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VMS3011 Veterinary Medicine 2 > Special Senses Treatment > Flashcards

Special Senses Treatment Flashcards

1
Q

Intraocular neoplasia

A
  • Depending on tumour behaviour, size, pigment content, visual potential of eye
  • Referral - diode/Nd:YAG laser photocoagulation
  • Referral - local excision = small, well-circumscribed tumours via iridectomy/iridocyclestomy
  • Enucleation - if 2y glaucoma/uveitis/larger tumour
  • Exenteration when extrascleral extension
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2
Q

Intraocular melanoma

A
  • Small mass - local excision via iridectomy/iridecyclectomy, poor post-op results (hyphaemia v likely)
  • Enucleation - preferred
  • Exenteration - if there is evidence of sclera/conjunctiva penetration
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3
Q

Hyphaema

A
  • Cage rest
  • Corticosteroids
  • Mydriacyl / Atropine = mydriatic, dilates pupil
  • Monitor glaucoma
  • Irrigation aspiration
  • Intracameral tPA - tissue plasminogen activator to resolve blood clot
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4
Q

Uveitis (granulomatous) (companion animal)

A
  • 1). Anti-inflam - corticosteroids (prednisolone, dexamethasone, subconjunctival corticosteroids)
  • 2). Acute uveitis/corticosteroids contraindicated = antiprostaglandins/NSAIDs: oral: aspirin; topical drops: acular, keratolac, naclof/Voltaren, ocufen; rimidyl; Metacam
  • 3). Immunosuppressive - azathioprine (imuran) - refractory cases, long-term therapy w/ prednisolone
  • 4). Mydriatics - atropine; tropicamide (mydriacyl, mydriaticum) = short-acting; adrenergic drugs - when danger or 2y glaucoma
  • 5). Fibrin/blood clot lysis - GA procedure, magnification + aseptic; if clot substantial; intracameral tPA can be used (tissue plasminogen activator)
  • 6). AB - will penetrate acutely inflamed uveal capillary bed when plasmoid aqueous produced
  • 7). Supportive Tx e.g. keep in dark due to photosensitivity
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5
Q

Cataract management (short-term therapy)

A
  • Atropine 1% - 1 drop every 2 - 3 d
  • Tx of lens-induced uveitis
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6
Q

Cataract surgery

A

-

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7
Q

Corneal ulceration - medical Tx

A
  • Topical AB (systemic in some cases)
  • Topical antivirals (cats - FHV-1)
  • Artificial tears
  • Collagenase inhibitors for melting ulcers
  • Atropine - reflex uveitis (not in KCS)
  • Analgesics (NOT topical/local - epitheliotoxic)
  • Contact lenses
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8
Q

Simple, epithelial corneal ulceration - management

A
  • Broad spectrum AB - BID/TID
  • Tear replacement therapy
  • Prevention of self-trauma
  • Pain control - systemical/topical NSAID
  • Atropine - reflex uveitis, v severe miosis
  • Re-exam 7 d - if not healed -> complicated ulceration
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9
Q

Stromal corneal ulceration - management

A
  • Broad spectrum AB
  • Antiproteolytic agents - autologous serum, N-acetylcysteine (stromease)
  • Atropine (not KCS)
  • Systemic NSAID +/- more potent analgesia
    (DON’T USE TOPICAL CORTICOSTEROIDS - can promote melting
  • Sx
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10
Q

Pseudomonas infection

A
  • Fluoroquinolones
  • Gentamicin
  • Tobramycin
  • Neomycin
  • PolymyxcinB
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11
Q

Streptococcus spp. infection

A
  • Bacitracin
  • Gramicidin
  • Cephalosporins
  • Penicillins
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12
Q

Melting ulcer

A
  • Loading dose - 1 drop every 5 min for 6 - 12 doses, followed by 1 drop every 1 - 2 h for 24 - 48 h
  • Ciprofloxacin (ciloxan) (AB) first choice (ofloxacin (exocin) = when other AB ineffective)
  • Autologous serum, anti-collagenase agent, EDTA/N-acetylcysteine)
  • Systemic AB if risk of globe rupture
  • Analgesia - NSAID
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13
Q

Corneal ulceration - Sx Tx

A
  • Epithelial debridement
  • Superficial keratotomy - SCCED: grid keratotomy, diamond bur keratotomy, punctate keratotomy
  • Conjunctival graft, island graft, 360 degree conjunctival flap, pedicle graft - gives blood supply, bridge of conjunctiva to surface of eye
  • Corneoscleral transposition
  • Cyanoacrylate adhesives (tissue glue, ophthalmic)
  • Third eyelid flap
  • Amnion graft/patch (equine) - from mare’s placenta, scaffold for eye
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14
Q

Recurrent epithelial erosion

A
  • Prophylactic AB every 6 - 13 h, cornea compromised
  • Debridement
  • Grid/punctate keratectomy
  • Superficial keratotomy
  • Diamond burr debridement
  • Tarsorrhaphy (joining upper + lower eyelids together)
  • Third eyelid flap
  • Bandage contact lens
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15
Q

Pannus - chronic superficial keratitis

A
  • No cure - life-long therapy
  • Initially topical corticosteroid - 1% prednisolone, 0.1% dexamethasone, TID/QID
  • Topical cyclosporine (0.2 - 2 %) w/ or w/o corticosteroids BID

Refractory cases:
- Subconjunctival injection of corticosteroids
- Beta-radiation
- Superficial keratotomy

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16
Q

Corneal lacerations - non-penetrating

A
  • Freq re-exam if stromal exposure small
  • Debridement
  • AB
  • Analgesia
  • Tear replacement therapy
  • Direct suturing or conjunctival graft
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17
Q

FHV-1 keratitis (cats)

A
  • Topical AB
  • Famciclovir q12 h (antiviral)
  • L-lysine q12 - 24 h
  • Autologous serum
  • Tear replacement therapy
  • Environmental modifications - stress reduction, overcrowding control
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18
Q

Corneal sequestrum (cat)

A
  • Topical AB
  • Famciclovir q12 h (antiviral)
  • L-lysine q12 - 24 h
  • Autologous serum
  • Tear replacement therapy
  • Environmental modifications - stress reduction, overcrowding control, hygiene, nutrition
  • Sx: keratotomy, contact lens, conjunctival flap, corneoscleral transposition
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19
Q

Feline eosinophilic keratitis

A
  • Topical AB
  • Famciclovir q12 h (antiviral)
  • L-lysine q12 - 24 h
  • Autologous serum
  • Tear replacement therapy
  • 0.1% Dexamethasone phosphate - glucocorticoid
  • Topical cyclosporine
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20
Q

Feline eosinophilic keratitis

A
  • Topical AB
  • Famciclovir q12 h (antiviral)
  • L-lysine q12 - 24 h
  • Autologous serum
  • Tear replacement therapy
  • 0.1% Dexamethasone phosphate - glucocorticoid
  • Topical cyclosporine (immunosuppressant)
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21
Q

Bacterial conjunctivitis

A
  • Correct 1y cause
  • Prevent self-trauma
  • Topical broad spectrum AB
  • Systemic AB if blepharitis/dermatitis/otitis preent
22
Q

Infectious bovine keratoconjunctivitis (IBK)

A
  • Topical AB - cloxacillin
  • Sub-conjunctival injection - penicillin/oxytetracycline
  • Systemic AB
  • Systemic NSAIDs
23
Q

Pink eye/infectious keratoconjunctivitis (IKC) (sheep)

A
  • Topical AB - cloxacillin (orbenin + opticlox)
  • Systemic NSAIDs
24
Q

Ophthalmic trauma (production animal)

A
  • Conservative - topical AB, NSAIDs, systemic AB if generalised infection in/around eye
  • Surgical repair +/- enucleation
25
Q

Listeria uveitis (ruminants)

A
  • Systemic AB - single dose long-acting oxytetracycline
  • Sub-conjunctival injection - penicillin/oxytetracycline +/- dexamethasone
  • Systemic NSAIDs
26
Q

Squamous cell carcinoma (cattle)

A
  • Third eyelid resection - early stages
  • Enucleation - later in disease process
27
Q

Entropion (sheep)

A
  • Manually correct
  • Subconjunctival injection (palpebral)
  • Metal clips
  • Sx - resection
28
Q

Glaucoma (companion animal)

A
  • Osmotic diuretics - mannitol
  • Aqueocentesis
  • Reduce aqueous production: carbonic anhydrase inhibitors (trusopt = dorzolamide, cosopt); alpha-agonists (iopidine) + reduces episcleral venous pressure; beta-blockers (timolol)
  • Inc aqueous outflow - cholinesterase-inhibitor (demecarium bromide)
  • Prostaglandin analogues (latanoprost/xalatan, travoprost/travatan, bimatoprost/lumigan), don’t use when there is concurrent uveitis
  • Neuroprotection - Ca2+ channel blockers, dextromethophortan, memantine, amlodipine, corticosteroids
  • Sx - cryotherapy, laser ablation of ciliary body, scleral trephination + peripheral iridectomy, anterior chamber valves, intraocular gentamicin
29
Q

Glaucoma (cat)

A
  • Carbonic anhydrase inhibitor (trusopt)
  • Beta-blocker (timolol) -> miosis, aggravate pupil block glaucoma
  • Apha-2 agonist - dec production, inc outflow, reduces episcleral venous pressure, dec HR, can lead to V+
  • Prostaglandin analogues - reduction of IOP, miosis
30
Q

Glaucoma - blind eyes

A
  • Enucleation
  • Evisceration + intraocular prosthesis
31
Q

Inherited Retinal Degenerations (Progressive Retinal Atrophy/ PRA)

A

(No true Tx available, genetic disease)

  • Antioxidant medication (lutein, zeaxanthin, grape seed extract, lycopene (eyes Rx plus), ocuglo)
  • Home management
  • Subretinal stem cell implants
32
Q

Hypertensive retinopathy

A
  • Calcium channel blockers - amlodipine
  • Beta-blockers, ACE inhibitors (fortekor)
  • Prednisolone +/- furosemide
33
Q

Optic neuritis

A
  • Prednisolone 1.1 mg/kg BID (anti-inflam)
  • If visual - Tx 6w
34
Q

Sudden acquired retinal degeneration

A

(No reliable Tx)

  • Experimental intravitreal immunoglobulins
  • Leflunomide?
  • Corticosteroids
35
Q

Orbital abscess/FB/cellulitis (companion animal)

A
  • Drainage - depending on location (pus + infection introduced)
  • Systemic AB - broad spectrum whilst results pending (amox-clav, cephalosporin)
  • Ocular maintenance - ocular lubricants, topical AB
  • Analgesia
36
Q

Traumatic proptosis (companion animal)

A
  • Sx replacement - temporary tarsorrhaphy (lateral suture to ensure doesn’t relapse)
  • Keep animal quiet/calm
  • Analgesia
  • Clean globe before replacement
  • Lubrication
  • AB - topical if patient compliant, systemic if not
37
Q

Distichiasis (companion animal)

A
  • Epilation (forceps)
  • Diathermy/electrocautery - lid splitting
  • Surgical resection - remove part of eyelid/eyelid wedge ressection
  • Cryotherapy - liquid nitrogen/nitrous oxide
38
Q

Ectopic cilia (companion animal)

A
  • Surgical resection
39
Q

Trichiasis (+ nasal fold) (companion animal)

A
  • Surgical correction of eyelid abnormalities
40
Q

Entropion (companion animal)

A
  • Conservative - until 12 - 18 m (shar peis require earlier surgical intervention at 12 w then repeat later): ocular lubrication, tacking sutures, monitor corneal + eyelid health
  • Sx - Celsus-Hotz, +/- medial canthoplasty, +/- lateral palpebral ligament resection
41
Q

Blepharitis (companion animal)

A
  • Systemic + topical AB
  • Identify underlying cause - dermatological case
42
Q

Eyelid neoplasm (companion animal)

A
  • If <25% total lid length affected = simple excision + repair
  • If >50% total lid length affected = reconstructive blepharoplasty
43
Q

Tear film deficiency (KCS) (companion animal)

A
  • Cyclosporine (Optimmune) (immune-modulator), stimulates tear production, BID
  • Tacrolimus (Proptopic) - calcineurin inhibitor, second line Tx
  • Pilocarpine - only for neurogenic KCS, BID, oral
  • Tear substitute (for quantitative/qualitative disorders) - aq tear replacements QID e.g. carbomer gel during day, soft white paraffin overnight
  • Maintain good ocular hygiene - cleaning, trimming fur around face, managing 2y infection
  • Sx - parotid duct transposition (tears substituted w/ saliva) + facial wetting from too much saliva, mineral deposits on cornea + eyelids
44
Q

Prolapsed nictitating membrane (cherry eye) (companion animal)

A

Surgical repositioning:
- 1). Posterior pocketing - create pocket in NM for gland
- 2). Anchor gland

45
Q

Nasolacrimal disease (companion animal)

A
  • Normograde irrigation
  • Topical/GA
46
Q

Tear substitution (companion animal)

A
  • Aq substitute e.g. Celluvisc
  • Mucinomimetics e.g. Ocry-gel
  • Viscoelastic e.g. Remend, Viskyal
  • Lipid-based e.g. Lacrilube
47
Q

Globe removal (companion animal)

A
  • 1). Enucleation - removal of globe, conjunctiva + eyelids
  • 2). Exenteration - removal of globe, orbital contents + eyelids (neoplastic changes, later canthotomy more appropriate)
  • 3). Evisceration - removal of intraocular structures (uvea, lens, retina + vitreous), leaving corneal-scleral shell for intrascleral prosthesis
48
Q

Non-healing corneal ulcer (equine)

A
  • Antibacterial - gentamicin, chloramphenicol, ciproflox, mainly for G-, strep = G+
  • Antifungal - enilconazole, voriconazole
  • Antiprotease (EDTA solution, serum) - inhibition of MMPs (prevent vascularisation/healing of cornea)
  • Atropine
  • Subpalpebral lavage catheter essential
49
Q

Uveitis (acute) (equine)

A
  • Mydriatics - 1% atropine
  • Anti-inflam - NSAIDs: systemic (flunixin); topical (bromfenac)
  • Glucocorticoids (if not ulcerated): systemic (dexamethasone, prednisolone); topical (prednisolone, good ocular penetration)
  • Keep out of sunlight
50
Q

Uveitis (chronic/quiescent) (equine)

A
  • Mydriatics - 1% atropine
  • Anti-inflam - NSAIDs: systemic (phenylbutazone/suxibuzone); topical (bromfenac)
  • Glucocorticoids (if not ulcerated): systemic (dexamethasone, prednisolone); topical (prednisolone, good ocular penetration)
  • Keep out of sunlight
  • Other: sub-scleral cyclsporin implant; virectomy; low-dose intravitreal gentamicin; enucleation
51
Q

Glaucoma (equine)

A
  • Timolol maleate - beta-adrenergic antagonist -> dec ciliary blood flow + aq production
  • Dorzolamide - carbonic anhydrase II inhibitor - dec aq production
  • Sx: transscleral cyclophotocoagulation (TSCP) - laser destruction of ciliary body to dec aq production

VMS3011 Veterinary Medicine 2 (20 decks)

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