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IP 11 Ophthalmology > 4: conjunctiva - giuliano > Flashcards

4: conjunctiva - giuliano Flashcards

1
Q

what is the conjunctiva?

A

pink, fleshy structure that coats and lines part of the globe

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2
Q

what are the regions of the conjunctiva?

A

palpebral conjunctiva
bulbar conjunctiva
fornix
Nictitans: anterior and posterior surface

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3
Q

where is the palpebral conjunctiva loc?

A

under the eyelid, facing the globe

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4
Q

where is bulbar conjunctiva?

A

the conjunctiva that projects on to the surface of the globe

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5
Q

what is the fornix of the conjunctiva?

A

the space where the conjunctiva folds over itself, loc superior and inferior to the bulbar conjunctiva

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6
Q

what is the fxn of the conjunctiva?

A
  • glove movement [low friction]
  • physical barrier [mucus of goblet cells]
  • immunologic barrier [conjunctival associated lymphoid tissue, M cells]
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7
Q

what is work up for conjunctival dz?

A

MODB - minimum ophthalmic data base

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8
Q

what are things to r/o when considering conjunctival dz?

A
  • tear deficiency
  • corneal dz
  • intraocular dz
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9
Q

what additional diagnostics might be conducted for conjunctival dz?

A
  • cytology
  • culture
  • biopsy
  • NL flush
  • rose bengal stain
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10
Q

c/s of conjunctival dz?

A 
epiphora
chemosis 
hyperemia
tissue proliferation
mucopurulent exudate
emphysema
hemorrhage
pruritis
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11
Q

what is epiphora?

A

tearing - inc in serous discharge

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12
Q

what causes epiphora?

A
  • inc prod: pain, irritation

- dec outflow: NL obstruction

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13
Q

what is chemosis?

A

conjunctival edema

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14
Q

what causes chemosis?

A
  • allergic rxn
  • trauma
  • infectious agents
  • tumors [rare]
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15
Q

what infectious agents cause chemosis?

A

chlamydophila felis

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16
Q

what infectious agents causes hyperemia?

A

herpes

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17
Q

what is hyperemia?

A

redness

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18
Q

what 2 types of hyperemia that are important to distinguish within the eye?

A

conjunctival vs scleral hyperemia

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19
Q

what does conjunctival hyperemia look like?

what kind of dz does this suggest is in the eye?

A

superficial
tortorous vessels, branching
move with conjunctiva
blanch with the epithelium

SUPERFICIAL DZ

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20
Q

what does scleral hyperemia look like?

what kind of dz does this suggest is in the eye?

A 
deeper red
straighter
less branching
immobile 
blanch slowly

DEEP DZ, FROM W/IN THE EYE

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21
Q

what is mucopurulent exudate?

A

excess mucus with WBCs

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22
Q

what are causes of mucopurulent exudate?

A
  • KCS [dry eye]
  • bacT infections
  • viral infections
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23
Q

what is emphysema of the eye?

A

entry of air into the periorbita from surrounding tissues

swelling and crepitus of conjunctiva

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24
Q

what causes emphysema of the eye?

A

trauma to sinus or tracheostomy

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25
Q

what is the term for hemorrhage inside the eye?

A

hyphema

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26
Q

what is the definition of hemorrhage in the eye?

A

extravasation of blood w/in the conjunctiva

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27
Q

what causes hemorrhage in the eye?

A

trauma: strangulation, CSF tap / SAH

often a manifestation of systemic dz:
septicemia
vasculitis
coagulopathies

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28
Q

what are 2 categories of tissue proliferation w/in the eye?

A

follicle formation or swelling/mass

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29
Q

what are 2 reasons for follicle formation w/in the eye?

A

lymphoid follicles [normal or abnormal location]

allergies

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30
Q

what are causes of mass or swelling in the eye?

A 
neoplasia
immune mediated
granuloma
congenital
gland prolapse
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31
Q

what are some causes of pruritus of the eye?

A

itching

2* lesions: alopecia, erythema, stained/matted hair [MC region or periocular]

32
Q

cats and cows 1* get what type of conjunctivitis?

A

infectious - bacT and viral

33
Q

what species MC get non infectious conjunctivitis?

A

canine and horse

34
Q

what is common cause of canine conjunctivitis?

A

pannus
KCS** (2 conjunctivitis)
entropion
FB

2* infections may occur

35
Q

what is common cause of equine conjunctivitis?

A

immune mediated
keratitis
uveitis

36
Q

conjunctivitis tx goals?

A 
make diagnosis
remove all exudates/cleanse the eye
maintain surface moisture
control 1* / 2* infections
reduce inflammation
37
Q

what are signs of feline conjunctivitis allergic reactions?

A

chemosis
epiphora
anaphylaxis possible

38
Q

feline conjunctivitis allergic reaction dx?

etiology?

A

hx!

administration of triple antibiotic (poly-bac, TAB) - suspected neomycin

39
Q

what is Tx of feline conjunctivitis allergic reactions?

A

discontinue therapy

+/- anti inflammatory therapy

40
Q

what is the MC etiology of feline conjunctivitis?

A

herpes - viral infection

41
Q

in addition to the risk of an allergic reaction, why is it typically not appropriate to administer TAB or poly-bac that contains neomycin?

A

it does not treat the MC etiology of conjunctivitis => herpes virus infection

and it does not treat the more common bacT causes either…

42
Q

what bacT infections in cats are common causes of conjunctivitis?

A

chlamydophila felis

mycoplasma

43
Q

c/s of feline conjunctivitis caused by chlamydophila felis?
dx?
tx?

A

chemosis
sneezing
nasal discharge

dx: cytology, PCR
tx: tetracyclines***, azithromycin [oral]

44
Q

c/s of feline conjunctivitis caused by mycoplasma spp?

dx?

tx?

A

conjunctivitis
90% cats normal

dx: cytology

tx: tetracyclines
topical oxytet
oral doxy or mino

45
Q

c/s of feline conjunctivitis caused by FHV-1?

dx?

tx?

A

hyperemia***
sneezing and nasal discharge - MC in kittens
keratitis

dx: serology, cytology, PCR, IFA, virus isolation
tx: oral L-lysine and anti viral agents

46
Q

t/f

anti viral agents are created among species. acyclovir and valcyclovir, common human anti viral agents, are safe to use in cats

A

false

they can kill cats - DO NOT USE THEM

47
Q

what is most classic lesion you will see in a cat infected with FHV-1?

A

dentritic corneal lesions - branching ulcers or erosions

48
Q

what is the major oral anti viral drug given to tx FHV-1 infections?

A

famciclovir

49
Q

what are two issues with topical anti viral drugs, such as cidofovir?

A

must be given often - b/c anti virals are static, NOT cidal

also, they sting - cats are very sensitive

50
Q

how would a clinician describe FHV-1 latency?

A

a period of time when a patient does not show any c/s of viral infection

51
Q

besides stress induced outbreaks, what will reactivate FHV-1 infection?

A

pharmacologic stress: corticosteroids [or epinephrine]

52
Q

how do FHV-1 establish latency?

A

by traveling down the sensory Nn from the site of replication - lies dormant in the sensory ganglia

53
Q

what type of transport does virus utilize in sensory neurons?

A

retrograde transport

54
Q

how does stress bring FHV-1 out of latency?

A

causes viral rep at site of latency w subsequent transport of the virus in the sensory Nn

virus travels to target tissue, replicates, causes clin dz

55
Q

how does lysine tx inhibit viral replication?

A

the virus incorporates lysine into its genome, instead or arginine, but then it cannot replicate properly

arginine cannot be removed from diet b/c it is necessary for life but influxes of lysine inc proportion of lysine in the genome

56
Q

t/f

lysine offers a cure to viral infection

A

false

dec duration and severity of clin dz - is NOT a cure

57
Q

what is symblepharon?

A

adherence of conjunctiva to cornea or itself

58
Q

what are 3 FHV-1 related conditions?

A

symblepharon
eosinophilic keratoconjunctivitis
corneal sequestrum

59
Q

what is common presentation of corneal sequestrum?

A

necrotic cornea - looks like a burn in the cornea

60
Q

corneal sequestrum tx?

A

keratectomy

61
Q

what is c/s of calcivirus in cats?

A 
ocular discharge - minimal conjunctivitis, no keratitis
oral ulceration ****
ptyalism (excess salivation)
nasal discharge
sneezing
62
Q

what is the common signalment of canine conjunctivitis caused by allergy?

c/s?

A

large breed dogs

follicles, periocular erthema, chemosis, skin/ears affected

63
Q

what is the pathogenesis of allergic canine conjunctivitis?

dx?

A

direct contact
inhalation
ingestion

cytology: lymphocytes and plasma cells

64
Q

Tx of canine allergic conjunctivitis?

A

flush out allergens w sterile eye wash
corticosteroids: topical, systemic
cyclosporine
allergy meds: mast cell stabilizers, anti histamines, eosinophil inhibitors

65
Q

c/s of canine conjunctivitis caused by KCS?

dx?

A

conjunctivitis
keratitis
mucopurulent discharge

dx: schirmer tear test

66
Q

etiology of canine conjunctivitis caused by trauma/irritation?

tx?

A 
FB
entroption
ectroption
direct trauma: strangulation, head trauma, CSF tap
masses (dermoids)

tx: remove 1* cause
anti inflammatory medication

67
Q

t/f

trauma should always be at the top of your differential list

A

false

trauma is unlikely - so unless it was witnessed, it should be on the bottom of the list

68
Q

canine viral conjunctivitis common etiologies?

A

canine distemper #1
adenovirus
herpesvirus

69
Q

what are early and chronic signs of distemper?

A

early: serous discharge, conjunctival hyperemia, systemic dz
chronic: KCS [viral adenitis], mucopurulent rhinitis

70
Q

what are some non neoplastic types of conjunctival masses?

A 
dermoids
nodular granulomatous episcleritis
cysts
granulation tissue
parasites
71
Q

what type of granulation tissue is MC present in cats?

horses?

A

cats: lipogranuloma
horses: habronemiasis

72
Q

what kind of parasite commonly affects the eyes?

A

oncocerca

73
Q

common conjunctival masses that are neoplastic?

A
  • melanoma, melanocytoma
  • SCC
  • adenoma, adenocarcinoma
  • HSA, hemangioma
  • papilloma
  • LSA
74
Q

what is the leading presentation of cats with systemic LSA?

A

ocular findings

uveitis

75
Q

clinical approach to conjunctival masses?

A

dx: clin presentation, cytology, biopsy
tx: tailored to condition

IP 11 Ophthalmology (13 decks)

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