Exophthalmos, Proptosis, Buphthalmos, Glaucoma Flashcards by Elizabeth Pritchard

What is the difference between Buphthalmos & Exophthalmos?

Buphthalmos=ENLARGED globe(from increased IOP)

Exophthalmos= NORMAL sized globe that PROTRUDEs

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A dog comes in with the main complaint of “pawing” at its eye. On tonometry you find the IOP=28 mmHg. While the eye is firm it does retropulse.
What is your top ddx?

Bupthalmos from glaucoma

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What are the 4 main things to consider when working up an exophthalmos case?

Signalment & history are critical clues
Complete PE
Ophthalmic exam
Oral exam

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What surgery removes ONLY the globe?

Enucleation

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What surgery removes the globe & orbital contents?

Exenteration

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Swelling of the eyelid conjunctiva=

Chemosis

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T/F: Orbital cellulitis due to Idiopathic inflammation causes only bilateral exopthalmos.

FALSE!

Idiopathic inflammation causes unilateral OR bilateral Orbital cellulitis

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What is the main c/s & reason the owner would bring in an orbital cellulitis / retrobulbar abscess case?

“Red eye”-hyperemia

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On US of the orbit of a dog that was brought in for “red eye” you find bilateral fluid pockets. What is your top ddx?

Bilateral=Orbital cellulitis

If it were unilateral think Retrobulbar abscess

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What is the difference in treating exopthalmos from Orbital cellulitis vs. Retrobulbar abscess?

Orbital cellulitis- Steriods & Antibiotics

Retrobulbar abscess- Antibiotics only

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A _______ may be placed on the lateral canthus of an exophthalmic eye if it protrudes so much the dog can’t blink.

Temporary tarsorrhapy

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What age & type of dog does orbital cellulitis/retrobulbar abscesses affect?

Young(1-5 y/o)

Large breed

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T/F: The oral exam of an orbital cellulitis case ma cause pain.

True

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Waxing/waning “suprised” expression
NON-painful when mouth opened
Normal behavior
NON-hyperemic orbital tissue

Extraocular polymyositis

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What is the treatment for Extraocular polymyositis?

Immunosuppressive corticosteroids-SLOW taper

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What should you warn the owner of with extraocular polymyositis?

May relapse 1-2 times

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What is the #1 cause of Anterior uveitis?

Infectious diseases

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What are the top ddx for Peripheral lymphadenopathy cases with the following signs?
Exophthalmos
Anterior uveitis
Ocular cloudiness
Fever

Lymphoma
Tick borne dz
Fungal dz
Protozoal dz

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Extreme exophthalmos to the point that they can’t close their eyes=

Proptosis

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What types of dogs are predisposed to proptosis?

Brachycephalics

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Trauma cases of proptosis in cats and non-brachycephalic dogs have what kind of prognosis?

SEVERE & more guarded prognosis

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What is the prognosis for vision of proptosed eyes?

Gaurded-poor

only 27% of proptosed canine retained vision

What can be used to reduce proptosis?

Lateral canthotomy w/ temporary tarsorrhaphy

What is the tx for a completely avulsed proptosed eye?

Enucleate

Buphthalmos is cause by ______ or _______.

Chronic glaucoma or IO neoplasia

``` What is the top ddx for the following c/s? Dilation of pupil Corneal edema Subluxation or luxation of lens Vision loss Buphthalmus ```

Chronic Glaucoma

What is the difference between Acute & Chronic glaucoma?

Globe size Acute: NOT enlarged Chronic: Enlarged(bupthalmic)

What is the name for the break in Descemet's membrane found with chronic glaucoma cases?

Haab's striae

T/F: Acute glaucoma is unilateral.

True

What are the two types of primary glaucoma & which is more common?

Narrow/closed angle=common -abnormal iridocorneal angle Open angle=less common -Normal iridocorneal angle

Which of the two types of primary glaucoma has Goniodysgenesis?

Narrow/closed angle

What are the top breeds that have the two types of primary glaucoma?

Close angle: - Cocker - Basset - Chow - Shar pei - Boston - WFT Open: -Beagle

What is the pathogenesis of glaucoma?

Aqueous humor can't get out(obstruction) Fluid build up-->Increased IOP, stretch of ocular structures & lens zonules--> vision loss, buphthalmus & subluxation/luxation of lens

What are the 4 main causes of secondary glaucoma?

Uveitis Lens diseases IO neoplasia Trauma

What is the most common cause of glaucoma in cats?

Uveitis

Glaucoma= IOP > ____

25 mmHg

What are the 2 main treatment goals of acute primary glaucoma if vision is present & c/s

Decrease aqueous production Increase outflow

What can be used to decrease aqueous production for acute primary glaucoma if vision is present & c/s

IV-mannitol Carbonic anhydrase inhibitors

What are the oral vs. topical carbonic anhydrase inhibitors?

Oral: - Methazolamide( Neptazane, Glautabs) - Acetazolamide(Diamox) - Dichlophenamide Topical: - Dorzolamide - Brinzolamide

What can be used to increase aqueous outflow for acute primary glaucoma if vision is present & c/s

F2a prostaglandin analouge("Prosts": Travoprost-->miosis, inc. outflow Beta blocker"-olol": Timolol, Betaxolol--> dec AH production, inc. outflow Parasymphathomimetics: Pilocarpine, Demecarium bromide-->miosis

What should you warn the owner about about with the treatment of actue primary glaucoma

CONTRALATERAL EYE! Prophylactically treat w/: | Timolol, Dorzolamide, or Demercarium bromide forever

What are the indications for salvage procedures?

- Blind PAINFUL eye - Blind eye REQUIRING MEDS - IO tumor - Severe IO infection - Severe orbital disease resulting in globe damage

What are the 3 salvage procedures?

- Enucleation - Evisceration & intrascleral prothesis insertior - Pharmacologic ablation of the ciliary body

What drug could be used for pharmacologic ablation of the ciliary body?

Gentamicin-vitreal injection DNU in cats

What might pharmacologic ablation of the ciliary body with a vitreal injection of Gentamicin?

Phthisis bulbi-"Phthisical eye" -ie. shrunken, non-functional eye

T/F: Medical management is normally enough to control glaucoma enough to maintain vision.

FALSE!!! Medical management is RARELY enough to control glaucoma enough to maintain vision.

What surgery is recommended for tx of acute glaucoma that's regaining vision & has an IOP

Diode laser surgery

What surgery is recommended for tx of acute glaucoma that's regaining vision & has an IOP >20mmHg?

Ahmed shunt placement & Diode Laser

What c/s should make you want to exam an eye immediately for actue glaucoma?

Red, cloudy, painful, or blind eye

Buphthalmos indicates _____ & ______ procedures are likely needed.

Chronicity; Salvage

How is Glaucoma diagnosed?

Tonometry: IOP >25 mmHg Applanation or Rebound= ideal

Glaucoma can be caused by an of the following EXCEPT: ``` A. IO neoplasia B. Lens luxation C, Uveitis D. Abnormal iridocorneal angle E. Optic nerve atrophy ```

E. Optic nerve atrophy

Treatment of an acute glaucoma case will involve all of the following EXCEPT: ``` A. Atropine B. Oral carbonic anhydrase inhibitor C. Topical miotic D. Mannitol E. Topical carbonic anhydrase inhibitor ```

A. Atropine