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Neurology & Special Senses > 1.0 Clinical Examination of the Eye > Flashcards

1.0 Clinical Examination of the Eye Flashcards

1
Q

What are the steps of a clinical eye exam?

A
  1. Hands off exam
  2. Hands on exam
  3. Schirmer tear test (STT1)
  4. Tonometry
  5. Focal Light Exam
  6. Ophthalmoscopy
  7. Complementary tests (other)
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2
Q

What does the hands off ophthalmic exam comprise of?

A
  1. Hx, signs, and signalment
  2. behavior (vision, signs of discomfort)
  3. size and position of the eye
  4. symmetry of the eyes and face
  5. abnormal eyelid conformation
  6. ocular discharge
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3
Q

What does DAMNITC stand for?

A

Possible differentials:

D: developmental, degenerative

A: acquired, autoimmune

M: metabolic

N: neoplastic, nutritional, neurologic

I: infectious, inflammatory, immune, inherited

T: traumatic, toxic

C: congenital

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4
Q

What does the hands on exam comprise of?

A
  1. Palpate and gently retropulse the globes (in dogs, horses, and cats)
    • Retropulsion: Use 2 fingers to gently push on the globe via upper eyelid → resist or sink into globe
  2. Closely examine the adnexa (eyelids), including the third eyelid
  3. Examine each external component of the globe separately: conjunctiva, episclera, and cornea
  4. Test the cranial nerves:
    1. Palpebral reflex
    2. Menace response
    3. Vestibulo-ocular reflex

NOTE: with corneal or scleral rupture patients present with red eye but should be minimally manipulated and treated as a fragile eye! Tests may be contraindicated.

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5
Q

What test is indicated for infectious keratitis?

A

corneal cytology, culture and sensitivity

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6
Q

What test in indicated for glaucoma?

A

gonioscopy (measures the angle between the iris and the cornea, using a goniolens together with a slit lamp or operating microscope)

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7
Q

What test is indicated for uveitis?

A

systemic investigations, ocular US

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8
Q

What investigations are indicated for retrobulbar disease?

A

MRI/CT

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9
Q

What is the shirmer tear test?

A

The Schirmer Tear test is a semiquantitative method of measuring the aqueous portion of the precorneal tear film.

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10
Q

When do you perform a Shirmer tear test?

A

BEFORE any manipulation of the eye, bright light exposure, or application of topical solutions.

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11
Q

How is the Shirmer tear test performed?

A
  1. Fold the strip while still packaged
  2. Remove from the packaging from the end NOT to be in contact with the eye (do not touch this portion)
  3. Retract the lateral lower eyelid with your thumb
  4. Insert the tip of the strip (up to the notch) into the lower conjunctival formix
  5. Wait ONE MINUTE per eye
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12
Q

What are normal Schirmer tear test readings?

A

Dog (mm/min):

> /= 15: Normal
10-15: suspicious of KCS
<5: definitely KCS

NOTE that readings must be considered in the context of the eye as a whole → e.g., if the eye is ulcerated or aggitated and is still reading 15mm/ml, the dog is likely UNDER-producing tears despite a normal Shirmer test reading.

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13
Q

What is tonometry?

A

Tonometry measures intraoccular pressure (IOP), which is diagnostically very powerful.

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14
Q

When should tonometry be performed

A

BEFORE pharmocological dilation of the pupil (can increase IOP)

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15
Q

What are the three ways IOP can be measured?

A
  1. Indentation (Schiotz)
  2. Applantation (Tonopen)
  3. Rebound (Tonovet)
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16
Q

What is the difference between the Tonopen and the Tonovet?

A

The Tonopen requires local anesthetic, but may be used in any position (e.g., patient on a table facing up); the Tonovet does NOT require local anesthetic, but must be taken in an upright position (gravity-dependent).

17
Q

What are normal IOP readings?

A

10-25mmHg

Variability is high between individuals, species, time of day, head position, etc. BUT measurements between the left and right eye should not vary more than 20% in a single individual.

18
Q

What tool does the focal light exam use?

A

the focal light exam uses a direct opthalmoscope, finoff transiluminator, or pen torch

19
Q

List the tests to be performed during a focal light exam.

A
  1. Dazzle reflex
  2. Pupillary light reflex (PLR)
  3. Swinging light test
  4. Retroillumination
  5. Other (Purkinje reflex, corneal / iris lesions, tyndall effect)
20
Q

What is the dazzle reflex?

A

Shine a bright light in the eye. In response, the eye should close (+- the head should move away).

CNII -> CNVII (+- XI)

21
Q

What is the PLR?

A

The pupil constricts in response to light. Check for a direct (ipsilateral) and indirect (contralateral) response to test for nerological deficits.

22
Q

What is the swinging light test?

A

Used to check for relative afferent pupillary defects.

A normal response: the pupil constricts as the light crosses its path, dilates slightly as the light crosses the nose, and then constricts again as the light crosses the other eye.

23
Q

What is retroillumination?

A

also called distant direct (low-light) opthalmoscopy

illuminates the tapetum lucidum and visualize pupillary size, shape, and the presence of opacities within the visual axis

24
Q

What is the term for unequal pupil size?

A

anisocoria

25
Q

What is the term for abnormal pupil shape?

A

dyscoria

26
Q

What is the Purkinje reflex?

A

occular surface light reflections: if normal, it will be bright, sharp, and smooth; if abnormal, it will be dull and broken

27
Q

What are the differences between direct and indirect opthalmoscopy?

A

DIRECT:

  • Provides a direct, upright image of the fundus at 19.5x magnification
  • VERY limited field of view (like looking through a keyhole)
  • Pupils do NOT need to be dilated
  • Light intesity and color may be adjusted: white (most commonly used), green (red-free filter used to distinguish pigment from hemorrhage), and blue (for viewing fluorescence)

Dioptre may be adjusted to see at various depths of the eye

INDIRECT:

  • Provides a virtual, inverted and slightly magnified image of the fundus
  • Wide field of view
  • Pupils must be dilated
  • Best used as a preliminary method to examine the eye → should be followed by direct opthalmoscopy
28
Q

What takes up fluorescein stain?

A

fluorescein stain will stain stroma but not the lipophilic descemet’s membrane, thus you can tell how deep an ulcer is

29
Q

What light detects fluorescein stain?

A

cobalt blue

30
Q

What is the Jones test?

A

uses fluorescein stain to test nasolacrimal duct patency

Fluorescein stain → wait a few minutes (≤ 4 mins) → monitor flow to the nose

Reaches nose → patent NLS

Doesn’t reach nose → not functioning NLS → flush

31
Q

What is the Seidel test?

A

uses fluorescein stain to check for active anterior chamber leakage

32
Q

When is corneal / conjunctival cytology indicated?

A

Mainly used to select an appropriate antibiotic in the supportive care of ulcers

Must numb the eye with topical anesthetic and sample with a cytobrush

diffquick stain is used for cytology

33
Q

What is gonioscopy?

A

checks for signs of glaucoma by evaluating your eye’s drainage angle (anterior chamber angle)

Neurology & Special Senses (22 decks)

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