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Basic Diagnostic Methods Flashcards

1
Q

List the process when examining ophthalmic cases

A
  1. History
  2. Physical exam (general)
  3. Ophthalmic exam
  4. Additional diagnostic techniques
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2
Q

What should you consider during the general physical exam in ophthalmic cases

A
  • Systemic diseases
  • Neurologic diseases

Both may be accompanied by ocular signs

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3
Q

What should be considered before performing the ophthalmic exam?

A

Restraint for examination

  • Manual restraint
  • Sedation

General anaesthesia is usually a drawback in the ophthalmic exam

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4
Q

Give the steps of the ophthalmic exam

A
  1. Examination of head, periocular area & globe
  2. Preliminary ocular exam
  3. Detailed physical exam of eye
  4. Additional diagnostic techniques
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5
Q

Ophthalmic exam: Examination of head & periocular area

A

Inspect & palpate in a light room

Normal:

  • Periocular area is symmetric, no gap, scar or inadequate movement of the bones.
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6
Q

Ophthalmic exam: Globe

A

Inspect & palpate in a light room

Normal:

  • Both globes are the same size & shape; symmetric, tightly undulating & painless
  • Optical axes of the globes meet on a demonstrative object.
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7
Q

Give the steps of the preliminary ocular exam

A
  1. PLR (Pupillary Light Reflex)
  2. STT (Schirmer Tear Test)
  3. Specimen collection
  4. Vision evaluation
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8
Q

Preliminary ocular exam: PLR (Pupillary light reflex)

A

Light → Constriction of the pupil

  • Inspect the speed & intensity
  • Normal: Symmetric reaction with equal intensity
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9
Q

Preliminary ocular exam: STT (Schirmer Tear Test)

A
  • Semiquantitative measurement of tear production
  • Indication: Dry-eye inflammation (KCS)
  • Test strip applied for 1 minute
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10
Q

Preliminary ocular exam: Interpretation of the Schirmer tear test

A

Normal = > 14 mm/min

Apparent disease = < 5 mm/min

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11
Q

Preliminary ocular exam: Specimen collection

A
  • Indication: Severe purulent inflammation; resistance to therapy; melting corneal ulcers; inflammation of the eyelids
  • Cytological or microbiological exam
  • Samples should be taken before any topical anaesthesia is applied
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12
Q

Preliminary ocular exam: Specimen collection may be from which locations?

A
  • Cornea
  • Conjunctiva
  • Corneoconjunctival region
  • Eyelid
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13
Q

Preliminary ocular exam: Steps of the vision evaluation

A
  1. Falling cotton test
  2. Obstacle test
  3. Menace reflex test
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14
Q

Summarise the falling cotton test

A

Nomal dx: The falling cotton is visually followed

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15
Q

Summarise the obstacle test

A

Normal dx: Negotiation of the obstacles is not impaired

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16
Q

Summarise the menace reflex test

A

Normal dx: The animal blinks and/or flinches when a threatening movement is given

17
Q

Detailed physical exam of the eye: How are these exams performed?

A
  • Under magnification
  • Focal light source
  • Darkened room
18
Q

Detailed physical exam of the eye: Structures examined

A
  1. Palpebral fissure
  2. Eyelids
  3. Third eyelid
  4. Conjunctiva
  5. Lacrimal system
  6. Cornea
  7. Sclera
  8. Anterior chamber
  9. Iris & pupil
  10. Lens
  11. Vitreous body
19
Q

Detailed physical exam of the eye: Palpebral fissure

A

Normal dx:

  • Symmetric and wide in the middle
  • Ø Discharge
20
Q

Detailed physical exam of the eye: Eyelids

A

Inspection & palpation

Normal dx:

  • Skin is thin, folded and moves freely
  • Margin of the lids is regular
  • The glandular opening is seen (grey line)
21
Q

Which species are lacking the lower ciliae (eyelash)

A
  • Cat
  • Horse
  • Cow
22
Q

Which species have multiple rows of upper ciliae?

23
Q

Detailed physical exam of the eye: Third eyelid

A

Inspection & palpation

Normal dx:

  • Fits the globe; only the free margin is visible at the medial canthus
  • Palpebral surface: Pink, moist, slightly vascularised
  • Bulbar surface: Fresh red, velvet-like, pale-pink follicles
24
Q

Detailed physical exam of the eye: Conjunctiva

A

Inspection & palpation

Normal dx:

  • Pale pink, gently folded, moistly shining
  • Barely any visible conjunctival vessels
  • Ventral fornix is hyperaemic w/ lymphoid follicles
25
Detailed physical exam of the eye: **Lacrimal system**
**Inspection** of the lacrimal puncta (entry to the tearduct) Normal dx: * Upper & lower puncta are 3mm from the medial canthus
26
Detailed physical exam of the eye: **Cornea**
**Inspection** & **'palpation'** ​Normal dx: * Uniformly glistening * Completely transparent & avascular * Animal should blink when a wisp of cotton touches cornea
27
Detailed physical exam of the eye: **Sclera**
**Inspection** only Normal dx: * Only a small part can be examined * Smooth, whitish; no scar or gap * Pigmentation from the point of the limbus
28
Detailed physical exam of the eye: **Anterior chamber**
**Inspection** only Normal dx: * Depth varies between species * Aq. humor is completely transparent; Ø content
29
Detailed physical exam of the eye: **Abnormal contents of the anterior chamber**
* Hypopyon: **Pus** in the anterior chamber * Hyphema: **Blood** in the anterior chamber
30
Detailed physical exam of the eye: **Iris & pupil**
**Inspection** only Normal dx: * Centrally placed; gentle circular pattern * Herbivores may have *corpora nigrum*
31
Shapes of the pupil across the species
* **Horizontal elliptical:** Horse, cow & pig * **Rounded:** Dog * **Perpendicular rhomboid:** Cat
32
Detailed physical exam of the eye: **Lens**
**Inspection** only Normal dx: * Purkinje's images formed on the anterior & posterior lens capsule * Ø Opacity in the lens
33
Detailed physical exam of the eye: **Vitreous body**
**Inspection** only Normal dx: * Vitreous is clear - Ø Opacity
34
Give the **vital staining** methods
1. Fluorescein 2. Rose bengal
35
Vital staining: **Fluorescein**
* Water-soluble, hydrophilic; orange colour * Solution/impregnated strips * Strips ↓ chance of infection * Fluorescein stains the exposed **stroma** bright green
36
Vital staining: **Indication** for **fluorescein**
Assessment of the corneal epithelium's condition * Suspicion of **corneal ulcer/injury** * **All** cases when the eye is **red/painful** * **Before topical/subconjunctival steroid therapy**
37
Vital staining: **Rose Bengal**
* Water soluble, hydrophilic; red colour * Stains the degenerated, **necrotic cells** & **mucus** red
38
Vital staining: **Indication** for **Rose Bengal** staining
Any suspicion of dry-eye inflammation ## Footnote *Early dx of KCS*

Ophthalmology (9 decks)

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