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SA DX & TX II > Final Exam - Conjunctiva & Lacrimal System > Flashcards

Final Exam - Conjunctiva & Lacrimal System Flashcards

1
Q

what are the 3 main red eye conditions?

A

keratoconjunctivitis, uveitis, & glaucoma

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2
Q

what is chemosis?

A

edema of the conjunctiva

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3
Q

what is conjunctival hyperemia?

A

term used to describe congestion of the superficial vessels of the conjunctiva

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4
Q

a predominant finding of conjunctival hyperemia suggests what?

A

superficial disease, such as: tear film disorders (KCS), primary conjunctivitis, eyelid disorders causing secondary conjunctivitis, & a response to superficial corneal ulceration

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5
Q

what are conjunctival lymphoid follicles?

A

response to non-specific antigenic stimulation

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6
Q

presence of cinjunctival lymphoid follicles anywhere but the bulbar surface of the 3rd eyelid is consistent with a diagnosis of what?

A

conjunctivitis

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7
Q

what is the conjunctival fornix?

A

area where the palpebral conjunctiva meets the bulbar conjunctiva

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8
Q

what is conjunctivitis?

A

inflammation exclusive to the conjunctiva

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9
Q

what type of conjunctivitis is most common in dogs? what about cats?

A

dogs - allergic conjunctivitis cats - infectious conjunctivitis

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10
Q

what is episcleral injection?

A

congestion of deep conjunctival vessels known as episcleral vessels

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11
Q

the presence of episcleral injection suggests what?

A

presence of deeper diseases such as: uveitis, glaucoma, & deep/complicated corneal ulcers

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12
Q

what is epiphora? what is it a common response to?

A

abnormal overproduction of tears, normal response to ocular irritation

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13
Q

what are ghost vessels? what do they mean?

A

non-perfused corneal blood vessels - provide evidence of previous keratitis

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14
Q

what are goblet cells? what pathology do they contribute to?

A

cells present within conjunctival epithelium & produce the inner most mucous layer of the 3 layers of the tear film - in conjunctivitis, will overproduce mucus causing mucoid discharge

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15
Q

what is keratitis?

A

inflammation of the cornea

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16
Q

what is the most common clinical sign of keratitis? what other signs are seen?

A

neovascularization is the most common - others include corneal pigmentation, corneal fibrosis, corneal ulceration, & white blood cell infiltration

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17
Q

why is mucopurulent discharge most commonly found in patients with KCS?

A

due to the loss of the aqueous portion of the tear film which then causes mucus overproduction, bacterial overgrowth, & subsequent white blood cell recruitment

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18
Q

what is symblepharon?

A

permanent adhesion between the conjunctiva & the cornea

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19
Q

what are the 5 landmarks of the conjunctiva you should be able to recognize?

A
  1. palpebral conjunctiva
  2. conjunctival fornix
  3. palpebral surface (3rd eyelid conjunctiva)
  4. bulbar surface (3rd eyelid conjunctiva)
  5. bulbar conjunctiva
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20
Q

T/F: isolated, prominent, j-shaped episcleral vessels are most often normal variants seen on the conjunctiva

A

TRUE

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21
Q

what makes conjunctival pigment normal? what makes it abnormal?

A

normal - is it is an isolated finding abnormal - scleral pigment often

abnormal that is associated with pigment proliferation (ocular melanosis & neoplasias) or scleral thinning

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22
Q

T/F: conjunctival biopsy can be performed with topical anesthetic alone

A

TRUE

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23
Q

what cells may be seen on epithelial cytology from a dog with conjunctivitis from allergies? what about an infectious/inflammatory cause?

A

allergic - eosinophils

infectious/inflammatory - neutrophils

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24
Q

T/F: the presence of epiphora is always abnormal, but it is not specific for any one disease & just indicates ocular irritation/pain

A

TRUE

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25
Q

if you see mucoid/mucopurulent ocular discharge, what is producing it? what conditions should you put on your differential list?

A

goblet cells! they will overproduce mucus when they are inflamed - need to think about KCS & doing a schirmer tear test

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26
Q

follicles in the conjunctiva are only a normal finding if they are located where?

A

only normal if found on the bulbar surface - abnormal if seen anywhere else

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27
Q

what can you do to elevate the 3rd eyelid during an ophthalmic exam?

A

retropulse the globe to elevate the 3rd eyelid

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28
Q

if a dog presents with the presence of follicles all over the conjunctiva, what condition should you think of?

A

primary conjunctivitis & non-specific antigenic stimulation

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29
Q

where are superficial vessels of the cornea located? what about the deep vessels?

A

superficial - just under the epithelium & deep - located in the episclera

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30
Q

if you see conjunctival hyperemia, what disease category should you be thinking of?

A

superficial disease causing superficial irritation & superficial vessels are angry

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31
Q

T/F: episcleral injection means these are vessels that can be seen with the naked eye

A

TRUE

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32
Q

what are some ocular conditions that feature episcleral injection?

A

episcleritis, canine glaucoma/lens subluxation, uveitis, & deep ulcers

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33
Q

what signalment of dogs are affected by allergic conjunctivitis?

A

young dogs and/or atopic dogs

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34
Q

what clinical signs are seen with allergic conjunctivitis in dogs?

A

lymphoid follicles are a specific sign!!!!! blepharospasm, epiphora, mucoid discharge, & hyperemia

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35
Q

what does the presence of lymphoid follicles without evidence of keratitis indicate?

A

satisifes a diagnosis of primary allergic conjunctivitis (aka - follicular conjunctivitis)

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36
Q

how is a diagnosis of allergic conjunctivitis in a dog made?

A

patient meets the compatible signalment, patient has compatible clinical signs, & the minimum database of STT/fluorescein dye/tonometry are within normal limits

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37
Q

how is allergic conjunctivitis in dogs treated?

A

treat underlying atopy if present & treat the eye - mainstay of therapy are topical anti-inflammatories

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38
Q

what are your 3 choices of topical anti-inflammatories for canine allergic conjunctivitis?

A

steroid - NeoPolyDex ointment (small bead 2-3X/day for 3 weeks then recheck)

NSAID - diclofenac 0.1% solution (1 drop 2X/day for 3 weeks then recheck)

t-cell inhibitor - optimmune ointment (cyclosporine 0.2%, small bead 2-3X/day for 6 weeks then recheck)

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39
Q

what are the 3 layers of the tear film?

A
  1. oil/lipid - outermost, contains meibomian glands
  2. aqueous - middle, 65% lacrimal glands & 35% gland of 3rd eyelid
  3. mucinous - innermost, conjunctival goblet cells
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40
Q

what are the 3 functions of the tear film?

A

nourish, cleanse, & protect the ocular surface

41
Q

what are the 2 categories of KCS?

A

quantitative & qualitative

42
Q

what is the most common cause of KCS in dogs?

A

immune-mediated destruction

43
Q

what drugs are associated with causing KCS?

A

sulfonamides & atrophine

44
Q

what is neurogenic KCS?

A

loss of parasympathetic innervation to the lacrimal gland that causes unilateral dry eye & xeromycteria (dry nose)

45
Q

what is an example of an iatrogenic cause of KCS?

A

surgical excision of the gland of the 3rd eyelid

46
Q

what is quantitative KCS?

A

aqueous deficiency that is diagnosed by the schirmer tear test < 15 mm/min + clinical signs

47
Q

T/F: KCS is the only common cause of bacterial conjunctivitis in dogs

A

TRUE

48
Q

what is the common clinical history seen in patients with KCS?

A

patient presented with mucupurulent discharge & they were prescribed a topical antibiotic which cleared up the discharge but once stopped, the discharge returned - STT never performed

49
Q

what is qualitative KCS?

A

lipid or mucin deficiency that is diagnosed by the schirmer tear test >/= 15 mm/min + clinical signs

50
Q

what signalment of dogs are predisposed to KCS?

A

toy breeds, brachycephalics, & cocker spaniels

51
Q

T/F: in dogs with KCS, the disease is often bilateral

A

TRUE

52
Q

what clinical signs of KCS are associated with keratitis?

A

superficial corneal neovascularization (most consistent clinical sign) that starts at the dorsal limbus of the cornea, corneal fibrosis, superficial corneal pigmentation, corneal ulceration, & white blood cell infiltration

53
Q

what clinical signs are seen in dogs with KCS that are associated with conjunctivitis?

A

mucopurulent discharge is the easiest way to recognize this disease macroscopically

54
Q

why is superficial neovascularization of the cornea with dorsal distribution common in dogs with KCS?

A

the remaining tear film of the eye provides health to the ventral cornea!!! not seeing these vessels on the ventral aspect!

55
Q

what is the effect of topical cyclosporine in dogs with KCS?

A

it suppresses further destruction of the lacrimal tissue, directly stimulates tear production, & anti-inflammatory effects such as reducing vessels, clears fibrosis, & clears pigments

56
Q

what are the 4 objectives in treating KCS?

A
  1. replace the tears (lubricate with artificial tears 2-6 times daily)
  2. stimulate more tears (topical cyclosporine)
  3. anti-inflammatory therapy (cyclosporine)
  4. temporary antibiotic therapy (to clear the initial bacterial infection while the tear film recovers)
57
Q

after doing routine KCS treatment on a dog for 4-6 weeks, and at recheck, improvement is seen, how is your therapeutic protocol changed?

A

decrease lubricant to 2X/day & continue optimmune 2X/day

58
Q

at the 3-4 month recheck for a patient that is responding well to routine therapy for KCS, what are your continued therapy plans?

A

lubricate as needed for redness, continue optimmune 2X/day, & recheck annually for optimmune refills!

59
Q

what are some potential causes of neurogenic KCS?

A

trauma, severe otitis interna, neoplasia, & idiopathic cause

60
Q

what surgical therapy is used for KCS?

A

parotid duct transposition for cases where medical therapy fails to recover tear production & clinical signs persist

61
Q

in cats, you should consider utilizing what diagnostic test for diagnosing separate causes of feline conjunctivitis?

A

conjunctival cytology

62
Q

what are the most common causes of feline conjunctivitis in order of prevalence?

A
  1. feline herpesvirus keratoconjunctivitis
  2. chlamydial conjunctivitis
  3. mycoplasma conjunctivitis
  4. calicivirus conjunctivitis
63
Q

what are the 3 clinical forms of feline herpes that are clinically recognized?

A

primary disease - young cats with acute lysis of epithelium latency - period of silence recrudescence - lysis & disease (periods of stress)

64
Q

what percentage of cats shed herpes during periods of stress?

A

50%

65
Q

what is the most common cause of feline conjunctivitis & feline keratitis

A

feline herpesvirus

66
Q

what clinical signs are seen in cats with an URI from herpes causing ocular surface infections?

A

primary infection of FHV-1 in naïve cats/kittens with a high occurrence of outbreaks in shelter environments that naturally resolves in 2-4 weeks - blepharospasm, epiphora, & mucoid discharge alongside URI signs

67
Q

what is neonatal ophtalmia?

A

**

68
Q

what are the non-specific signs related to FHV-1?

A

blepharospasm, epiphora, & mucoid discharge

69
Q

what are the more specific & very specific signs related to FHV-1?

A

more specific - URTI (more common with primary infection) & hyperemia is for herpes!!! very specific - conjunctival & possible corneal epitheial ulceration (dendritic ulcers are pathognomonic), & symblepharon

70
Q

what are dendritic ulcers pathognomonic for in cats? what do they represent?

A

FHV-1 infection, represents one form of a continuum of epithelial lysis (punctate, linear, dendritic, & geographic)

71
Q

what is symblepharon?

A

permanent adhesion between the conjunctiva & the cornea

72
Q

what is historic keratitis?

A

inactive & non-perfused superficial neovascularization (ghost vessels)

73
Q

if you observe conjunctivitis & evidence of active or historic keratitis in a cat, you should consider what as the cause of the conjunctivitis?

A

FHV-1 over any other cause

74
Q

which are you more likely to see clinically, dendritic or geographic ulcers in a cat with FHV-1 infection causing conjunctivitis?

A

geographic - FHV-1 still most likely culprit

75
Q

what occurs when two ulcerated epithelial surfaces heal to each other?

A

symblepharon - adhesion of the conjunctiva to the cornea

76
Q

T/F: symblepharon in cats occurs most often with FHV-1 infections

A

TRUE

77
Q

what do you need to build a case for FHV-1 associated conjunctivitis?

A

history, clinical signs, response to therapy, & maybe other tests (cytology looking for intranuclear inclusion bodies, fluorescent antibody testing, PCR, & virus isolation)

78
Q

what are you looking for on cytology that would support a diagnosis of FHV-1 associated conjunctivitis?

A

intranuclear inclusion bodies

79
Q

what questions should you consider in your clinical assessment of a cat that you suspect has FHV-1 associated conjunctivitis?

A
  1. is keratitis present or ever been present? (look for dendritic ulcers & ghost vessels)
  2. history of URTI?
  3. is there a positive response to anti-viral therapy?
  4. have you ruled out other causes of red eye using fluorescein dye & tonometry?
80
Q

what is the current gold standard for treating FHV-1 conjunctivitis? what topical therapy is another treatment option?

A

oral famciclovir - topical option of cidofovir 0.5% (compounded & given twice daily)

81
Q

what supportive care is recommended for FHV-1 conjunctivitis?

A

topical erythromycin - wide spectrum macrolide antibiotic used 3-4X daily

82
Q

what cats are affected by chlamydial conjunctivitis?

A

young & stressed cats

83
Q

what type of agent causes chlamydial conjunctivitis?

A

obligate intracellular bacteria!!

84
Q

does chlamydial conjunctivitis cause corneal or conjunctival ulceration in cats?

A

nope!

85
Q

what is a more specific clinical sign associated with chlamydial conjunctivitis in cats?

A

chemosis - less specific signs include blepharospasm, epiphora, mucoid/mucopurulent discharge, & hyperemia

86
Q

what is seen on cytology that is used to diagnose chlamydial conjunctivitis in cats?

A

intracytoplasmic inclusion bodies

87
Q

how is chlamydial conjunctivitis diagnosed in cats?

A

PCR, history, clinical signs, cytology, & ruling out other causes

88
Q

what kind of antibiotic do you need for treating chlamydial conjunctivitis in cats? what are your options?

A

need one that has intracellular penetration!!! tetracyclines (oxytetracycline - terramycin), macrolides (erythromycin), fluoroquinolones as a last resort (ofloxacin & ciprofloxacin), or oral tetracyclines (doxycycline) for 3 weeks

89
Q

what is seen on cytology that supports mycoplasma conjunctivitis?

A

membrane associated bacteria

90
Q

how is mycoplasma conjunctivitis diagnosed?

A

PCR, compatibile clinical signs, cytology, & ruling out other causes of feline conjunctivitis

91
Q

what are some clinical signs seen with mycoplasma conjunctivitis?

A

nonspecific signs - blepharospasm, epiphora, mucoid/mucopurulent discharge, hyperemia, & +/- chemosis

92
Q

does mycoplasma conjunctivitis cause corneal or conjunctival ulceration?

A

nope!

93
Q

what treatment is used for mycoplasma conjunctivitis?

A

similar sensitivity to chlamydial organisms - same treatment protocol with intracellular penetration antibiotics

94
Q

what cats are affected by calicivirus conjunctivitis?

A

shelter environments & catteries

95
Q

what are some very specific signs that indicate calicivirus conjunctivitis? what are some other less specific signs?

A

very specific - tongue/oral ulceration (pathognomonic when present!!!) less specific - conjunctival ulceration but no corneal ulceration, blepharospasm, mucoid/mucopurulent discharge, & hyperemia

96
Q

T/F: calicivirus conjunctivitis can cause conjunctival ulceration but not corneal ulceration

A

TRUE

97
Q

what treatment is used for calicivirus conjunctivitis?

A

supportive topical therapy - erythromycin ointment applied 3-4X daily

98
Q

how is calicivirus conjunctivitis diagnosed?

A

challenging diagnosis to make - use PCR, compatible history, compatible clinical signs, & rule out other causes of feline conjunctivitis

SA DX & TX II (62 decks)

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