SAM II Exam II Material - Ophthalmology

Question 1

Primary lens luxations are due to:

Answer 1

Inherited dysplasia or degeneration of zonules​

• ​DNA testing can be done for clear, carrier, and genetically affected
• Predisposed: Terrier breeds, poodles, Shar Peis, others

Question 2

Which of the following treatments would be least indicated in the treatment of a deep corneal ulcer?

• Autologous serum administration on the eye
• Conjunctival graft
• Gentamycin ophthalmic drops
• Grid keratotomy

Answer 2

Grid keratotomy​

Question 3

This is the most common cause of glaucoma in cats:

Answer 3

uveitis

Question 4

What is the most common eyelid tumor that we see in the cat?

Answer 4

Squamous cell carcinoma​

MALIGNANT!!

Question 5

Holes or defects in uveal tissue (iris or choroid):

Answer 5

colobomas

• Holes or defects in uveal tissue: iris or choroid
• Typical at 6 o’clock
• Choroidal colobomas can result in poor retinal development = impaired vision

Question 6

Which of the following are congenital diseases of the eyelids?

• Dermoids
• Entropion
• Eyelid agenesis

Answer 6

Dermoids and Eyelid agenesis

Question 7

When a dog can’t close its eyes completely (and sleeps with its eyes open), this is termed:

Answer 7

lagophthalmos

Question 8

A cat presented with conjunctivitis (owner called it a ‘red eye’). Fluorescein stain showed a small corneal ulcer. Tear production was also lower than expected for a cat. What is the most likely cause of these signs?

Answer 8

herpes virus

Question 9

Intumescent cataracts are associated with what systemic metabolic disease?

Answer 9

Diabetes mellitus

• Hyperglycemia causes high glucose in the lens → Hexokinase becomes saturates so alternate sorbitol pathway is used → Sorbitol and fructose accumulate in the lens → Sorbitol cannot escape from the lens, resulting in hypertonicity → causes water uptake, swelling, and rupture of lens fibers → uveitis*
• (Note: cats do not have the alternative sorbitol pathway)*

Question 10

What IOP is indicative of glaucoma?

Answer 10

> 25 mmHg

Question 11

This is a purulent bacterial infection of the meibomian gland (internal site) or skin gland of the lid (gland of Moll or Zeis/external site):

Answer 11

hordeolum or stye

• Clinical signs: red raised area on lid margin; epiphora; blepharospasm, blepharedema
• Painful and comes to a head on outside of lid
• Often seen in young dogs but also cats
• May be multiple
• Treatment: local warm packs, topical & systemic anti-inflammatories & antibiotics
• May need culture and sensitivity if chronic recurrent infection
• Rarely need surgical correction

Question 12

A cat presents with this fleshy growth with superficial vascularization on the lateral conjunctiva. You perform a cytology and note infiltrates of eosinophils, plasma cells and lymphocytes. What is your diagnosis?

Answer 12

Feline Eosinophilic Keratoconjunctivitis​

• May be associated with FHV‐1 immune stimulation or reaction​
• Treatment: topical glucocorticoids only if no corneal ulcer (may need to use cyclosporine)​
  
  • ​Could activate herpes infection!

Question 13

What are the 5 basic layers of the cornea?

Answer 13

• Tear film
• Epithelium
• Stroma
• Descemet’s membrane
• Posterior epithelium

_T_hat _E_ye’s _S_o _D_amn _P_imp

Question 14

Glaucoma can be caused by any of the following except:

• Intraocular neoplasia
• Lens luxation
• Uveitis
• Abnormal iridocorneal angle
• Optic nerve atrophy

Answer 14

Optic nerve atrophy​

Question 15

What is the term used to describe ingrowth or introversion of the eyelashes resulting in normal hairs contacting the cornea?

Answer 15

trichiasis

• Normal hairs contacting cornea
  
  • Eyelids/lashes, nasal fold fur
• Common in long-haired dogs & brachycephalics
• Often subclinical
  
  • Epiphora
  • Corneal pigmentation and ulcerations

Question 16

What treatment for indolent ulcers has the highest rate of success?

Answer 16

superficial keratectomy

• Best chance of success (99-100%), but most invasive
• Remove epithelial layer & parts of stroma allowing for reformation of normal epithelial complexes
• Success proves the poor healing is related to abnormal BM & lack of stroma adhesion
• Not recommended as first line due to need for general anesthesia and cost
• Not recommended in cats: may predispose to formation of a corneal sequestrum.
• Referral procedure usually

Question 17

T/F: The majority of diabetic dogs develop cataracts within 1 year of diagnosis despite adequate glycemic control

Answer 17

True

Question 18

inflammation of the lacrimal sac is termed:

Answer 18

dacryocystitis

Question 19

Identify this progressive, bilateral, inflammatory, non‐ulcerative potentially blinding corneal abnormality:

Answer 19

chronic superficial keratitis​

(aka Pannus or Uberreiter’s syndrome)

• Immune-mediated theory: Reaction to corneal antigens; exacerbated by exposure to UV light & possibly associated with high altitudes.
• German shepherds:
  
  • Young, 1–5 yrs, usually severely progressive & extensive
  • Older dogs, 4 ‐6 yrs slowly progressive & extensive
• Greyhounds: 2‐3 yrs with relatively mild lesions

Question 20

An overflow of tears on the cheek is termed:

Answer 20

epiphora

Question 21

T/F: Lagopathalmos refers to the inability to open the eyelids completely

Answer 21

False

Lagopathalmos refers to the inability to close the eyelids completely

Question 22

T/F: Cyclosporine A is a drug of choice for treatment of KCS and Pannus

Answer 22

True

Question 23

Which one of the following findings is NOT found with acute glaucoma?

• Cloudy cornea
• Blindness
• Buphthalmia
• Red eye
• Painful eye

Answer 23

Buphthalmia​

Question 24

• What kind of ulcer is this?
• What part of the cornea is affected?
• How is it treated?
• How long will it take to heal?
• When will you do a recheck fluorescein stain?

Answer 24

• Superficial corneal ulcer
  
  • Superficial epithelial layer is affected
  • Treated with topical antibiotics (BNP if it’s a dog)
  • May take ~1 week to heal
  • Recheck in 1-4 days

Question 25

What is the most common cause of **cataracts** in dogs?

Answer 25

**developmental** * *Hereditary* * *Many breeds* * *1‐7 years old* * *Often bilateral; can be asymmetrical*

Question 26

In general, what are the three main tests that should be performed on all eyes and in a specific order?

Answer 26

1. **Schirmer Tear Test (STT)** 2. **Fluorescein stain (FS)** 3. **Tonometry**

Question 27

This dog presents with "big eye" on the left and decreased vision for 2 weeks. He now has ocular cloudiness bilaterally and has also stopped eating. On physical examination, you note exophthalmos on the left, anterior uveitis bilaterally, and peripheral lymphadenopathy. Temperature = 39.5˚C What diagnostic test could be done next to help with your diagnosis?

Answer 27

**Lymph node aspiration or biopsy** * *What are some differential diagnoses for lymphadenopathy?* * *Lymphoma* * *Tick-borne disease* * *Fungal disease* * *Protozoal disease*

Question 28

EXTREME exophthalmos is termed:

Answer 28

**proptosis** *forward displacement of the globe with simultaneous entrapment of the eyelids behind the equator*

Question 29

T/F: Corticosteroids are the drug of choice for treating **corneal ulcers**

Answer 29

**FALSE** ## Footnote **IF EVER ASKED ABOUT STEROIDS AND ULCERS, IN GENERAL THE ANSWER IS _AVOID_.** *The only real exception to this is to treat Superficial Punctate Keratitis*

Question 30

What is normal IOP in the dog?

Answer 30

**10-25mmHg**

Question 31

What is your diagnosis?

Answer 31

**essential iris atrophy** * *(aka stromal iris atrophy)* * *Holes are present in the iris so that you can see tapetal reflex through the defects* * *PLR is reduced, but does not affect vision*

Question 32

A 7-year-old obese dog presents with acute onset blindness, mydriasis, slow or no PLRs, positive but slow dazzle response. You don't note any abnormalities on fundic examination. How do you definitively diagnose this condition?

Answer 32

**ERG** *The description is of SARDS (Sudden Acquired Retinal Degeneration Syndrome)*

Question 33

What are the indications for surgical intervention with regard to **deep corneal ulcers**?

Answer 33

1. **Deep ulcer (melting, perforating, or descemetocele) that may rupture** 2. **Greater than 50% of the corneal thickness** 3. **If refractory to medical therapy**

Question 34

You surgically repaired a ‘**Cherry eye**’ using one of the techniques recommended in class. Which of the following should you tell the owner? * Artificial tears will be needed for rest of the patient’s life * Epiphora could occur as result of the prolapse * The other gland could prolapse * Topical cyclosporine will help prevent future prolapses

Answer 34

**The other gland could prolapse​**

Question 35

Which of the following is one advantage to **direct ophthalmoscopy**? * A better view of the anterior chamber * A more magnified image * A wider field of vision * Less interference by choroid

Answer 35

**A more magnified image**

Question 36

What is _hallmark sign_ of **uveitis**?

Answer 36

**aqueous flare** *During slit lamp examination of the eye, an abnormal appearance of the beam of light as it travels through the anterior chamber. The flare is caused by light reflecting off proteins in the aqueous humor. It is found in patients with inflammation in the anterior chamber.​*

Question 37

\_\_\_\_\_\_\_\_\_\_ is a firm, usually nonpainful swelling of the meibomian gland caused by the accumulation of secretions that results in chronic inflammation and a granulomatous reaction

Answer 37

**chalazion**

Question 38

The treatment of choice for adult dogs with **entropion** is:

Answer 38

**Hotz-Celsus technique​**

Question 39

Inward rolling of the eyelids is termed:

Answer 39

**entropion** * *Inherited or Breed-related:* * *Medial: brachycephalics usually* * *Dorsolateral/ventrolateral: giant breeds* * *Circumferential: Shar Peis & Chow Chows* * *Puppies may “grow out of it”* * *Acquired: more common in cats* * *Spastic: Chronic blepharospasm* * *Non-spastic: Post-trauma or surgery*

Question 40

To treat **eyelid lacerations**, you should first clean the area. You should avoid chlorhexidine, but you can use betadine. What should you do with betadine before using is on an eyelid laceration?

Answer 40

**dilute the shit out of it!** *Can use VERY VERY dilute betadine on corneal surface (1:50 dilution)*

Question 41

What is the treatment for the **corneal abnormality** shown?

Answer 41

**benign neglect (active monitoring)** *The image shows Florida Keratopathy (aka Florida spots, Florida keratitis, Caribbean keratopathy)*

Question 42

In the case of **posterior synechia**, the _**\_\_\_\_\_\_\_\_**_ sticks to the _**\_\_\_\_\_\_\_\_**_

Answer 42

In the case of posterior synechia, the **_iris_** sticks to the **_lens_**

Question 43

What layer of the **tear film** is closest to the cornea?

Answer 43

**mucous layer (goblet cells)** * *Three tear film layers:* * *Inner mucin layer* * *Middle aqueous layer* * *Outer lipid layer*

Question 44

Define **enucleation**:

Answer 44

**removal of the globe of the eye**

Question 45

Identify the type of **ulcerative keratitis**:

Answer 45

**superficial punctate keratitis**

Question 46

T/F: **IV mannitol** is indicated in a case of acute primary glaucoma

Answer 46

**True** *IV mannitol osmotically draws water from eye; dehydrates vitreous*

Question 47

Which of the following clinical signs is _not_ typically associated with **keratoconjunctivitis sicca (KCS)**? * Conjunctivitis * Corneal ulcer * Hyphema * Mucopurulent discharge

Answer 47

**Hyphema​**

Question 48

What _drugs_ are well-known to cause **keratoconjunctivitis sicca (KCS)**?

Answer 48

**Sulfa drugs and Etogesic (NSAID)**

Question 49

Identify the corneal abnormality:

Answer 49

**corneal foreign body** * *Penetrating FB will need to be removed; some might be flushed out with saline* * *May need surgery for ruptured cornea* * *Remove any prolapsed iris that is devitalized; will* *likely have uveitis too with prolapsed iris* * *Use conjunctival flap if \> 2/3 cornea involved*

Question 50

Identify this corneal abnormality:

Answer 50

**persistent pupillary membrane** * *Usually of minimal significance* * *See focally pigmented endothelial opacity & a uveal strand that extends from the iris collarette (not from iris margin)* * *Common for the strand to be resorbed leaving just a patch on the back of the cornea* * *Naturally regress from pupillary membrane during the first 6 to 8 weeks of life* * *All breeds, but especially Basenji and Pembroke Welsh Corgi*

Question 51

You suspect **herpesvirus** in a cat with conjunctivitis. What is the best modality to confirm your diagnosis?

Answer 51

**PCR**

Question 52

Ignore the fact that this picture is of a human. What congenital **uveal disease** is present?

Answer 52

**persistent pupillary membranes​** * *Failure of complete regression of embryonic pupillary membrane* * *Normally regress by 6-8 weeks* * *No treatment*

Question 53

What surgical procedure is shown here?

Answer 53

**conjunctival graft (pedicle graft)** *used in the treatment of deep ulcers* * *Conjunctival graft advantages* * *Mechanical support for weak area* * *Continuous supply of serum, anticollagenases, GFs* * *Immediate source of actively replicating fibroblasts for collagen regeneration in the stroma* * *Route for systemic antibiotics to be delivered to ulcer*

Question 54

\_\_\_\_\_\_\_\_\_\_ is the most common cause of conjunctivitis in cats and kittens

Answer 54

**herpesvirus** * *Feline Herpesviral Conjunctivitis​* * *3 different age presentations* * *Neonatal Ophthalmia 􏰚* * *Ankyloblepharon 􏰚* * *Symblepharon* * *8-12 wks* * *􏰚Upper respiratory and ocular signs* * *􏰚Mature* * *􏰚Recrudescence* * *􏰚Harbored in CN V ganglion*

Question 55

What drug is most commonly used to *stimulate tear production* in a **KCS** case?

Answer 55

**Topical Cyclosporine A** *If that is not working, Topical Tacrolimus is the 2nd choice* * *Cyclosporine A: T cell inhibitor* * *Directly lacrimogenic* * *Inhibits pigmentation & vascularization* * *􏰚Q 12 hr topically*; *Up to 8 wks to max effect* * *Tacrolimus: topical 􏰚* * *Refractory cases* * *􏰚Up to 30% better response*

Question 56

What is most likely the cause of **superficial punctate keratopathy**?

Answer 56

**tear film deficiency (mucin deficiency most likely)** * *May also be an autoimmune disease* * *Superficial keratitis from mild insults or after anesthesia can look similar but not the same disease*

Question 57

Was this image taken using a **direct** or **indirect** ophthalmoscopic technique?

Answer 57

**indirect** * *Inverted, reversed image* * *Larger field of view* * *Can see periphery* * *Distant from patient*

Question 58

T/F: **Eyelid tumors** are often benign in cats

Answer 58

**False** * *Eyelid tumors are infrequent and often malignant in cats* * *Squamous cell carcinoma most common in cat & is malignant* * *Others: basal cell carcinoma, mast cell tumor, apocrine hidrocystomas in Persians and Himalayans* * *Treatment: Surgery, chemo, RT, Cryo, grafts*

Question 59

Abnormal growth of the cilia from the *Meibomian gland openings* is termed:

Answer 59

**distichiasis** * *Aberrant cilia erupt from Meibomian gland openings* * *Common in dogs, uncommon in cats, rare in horses* * *Upper or lower lid* * *May be incidental findings* * *Keratitis, epiphora, ulcers, etc.*

Question 60

What cranial nerves are tested with the **menace response**?

Answer 60

**CN II (optic) and CN VII (facial)**

Question 61

\_\_\_\_\_\_\_\_\_\_ is the 2^nd most common cause of **conjunctivitis** in cats and kittens

Answer 61

***Chlamydophila felis*** * *_Obligate intracellular bacterium_* * *Conjunctivitis most common clinical sign in cats* * *Chemosis* * *Respiratory & GI: mild or absent* * *Diagnosis* * *Conj. Smear cytology: intracellular inclusion bodies ; can submit for fluorescent Ab test* * *􏰚Conj. Swab: PCR for organism* * *Treatment* * *Supportive care* * *Topical tetracyclines, chloramphenicol (Risk for humans)* * *Systemic doxycycline if severe*

Question 62

**Pannus** may be bilateral, but lesions are not symmetrical in development. It starts at the ________ as red vascularized area on conjunctiva before speading centrally

Answer 62

Pannus may be bilateral, but lesions are not symmetrical in development. It starts at the **_temporal limbus_** as red vascularized area on conjunctiva becoming "fleshy" before speading centrally

Question 63

Is buphthalmia seen in **acute** or **chronic** glaucoma cases?

Answer 63

**chronic**

Question 64

T/F: **Blue irises** are a form of iris hypoplasia

Answer 64

**True**

Question 65

Enlarged globe caused by ↑ IOP is termed:

Answer 65

**buphthalmos** *↑ IOP, often blind with mydriasis, often painful, often firm but should retropulse​*

Question 66

All of the following clinical signs may be seen with **uveitis**. Which one(s) is/are _specific_ for uveitis? * Blepharospasm * Episcleral injection * Corneal edema * Deep perilimbal vascularization * Aqueous flare * Miosis * Iritis * Hypopyon or hyphema

Answer 66

* **Aqueous flare** * **Miosis** * **Hypopyon or hyphema**

Question 67

Name two contraindications for using **Tropicamide**:

Answer 67

**glaucoma and some lens luxations** * *0.5-1% Tropicamide (Mydriacyl®)* * *Rapidly dilates pupil* * *Within 15-30 min; can repeat if not dilated in 10 min.* * *Short duration 6-8 hours* * *Well tolerated* * *Salivation in cats*

Question 68

What are the three main acquired **diseases of the lens**?

Answer 68

1. **Nuclear or lenticular sclerosis** 2. **Cataracts: focal or diffuse opacity of lens or lens capsule** 3. **Luxations: displacement of lens from its normal fossa**

Question 69

T/F: **Cherry eye** is treated by removing the gland of the nictitans

Answer 69

**NO!**

Question 70

About \_\_\_% of acquired KCS cases are immune-mediated

Answer 70

About **_80%_** of acquired KCS cases are immune-mediated * *Lymphoplasmacytic inflammation of lacrimal (and nictitans) glands​* * *Progressive until complete gland destruction*

Question 71

You diagnosed an **acute superficial corneal** **ulcer** in a dog. Which of the following would be _incorrect_ information to give to the owner? * An E collar needs to be kept on the dog until the ulcer heals * Most of these cases resolve in 2-6 days * Topical antibiotics are indicated because infection is often present * You will need to put medications into the eye every hour for the first 24 hours

Answer 71

**You will need to put medications into the eye every hour for the first 24 hours** *(this is part of the treatment plan for _deep ulcers_)*

Question 72

What part of the eye produces **aqueous humor**?

Answer 72

**ciliary body**

Question 73

In the case of **anterior synechia**, the ________ sticks to the \_\_\_\_\_\_\_\_

Answer 73

In the case of anterior synechia, the **_iris_** sticks to the **_cornea_**

Question 74

\_\_\_\_\_\_\_\_\_\_ syndrome refers to the chronic conjunctivitis occurring in dogs with deep orbits, enophthalmia, narrow skulls, slight entropion, and inadequate tear drainage

Answer 74

**Medial Canthal Pocket Syndrome**

Question 75

What two types of **tonometry** require local anesthetic (proparacaine)?

Answer 75

**Schiotz and Applanation**

Question 76

A 2-year-old poodle presents with **night blindness**. This is an early sign of:

Answer 76

**Progressive retinal atrophy (PRA)**

Question 77

T/F: **Melanoma** is often benign in the canine eyelid

Answer 77

**True**

Question 78

Diagnosis in a cat?

Answer 78

**Feline Diffuse Iris Melanoma** * *Starts as multiple patches* * *Becomes confluent* * *Late metastasis possible*

Question 79

What recently developed drug is known as the 'cure for **KCS**'?

Answer 79

**Doesnotexisticol®** **THERE IS NO CURE FOR KCS** * But we have treatment goals: * Stimulate tear production * Control 2° inflammation or infection * Maintain lubrication * Treat ulcer if present; prevent future ulcers * Educate owner: treatment is FOREVER & FOREVER

Question 80

Inflammation of choroid and retina is termed:

Answer 80

**chorioretinitis** *inflammation of choroid and retina usually due to infectious agent​*

Question 81

Which one of the following findings is _not found_ with **acute glaucoma**? * Cloudy cornea * Blindness * Buphthalmia * Red eye * Painful eye

Answer 81

**Buphthalmia​**

Question 82

What are the two main rule-outs for this condition?

Answer 82

**intraocular neoplasia** and **chronic glaucoma**

Question 83

T/F: **Anterior uveitis** affects the iris and ciliary body, whereas **posterior uveitis** affects the choroid

Answer 83

**True**

Question 84

T/F: Topical steroids may be indicated in cases of **superficial punctate keratitis**

Answer 84

**TRUE** *This is an exception to avoiding topical steroids with corneal ulcers! If you're asked about steroids and ulcers, the general answer is to AVOID.*

Question 85

What **tear film layer** is responsible for stabilizing the tear film?

Answer 85

**outer lipid layer (meibomian gland)** * *Three tear film layers:* * *Inner mucin layer* * *Middle aqueous layer* * *Outer lipid layer*

Question 86

This **layer of the cornea** is _hydrophobic_:

Answer 86

**epithelial layer** * *Hydrophobic: no fluorescein dye uptake if normal (no ulcer).* * *If break (ulcer) in it, see [+] fluorescein dye because it is absorbed by next layer (stroma). Will look ‘smooth,’ not like a crater.*

Question 87

What are the medical and surgical treatments for **bullous keratopathy**?

Answer 87

* _Medical_: * **Topical 5% NaCl ointment**: *minimize edema and bullae formation (need to apply 4x/day)* * _Surgical_: * **Thermokeratoplasty** * *Make multiple small superficial stromal burns with special equipment (referral procedure)* * *Forms scar which helps to get rid of excess water*

Question 88

Removal of the globe and orbital contents is termed:

Answer 88

**exenteration**

Question 89

The **third eyelid** contains the gland of \_\_\_\_\_\_\_\_, which makes up 40% of tears

Answer 89

The third eyelid contains the gland of **_nictitans_**, which makes up 40% of tears ## Footnote *Removing this may cause KCS*

Question 90

This **corneal abnormality** may be due to a post-vaccine reaction to MLV canine adenovirus-1:

Answer 90

**infectious canine hepatitis (blue eye)**

Question 91

T/F: **Glaucoma** in cats is typically primary

Answer 91

**False** *Feline glaucoma is usually secondary to chronic uveitis, aqueous misdirection syndrome (shallow anterior chamber), lens luxation, intraocular neoplasia*

Question 92

Identify the type of ulcerative keratitis:

Answer 92

**Acute Superficial Corneal Ulceration (erosion)** * *This is an uncomplicated ulcer that involves variable degrees of loss of the corneal epithelium and basement membrane* * *Does not extend into stroma* * *Note ‘smooth’ appearance; not a crater!*

Question 93

removal of the globe contents while leaving the sclera & extraocular muscles intact is termed:

Answer 93

**evisceration**

Question 94

For most **proptosed eyes**, what treatment will most likely be needed? * Same treatment as for glaucoma * Exenteration * Enucleation * Temporary tarsorrhaphy

Answer 94

**Temporary tarsorrhaphy** *(lateral canthotomy may also be needed)*

Question 95

In a patient with unilateral **acute primary glaucoma**, what should the contralateral eye be treated with?

Answer 95

**Timolol, dorzolamide, or demecarium bromide** *prophylactically treat the contralateral eye with Timolol, dorzolamide, or demecarium bromide forever*

Question 96

This image shows an ulcer that extends to *what layer of the cornea*?

Answer 96

**Descemet's membrane (DM)** *For a corneal ulcer that extends to DM, only the sides of the crater will stain with fluorescein. This ulcer is termed a _Descemetocele_*

Question 97

Which of the following is NOT USED to treat **glaucoma**? * Atropine * Oral carbonic anhydrase inhibitor * Topical miotic * Mannitol * Topical carbonic anhydrase inhibitor

Answer 97

**Atropine​**

Question 98

This **layer of the cornea** is important in normal corneal epithelial cell turnover and wound healing, as it contains proteinases, natural proteinase inhibitors, growth factors and cytokines:

Answer 98

**tear film** *Outermost aspect of the cornea*

Question 99

_Eversion_ of the lower eyelid; exposing conjunctival surface is termed:

Answer 99

**ectropion** * *Eversion of the lower lid; exposes conjunctival surface* * *Common in dogs; rare in cats* * *Causes* * *Conformational; Loose facial skin: Bloodhounds, St Bernards* * *Paralytic: facial paralysis* * *Acquired: scar after eyelid injury or overcorrection of entropion* * *Signs: subclinical or conjunctivitis, epiphora*

Question 100

What is the only indication for removal of the gland of the nictitans?

Answer 100

**third eyelid neoplasia** * *Uncommon; usually older pets* * *Usually malignant SCC, HSA, LSA, melanoma* * *Can look like cherry eye!* * *Biopsy!* * *Surgical removal of entire TEL, including gland, if neoplastic* * *Only indication for gland removal!*

Question 101

Describe the medical treatment for **ectropion**

Answer 101

**n/a** * Surgery is the only treatment for ectropion (aside from medical treatment for secondary infection that may be associated with the condition)* * Full-thickness V plasty is the surgery*

Question 102

T/F: Cataracts are very common to see associated with **diabetes mellitus** in dogs and cats

Answer 102

**False** *DM uncommonly results in cataracts in cats*

Question 103

T/F: Corneal surgery in cats predisposes them to **corneal sequestrum**

Answer 103

**True** *That's true.*

Question 104

Which is FALSE regarding acquired **eyelid disorders**? * Blepharitis & blepharedema usually is associated with underlying skin dz * Eyelid lacerations although dramatic, are not emergencies * When correcting eyelid lacerations, it is important that apposition of eyelid margins must be exact

Answer 104

**Eyelid lacerations although dramatic, are not emergencies​**

Question 105

Identify this brown-black focal region of **necrotic cornea** in this cat:

Answer 105

**Feline Sequestrum** *(corneal necrosis, corneal nigrum, keratitis nigrum)​* * *Unknown etiology but often hx of previous corneal irritation /ulceration or FHV-1* * *Increased incidence in Persian, Siamese, Burmese and Himalayan* * *Treatment: remove the source of irritation/inflammation or treat for FHV1* * *Conservative treatment usually adequate because in most cases the focal necrotic plaque will detach and slough in several weeks* * *Surgical therapy if no change in 2 to 4 weeks*

Question 106

A 2 year old German shepherd has had an eye discharge for several months. Schirmer tear test results were: OS: 5 mm/min, OD: 2 mm/min. The fluorescein stain was positive for a **superficial corneal ulcer**. Based on these results, which of the following drugs would _not_ be used? * Artificial tears * Cyclosporine A * Tacrolimus * Topical corticosteroid

Answer 106

**Topical corticosteroid​**

Question 107

What term is used to describe abnormal iridocorneal angle due to developmental changes in pectinate ligaments (seen in narrow or closed angle glaucoma)?

Answer 107

**goniodysgenesis**

Question 108

**Gentamicin** is often used (vitreal injection) for pharmacologic ablation of the ciliary body. Why should this be avoided in cats?

Answer 108

gentamicin has been reported to cause **sarcomas** in cats

Question 109

Which of the following is the most common cause of **glaucoma** in cats? * Intraocular neoplasia * Lens luxation * Uveitis * Abnormal iridocorneal angle * Optic nerve atrophy

Answer 109

**Uveitis**

Question 110

With regard to cataracts, what stage of development is best described below: ## Footnote **Affects 15-99% of the lens; vision is affected if the cataracts are bilateral**

Answer 110

**Immature**

Question 111

When the eyelids are fused to each other, this is termed:

Answer 111

**ankyloblepharon**

Question 112

What are the two main causes of **buphthalmos**?

Answer 112

**glaucoma** and **intraocular neoplasia**

Question 113

Which type of conjunctivitis is more common in the _cat_: ## Footnote **primary or secondary**

Answer 113

**primary** *Primary conjunctivitis: common in cat; usually associated with feline herpesvirus or Chlamydophila, calici virus, or mycoplasma*

Question 114

What is your most likely diagnosis?

Answer 114

**uveal cysts**

Question 115

This portion of the **uvea** controls the amount of light entering eye; focuses light on retina:

Answer 115

**Iris**

Question 116

A cat presents with **conjunctivitis** and mild respiratory signs. You identify the organism responsible via PCR and decide to treat with topical tetracycline. What organism was likely identified on PCR?

Answer 116

***Chlamydophila felis*** *Chlamydophila felis* is the 2^nd most common cause of conjunctivitis in the cat

Question 117

Which type of conjunctivitis is more common in the _dog_: ## Footnote **primary or secondary**

Answer 117

**secondary** *Secondary conjunctivitis: common in dog; associated with with systemic (viral, parasitic, bacterial, allergic, immune mediated, etc) & ocular diseases*

Question 118

If a dog presents with **acute primary glaucoma**, still has his vision, and signs have been present for less than three days, what are your two avenues of treatment?

Answer 118

**decrease aqueous production, increase outflow** * ***Decrease aqueous production** - do not give IV fluids* * *_Hyperosmotic agent_: IV mannitol osmotically draws water from eye; dehydrates vitreous* * *_Carbonic anhydrase inhibitor_* * *Oral: Methazolamide (Neptazane, Glauctabs), acetazolamide (Diamox), dichlophenamide* * *Topical: Dorzolamide or brinzolamide* * ***Increase outflow*** * *_F2 α prostaglandin analogue_: Ex: Travoprost. Causes miosis & increase in outflow* * *_Β-adrenergic blocker_: Ex: Timolol, Betaxolol. ↓ aqueous production & ↑ ou􏰘tflow* * *_Parasympathomimetics_: Ex: pilocarpine, demecarium bromide. Both induce miosis*

Question 119

With regard to **cataracts**, what stage of development is best described below: Affects 100% of the lens; can't see the fundus; totally opaque lens; vision loss if bilateral

Answer 119

**Mature**

Question 120

With regard to the healing process of a **superficial stromal ulcer**, at about 30 minutes to 5 hours, _**\_\_\_\_\_\_\_\_**_ infiltrate the defect. After ~12 hours, the keratocytes transform into _**\_\_\_\_\_\_\_\_**_. Collagenases help epithelial cells migrate in. These epithelial cells fill the defect and fibroblasts lay down _**\_\_\_\_\_\_\_\_**_ to restore the stromal defect.

Answer 120

With regard to the healing process of a **superficial stromal ulcer**, at about 30 minutes to 5 hours, **_leukocytes_** infiltrate the defect. After ~12 hours, the keratocytes transform into **_fibroblasts_**. Collagenases help epithelial cells migrate in. These epithelial cells fill the defect and fibroblasts lay down **_collagen_** to restore the stromal defect.

Question 121

Owner says dog had an eye problem and vet had to do surgery. What disease was most likely present to result in this? * Descemetocele * “Boxer” ulcer * Superficial non-healing ulcer * Pannus * Melting ulcer

Answer 121

**Descemetocele** and/or **Melting ulcer**

Question 122

Systemic **Famciclovir** may be used in cats with herpesvirus conjunctivitis. What is the main drawback of this drug in cats?

Answer 122

**may be hepatotoxic** *Famciclovir is an antiviral drug that is active against herpesvirus*

Question 123

Lens proteins are called \_\_\_\_\_\_\_\_

Answer 123

**crystallins** *The lens capsule forms before immune system so embryo fails to learn that lens protein is ‘self.' If there is lens damage and subsequent release of proteins in aqueous, there will be severe inflammation because they are not recognized as 'self'*

Question 124

Why do we not use intraocular prosthesis or intravitreal gentamicin injections in cats?

Answer 124

**increases risk of sarcoma development​**

Question 125

With what dog breed is **pannus** most associated?

Answer 125

**German Shepherds** * *Young, 1–5 yrs, usually severely progressive & extensive* * *Older dogs, 4 ‐6 yrs slowly progressive & extensive* *(Also seen in greyhounds)*

Question 126

If there's no response after debridement of an **indolent ulcer**, what is your next step in treatment?

Answer 126

**grid keratotomy** * *Create scaffold for epithelium to attach* * *May have to repeat 2‐3 x* * *Punctate: less scarring but less likely to heal & more risks*

Question 127

What is **hypopyon**?

Answer 127

**_pus_ in the anterior chamber of the eye​​**

Question 128

**large palpebral fissure** is termed:

Answer 128

**euryblepharon​**

Question 129

Primary glaucoma can be broken down into two types. What are the two types and which one is more commonly seen?

Answer 129

1. **Narrow or closed angle (more common)** 2. **Open angle (less common)**

Question 130

When is **tonometry** performed during diagnostic testing? * After dilating the pupil * After examination of the retina * After fluorescein staining * Before performing Schirmer’s tear test

Answer 130

**After fluorescein staining**

Question 131

What are the two most commonly seen **systemic metabolic diseases** that cause cataracts?

Answer 131

**Diabetes mellitus** and **Cushing's disease**

Question 132

The most common **intraocular tumor** is:

Answer 132

**melanoma** * *Most common intraocular tumor* * *Usually benign in dogs but locally destructive* * *Cats: diffuse pigment changes* * *Refer for evaluation, monitoring, laser?* * *Enucleation when indicated*

Question 133

A 5 year old dog has mucopurulent ocular discharge OU Schirmer Tear Test values: \<5 o.u. Which of the following is the _least likely_ etiology of the findings? * CN 7 damage * Sulfa drug use * Corneal ulcer * Destruction of the lacrimal gland * Etogesic drug use

Answer 133

**Corneal ulcer​**

Question 134

This test can distinguish retinal blindness from optic nerve or intracranial blindness:

Answer 134

**ERG**

Question 135

Identify the type of **ulcerative keratitis**:

Answer 135

**Non‐healing superficial ulcer (chronic ulcer)** *also called chronic corneal epithelial defect, indolent ulcer, Boxer ulcer, etc.​*

Question 136

Name the cells found in the conjunctiva that secrete inner mucin layer of tear film:

Answer 136

**goblet cells**

Question 137

When aberrant cilia from *tarsal gland* grows through palpebral conjunctiva, this is termed:

Answer 137

**ectopic cilia** * *Aberrant cilia from tarsal gland grows through palpebral conjunctiva* * *4-12 mo. old dogs most common* * *Acute onset blepharospasm.* * *Non-healing or recurrent corneal ulcer* * *_Dorsal elliptical ulcer_* * *Often microscopic*

Question 138

2 year old dog. How is this treated? * Topical antibiotics * Replace gland via surgery * Remove scrolled cartilage via surgery * Topical antibiotics and Cyclosporin A

Answer 138

**Replace gland via surgery​** *The picture is showing 'cherry eye.'*

Question 139

This corneal abnormality is characterized by **vesicles in stroma**:

Answer 139

**Bullous Keratopathy​** * *Characterized by vesicles in stroma* * *Due to chronic endothelial disease* * *Stromal bullae may rupture & cause erosions* * *Does not always cause ulcer* * *Bullae may coalesce to form large bullae* * *Surrounding stroma and epithelium may be edematous and vascularized due to bulla or underlying disorder*

Question 140

With regard to cataracts, what stage of development is best described below: ## Footnote **Affects \<15% of the lens; No change in vision**

Answer 140

**Incipient**

Question 141

Diagnosis?

Answer 141

**cherry eye.**

Question 142

T/F: In the case of **deep ulcers**, part of the treatment plan involves administering antibiotics every 1 to 2 hours for the first 24 hours

Answer 142

**True**

Question 143

This dog was hit by a car. What is this? * Exophthalmos * Panophthalmos * Proptosis * Buphthalmos

Answer 143

**Proptosis​**

Question 144

Note the scalloped margin of the pupil in this image. What is your most likely diagnosis?

Answer 144

**senile iris atrophy** * *Senile iris atrophy – scalloped margin* * *PLR reduced* * *Dilated pupil; +/- abnormal shape* * *PLR is reduced, but does not affect vision​*

Question 145

Which of the following is _true_ in treatment for **KCS**? * The drug of choice is topical cyclosporin 0.2% * The drug of choice for neurogenic cases is pilocarpine * Glucocorticosteroids for treatment of chronic KCS * All of the above * A and B

Answer 145

**All of the above​**

Question 146

Which of the following ulcers would you use **grid keratotomy** to treat? * Deep corneal ulcer * Superficial corneal ulcer * Non-healing superficial ulcer * Descemetocele * Melting corneal ulcer

Answer 146

**Non-healing superficial ulcer** *(aka indolent ulcer, "boxer ulcer")*

Question 147

What is the most common **metastatic tumor** seen in the eye?

Answer 147

**lymphoma**

Question 148

What is a normal Schirmer Tear Test result in a dog?

Answer 148

**\> 15 mm/min** *low values are significant*

Question 149

What diagnostic tool is most useful for confirming **glaucoma**?

Answer 149

**tonometer** * *Measures intraocular pressure (IOP)* * *Indentation tonometry* * *Applanation tonometry* * *Rebound tonometry* * *Normal IOP \<25mmHg* * *Glaucoma \>25mmHg*

Question 150

What would you do first? * IOP * Fluorescein stain * Refer * Schirmer tear test

Answer 150

**Schirmer tear test​**

Question 151

For **lens luxations, subluxations, and some cataracts**, the treatment of choice is:

Answer 151

**lens removal** * ***Phacoemulsification** for cataract removal & ruptured lens* * *95% success rate with experience! preferred* * *Small corneal incision; small opening in lens capsule; lens emulsified by ultrasonic handpiece; then aspirated.* * *Artificial lens implanted into capsule* * *Removes entire lens* * ***Intracapsular lens extraction** for luxated lens* * *70% success rate* * *Large corneal incision* * *Artificial lens implant may be sutured into place*

Question 152

Identify the type of **ulcerative keratitis**:

Answer 152

**Bullous keratopathy** *Does not always ulcerate​*

Question 153

Which two parts of the eye are **avascular**?

Answer 153

**cornea and lens** *This is important when thinking about corneal ulcer healing.* * *Vessels invade in response to injury on day 3-6 and supply nutrients and growth factors* * *Source of vessels:* * *Superficial: from _conjunctiva_; tree branching appearance; cross the limbus* * *Deep: from _sclera_; shorter & straighter vessels; may appear as deep red halo near limbus*

Question 154

What are the two most common **tear film abnormalities** and the most important sequela of each?

Answer 154

* **Impaired production** *(results in keratoconjunctivitis sicca - KCS)* * **Impaired drainage** *(results in epiphora)*

Question 155

Inflammation of the tissues of the eye is termed:

Answer 155

**orbital cellulitis** * *May progress to retrobulbar abscess or orbital infection* * *Causes* * *Puncture : unilateral more often (like prior example)* * *Foreign body: more unilateral. Enter via eyelids, mouth or conj. sac* * *Infectious: bacterial, fungal, parasitic or extension from adjacent salivary infection, sinus, tooth root* * *􏰖Idiopathic inflammation: unilateral or bilateral* * *Treatment* * *Topical & systemic antibiotics (Broad Spectrum pending culture)* * *Systemic anti-inflammatories (Steroids preferred)* * *Supportive care*

Question 156

A 10-year-old mixed breed dog presents to your clinic with opacity of the lens. He appears to still have his vision and on direct ophthalmoscopy, you can clearly see the fundus. What is your diagnosis?

Answer 156

**lenticular sclerosis** * *Normal aging of lens* * *Starts about 7 yrs of age (dog) - later in cats* * *Changes refractive index = bluish‐grey appearance when light hits eye at angle.* * *Does not affect vision* * *Can see fundus*

Question 157

A break in Descemet's membrane is termed:

Answer 157

**Haab's striae**

Question 158

Note the wrinkled appearance to the anterior lens capsule from lens protein liquefaction. At what stage of development is this **cataract**?

Answer 158

**Hypermature**

Question 159

Was this image taken using a **direct** or **indirect** ophthalmoscopic technique?

Answer 159

**direct** * *​**Upright image* * *Small field of view* * *Can't see periphery* * *Closer to patient*

Question 160

T/F: Atropine is indicated in cases of **acute primary glaucoma**

Answer 160

**False**! ## Footnote *Atropine is contraindicated. In cases of acute primary glaucoma, you want the eye miotic, NOT mydriatic*

Question 161

Prolapsed gland of the nictitans is termed:

Answer 161

**cherry eye** * *Common in dogs: often \< 2 yrs* * *English bulldogs, Cocker spaniels, Beagles* * *Rare in cats: Burmese* * *_Acute appearance of red mass at medial canthus_* * *Secondary inflammation variable: conjunctivitis, epiphora* * *Rule out neoplasia or other diseases in older pets: FNA or biopsy*

Question 162

What would a _normal_ **Schirmer tear test** result be in dogs?

Answer 162

≥**15 mm/min** * *Dogs* * *􏰚 ≥15 mm/min – WNL* * *􏰚 11-14 mm/min – early* * *􏰚 6-10 mm/min – moderate 􏰚* * *\<5 mm/min - severe* * *Cats* * *≈10 mm/min – WNL* * *\> 5 mm/min may be normal*

Question 163

What breeds are predisposed to **proptosis**?

Answer 163

**brachycephalic breeds** *they have a more shallow orbit*

Question 164

Identify the corneal abnormality:

Answer 164

**melting corneal ulcer with hypopyon ventrally** *Melting ulcer* * *Exogenous proteases released by bacteria cause collagenolysis of stroma* * *Serious condition* * *Usually Gram [-] bacteria, but also can be sterile or due to other bacteria* * *Usually causes or can result in a deep ulcer*

Question 165

T/F: Immunosuppressive agents are indicated in the treatment of **chronic superficial keratitis (pannus)**

Answer 165

**True** *Topical immunosuppression:* * *Ophthalmic 0.1% dexamethasone or 1% prednisolone acetate* * *Cyclosporine 0.2% ointment or 1-2% solution* * *Pimecrolimus or tacrolimus* * *Combination of above* * *Doggle sunglasses*

Question 166

Normal sized globe that protrudes anteriorly is termed:

Answer 166

**exophthalmos**

Question 167

What is the most common **eyelid tumor** that we see in the dog?

Answer 167

**Meibomian gland adenoma​** *Meibomian gland adenoma (sebaceous adenoma or cystadenoma) is usually benign. Can be associated with chalazion due to obstructed gland​*

Question 168

A dog presents with this type of ulcerative keratitis. As part of your treatment protocol, you prescribe topical antibiotics. Which antibiotics would you use?

Answer 168

**triple antibiotic (BNP) or chloramphenicol or gentamicin** *In cats, avoid using BNP (causes anaphylaxis). Instead you can use terramycin, erythromycin, tobramycin, chloramphenicol, or gentamicin.*

Question 169

This **layer of the cornea** makes up 90% of the corneal thickness and is _hydrophilic_:

Answer 169

**stroma** * *Layers of collagen fibers, GAGs, some mesenchymal cells* * *Hydrophilic: will take up fluorescein dye: will look like crater.* * *Slow turnover: 2 years* * *Endothelial cells remove water from this layer. Amount of water in stroma is tightly regulated to maintain corneal clarity*

Question 170

Identify the type of **ulcerative keratitis**:

Answer 170

**Deep corneal ulcer​** *See crater‐like lesion of variable depth in cornea. Includes descemetocele & melting ulcer​*

Question 171

Identify the **corneal abnormality**. Multifocal punctuate circular grey fluffy cotton‐like opacities in corneal stroma:

Answer 171

**Florida Keratopathy: Florida spots, Florida keratitis, Caribbean keratopathy** * *Unknown etiology* * *Multifocal punctuate circular grey fluffy cotton‐like opacities in corneal stroma* * *Inflammatory component* * *Generally not painful* * *Typically asymptomatic* * *Some have a transient conjunctivitis at first* * *Treatment: benign neglect* * *No response to glucocorticoids, antibiotics or antifungals*

Question 172

If a dog presents with an acute **superficial corneal ulceration** as well as miosis and uveitis, what should you make sure to use as part of your treatment plan?

Answer 172

**mydriatic** *_Atropine_ to counteract painful ciliary muscle spasm, to prevent synechia (adhesion of iris to cornea or lens) & to ↓ uveal area available to incite inflammation.​​*

Question 173

Name three fundic signs of **retinal disease**:

Answer 173

**hy**_per_**reflectivity, hy**_po_**reflectivity, and vessel changes** * ***Hy**_per_**reflectivity**: shiny bright tapetum due to thinning of retinal layers allowing more light to be reflected back from tapetum* * *Inflammation, degeneration, toxins, ischemia* * ***Hy**_po_**reflectivity**: dull, fuzzy because of fluid or cell infiltrate between retina & tapetum* * *Hypertension, inflammation, infection, neoplasia* * ***Vessel changes*** * *Decreased size (attenuation) seen with degeneration, anemia, hypovolemia* * *Large size seen with inflammation, hyperviscosity, hypertension, polycythemia* * *Bleeding: trauma, coagulopathy, hypertension, neoplasia, microaneurysms*

Question 174

Inflammation of the lacrimal _gland_ is termed:

Answer 174

**dacryoadenitis**

Question 175

Identify the type of **ulcerative keratitis**:

Answer 175

**Corneal laceration​** *If deep, can exude aqueous humor; iris can prolapse. Small lacerations may heal quickly​*

Question 176

This **acquired vitreal disease** results when Ca²⁺ and phospholipids condense within the vitreal gel. It is seen in older pets:

Answer 176

**Asteroid Hyalosis**

Question 177

What is **hyphema**?

Answer 177

**blood in the anterior chamber of the eye​**

Question 178

Identify the type of **ulcerative keratitis**:

Answer 178

**Acute superficial corneal ulcer** *(aka corneal erosion). Epithelial layer involved*

Question 179

For which condition below would you use **autologous serum** in the treatment? * Indolent corneal ulcer * Melting corneal ulcer * Non-ulcerative keratitis * Superficial corneal ulcer

Answer 179

**Melting corneal ulcer​**

Question 180

Golden retreiver presents with waxing/waning "surprised" expression over the past 2 weeks; non-painful when the mouth is opened. Orbital tissues are not hyperemic and the dog's behavior is normal. What is your primary differential?

Answer 180

**extraocular polymyositis** * *Etiology is known; more than likely immune-mediated* * *Treat with corticosteroids* * *​May relapse* * *Good prognosis*

Question 181

When treating a **corneal ulcer** with \_\_\_\_\_\_\_\_, the resultant mydriasis will prevent ________ from occurring. * Antibiotics, a descemetocele * Tropicamide, glaucoma * Atropine, synechiae * Steroids, melting ulcer

Answer 181

When treating a corneal ulcer with **_Atropine_**, the resultant mydriasis will prevent **_synechiae_** from occurring.

Question 182

What is a **senile cataract**?

Answer 182

**The most advanced form of _nuclear sclerosis_** * *Fundus view is obscured* * *Impaired vision* * *Dogs \>14 years old* * *Cats older*

Question 183

Adhesion of the conjunctiva to itself or the cornea is termed:

Answer 183

**symblepharon** *Treatment: eliminate infection; trim tissue; often repeat trimming*

Question 184

Presence of haired skin on the surface of the eye is termed:

Answer 184

**dermoid**