All Ophtho Flashcards by Madison Warnke

What are the functions of the uvea?

(Aqueous humor dynamics, remove waste, absorb light, control light, and is the blood aqueous barrier)

How well did you know this?

Not at all

Perfectly

What anatomical structures make up the uvea which is the vascular tunic of the eye?

(The iris, the ciliary body, and the choroid)

How well did you know this?

Not at all

Perfectly

What anatomical structure is affected in anterior versus posterior uveitis?

(Anterior → iris and ciliary body; posterior → choroid)

How well did you know this?

Not at all

Perfectly

What are some of the ocular signs of uveitis?

(Episcleral injection, ciliary flush, corneal edema, miosis, synechiae, aqueous flare, hyphema, hypopyon, keratic precipitates, and rubiosis irides)

How well did you know this?

Not at all

Perfectly

What is the term for 360 degree vascularization of the cornea that you will not typically see with surface diseases so it indicates something wrong inside the eye?

(Ciliary flush)

How well did you know this?

Not at all

Perfectly

What results in miosis in cases of uveitis?

(Painful spasming of the ciliary body musculature)

How well did you know this?

Not at all

Perfectly

What is synechiae and which type is more common in uveitis cases?

(Adherence of the iris to the cornea (anterior) or lens (posterior) led by inflammatory cells, fibrin, and fibroblasts; posterior is more common in uveitis cases)

How well did you know this?

Not at all

Perfectly

What is the presentation of aqueous flare and why does it occur?

(It will present as a hazy anterior chamber and it is a result of proteins leaking through the disrupted BAB into the aqueous humor)

How well did you know this?

Not at all

Perfectly

If you are presented with a dog with keratic precipitates but they are otherwise completely normal both ocularly and systemically, what does that indicate?

(They had a prior occurrence of inflammation that has resolved on its own)

How well did you know this?

Not at all

Perfectly

What is rubiosis irides?

(Injection of the iridal blood vessels)

How well did you know this?

Not at all

Perfectly

Do you expect the IOP to be high or low in an animal with other signs of uveitis and why?

(Low → ciliary body is not producing enough AH and BAB is allowing fluid to escape faster than it is being replaced)

How well did you know this?

Not at all

Perfectly

What are some potential complications of uveitis?

(Synechiae, iris bombe, corneal edema and degeneration (permanent), cataracts, lens instability, vitreous degeneration, retinal detachment, secondary glaucoma, and phthisis bulbi)

How well did you know this?

Not at all

Perfectly

What are possible causes for uveitis?

(Primary ocular dz (have another ? on this so not going to list them here), idiopathic, trauma, and ocular manifestation of systemic dzs)

How well did you know this?

Not at all

Perfectly

What are primary ocular diseases that can lead to uveitis?

(Cataracts, lens rupture, corneal ulcers, and intraocular masses)

How well did you know this?

Not at all

Perfectly

What are the two types of lens induced uveitis (a common cause of uveitis in dogs) and what diseases lead to them?

(Phacolytic uveitis → soluble lens protein leaks through an intact lens, cataracts can cause this; phacoclastic uveitis → sudden exposure of intact lens protein d/t lens capsule tear, diabetes and trauma can cause this)

How well did you know this?

Not at all

Perfectly

What are the most common primary and metastatic neoplasms that cause uveitis in dogs?

(Primary → melanoma; metastatic → lymphoma)

How well did you know this?

Not at all

Perfectly

What are the common causes of uveitis in dogs?

(Infectious, lens induced uveitis, reflex uveitis, neoplasia, breed specific/immune mediated, and metabolic)

How well did you know this?

Not at all

Perfectly

What are the common causes of uveitis in cats?

(Infectious, metabolic, and neoplastic)

How well did you know this?

Not at all

Perfectly

What should your initial serology testing plan include for dogs with uveitis?

(Fungal, tick titers, and toxoplasmosis)

How well did you know this?

Not at all

Perfectly

What should your initial serology testing plan include for cats with uveitis?

(Fungal, FeLV, FIV, FIP, and toxoplasmosis)

How well did you know this?

Not at all

Perfectly

What presentation of uveitis warrants an ocular ultrasound?

(If you cannot see past the iris and lens)

How well did you know this?

Not at all

Perfectly

When might you pursue thoracic radiographs and/or an ultrasound in a patient with uveitis?

(When you suspect fungal or neoplasia)

How well did you know this?

Not at all

Perfectly

What should the goals be of your supportive care for a patient with uveitis?

(Control pain, prevent sequela, and stabilize/restore BAB)

How well did you know this?

Not at all

Perfectly

What does topical atropine do to the eye that is useful in treatment of uveitis?

(Induces mydriasis → prevents synechiae, cycloplegic → analgesia, and stabilizes BAB)

How well did you know this?

Not at all

Perfectly

When is topical atropine contraindicated?

(If there is lens instability, if there is glaucoma, and if a patient has dry eye)

You are presented with a dog with a cloudy eye, you believe you have localized it to the cornea and are between a corneal ulcer or endothelial dysfunction based on its appearance (fairly homogenous cloudiness), what diagnostic test can help you distinguish between those two options?

(Fluorescein stain)

You are presented with a dog with a cloudy eye that you believe you have localized to the cornea and it has a relatively homogenous, diffuse presentation with some faint stippling (you might say it looks like ground glass), the dog is non-painful and fluorescein stain negative, what is your top differential?

(Endothelial dystrophy/degeneration)

What are your differentials for a homogenous, focal cloudiness of the cornea?

(Corneal scar/fibrosis, corneal ulcer or an anterior lens luxation causing focal edema)

What are some causes for chronic abrasions of the eye resulting in corneal scars/fibrosis?

(Entropion, distichia, ectopic cilia)

What are some causes for chronic exposure of the eye resulting in corneal scars/fibrosis?

(Lagophthalmos and KCS)

What are the two causes for lipid keratopathy?

(Lipid dystrophy and lipid degeneration)

What can cause lipid degeneration that can then result in lipid keratopathy?

(Prior keratitis, infiltrative corneal dz, topical corticosteroid use, and systemic metabolic dzs such as cushings, diabetes, hyperthyroidism, and primary hyperlipidemia)

What is the typical presentation of a dog affected by lipid dystrophy?

(A young dog with bilaterally cloudy, non-painful eyes; lesion of the eye will appear particulate with numerous coalescing small particles → may appear glittery/sparkly/refractile)

If you note a sparkly lesion on the periphery of the cornea in an older dog who also has PU/PD and weight loss with an increased appetite, what is your top differential?

(Diabetes → lipid at the periphery of the cornea is often related to metabolic dz)

Compare and contrast the appearance of corneal lipid and corneal mineralization.

(Similar → numerous coalescing particles; differences → corneal mineralization is spiculated and not shiny whereas corneal lipid is not spiculated and shiny)

If a patient of yours has a cloudy cornea and they are painful, that narrows down your list of causes; describe what their cloudiness should look like on closer inspection and list the causes of that cloudiness.

(Edema > homogenous, faintly stippled (if more chronic), focal (ulcer) to diffuse (uveitis/glaucoma); caused by an ulcer, anterior uveitis, or glaucoma)

What clinical sign associated with uveitis can cause a cloudy eye, which you can diagnose by looking for the Tyndall effect with a slit lamp?

(Aqueous flare)

What is the main way to distinguish between aqueous and lipemic flare?

(Pain, unless the lipemic flare is caused by uveitis it will be painless, if it is caused by uveitis then it doesn’t really matter if its lipemic or aqueous, tx the uveitis)

What is an easy diagnostic test you can run when you have a cloudy eye that you suspect is either aqueous or lipemic flare but you’re just not quite sure?

(Spin down a hematocrit tube → milky serum = lipemia, not milky serum = aqueous flare d/t uveitis)

What are two causes of a cloudy lens?

(Nuclear sclerosis and cataracts)

What is the main way to determine if a cloudy lens is d/t nuclear sclerosis versus a cataract?

(If the light can get through the cloudiness when using a distant direct ophthalmoscopy technique = nuclear sclerosis, if light cannot get through = cataract)

What is asteroid hyalosis?

(A normal aging change (though can also be seen with intraocular masses) → calcium and phosphorus particulates in the vitreous fluid which is also starting to liquify)

(T/F) In a case of conjunctival hyperemia, the location of the most severe hyperemia often suggests the location of disease.

(T)

What are differentials for subconjunctival hemorrhage?

(Coagulation disorders, vasculitis, proptosis, trauma, and strangulation)

What are differentials for hyphema?

(Retinal detachment, coagulation disorders, vasculitis, systemic hypertension, uveitis, and neoplasia)

You are presented with a dog with an owner complaining of a red eye, you take a look and notice episcleral injection and mydriasis but no other abnormalities of the eye. What is at the top of your differential list and how would you definitively diagnose it?

(Glaucoma, tonometry)

You are presented with a dog with an owner complaining of a red eye, you take a look and notice episcleral injection, diffuse conjunctival hyperemia, and miosis. What is at the top of your differential list?

(Uveitis)

What are the most important immediate rule-outs for a red eye → you should not empirically treat an eyeball until you have ruled out these four diseases?

(Corneal ulcer, dry eye, glaucoma, and uveitis)

What are the causes of corneal ulcers?

(Trauma, corneal abrasions d/t adnexal disease, tear film deficiency, exposure keratitis, and infection)

What secondary pathology can happen to an acute superficial ulcer instead of normal healing?

(Chronic superficial ulcer)

What are risk factors for delayed corneal healing (most of them are also risk factors for corneal ulcers in general)?

(Abnormal tear production, abnormal blinking, brachycephalic breed, conformational exophthalmos, adnexal abnormalities, and infection of the ulcer)

What is distichia?

(Single or multiple abnormal hairs protruding from the meibomian gland openings of the eyelids)

You are presented with a 10 year old MN german shepherd dog that has a corneal ulcer. Upon further examination, you also find he has lower eyelid distichia, would you like to pursue further diagnostics?

(Yes bc he’s likely had distichia his whole life so if it was going to cause an ulcer, it would have done it when he was a baby, look for other issues)

(T/F) Patients with an ectopic cilia are always symptomatic.

(T)

You can readily diagnose keratoconjunctivitis sicca with what test?

(Schrimer tear test)

What are the typical causes of exposure keratitis?

(Exophthalmos d/t conformation or orbital dz, buphthalmos d/t glaucoma, or an inability to blink d/t facial paralysis)

Neurotropic keratitis is characterized by the loss of corneal sensation resulting in spontaneous non-healing ulceration, issues with which cranial nerve and which branch of that cranial nerve are the cause of this disease?

(Ophthalmic branch of the trigeminal nerve)

What disease is characterized by a chronic non-healing superficial corneal ulcer for which no underlying cause can be determined that occurs in middle-aged dogs?

(Spontaneous chronic corneal epithelial defect → SCCED)

Sort the following into medical or surgical disease: Acute superficial ulcer Corneal perforation Chronic superficial ulcer Deep stromal ulcer Descemetocele Mid-stromal ulcer

Acute superficial ulcer (Medical) Corneal perforation (Surgical) Chronic superficial ulcer (Surgical) Deep stromal ulcer (Both) Descemetocoele (Surgical) Mid-stromal ulcer (Medical)

What are the goals for medical therapy for treatment of an ulcer?

(Prevent/control infection, prevent/control collagenolysis, increase patient comfort, and promote corneal healing)

Corneal pain and vascularization in SCCED cases are mild/moderate/severe/variable.

(Variable)

(T/F) SCCED lesions very rarely become infected.

(T)

What is the purpose of the anterior stromal puncture procedure performed for SCCED cases?

(To penetrate the zone of hyalinized anterior corneal stroma and expose type I collagen → facilitates epithelial adhesion complex formation)

The usual treatment plan for an acute superficial corneal ulcer entails topical abx, +/- atropine, +/- systemic analgesics, what medication could be added if it is instead a mid-stromal ulceration?

(Protease inhibitors → systemic tetracycline or topical autogenous serum q 4-6 hours)

What are the surgical treatment options for a descemetocele?

(Conjunctival flap or corneoconjunctival transposition)

What is the main characterization of glaucoma?

(Elevation of intraocular pressure incompatible with ocular health)

What are possible causes for secondary glaucoma?

(Lens luxation, uveitis, hyphema, intraocular neoplasia, melanocytic glaucoma of cairn terriers, pigmentary uveitis of golden retrievers, pseudophakia/aphakia, and trauma)

What is a unique to cats cause of glaucoma?

(Aqueous humor misdirection → aqueous fluid goes behind the lens instead of in front of it and pushes the lens + iris forward, will see decreased space between the cornea and lens)

What is the most common cause of secondary glaucoma in cats?

(Uveitis, otherwise the list is similar to dogs for other causes)

What are acute clinical signs of glaucoma?

(Blepharospasm, corneal edema, episcleral injection, dilated pupil, and variable vision)

What are chronic clinical signs of glaucoma?

(All acute signs, buphthalmos, haab’s striae, lens subluxation, and cupped optic nerve)

What is the primary means of diagnosing glaucoma and assessing efficacy of glaucoma therapy?

(Tonometry)

What are the goals of glaucoma therapy?

(Maintenance of vision where possible, patient comfort in all cases, and prophylaxis in “at risk” eyes)

When are prostaglandin analogues contraindicated in glaucoma cases?

(Anterior chamber lens subluxations → will close the pupil behind the lens)

(T/F) Topical carbonic anhydrase inhibitors can be used in all species, have no contraindications, and though they may cause local irritation they do not cause systemic side effects.

(T)

Miotics should be avoided in glaucoma secondary to what two diseases?

(Anterior lens luxation and uveitis)

Give the drug class for the following drug(s): Latanoprost/travoprost/bimatoprost

(Prostaglandin analogues)

Give the drug class for the following drug(s): IV mannitol

(Systemic hyperosmotic medication)

Give the drug class for the following drug(s): Oral glycerin

(Systemic hyperosmotic medication)

Give the drug class for the following drug(s): Dorzolamide/brinzolamide

(Carbonic anhydrase inhibitors)

Give the drug class for the following drug(s): Demecarium bromide

(Miotic)

Give the drug class for the following drug(s): Pilocarpine

(Miotic)

Give the drug class for the following drug(s): Timolol maleate/betaxolol

(Beta blockers)

Give the drug class for the following drug(s): Dorzolamide-timolol

(CAI and beta blocker combo)

(T/F) It is okay and sufficient for a patient who had severe glaucoma (IOP was 60) to be hovering around an IOP of 22-24 mmHg.

(F, high normal IOP is undesirable in a glaucoma patient)

(T/F) Medical prophylaxis significantly delays onset of primary glaucoma in the second eye.

(T)

What type of maintenance medication for glaucoma is especially beneficial for prophylaxis in the other eye?

(Miotics)

What are the two main surgical goals for a glaucoma patient?

(Decrease aqueous production and increase aqueous outflow)

How is decreased aqueous production surgically obtained in glaucoma patients?

(Cyclodestructive procedures → cyclophotocoagulation or cyclocryotherapy)

How is increased aqueous outflow surgically obtained in glaucoma patients?

(Aqueous shunts/gonioimplants)

What are the salvage procedure options for an end stage glaucoma patient?

(Enucleation, evisceration/intrascleral prosthesis, and chemical ciliary body ablation)

What medication is injected into the ciliary body in chemical ciliary body ablation procedures in a glaucoma patient?

(Gentamicin +/- steroid, used in blind eyes only, outcome is unpredictable)

Why would an eye with a retinal or optic nerve lesion not be entirely mydriatic?

(Consensual PLR reflex)

Why do you expect the PLRs and dazzle reflexes to be normal in a patient with an occipital cortex lesion?

(Because the pathway responsible for those responses splits off of the optic pathway prior to where it ends in the occipital lobe so an occipital lesions will not affect those reflexes (unless the lesion were to become big enough to then affect the subcortical area responsible for PLR and dazzle))

If you have a right occipital lobe lesion, which field of vision is lost, left or right?

(Left)

Is parasympathetic or sympathetic innervation responsible for constriction of the pupil? (

Parasympathetic → you don’t need floods of light when you’re chilling in your bed)

A lesion in the right oculomotor nerve will cause miosis/mydriasis (choose) of the left eye.

(Tricky me, it won’t cause either to the left eye; will cause MYDRIASIS of the RIGHT eye)

What disease is caused by injury/insult to the sympathetic innervation to the eye?

(Horners)

Is mild or dramatic anisocoria associated with insults to the efferent pathways of the eye?

(Dramatic, if an insult to the afferent pathway, will be mild)

What should you consider when trying to decide which pupil is abnormal in an anisocoric cat?

(Lighting conditions and animal stress)

What are some non-neurological causes of mydriasis?

(Iris atrophy, glaucoma, and drugs such as atropine)

What are some non-neurological causes of miosis?

(Uveitis, keratitis, posterior synechiae, and drugs such as pilocarpine)

What is the diagnostic triad associated with sudden acquired retinal degeneration?

(Acute vision loss, normal fundus, and flat ERG)

What is the typical signalment for a SARDs patient (age, sex, intact status, and BCS)?

(Middle aged to older, spayed females, over conditioned)

Why would a dog with progressive retinal atrophy being hesitant on nightly walks be the first sign?

(Because rods degenerate first so dim light vision becomes diminished first)

What are the fundic changes that can be seen via ophthalmoscopic examination of a dog with progressive retinal atrophy?

(Vascular attenuation, tapetal hyper-reflectivity, and optic nerve atrophy)

What disease is a common rule out for retrobulbar optic neuritis and how can you rule it out?

(SARDs, r/o with ERG)

What disease is indicated by an animal having a poor PLR response but a good dazzle reflex?

(Iris atrophy)