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Ophthalmology Rotation > Cornea > Flashcards

Cornea Flashcards

1
Q

cornea (rankin)

Pannus

A
  • Chronic superficial keratitis
  • Most common
    • German Shepherds
    • Greyhounds
    • Dobermans
  • Pigment and vascularization
    • Starts laterally
  • Higher altitudes
  • Bilateral disease
  • NONPAINFUL!!!!!!
  • Atypical pannus
    • Third eyelid
    • Depigmented and follicles
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2
Q

cornea (rankin)

Pannus Treatment

A
  • Life long treatment!!!!
  • Treat aggressively initially then taper
  • Topical steroids
    • Prednisolone acetate 1%
    • Neopolydex (0.1% dexamethasone)
    • 3-4 times daily
  • Topical cyclosporine A or tacrolimus
    • 1or 2% CsA from licensed compounding pharmacy
    • 0.2% CsA Optimmune ®
    • 0.02% 0.03% tacrolimus from licensed compounding pharmacy
    • BID
  • Taper medications
    • Control with CSA or tacrolimus
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3
Q

Pigmentary Keratitis

A
  • PUGS!!!!
    • 82.4%
  • Nonpainful
    • Blinding
  • Starts medially
  • Multifactorial
    • Exposure
    • Medial entropion
    • Trichiasis
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4
Q

Treatment of Pigmentary Keratitis

A
  • Surgical
    • Medial canthoplasty
  • Medical therapy
    • Mild cases
    • Topical cyclosporine or tacrolimus (SID to BID)
    • Avoid topical steroids in PUGS!!!
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5
Q

Corneal Dystrophy

A
  • Opacity
    • Axial or paraxial
  • Inherited, bilateral
  • Relatively common
  • Nonpainful
  • Lipid deposition
  • No treatment
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6
Q

Corneal Endothelial Dystrophy

A
  • Corneal edema
  • Inherited
    • Boston Terriers, Boxers, Dachshunds, Poodles, and Chihuahuas
  • Generally young dogs
  • Treatment:
    • NaCl ointment 5% T-QID
      • Muro128
    • Topical antibiotics for ulcers
    • Referral surgical procedures
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7
Q

Corneal Endothelial Degeneration

A
  • Corneal edema
  • Bulla formation
    • Recurrent ulcerations
  • Old dog disease
  • Treatment
    • NaCl ointment 5% T-QID
      • Muro 128
    • Topical antibiotics for ulcers
    • Referral surgical procedures
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8
Q

Corneal Foreign Body

A

rare in cats

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9
Q

cornea (rankin)

Corneal Ulcers

  • Clinical signs
A
  • Blepharospasm
  • Rubbing
  • Epiphora
  • Elevated third eyelid
    • “Red
    • Reflex uveitis
      • Miosis , aqueous flare, hypopyon, fibrin, photophobia
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10
Q

cornea (rankin)

Diagnosis of Corneal Ulcer

A
  • Examine eyelids and conjunctiva
  • Palpebral reflex
  • STT
  • Fluorescein staining
  • Examine posterior TEL
  • Cytology
  • Culture and sensitivity
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11
Q

cornea (rankin)

Corneal Ulcer

  • superficial vs deep
A
  • Corneal blood vessels
    • 3-5 days to begin to grow
    • ~1mm/day
  • Is it superficial or deep?
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12
Q

cornea (rankin)

Infected Corneal Ulcer Signs

A
  • Depth
  • Corneal malacia
  • Cellular infiltrate
  • Pain
  • Purulent ocular discharge
  • Hypopyon
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13
Q

Has the ulcer perforated?

A
  • Perforation site will be “bulging”
  • Sealed with
    • Fibrin
    • Blood
    • Iris
  • Hyphema
  • Shallow anterior chamber
  • Restrain patient “VERY GENTLY”
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14
Q

Causes of ulcers

A
  • Trauma
  • KCS
  • Eyelash disorders (ectopic cilia/rarely distichiasis)
  • Eyelid disorders (entropion)
  • Exposure (lubricate under general anesthesia!!!)
  • Foreign body
  • Infectious causes (herpesvirus and Moraxella Bovis
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15
Q

cornea (rankin)

How am I going to manage the ulcer?

A
  • If greater than 50% depth or severe infection:
    • Surgical therapy recommended: Conjunctival graft, corneoconjunctival transposition, corneal transplant, amnionic memebrane graft referral
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16
Q

cornea (rankin)

Surgical Therapy for Ulcers

A

Do NOT place a third eyelid flap…it only covers up the cornea and prevents you from observing the ulcer…

17
Q

cornea (rankin)

Superficial NON-infected Ulcer

  • meds
A
  • Broad spectrum antibiotic
    • Neomycin/bacitracin/polymyxin B ointment
      Neomycin/bacitracin/ gramacidin solution
    • Tobramycin ophthalmic solution
    • Treat T-QID
  • Mydriatic therapy
    • Treat “reflex uveitis”
    • Topical 1% atropine (SID or BID)
    • Do not use if decreased tear production or glaucoma
  • Drops vs. ointment?
    • Hypersalivation (especially in cats)
  • Analgesic/anti-inflammatory therapy
    • DO NOT EVER USE TOPICAL STEROIDS OR TOPICAL NONSTEROIDAL MEDICATIONS
      • Delay corneal wound healing
      • Predispose to infection
      • Potentiate enzymatic destruction of the cornea
    • Systemic NSAIDS
  • Analgesic therapy
    • Codeine
    • Tramadol
  • Prevent self trauma
    • Elizabethan collar!!!!
18
Q

cornea (rankin)

Superficial NON-infected Ulcer

  • after treatment?
A
  • Recheck in 5 7 days
  • If the ulcer has not healed
    • Change the diagnosis…not the antibiotic!!!
  • If the ulcer has not resolved
    • Underlying cause
    • Ulcer is infected
    • Indolent ulcer
19
Q

cornea (rankin)

Treatment of Infected Ulcers

A
  • Antimicrobials - based on culture/sensitivity
  • Antimicrobials - based on cytology
    • Cocci - cefazolin 5%,chloramphenicol
    • Rods - ofloxacin, gentamicin, tobramycin
  • Use q 1-2 hrs initially and decrease as infection resolves
  • Use drops if the ulcer is deep or if perforation is a possibility…the petrolatum vehicle in ointments causes severe inflammation inside the eye
  • Anticollagenase agents
    • Decrease stromal melting
    • Serum/plasma
      • Autologous/ homogolous /heterologous
      • Treat q 1-2 hrs initially
      • Keep refrigerated for up to 2 weeks
    • Others: EDTA, N-acetylcysteine , ilmostat , tetracycline antibiotics
  • Topical atropine1% SID or BID
  • Oral antibiotics
    • Clavamox or enrofloxacin
  • Oral anti-inflammatory/analgesics
  • ELIZABETHAN COLLAR AND RESTRICT ACTIVITY!
  • Recheck in 24 hours
20
Q

cornea (rankin)

Indolent Ulcer/SCCED

A
  • Spontaneous chronic corneal epithelial defect
  • BOXERS
  • Middle/older age dogs
  • Chronic
  • Epithelial lip
  • Fluorescein ‘leaking’
21
Q

cornea (rankin)

Surgical Treatment of Indolent Ulcers

A
  • Remove loose epithelium
    • Topical anesthetic
    • Dilute providone-iodine soln.
    • Sterile eyewash
    • Debride with sterile cotton tipped applicator
    • ~4 0% will heal
    • Need to remove ALL loose epithelium
    • Usually need to go several millimeters past fluorescein positive area
  • Grid / diamond burr keratotomy (NOT IN CATS)
    • ~85 90% success rate
22
Q

cornea (rankin)

Indolent Ulcers

  • meds
A
  • Topical broad spectrum antibiotic T QID
  • Topical atropine 1% (SID to BID)
  • Elizabethan collar
  • Oral analgesics/NSAIDS if needed

Ophthalmology Rotation (20 decks)

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