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Small Animal Final Year > Conjunctiva and KCS > Flashcards

Conjunctiva and KCS Flashcards

1
Q

What is the anatomy of the conjunctiva?

A
  • Thin, transparent pink mucous membrane
  • Starts at limbus (junction between cornea and sclera)
  • Covers the globe itself – bulbar conjunctiva
  • Lines inner aspects of upper/lower eyelids - palpebral conjunctiva
  • Space between is conjunctival sac
  • Lines both sides of third eyelid
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2
Q

Label

A
  1. Dorsal fornix
  2. Bulbar conjunctiva
  3. Palpebral conjunctiva
  4. Upper eyelid
  5. Lower eyelid
  6. Third eye lid
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3
Q

Of the conjunctiva, what is the:

A) Vascular supply?

B) Nerve supply?

A

A) Rich

B) Sparse

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4
Q

What provides the lymphatic drainage of the conjunctiva?

A

CALT = Conjunctiva-Associated-Lymphoid- Tissue

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5
Q

What is the mobility of the conjunctiva?

A

•Freely mobile apart from attachments at limbus and eyelid margin

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6
Q

Name 4 clinical signs of Acute conjunctivitis (6)

A
  • Unilateral or bilateral
  • Hyperaemia (conjunctival redness)
  • Chemosis (oedema of conjuctiva)
  • Swelling or thickening
  • Mild irritation, e.g. mild blepharospasm
  • Discharge

–Lacrimation

–Mucoid, purulent, mucopurulent, haemorrhagic

•(Pruritus, e.g allergic conjunctivitis)

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7
Q

What is seen with this acute conjunctivitis?

A
  • Hyperaemia
  • Mild chemosis
  • Serous discharge
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8
Q

What is this? Give an example of a cause

A

Chemosis e.g. allergy

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9
Q

Which breed is commonly affected by this? What is it?

A

Shar Pei dogs are frequently affected with mucinosis

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10
Q

What is the term for deep set eyes?

A

Enophthalmos

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11
Q

What is ‘medial canthal pocket syndrome’? Where is it “normal”?

A

•Mucus accumulates at medial canthus

Dolichocephalic breeds

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12
Q

What is this?

A

‘medial canthal pocket syndrome’

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13
Q

Name 3 clinical signs of Chronic conjunctivitis (4)

A
  • Hyperaemia, discharge etc as for acute conjunctivitis
  • Thickening (squamous metaplasia of epithelium) of conjunctiva
  • Hyperpigmentation
  • Follicular hyperplasia
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14
Q

What can be seen here?

A

Chronic conjunctivitis

Palpebral is pigmented

Thickened

Hyperpigmented

(upper is inverted)

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15
Q

What can be seen here?

A

Follicular hypertrophy
See all follicles

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16
Q

Where is it normal for some species to have a patch of follicles?

A

Back of third eyelids

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17
Q

What are the 5 types of canine conjunctivitis?

A
  • Infectious
  • Non-infectious
  • Extension from local disease
  • Secondary to another ocular disease
  • Secondary to systemic disease
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18
Q

What is the most common type of infectious conjunctivitis?

A

Secondary

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19
Q

What is the common bacterial infection cause of (secondary) infectious conjuctivitis?

A

–Commensal Gram +ve organisms, e.g. Staphylococcus sp, Streptococcus sp

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20
Q

Name a viral infection which may cause infectious conjunctivitis?

A

Canine herpes 1

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21
Q

Name a paratie infection which may cause infectious conjunctivitis?

How would you find it?

A

Thelazia

–Worm living behind third eyelid

–Think about the rescue dogs coming in

–Look behind the 3rd eyelid with forceps

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22
Q

What is this?

A

Bacterial conjunctivitis

(purulent discharge)

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23
Q

Name 6 underlying causes for conjunctivitis (9)

A
  • Eyelid problem, e.g. entropion, ectropion
  • Eyelash problem, e.g. distichia, ectopic cilia
  • Tear film problem, e.g. dry eye
  • Tear duct infection (dacryocystitis)
  • Trauma, e.g. FB, laceration
  • Allergic e.g. atopic dermatitis

–If it does have skin disease they are probably linked

  • Irritants e.g. smoke, sand, neomycin
  • Ligneous conj’itis in Dobermann
  • Radiation-induced
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24
Q

What is this?

A

Entropion - eyelid turns in

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25
Q

How would you treat entropian?

A

Hotz-Celsus: removal of elliptical piece of skin and evert the eyelid

26
Q

What is this?

A

Ectropion - everted eyelid

27
Q

What are each of these?

A

A) Normal

B) Distichia

C) Ectopic cilia

28
Q

What is this?

A

Distichiasis - extra eyelashes

29
Q

What is this?

A

Ectopic cilia – Pain! Everted upper to show
just one will cause discomfort

30
Q

What does this show?

A

Subconjunctival haemorrhage.

31
Q

Name 2 things conjunctiva might be affected by (3)

A
  • Blepharitis (eyelid inflammation)
  • Lacrimal disease, e.g. ‘cherry eye’ (prolapse of third eyelid gland)
  • Orbital disease, e.g. retrobulbar abscess
32
Q

Other than conjuctivitis, name 2 causes of a red eye (3)

A

–Uveitis

–Glaucoma

–Scleritis/episcleritis

33
Q

Name 4 systemic diseases which involves the conjunctiva (6)

A

–Anaemia

–Jaundice

–Coagulopathy

–Neoplasia,e.g. lymphoma

–Auto-immune disease

–Systemic hypertension

34
Q

Name 2 diagnostic approaches to diagnosing canine conjunctivitis to examine the pertinent parts of the eye exam (4)

A
  • Eyelid conformation and eyelid margins
  • Tear production

–Schirmer tear test

• Fluorescein dye application

– Check for corneal ulcer

– Assess patency of tear duct

• General examination including skin

35
Q

How do we treat canine conjuncitivits?

A
  • Treat/remove underlying cause
  • Topical antibiotic therapy

–Fusidic acid (Isathal®)

  • First choice in the UK
  • Treats Gram +ve organisms most commonly found in canine conjunctivitis (Staph’ sp, Strep sp)

–Chloramphenicol drops/ointment

–Other antibiotics based on culture & sensitivity

36
Q

What is Keratoconjunctivitis sicca?

A

•Immune-mediated destruction of lacrimal tissue

37
Q

Label

A

a = lacrimal gland (dorsolateral orbit)

b = third eyelid gland (nictitans gland);

38
Q

Name 5 causes of dry eye in the dog (6)

A
  • Immune-mediated MOST COMMON CAUSE
  • Congenital

–Lacrimal gland aplasia/hypoplasia

•Neurogenic

–Unilateral, dry eye/dry nose

•Toxic

–Sulphonamide drugs

•Endocrine disease

–Diabetes mellitus, hypothyroidism

•Iatrogenic

–Removal of third eyelid gland

39
Q

How can you diagnose KCS?

A
  • Schirmer tear test (STT)
  • Quantitative measurement of tear production
  • Measures aqueous part of tear film (3 parts)
  • Measures basal and reflex tear production

–Reflex tear production is in response to sensation of paper strip in contact with cornea, therefore placement of strip in eye is important

40
Q

What is a diagnostic STT for KCS?

A

0-10 mm/min

41
Q

What makes us suspect KCS?

A

Conjunctivitis & tenacious discharge

Discharge stick to the surface

Eye is dry

42
Q

What is the difference in discharge betwen dry eye and a dog with normal tear production?

A

Dry eye - discharge adheres to cornea

Normal producton - collects around eyelid

43
Q

How do you treat KCS?

A
  • Lifelong therapy - control not cure
  • Tear substitutes

–Various false tear preparations in eye drop, gel or ointment formulation

•Tear stimulants (lacrimogenic)

–Cyclosporine 0.2% (Optimmune)

•Broad spectrum topical antibiotic to treat secondary e.g. Staphylococcal sp infection

44
Q

What is cherry eye?

A

Prolapse of third eyelid gland

45
Q

Cherry eye:

A) What age is affected?

B) Name 2 common breeds

A

A) <1yo

B) Bulldog, Lhasa Apso, Shih Tzu, ACSp, Mastiff breeds

46
Q

What is this?

A

Cherry eye

47
Q

How can we treat cherry eye?

A

•Surgical replacement

–‘pocket’ technique

–tacking procedures

48
Q

What are the 2 causes of feline infectious conjunctivitis?

A

–Chlamydia

–Herpes

49
Q

What are the 5 agents of bacterial conjunctivitis. Highlight the most important

A

1.Chlamydophila felis (bacterium)

2.Feline herpesvirus-1 (FHV-1) (virus)

  1. Feline calicivirus (FCV)
  2. Mycoplasma felis (bacterium)
  3. Bordetella bronchiseptica (bacterium)
50
Q

Name clinical signs of Chlamydophila felis

A

–Unilateral conjunctivitis, becomes bilateral within a few days

–Chemosis often marked, hyperaemia

–No corneal signs

•Differentiate from herpes

–Absent or mild upper respiratory disease

•Not generally coughing or sneezing

51
Q

What do we suspect?

A

Chlamydophila felis

52
Q

How do we diagnose C. Felis?

A
  • Clinical signs (non specific)
  • Conjunctival swab for PCR test
  • PCR has superseded culture
53
Q

How do we treat C. Felis?

A
  • Systemic treatment indicated as organism affects respiratory tract, GIT and reproductive tract as well as eye
  • Doxycycline antibiotic of choice

–5mg/kg bid or 10mg/kg sid for three weeks

–NB teeth discolouration and oesophagitis

•Amoxycillin-clavulanate in pregnant queen or kittens

54
Q

What are the clinical signs of Feline Herpesvirus 1 by age?

A

•Kittens and young cats

–Bilateral conjunctivitis in conjunction with upper respiratory signs (cat flu)

–+/- corneal ulceration

•Adult cats

–Unilateral ocular discharge with mild conjunctivitis

–History of previous upper respiratory infection

–Wide range of other conditions, e.g. sequestrum, entropion, eosinophilic keratitis

55
Q

What is this and how do we know?

A

Dendritic corneal ulcer
Uptake – virus tracking along epithelium and chlamydia has not tropism for corneal epithelium – KNOW this is herpes as nothing lse does this

56
Q

How can we diagnose FHV 1?

A
  • History and clinical signs
  • Conjunctival swab for PCR test

–Same technique as for C felis

–Swab site of interest i.e. swab cornea, conjunctiva and/or oropharynx

•PCR has superseded culture (like C felis)

57
Q

How can we treat FHV 1?

A

•Nursing

–Cleaning eyes, nutrition, rehydration

–Supportive

–Kittens can easily get dehydrated

•Broad-spectrum antibiotic to prevent/treat secondary bacterial infection

–Topical for eyes (e.g. fusidic acid, chloramphenicol)

–Systemic for respiratory involvement e.g. amoxycillin-clavulanate

–Reason behind this – prevent secondary

•Anti-virals

–Topical e.g. ganciclovir

–Systemic e.g. famcyclovir (fairly expensive)

–Expensive and hard to obtain

–Reserve for persistence

58
Q

Give clinical signs of feline calcivirus

A
  • Upper respiratory disease, oral ulceration, polyarthritis
  • Conjunctivitis
59
Q

Mycoplasma sp:

A) Where is it seen?

B) How do we diagnose?

C) How do we treat?

A

A) Normal cats

B) PCR

C) Topical antibiotics

60
Q

Bordetella bronchiseptica:

A) What gram??

B) What is affected?

C) What is the risk?

D) How do we diagnose?

E) Name a treatment option

A

A) Negative

B) Respiratory tract s

C) Dogs infect cats
Zoonosis

D) Culture and/or PCR

E) Doxycycline

Small Animal Final Year (317 decks)

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