine (stromease) - new product
33
feline ulcers
infection/trauma/corneal sequestrum non-healing - gentle cotton bud debridement, never grid on a cat
34
traumatic globe prolapse
pathophysiology - immediate oedema traction on optic nerve can blind desiccation of ocular surface - potential to ulcerate, dries quickly. rupture of ocular muscles brachycephalic much more likely to occur but better prognosis, long nose, much less likely but bad prognosis, cats unlikely except RTA replace or enucleate treat immediately, dont refer. distressing, painful, prevent self trauma GA for replacement lateral canthotomy to make replacement easier temporary tarsorrhaphy to prevent reprolapse and tamponade haematoma - needle cannot go full thickness as dont want sutures against eye treat with antibiotics, antiinflammatories and buster collar most eyes are blind
35
retrobulbar abscess
cs - acute onset, unilateral, exophthalmos, pain (worse on mouth opening) third eyelid protrusion/swelling, ocular discharge, pyrexia, lethargy ultrasound for fluid filled cavity treatment - drain abscess under GA, abscess via mouth and release pus, amoxy clav and nsaids referral approrpiate
36
acute glaucoma
ocular pain (blepharospasm, increased lacrimation, photophobia), head shy, yelping, dull/quiet, vision loss, appearance change emergency in purebreeds with hereditary, terrier breeds with acute lens luxation diagnose with tonometry often >40mmHg can be 60-80mmHg treatment - reduce IOP - prostaglandin analogue (latanoprost) is primary, carbonic anhydrase inhibitors (brinzolamide/dorzolamide). analgesia seek referral advice/offer
37
anterior lens luxation
cs - acutely painful eye glaucoma focal corneal oedema lens outline can be visible in anterior chamber if terrier with acutely painful eye - assume luxation until proven otherwise treatment - referral - couching, analgesia. ongoing management
38
chemical injury
acid/alkali - immediate loss of epithelium, alkali can be worse acids - bleach, toilet cleaner, spirit base skin prep alkali - caustic solution, lime burns, washing detergents treatment - immediate irrigation - tap water and copious flushing test pH
39
eye foreign body
urgent attention needed most not true emergencies refer with lots of pain relief
40
causes of sudden onset blindness
acute glaucoma acute uveitis intraocular haemorrhage retinal detachment optic neuritis sudden acquired retinal degeneration toxicity intracranial lesion
41
vision diagnostics
menace PLR tracking obstacle course ophthalmoscopy
42
nuclear sclerosis
nucleus becomes denser and harder appearing with a grey-blue haze minimal visual effects no effects on ocular health common with ageing
43
cataracts
opacity of lens or capsule very variable appearance classification on onset, aetiology, extent, position variable visual effects can cause uveitis may need surgery
44
diabetic cataracts
increased glucose - hexokinase pathway overwhelmed producing cortisol leading to lens osmosis absorbing water causing them to swell and turn white occurs in days - hours 50% blind within 6 months of diabetes, 75% in 1 year
45
generalised progressive retinal atrophy
important cause of inherited blindness bilateral symmetrical degeneration of neurosensory retina no treatment night vision goes first, secondary cataract and fundus changes common
46
what are the causative agents of bacterial granulomatous dermatitis
mycobacterium tuberculosis complex non-tuberculous mycobacteria treatment - long term antibiotic treatment
47
dermatophytosis
microsporum canis most common multifocal circular patches of alopecia +/- hyperpigmentation and follicular casts dx - woods lamp flouresence trichography - arthrospores around hair shaft
48
demodex
follicular long bodied mites short bodied surface mites inflammation = hair hair loss clip hair isoxazolines
49
what should you always do with comedomes
squeeze and scrape
50
most common cause of bacterial pyoderma
s, pseudintermedius
51
what are hotspots
acute moist dermatitis (pyotraumatic dermatitis) triggered by irritants very rapid bacterial overgrowth
52
treatment for surface pyoderma
topical treatment only - flamazine/isoderm
53
treatment for superficial pyoderma
topical where possible first tier antimicrobial where necessary
54
urticaria/angiogenic oedema
degranulation of mast cells/basophils leading to painless pitting oedema type 1/3 hypersensitivity treatment - immunosuppressants
55
what is panniculitis
inflammation of SC fat
56
pruritis of pinnal margins
scabies neotrombicular autumnalis
57
pruritis of pinnal surface
atopic dermatitis food allergy pemphigus foliaceus fleas contact irritant dermatitis
58
pruritis of pinnal body
aural haematoma
59
things to consider in otitis externa
primary disease secondary disease predisposing factors perpetuating factors
60
primary causes of otitis
otodectes, demodex, scabies foreign bodies (grass awns) hypersensitivity keratinisation disorders glandular disorders
61
clinical signs of otitis external
aural pruritis exudate malodour head tily deafnesss
62
treatment of otitis media
myringotomy + flush till clean aqueous antibiotics pain relief
63
indications for myringotomy
bulging TM with pain/neuro signs tympanosclerosis radiographic/MRI bulla changes tissue/fluid behind tm medically unresponsive
64
myringotomy
clean and dry canal incise tm with polypropylene catheter at caudal ventral aspect swab for bacteriology flush with saline until clean
65
imaging for OM
radiography - insensitive ct - quite good mri - far better soft tissue images, ct often as useful and cheaper
66
otitis interna
rare extension of OM cs - head tilt, spontaneous/rotatroy nystagmus, asymmetric limb ataxia, falling, V+/anorexia ddx - vestibular diseases dx - cs, neuro exam, otic exam, mri/ct specialist advice needed
67
examination points
canal - wall (swelling ulceration, hyperplasia, hair, masses, redness), lumen (wax, pus, mites, fb, occlusion drum - present/absent, colour changes, bulges? discharge/cerumen smell
68
biofilm
extracellular matrix produced by bacteria lead to lack of antibiotics/disinfectant penetration
69
flushing solutions
saline squalene (dissolution of wax) chlorhexidine
70
types of ear cleaner
cleanaural/epiotic - general purpose otodine - purulent otitis cerumaural/otoact - waxy ceruminous otitis triz edta - base or pre flush triz edta with n-actyl cycsteine - biofilm breakdown
71
ear treatment for cocci bacterial +/- yeast overgrowth with minimal inflammation
treat inflammation alone with cleaner
72
ear treatment for cocci bacterial +/- yeast overgrowth with consistent inflammation
narrow spectrum polypharmacy product
73
ear treatment for rods +/- cocci and yeast with significant inflammation
polypharmacy product systemic steroids antibiotics with good action in pus
74
ear treatment for chronic inflammatory rod based inflammation
polypharmacy/ homemade mixture systemic steroids GA flush
75
care for drugs in the ear
none are licensed for the ear all state not to use with ear drum perforation - must get owner consent and warn if drum cannot be visualised
76
aural haematoma treatment
incision, drainage, suture (longitudinal with blood supply) drip tubing to spread pressure skin punches to tack onto cartilage teat tubes/surgical drains possible complications - cosmetics, recurrence, pinna necrosis
77
indications for lateral wall resection
neoplasia of lateral wall of vertical external canal management of otitis media (rare)
78
total ear canal ablation and lateral bulla osteotomy indication
chronic/recurrent otitis externa with hyperplastic changes in luminal epithelium failure of more conservative surgery neoplasia of external canal unmanageable otitis media
79
ventral bulla osteotomy indications
certain brachycephalics (lateral impossible) cases where teca not required often used in cats as 2 bulla compartments
80
cholesteatoma
Slowly enlarging, cystic lesions within the middle ear cavity treatment - tecabo or vbo guarded prognosis
81
inflammatory polyps
emanate from tympanic bulla - nasopharyngeal/horizontal ear canal lead to otitis media - obstruct nasopharynx can present mouth breathing can use spay hook to grasp after pulling soft palate forward
82
medial canthal pocket syndrome
mucus accumulation at medaial cathas keep clean common in dolichocephalic
83
differentials for discharging eyes
purulent - fb, infection, KCS thick/tenacious - KCS serous - ulcer, blocked nasolacrimal duct, tear overflow haemorrhaegic - ocular trauma, coagulopathy
84
entropion treatment
hotz-celsus elliptical removal +/-wedge resection
85
distichiasis
eyelashes emerging from meibomian glands in line with eyes
86
ectopic cilia
emerge through conjunctiva at right angles to cornea and irritate
87
KCS
keratoconjunctivitis sicca immune mediated destruction of lacrimal tissue common cause of conjunctivitis cs - recurrent conjunctivitis, tacky mucoid-mucopurulent discharge, blepharospasm +/- ulceration Dx - schirmer tear test <10mm/min tears, 10-15 borderline Tx - lifelong treatment, tear substitutes/stimulants, broad spectrum antibiotics for secondary infection
88
dacryocystitis -
tear duct infection - common in rabbits often caused by over long molar roots pressing on nasolacrimal ducts
89
conjunctival involvement of systemic disease
anaemia jaundice coagulopathy neoplasia auto-immune disease
90
feline infectious conjunctivitis
chlamydophilia felis - treat with doxycycline feline herpes virus - nursing, anti-virals feline calicivirus mycoplasma felis - chloramphenicol/tetracyclines bordetella bronchiseptica - doxycycline
91
cataract classification
dependent on age, aetiology, position extent
92
acute glaucoma signs
pain , belpharospasm, altered behaviour red eye - engorged episcleral vessels, corneal vascularisation corneal oedema fixed dilated pupil vision loss IOP >40mmHg
93
chronic glaucoma signs
globe engorgement corneal changes lens luxation cataracts
94
glaucoma treatment
urgent treatment IOP hard to control may require enucleation
95
generalised progressive retinal atrophy
inherited retinal diseases bilateral symmetrical degeneration of neurosensory retina no treatment
96
sudden acquired retinal degeneration
middle aged-older acute vision loss present with dilated pupils and absent PLRs fundus normal in early stages electroretinogram needed for diagnosis no treatment
97
uveitis
CS Pain –blepharospasm, epiphora, photophobia Red eye – conjunctival and episcleral hyperaemia Miosis, swollen dull iris, rubeosis iridis Inflammation in anterior chamber - Aqueous flare, hypopyon, hyphaema, keratic precipitates Corneal oedema low intraocular pressure (may help diagnosis!) secondary vision loss treat - underlying cause, topical +/- systemic anti-inflammatories
98
feline hypertensive chorioretinopathy
ocular changes in 50% of hypertensive cats - develop >160mmHg (may reflect late hypertension diagnosis) treat - amlodipine, may need ACEi, address underlying cause
99
feline eosinophilic keratitis
cottage cheese deposits on cornea immune mediated dx - cytology/appearance tx - topical corticosteroid
100
feline corneal sequestrum
amber corneal discolouration - dark brown plaque cause unknown, chronic irritation can predispose dx - characteristic appearance tx - keratectomy +/- graft
101
feline diffuse iris melanoma
hyperpigmented iris spots progressing to whole iris histopathology for definitive enucleation if highly suspicious
102
horners syndrome
cs - miosis, third eyelid protrusion, ptosis, enopthalmos
103
uveal neoplasias
fdim in cat, iris melanoma in dog most common

Year 4 small animal (18 decks)

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