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SA DX & TX II > Final Exam - Ophthalmic Exam > Flashcards

Final Exam - Ophthalmic Exam Flashcards

1
Q

what ocular lesion is seen in this photo?

A

rubeosis iridis - engorged iris radial arterioles & new blood vessels with uveitis

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2
Q

this dog has hypertriglyceridemia - what is seen on its ocular lesion?

A

pale, fat-laden vessels

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3
Q

this dog has vasculitis - what is seen on its ocular exam?

A

retinal vessel damage causing hemorrhage

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4
Q

what ocular lesion is shown? what part of the eyes are you evaluating?

A

optic neuritis - looking at the CNS

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5
Q

T/F: ocular manifestations of systemic disease are common in veterinary medicine

A

TRUE

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6
Q

what lesion is shown in this photo as a result of stomatitis?

A

pseudobuphthalmos

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7
Q

what ocular lesion is shown in this dog that is occurring secondary to diabetes mellitus?

A

equatorial vacuoles in the lens

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8
Q

what may be seen on ocular exam that supports anemia in a cat?

A

thin, pale vessels

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9
Q

what does OMSD mean?

A

ocular manifestations of systemic disease

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10
Q

why do owners often readily recognize ocular disease in their pets?

A

eye contact is a significant factor in the human-animal bond, so they are quick to notice changes

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11
Q

what is the most important component of a successful ophthalmic exam when you’re trying to exam/image the globe & its associated structures?

A

room lights off!!!!!!!

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12
Q

what is the most important tool needed for an ophthalmic exam?

A

controlled light source in a dark environment

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13
Q

what components make up the tools required for a successful ophthalmic exam?

A

controlled light source in a dark environment, means of dilating the pupil/performing fundoscopy, means of achieving magnification, means of discerning depth, & minimum database resources for STT, fluorescein stain, & tonometry

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14
Q

why is an incandescent pen light not a great light source for an ophthalmic exam?

A

it is too dim

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15
Q

why is an LED flashlight from an iPhone not a great light source for an ophthalmic exam?

A

it is too bright by itself

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16
Q

what are your appropriate light source choices for an ophthalmic exam?

A

halogen lights - finoff transilluminator & otoscope

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17
Q

what challenges are presented when trying to perform an ophthalmic exam in a well lit environment?

A

creation of specular reflections that obscure/prevent/confuse your intraocular exam

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18
Q

what should you do with the lights when you’re examining/imaging the head/orbit/eyelids?

A

room lights on!!!!

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19
Q

what is the benefit of using a dark environment for an ophthalmic exam?

A

removing environmental light allows the examiner to use imposed light to highlight specific aspects of the eye when subtley changing light to highlight iris topography & lens opacities

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20
Q

_____ ______, or mydriasis, facilitates fundoscopy

A

pupil dilation

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21
Q

what is the time of onset for tropicamide? How long does it last?

A

15-20 minutes for onset & it lasts 2-4 hours

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22
Q

what is the purpose of using tropicamide?

A

dilating the pupil

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23
Q

what is the orientation provided when using the indirect fundoscopy technique?

A

it is upside down & backwards

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24
Q

what is the preferred technique used for performing fundoscopy?

A

indirect using a light source & macro lens

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25
Q

how is direct fundoscopy done using an iPhone?

A

white tape is placed over LED flash & flash is toggled on to run continuously in video mode, move the phone within 1cm of the patient’s eye & record with the room lights turned off!!!

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26
Q

what is one limitation of using a smart phone for direct fundoscopy regarding the corneal or lens opacity?

A

cornea or lens opacity - smart phone software will focus on the nearest object to the lens

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27
Q

what is shadowing dependent on when doing fundoscopy with a smart phone?

A

associated with the distance between the flash & wide-angle camera lens (most often the corner lens)

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28
Q

why is direct fundoscopy done with a smart phone not great for looking at the fundus?

A

direct technique will not allow visualization of the peripheral fundus

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29
Q

T/F: centered camera lenses can still be used effectively for direct fundoscopy with a smart phone

A

FALSE

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30
Q

why is a smart phone with a centered camera lens not an option for direct fundoscopy?

A

the patient’s nose & camera lens’ center location prevent the camera lens from being positioned closely over the eye

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31
Q

how is indirect fundoscopy performed when using a smart phone?

A

white tape is placed over the LED flash (very important for safety/patient comfort), flash is toggled on for continuous function, &align the phone between your eye & the condensing lens attempting to fill the condensing lens & camera lens with the fundus

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32
Q

what limitations are posed by indirect fundoscopy with a smart phone?

A

initially challenging, but no other limitations unlike the direct technique

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33
Q

why is the indirect technique for fundoscopy more valuable for veterinary patients?

A

a large field of view, provided by the indirect technique, allows for a more rapid & thorough fundus examination

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34
Q

what fundoscopy technique provides better magnification & is initially easier to perform?

A

direct technique of fundoscopy

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35
Q

why should you initially look at the head/eyes at rest with the room lights on when working up a patient?

A

you can assess the degree of discomfort at rest

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36
Q

what is the minimum level of magnification you need to see in practice for an ophthalmic exam?

A

need to see 3-5X magnification

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37
Q

do you want the room lights on or off when looking at the magnified eye?

A

room lights off!!!!!!!

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38
Q

how much magnification is provided with an otoscope? What about an optivisor?

A

otoscope - 3x
optivisor - 3-5X

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39
Q

what are your two options for achieving magnification in general practice using a smart phone?

A

video imaging using maximal optical zoom or video imaging using a macrolens (preferred)

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40
Q

how is video imaging using maximal optical zoom done on a smart phone? what limitations may be met?

A

for iPhone 7 & newer - 2X zoom doesn’t lead to any loss of resolution or detail, but above 2X, digital zoom is employed which leads to image pixilation

41
Q

T/F: when using a macro lens, the tape placed over the flash is completely independent of the lens

A

TRUE

42
Q

what should you have the room lights at when imaging the globe? why?

A

always off!!! if you leave it on, specular reflections will dominate/obscure & you won’t be able to see depth of structures, but if they are off, the ocular surface & intraocular environment can be seen

43
Q

what is the most common macro lens mistake?

A

overlap of the LED light & band and/or tape

44
Q

what are the two techniques used for discerning ocular depth?

A

optical dissection & specular reflection

45
Q

optical dissection allows the examiner to do what?

A

allows the examiner to distinguish anatomy & pathology in the anterior segment of the eye

46
Q

what structures are included in the anterior segment of the eye that are easiest to distinguish upon examination?

A

cornea, anterior chamber, & lens

47
Q

optical dissection requires what?

A

requires a focused, narrow, bright beam of light in a dark environment

48
Q

is the slit beam setting used for optical dissection of the anterior chamber?

A

nope

49
Q

what otoscope settings are approprate for optical dissection?

A

smallest aperture or the split beam view

50
Q

what is the purpose of optical dissection?

A

allows us to detect depth & clarity of ocular media

51
Q

how does optical dissection undercover pathology?

A

uncovers pathology by means of the tyndall effect (light passing through that shows particles suspended in solution - think movie projector light & how you can see dust in front of it)

52
Q

when doing optical dissection to assess for aqueous flare, what do the room lights need to be set at?

A

need to be off

53
Q

how is interpretation of the specular reflection used to discern depth on opthalmic examination?

A

can be used to determine which one of the white opacities is associated with the ocular surface

54
Q

what is the concept of using specular reflections to discern depth of ocular structures?

A

involves interpretation of natural & imposed reflections to determine the smoothness of a reflective surface

55
Q

what structures must be healthy to provide a predictable specular reflection of an eye?

A

healthy tear film, corneal epithelium, and/or anterior corneal stroma

56
Q

what is an example of how specular reflections can reflect focal pathology?

A

normal specular reflection seen in a normal region of the cornea with fluorescein dye vs abnormal specular reflection in an abnormal region of the cornea indicating the presence of an ulcer

57
Q

what is an example of using specular reflection to discern a surface disease from an intraocular disease?

A

normal specular reflection seen in an intraocular disease (uveitis) vs abnormal specular reflection in a surface disease (anterior corneal stromal lipid infiltration)

58
Q

in health, what does the ocular surface consist of?

A

precorneal tear film, corneal epithelium, & anterior corneal stroma

59
Q

what are the limitations when using specular reflection as a tool for discerning depth?

A

surface reflections from natural light, eyelids/periocular hair/photographer’s hand/clothing, can obscure or confuse the examiner’s assessment of the eye

60
Q

T/F: with natural light, intraocular structures are obscured on specular reflection, but we can say that the ocular surface is healthy (if a predictable reflection is seen)

A

TRUE

61
Q

what is the most common artifact seen in specular reflection?

A

examiner’s hand/clothing

62
Q

what does the schirmer tear test assess?

A

baseline & reflexive production of the aqueous portion of the precorneal tear film

63
Q

what does the schirmer tear test help diagnose?

A

keratoconjunctivitis sicca

64
Q

what are the guidelines for performing a schirmer tear test?

A

performed before any other drops/ointments, performed before sedation/anesthesia, performed for 60 seconds

65
Q

what are examples of fragile eyes that you wouldn’t do a schirmer tear test on?

A

deep/stromal corneal ulcers, corneal perforations/ruptures, & descemetoceles

66
Q

what are the normal results on schirmer tear tests for dogs & cats?

A

dogs - >15mm wetting/min (basal & reflex tearing) cats - unpredictable!

67
Q

why do we use fluorescein dye?

A

it is a hydrophilic dye that binds to other hydrophillic substances (tear film & corneal stroma) that will fluoresce bright green under cobalt blue light

68
Q

what are the 3 main clinical uses of fluorescein stain?

A

diagnosis & characterization of corneal ulcers, jones test of nasolacrimal patency, & seidel test of corneal perforation

69
Q

what components of the eye are hydrophilic & will take up fluorescein dye?

A

tear film is hydrophilic - will take up dye & stroma is hydrophilic & will stain bright green

70
Q

what needs to be done if you get a positive fluorescein stain of the tear film?

A

you need to flush it!!!!!!

71
Q

what is a common cause of a false positive to fluorescein dye?

A

schirmer smudge - creates a false positive (not actually on the eye)

72
Q

does a negative jones test verify blockage of the nasolacrimal duct?

A

nope

73
Q

what does a positive jones test indicate?

A

verifies that the nasolacrimal duct is patent

74
Q

what does a positive seidel test indicate?

A

verifies perforation of the cornea by showing aqueous humor leaking through a fluorescein stained tear film

75
Q

what is the most common cause of blindness in animals?

A

glaucoma

76
Q

what is tonometry? What two methods are used in practice?

A

measurement of intraocular pressure in mmHg - applanation (tonopen) & rebound (tonovet)

77
Q

what are the guidelines for performing tonometry?

A

not performed in fragile eyes & done before pupil dilation (tropicamide) due to possible pressure elevation!!

78
Q

with repeat tonometry tests, what reading is your most accurate?

A

lowest value

79
Q

what is the normal result of tonometry?

A

normal is 10-20 mmHg, under 25 mmHg at all times

80
Q

intraocular pressures > 25 mmHg with vision loss is defined as what?

A

glaucoma

81
Q

low intraocular pressures are consistent with what condition?

A

uveitis

82
Q

what is the main difference in performing tonometry between a tonopen & tonovet?

A

tonopen requires topical anesthetic (proparacaine) & tonovet does not

83
Q

what is the most common ophthalmic emergency seen in veterinary patients?

A

deep/stromal/infected corneal ulcers

84
Q

what must you own in your practice to diagnose glaucoma?

A

must have a tonometer to measure intraocular pressures

85
Q

T/F: if left untreated, glaucoma can cause blindness within a few hours

A

TRUE

86
Q

what are some reflexes that are testing during the cranial nerve/vision assessment aspect of the ophthalmic exam?

A

palpebral reflex, menace response, pupillary light reflex, dazzle reflex, oculocephalic reflex, corneal reflex, & cotton ball test

87
Q

what cranial nerves are assessed with the palpebral reflex?

A

afferent - CN V

efferent - CN VII

88
Q

what cranial nerves are assessed with the menace response?

A

afferent - CN II

efferent - CN VII

89
Q

what cranial nerves are assessed in the pupillary light reflex?

A

afferent - CN II

efferent - CN III

90
Q

what cranial nerves are assessed in the dazzle reflex?

A

afferent - CN II

efferent - CN VII

91
Q

what cranial nerves are assessed in the oculocephalic reflex?

A

intact CN II, peripheral/central vestibular components, CN III, IV, & V

92
Q

what cranial nerves are assessed in the corneal reflex?

A

afferent - CN V

efferent - CN VI & VII

93
Q

does CN II need to function for a positive oculocephalic reflex?

A

doesn’t have to be functional to get a positive reflex, but it needs to be present initially for the reflex to develop

94
Q

what is neurotrophic keratitis?

A

loss of the ophthalmic branch of CN V

95
Q

what reflexes/responses specifically identify the function of cranial nerves & also help assess for the presence of vision?

A

menace response, pupillary light reflex, & dazzle reflex

96
Q

what tests are done for orbital symmetry in an ophthalmic exam?

A

orbital palpation, dorsal view assessment, & retropulsion of the eyes

97
Q

what are the two purposes of retroillumination?

A

used to initiate & align fundoscopy as well as to confirm the presence of any opacity (looking at tapetum lucidum) located between the cornea & fundus

98
Q

T/F: when doing a PLR, both direct & consensual should be recorded

A

TRUE

SA DX & TX II (62 decks)

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