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Ophthalmology > Conjunctiva > Flashcards

Conjunctiva Flashcards

1
Q

the area where the palpebral conjunctiva meets the bulbar conjunctiva

A

conjunctival fornix

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2
Q

conjunctiva that lines the inner surface of the eyelid and the anterior aspect of the globe respectively

A

palpebral and bulbar conjunctiva

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3
Q

term used to describe congestion of the superficial vessels of the conjunctiva
suggest superficial disease(KCS, primary conjunctivitis, eyelid disorders causing secondary conjunctivitis, a response to superficial cornea ulceration

A

conjunctival hyperemia

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4
Q

congection of the deep conjunctival vessels, known as episcleral vessels
suggest deeper disease processes
(uveitis, glaucoma, deep/complicated corneal ulceration)

A

episcleral injection

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5
Q

Conjunctival hyperemia suggests

A

suggest superficial disease (KCS, primary conjunctivitis, eyelid disorders causing secondary conjunctivitis, a response to superficial cornea ulceration)

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5
Q

Episcleral injection suggests

A

deeper disease processes
(uveitis, glaucoma, deep/complicated corneal ulceration)

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6
Q

permanent adhesion between the conjunctiva and the cornea

A

Symblepharon

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7
Q

What is symblepharon

A

permanent adhesion between the conjunctiva and the cornea

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8
Q

What is edema of the conjuctiva called

A

Chemosis

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9
Q

What is the purpose of the conjuctiva

A

1) Provide smooth, lubricated surface for eyelids to contact cornea
2) Disperse tear film
3) Remove debris from ocular surface
4) Produce mucin component of tear film- goblet cells
5) Protective/ immunologic function- lymphoid follicles, IgA production

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10
Q

What are the protective/immunological function of the conjunctiva

A

1) lymphoid follicles
2) IgA production

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11
Q

What should you look for in the conjunctiva

A

petechiae, icterus, hemorrhage, palor

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12
Q

what lines the inner surface of the eyelids

A

palpebral conjunctiva

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13
Q

what lines the globe, starting at the limbus

A

bulbar conjunctiva

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14
Q

what completely covers the nicitans

A

third eye lid conjunctiva
1) palpebral surface
2) bulbar surface

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15
Q

how do you examine the palpebral surface of the third eyelid

A

retropulse the eye to examine the third eyelid

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16
Q

how do you examine the bulbar surface of the third eyelid

A

need proparacaine and lift up the third eyelid to examine the back side (bulbar surface)

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17
Q

How many episcleral vessels are normal

A

1-2 prominent episcleral vessels are normal

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18
Q

T/F: conjunctival pigment may be normal

A

True - happens with aging (conjunctival pigment on medial and lateral limbus)

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19
Q

produce mucinous portion of tear film
increased mucus production during inflammation

A

goblet cells

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20
Q

mucopurulent discharge of the eye is most common for

A

canine KCS- mucus provides growth media for bacteria and WBCs which result in mucopurulent discharge often seen with KCS, infected corneal ulcers

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21
Q

lymphoid follicles are normal on the

A

bulbar surface of third eyelid

also younger animals

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22
Q

small superficial vessels under the epithelium of conjunctiva

A

conjunctival vessels

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23
Q

When might you see conjunctival hyperemia

A

1) Conjunctivitis
2) KCS

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24
Q

How do you distinguish superficial conjunctiva vessels

A

they move when you move the conjunctiva

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25
Q

What is the most common eyelid mass in a dog *

A

meibomian gland adenoma

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26
Q

When might you see episcleral injection

A

1) Deep corneal ulcers
2) Uveitis
3) Glaucoma

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27
Q

in episcleral injection, the large vessels run __________

A

perpendicular to the limbus

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28
Q

How do you tell the difference between episcleral and conjunctival hyperemia

A

Drop phenylephrine in the eye (vasoconstriction of conjunctival vessels)

Only episcleral vessels remain following application *

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29
Q

What goes away when phenylephrine drops are applied to the eye

A

conjunctival hyperemia

side effect: may increase intraocular pressure- dilates the pupil

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30
Q

causes vasoconstriction of the conjunctival vessels

A

phenylephrine

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31
Q

What is a side effect of giving phenylephrine to a patient’s eye

A

may increase intraocular pressure- dilates the pupil

beware in glaucoma cases

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32
Q

congenital disease of the conjunctiva where there is a mass of normal tissue in an abnormal place (choristoma)

A

Dermoid

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33
Q

Congenital, A type of choristoma made up of keratinized epithelium and adnexal structures like hair follicles, sweat glands, and sebaceous glands.

A

dermoid

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34
Q

What breeds commonly get dermoids

A

French Bulldogs, Pugs, mastiffs, great danes

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35
Q

How do you treat conjunctival dermoids

A

surgical excision or cryrotherapy and freeze bed to destroy hair follicles

if surgery need to be delayed (young dog)
-trim hairs (although sometimes shorter are sharper)
-lubrication (eyedrops)

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36
Q

acquired conjunctivitis

A

common in all species
very non-specific response
variable clinical signs
treatment varies with cause
cause of conjunctivitis varies by species

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37
Q

What are the clinical signs of conjunctivitis

A

1) Conjunctival hyperemia
2) Chemosis (swollen conjuctiva)
3) Lymphoid follicles
4) Ocular discharge (ranging from epiphora to mucopurulent discharge)

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38
Q

swollen conjunctiva

A

chemosis

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39
Q

T/F: you should never see any lymphoid follicles in the horse

A

false- sometimes its okay to see a few lymphoid follicles

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40
Q

What are the causes of conjunctivitis across all species

A

1) Bacterial:
Mycoplasma (commonly goats and cats)
Chlamydia (cats and sheep)
Relatively uncommon in other species
2) Viral:
FHV-1 + Calicivirus (cats)
Canine Distemper Virus (CDV)
3) Parasitic: Thelazia, Onchocera, Habronema, Hepatozoon, Leishmania
4) Allergic- common in young dogs
5) Neoplasia- lymphoma most common (conjunctiva is not the primary tumor)
6) Environmental / physical irritants
7) Immune mediated (eosinophilic conjunctivitis in cats and horses)
8) Other ocular disease: KCS

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41
Q

What are common bacterial causes of conjunctivitis

A

1) Mycoplasma (commonly goats and cats)
2) Chlamydia (cats and sheep)
Relatively uncommon in other species

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42
Q

What are common viral causes of conjunctivitis

A

1) FHV-1 (cats)
2) Calicivirus (cats)
3) Canine Distemper Virus (CDV)

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43
Q

What are common parasitic causes of conjunctivitis

A

Thelazia, Onchocera, Habronema, Hepatozoon, Leishmania

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44
Q

Allergic conjunctivitis is common in

A

young dogs - need to treat skin too

cytology, exam
lymphoid follicles, lymphocytes and plasma cells

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45
Q

What is most common neoplasia causing conjunctivitis

A

lymphoma most common
(conjunctiva is not the primary tumor)

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46
Q

immune mediated eosinophilic conjunctivitis is typically seen in

A

cats and horses

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47
Q

What is the most common cause of canine conjunctivitis

A

Keratoconjuncitivits sicca (KCS)

48
Q

What are the major causes of conjunctival inflammation in the dog

A

1) KCS * (STT + clinical signs)
2) Infectious- cytology, culture, PCR (CHV, CDV)
3) Foreign body (examine fornix in front of and behind nictitans)
4) Allergic (cytology, exam- lymphoid follicles, lymphocytes and plasma cells)
5) Eyelid disease - ectropion, entropion, distichia
6) Neoplasia- older dogs with primary tumor elsewhere

49
Q

What are the clinical signs of dogs with allergic conjunctivitis

A

+/- atopy, seasonal signs
signs tend to be bilateral
1) hyperemia
2) Chemosis
3) Lymphoid follicles
4) mucoid discharge
5) epiphora
6) Belpharospasm/blepharitis

50
Q

allergic conjunctivitis tend to be unilateral or bilateral

A

bilateral

51
Q

T/F: viral conjunctivitis in dogs has similar signalment and clinical signs

A

allergic conjunctivitis

52
Q

What are your diagnostic techniques for conjunctivitis

A

1) complete ophthalmic exam and PE (other signs of allergeries and foreign body behind the third eyelid
2) Schirmer tear test - rule out KCS
3) Cytology
4) Biopsy
5) Culture and sensitivity
6) Special stains/ PCR

53
Q

Conjunctival swab

A

a microbrush that has a softer edge to them
proparacaine
used for cytology
PCR, virus isolation +/- culture

54
Q

How do you treat canine conjunctivitis

A

1) Treat underlying allergy / atopy (or KCS)
2) Topical anti-inflammatories are mainstay of therapy
If normal tears and quality:
*Neopolydexamethosone (3-4x/day for 2-3 weeks then taper) to treat inflammation

Diclofenac 0.1% or Ketorolac 0.5%
-NSAID 2-3x/day for 2-4 weeks then taper
Cyclosproin 0.2% (Optimmune)
-T cell inhibitor (anti-inflammatory for 2-3 times daily long term

55
Q

How should you treat canine conjunctivitis if the tears are normal and normal quality of production

A

*Neopolydexamethosone (3-4x/day for 2-3 weeks then taper) to treat inflammation

56
Q

What are the major causes of conjunctival inflammation in cats *

A

FHV-1 **
Chlamydia felis
Mycoplasma sp
Calicivirus
Less common: non-infectious

57
Q

the most common cause of feline conjunctivitis and feline keratitis

A

FHV-1

58
Q

what tropism does FHV-1 have

A

Epithelial tropism

59
Q

What are the two forms of FHV-1

A

1) Primary disease (young cats)
2) Recrudescence with stress (lysis)

60
Q

Where does FHV-1 remain latent

A

trigeminal ganglion

61
Q

What is the prevalence of FHV-1

A

100% seropositive (exposed)
80% persistently infected (establish latency in trigeminal ganglion)
50% shed virus spontaneously or during periods of stress
70% shed virus after exposure to corticosteroids (chronic steroid use)

62
Q

70% of cats with FHV-1 will shed virus after

A

exposure to corticosteroids (chronic steroid use)
-includes topical steroids

63
Q

What are the clinical signs of FHV-1 in the exposure (typically kittens and adolescents)

A

1) Upper respiratory tract infection (URTI)
2) Ocular signs (belpharospasm, epiphora, and mucoid discharge)

64
Q

when does the primary infection of FHV-1 in naive cats/kittens typically resolve

A

within 2-4 weeks (often tend to not treat young cats)

65
Q

During primary infection FHV-1 virions invade

A

sensory nerve endings of the trigeminal nerve
1) travel to the trigeminal ganglion +/- within the cornea
2) Viral DNA incorporated into the host
3) Sick cats recover to healthy cats

66
Q

When might latent FHV-1 become reactivated

A

-Spontaneous
-Environmental stress
-Corticosteroids
-Co-infection

67
Q

What happens when FHV-1 becomes reactivated

A

Viral replication and migration down sensory axons to epithelial tissues
-Subclinical shedding
-Immunopathological disease: Conjunctivitis, keratitis, dermatitis, symbleparon, URTI,
clinical signs may be unilateral or bilateral but not symmetric

68
Q

What are the clinical signs of FHV-1

A

1) URT signs
2) Chemosis
3) Geographic corneal ulcer
4) Dendiritic ulcer
5) Conjunctivitis and mucoid discharge
6) Symblepharon (in-utero)
7) Keratitis
8) Plaques- eosinophilic keratoconjunctivitis

69
Q

where the conjunctiva forms a permanent adhesion to the cornea
from in-utero

A

symblepharon

70
Q

In a cat, if conjunctivitis is present with a history of keratitis and/or URT assume

A

FHV-1

there is no definitive test for FHV-1: look at the history signalment, clinical signs

71
Q

How do you treat FHV-1

A

1) Reduce stress

2) Supportive care: topical antibiotic if ulcers present (erythromycin)
*No neomycin-polymyxin in cats (REACTIONS)

3) L-lysine 500mg PO BID (adult) q24h (kitten)
may not help or wont hurt, treat all cats in household

4) Cidofofovir 0.5% solution BID (topical anti-viral) if only ocular signs present
AND/OR
5) Famciclovir 40mg/kg PO TID - oral anti-viral to treat ocular and URT signs, wide dose range

72
Q

What ulcer is pathognomic for FHV-1

A

dendritic ulcer: ulcers stain along the corneal nerves (abrasions along nerve)

73
Q

ulcers stain along the corneal nerves (abrasions along nerve)

A

dendritic ulcer

74
Q

What embryonic defect are seen in kittnes infected with FHV-1

A

Symblepharon: conjunctiva formed a permanent adhesion to cornea
Intra-ocular changes

75
Q

T/F: there is no definitive test for FHV-1

A

true -look at history, signalment, clinical signs

76
Q

T/F: neomycin-polymyxin is used to treat ulcers in cats *

A

FALSE- absolutely not they have reaction locally anaphylaxis

77
Q

For FHV-1, what topical antibiotic should you use if there are ulcers present

A

Erythromycin ointment

*Never neomycin-polymyxin or formulations with it (cats have reactions)

78
Q

For cats with FHV-1, what can you add to their diet

A

L-lysine 500mg PO BID (adult) q24h (kitten)

79
Q

topical anti-viral used for FHV-1 cases if only ocular signs are present

A

Cidofofovir 0.5% solution BID

80
Q

oral anti-viral to treat FHV-1 ocular AND URT signs

A

Famciclovir 40mg/kg PO TID

81
Q

Cidofovir is administered _________ for ______ while Famciclovir is administered ________ for _________

A

Cidofovir: Topical antiviral only for ocular signs

Famciclovir: Oral antiviral for ocular and URT

82
Q

obligate intracellular bacteria that is the second most common cause of conjunctivitis behind FHV-1
typically in young and/or stressed cats *

A

Chlamydia felis

83
Q

What is not seen in Chlamydophia and Mycoplasma conjunctiva infections *

A

ulcerations of conjunctiva or cornea

84
Q

What are the clinical signs of Chlamydia felis *

A

1) Belpharospasm
2) Epiphora
3) Mucoid or mucopurulent discharge
4) Hyperemia
5) Chemosis

85
Q

What is a very specific clinical sign that makes you think the cat has Chlamydophilia

A

Chemosis

86
Q

T/F: Mycoplasma causes chemosis

A

false- not likely
likely Chlamydophilia

87
Q

How do you treat Chlamydia felis infections?

A

Choose antibiotic that has intracellular penetration, BID-TID
Topical:
Erythromycin ointment (Macrolide)

88
Q

Why might you not want to use oxytetracycline (terramycin) to treat bacterial feline conjunctivitis

A

Polymyxin is in terramycin and cats have reactions to neomycin-polymyxin

89
Q

What topical antibiotic should you use for Chlamydia felis

A

Erythromycin ointment BID-TID

90
Q

What topical antibioitc should you use for mycoplasmal conjunctivitis in cats

A

Erythromycin ointment BID-TID

91
Q

RNA virus that causes conjunctivitis in cats
far less common than FHV-1 -seen in shelter environments/cattereis
oral ulceration is pathognomonic for disease

A

Calicivirus

92
Q

Calicivirus causes

A

Conjunctival and oral ulcerations

93
Q

How do you treat feline conjunctivitis calicivirus

A

Supportive care
Topical antibiotic to treat conjunctival ulcers

94
Q

What is the most common cause of bovine conjunctivitis

A

Moraxella bovis

95
Q

What systemic diseases in cattle cause conjunctivitis

A

Infectious bovine rhinotracheitis
Malignant catarrhal fever

96
Q

What causes infectious bovine keratoconjunctivitis in cattle

A

Moraxella bovis

97
Q

What are the clinical signs of infectious bovine keratoconjunctivitis

A

1) Conjunctivitis
2) Keratitis- central corneal ulceration /edema that ay become abscessed

98
Q

How do you treat infectious bovine keratoconjunctivitis

A

1) Various antibiotics - topical terramycin (oxytet.) or subconjunctival procaine penicillin
2) Eyepatch, tarsorrhaphy
3) Limit Predisposing factors: UV light, environment, hereford, hereford crosses, face flies
4) Prevention: control flies and UV light exposure, breeding programs, vaccinate, isolated affected/ contagious animals

99
Q

a surgical procedure that partially or completely closes the eyelids by sewing them together
can be used to treat infectious bovine keratoconjunctivitis

A

tarsorrhaphy

100
Q

What antibiotics can you use for infectious bovine keratoconjunctivitis

A

Various antibiotics - topical terramycin (oxytet.) or subconjunctival procaine penicillin

101
Q

What breeds are predisposed to infectious bovine keratoconjunctivitis

A

Herefords

102
Q

What are the three most common parasites causing conjunctivitis in horses

A

1) Onchocerca
2) Habronema
3) Thelazia

103
Q

What are the clinical signs of equine parasitic conjunctivitis

A

1) Parasite on medial canthal nodules (sulfur granules)
2) Conjunctival hyperemia
3) Mucoid discharge
4) Chemosis
5) Depigment of medial canthus

104
Q

How do you treat equine parasitic conjunctivitis caused by onchocerca, habronema, thelazia

A

two dose ivermectin 2 weeks apart
control fly population
inflammation with neo-poly-dex

105
Q

Conjunctival neoplasia is typically benign or malignant?

A

Malignant

106
Q

How do you diagnose conjunctival neoplasia

A

fine needle aspirate

107
Q

How do you treat conjunctival neoplasia

A

local excision + adjunctive therapy (cryoablation, chemotherapy, hyperthermia)

enucleation may be required

108
Q

What are the different kinds of conjunctival neoplasia

A

1) Canine Papiloma
2) Medial Conjunctival Melanoma
3) Hemangioma
4) Equine Conjunctival SCC

109
Q

most common ocular tumor in horses

A

squamous cell carcinoma

110
Q

Wha are the predisposing factors of ocular SCC in horses

A

-Non-pigmented adnexa
-High altitude
-Sun exposure
-Breeds: Haflingers, Belgians, QH, Paints

111
Q

What horse breeds are predisposed to SCC

A

Haflingers, Belgians, QH, Paints

112
Q

How do you treat equine SCC

A

Excisions
Cryotherapy, beta-radiation, chemotherapy, immunotherapy

*No perfect treatment for SCC

113
Q

Is FHV-1 mostly unilateral or bilateral

A

unilateral

114
Q

Dogs with conjunctival hemangiosarcoma

A

Benign behavior
-excise, cryotherapy, beta-radiation

115
Q

Compare and contrast conjunctival hemangiosarcoma in dogs and horses

A

Dogs: typically benign- excise, cryotherpay, b-rad

Horses: May be aggressive/metastatic - enucleation/exenteration is often necessary

116
Q

Is chlamydia typically unilateral or bilateral

A

bilateral

117
Q

Horses with conjunctival hemangiosarcoma

A

May be aggressive/metastatic - enucleation/exenteration is often necessary

Ophthalmology (7 decks)

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