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Medicine I > Cornea & Sclera > Flashcards

Cornea & Sclera Flashcards

1
Q

What is Pannus

A
  • Chronic superficial keratitis
  • Common in:
    • German shepherds, greyhounds, dobermans
  • Bilateral disease
    • pigment and vascularization starts laterally
  • Non-painful
  • More common at higher altitudes (Mountains)
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2
Q

What is atypical pannus?

A
  • Affecting 3rd eyelid
  • Depigmentation and follicles
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3
Q

What is the treatment for Pannus?

A
  • Life long treatment
  • Initially aggressive then tapers
  • Topical steroids
    • Prednisolone acetate 1%
    • Neopolydex (0.1% dexamethasone)
    • 3-4x daily
  • Topical cyclosporine A or Tacrolimus
    • 1 or 2% CsA from licensed compounding pharmacy
    • 0.2% CsA Optimmune®
    • 0.02% - 0.03% tacrolimus from licensed compounding pharmacy
    • BID
  • Taper medications - control w/ CsA or Tacrolimus
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4
Q

What is Pigmentary keratitis?

A
  • Non-painful but blinding
  • Starts medially
  • Multifactorial
    • Exposure
    • Medial entropion
    • Trichiasis
  • Common in Pugs - 82.4%
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5
Q

What is the treatment for Pigmentary Keratitis?

A
  • Surgical
    • medical canthoplasty
  • Medical Therapy
    • mild cases
    • Topical cyclosporine or tacrolimus (SID to BID)
    • Avoid topical steroids in Pugs
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6
Q

What is Corneal Dystrophy?

A
  • Inherited, bilateral disease
  • Opacity in cornea - lipid deposition
    • axial or paraxial
  • Relatively common
  • Non-painful
  • No treatment
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7
Q

What is Corneal Endothelial Dystrophy? Treatment?

A
  • Corneal Edema
  • Genetic - Boston Terriers, Boxers, Dachshunds, Poodles, Chihuahuas
  • Young dog disease
  • Treatment
    • NaCl Ointment 5% TID to QID
      • Muro128
    • Topical antibiotics for ulcers
    • Referral surgical procedures
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8
Q

What is Corneal Endothelial Degeneration? Treatment?

A
  • Corneal Edema
  • Bulla Formation w/ recurrent ulcerations
  • Old dog disease
  • Treatment:
    • NaCl ointment 5% TID to QID
      • Muro128
    • Topical antibiotics for ulcers
    • Referral surgical procedures
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9
Q

What is the treatment for Corneal Foreign Bodies?

A
  • Superficial - Irrigation or cotton swab
  • Deep - Referral for surgical removal
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10
Q

What are the clinical signs of Corneal Ulcers?

A
  • Blephorospasm
  • Rubbing
  • Epiphora
  • Elevated Third eyelid
  • “Red eye”
  • Reflex uveitis
    • Miosis, aqueous flare, hypopyon, fibrin, photophobia
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11
Q

How are Corneal Ulcers diagnosed?

A
  • Examine eyelids and conjunctiva
  • Palpebral reflex
  • STT
  • Fluorescein staining
  • Examine posterior TEL
  • Cytology
  • Culture and sensitivity
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12
Q

What are the signs of infected corneal ulcers?

A
  • Depth
  • Corneal malacia
  • Cellular infiltrate
  • Pain
  • Purulent ocular discharge
  • Hypopyon (accumulation of leukocytes in the anterior chamber of the eye)
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13
Q

What happens when a corneal ulcer perforates?

A
  • Perforation site will “bulge”
  • Sealed with Fibrin, Blood, Iris
  • Hyphema (accumulation of blood in the anterior chamber of the eye)
  • Shallow anterior chamber
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14
Q

What causes ulcers?

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

What is the recommendation for ulcers greater than 50% in depth or severe infection?

A
  • Surgical therapy:
    • Conjunctival graft
    • Corneoconjunctival transposition
    • corneal transplant
    • amniotic membrane graft (referral)
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16
Q

What surgical therapy is not recommended for ulcers?

A
  • Do not place 3rd eyelid flap
    • covers cornea
    • prevents observation of the ulcer
17
Q

What is the recommendation for superficial non-infected ulcers?

A
  • Broad spectrum antibiotic
    • Neomycin/bacitracin/polymyxin B ointment
    • Neomycin/bacitracin/gramacidin solution
    • Tobramycin ophthalmic solution
    • Treat TID to QID
  • Mydriatic therapy
    • Treat “reflex uveitis”
    • Topical 1% atropine (SID to BID)
    • Do not use if decreased tear production or glaucoma
  • Analgesic/anti-inflammatory Therapy
    • Never use topical steroids or topical nonsteroidal medications
    • Systemic NSAIDS
  • Analgesic therapy
    • Codeine
    • Tramadol
  • Prevent self trauma
18
Q

Why are topical analgesic/anti-inflammatory treatments not used on eyes with corneal ulcers?

A
  • Delay corneal wound healing
  • Predispose to infection
  • Potentiate enzymatic destruction of the cornea
19
Q

What should be done if a superficial non-infected ulcer is still present at a 5-7 day recheck?

A
  • If ulcer is not healed - change the diagnosis, not antibiotic
  • If ulcer has not resolved:
    • Underlying cause not addressed
    • Ulcer is infected
    • Indolent ulcer
20
Q

What is the treatment for Infected corneal ulcers?

A
  • Antimicrobials:
    • Based on Culture/sensitivity
    • Based on cytology
      • Cocci - cefazolin 5%, chloramphenicol
      • Rods - ofloxacin, gentamicin, tobramycin
    • Use every 1-2 hrs initially and decrease as infection resolves
    • Use drops for deep ulcers, or in ulcers where perforation is a possibility
  • Anticollagenase agents
    • decrease stromal melting
    • Serum/plasma
      • Autologous/homogolous/heterologous
      • Treat q1-2 hrs initially
      • Keep refrigerated for up to 2wks
    • Others: EDTA, N-acetylcysteine, ilmostat, tetracycline antibiotics
  • Topical Atropine 1% SID or BID
  • Oral Antibiotics - Clavamox or Enrofloxacin
  • Oral anti-inflammatory/analgesics
  • E-collar and restrict activity
  • Recheck in 24hrs
21
Q

Why should eye drops be used for deep ulcers, or in ulcers where perforation is a possibility?

A

Petrolatum vehicle in eye ointments causes severe inflammation inside the eye

22
Q

What is a Spontaneous Chronic Corneal Epithelial Defect (SCCED)?

A
  • Indolent ulcer
    • Chronic
    • has epithelial lip
    • Fluorescein is “leaking”
  • Affects Middle/older aged dogs
    • Common in Boxers
23
Q

What is the surgical treatment options for Indolent Ulcers

A
  • Remove loose epithelium
    • Topical anesthetic
    • Dilute providone-iodiine solution
    • Sterile eyewash
    • Debride w/ sterile cotton tipped applicator
      • remove ALL loose epithelium
      • usually need to go several mm past fluorescein positive area
    • ~40% will heal
  • Grid/Diamond burr keratotomy
    • ~85-90% success
    • Do not do in cats
24
Q

What is the treatment for indolent ulcers outside of surgery?

A
  • Topical broad spectrum antibiotic TID to QID
  • Topical atropine 1% (SID to BID)
  • E-collar
  • Oral analgesics/NSAIDS if needed

Medicine I (43 decks)

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