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SAM 2 scs RUSVM > Final: Ophthalmology - Exam, Orbit, Eyelids, Conjunctiva and Lacrimal System > Flashcards

Final: Ophthalmology - Exam, Orbit, Eyelids, Conjunctiva and Lacrimal System Flashcards

1
Q

What term describes vision in a well-lit environment? What about a dark environment?

A

Photoptic

Scotoptic

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2
Q

What is the term for using light that is shone into the eye to reflect against internal structures and highlight normal and abnormal features during an ophtho exam?

A

Retroillumination

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3
Q

What test can you perform to detect disease of the orbit or space occupying disease behind the globe?

A

Retropulsion

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4
Q

What test can you perform to test nasolacrimal patency? What type of solution is used?

A

Jones Test

Fluoroscein stain (goes in the eye, and if positive comes out the nose)

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5
Q

Which test is used to confirm corneal perforation?

A

Seidel test

(will see ‘bubbles’ when you stain the eye at the site of perforation)

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6
Q

What can be used to assess the health of the ocular surface because it becomes disturbed when the surface is irregular?

A

Specular reflection

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7
Q

What are the 3 tests you can perform during an exam to assess vision?

A

Cotton ball test

Photopic maze

Scotopic maze

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8
Q

What are the 3 tests used for orbital symmetry?

A

Orbital palpation

Dorsal view assessment

Retropulsion

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9
Q

Which of these pictures shows an eyeball being retroilluminated?

A

The bottom one

(Can see vitreal opacities)

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10
Q

What nerves does the palpebral reflex test? Menace response?

A

Palpebral: V (afferent), VII (efferent)

Menace: II (afferent), VII (efferent)

Also note that menace is a response not a reflex

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11
Q

What nerves does the PLR test? What about the dazzle reflex?

A

PLR: II (afferent), III (efferent)

Dazzle: II (afferent), VII (efferent)

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12
Q

What nerve does not need to function in order to elicit a postive oculocephalic reflex, though it is necessary to develop the reflex initially?

A

CN II

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13
Q

What tests are in the Minimum Data Base (for ophtho)?

A

Schirmer Tear Test

Fluoroscein Stain- for corneal ulcer, Jones, and Seidel

Tonometry

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14
Q

Which parts of the eye stain because the are hydrophilic?

A

Tear film

Stroma

(Epithelium and Descemet’s membrane don’t stain- hydrophobic)

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15
Q

T/F: A positive Jones Test demonstrates nasolacrimal patency, but a negative test does not necessarily prove nasolacrimal obstruction.

A

True

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16
Q

Should you perform tonometry to measure intraocular pressure before or after pupil dilation with tropicamide? What is the measurement in (unit)? What do pressures >25 with vision loss indicate? What does low pressure indicate?

A

Before

mmHg

High= Glaucoma

Low= Uveitis

N= 10-25mmHg

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17
Q

What is the arrow indicating?

A

A disrupted specular reflection

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18
Q

Aqueous flare is pathognomic for what disease process?

A

Uveitis

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19
Q

What is the term for a congenitally small and malformed globe?

A

Microphthalmos

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20
Q

What is the term for an acquired shrunken globe, most often from severe or chronic inflammation?

A

Phthisis bulbi

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21
Q

What is the term for anterior displacement of the globe such that the eyelids are caught behind the equator of the globe?

A

Proptosis

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22
Q

T/F: The boney orbit is part of the adnexa.

A

True

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23
Q

T/F: Cats and dogs have open orbits with an orbital ligament which forms the lateral boundary of the orbital rim.

A

True

(Horses and ruminants have closed orbits)

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24
Q

Relative to skull size, does the orbital ligament span a greater or shorter portion of the orbital rim in brachycephalic dogs?

A

Greater

(Orbit is much shallower)

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25
Q

What disorder of globe position is commonly associated with third eyelid protrusion, facial swelling, soft palate bulging, fever and pain when opening the mouth?

A

Exophthamos - abnormal protrusion of eye from orbit

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26
Q

What is the single most common mechanism that causes exophthalmos? What are 2 conditions in the dog that commonly cause this?

A

Orbital volume imbalance

Orbital neoplasia (no pain) and orbital cellulitis/abscess (pain)

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27
Q

What is the enlargement of the globe due to glaucoma?

A

Buphthalmos

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28
Q

What is the difference between enucleation and exenteration?

A

Enucleation= removal of eye

Exenteration = removal of eye + all orbital contents

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29
Q

What’s wrong here? What clinical signs are commonly associated with this condition?

A

Enophthalmos (abnormal recession of the eye within the orbit)

CS: uni-or bilateral facial muscle loss, third eyelid protrusion, entropion

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30
Q

What are the three common mechanisms of enophalmos? Also give one common cause of each of these.

A
  1. Orbital volume imbalances: Dehydration, emaciation/cachexia, myopathies, space occupying lesions anterior to globe
  2. Active globe retraction: Pain (skeletal muscle (retractor bulbi))
  3. Passive glove retraction: Horner’s Syndrome
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31
Q

What is strabismus?

A

Deviation of one or both eyes, so both eyes are not directed at the same object

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32
Q

What are some poor prognostic indicators for globe retention following proptosis?

A

Rupture of the eye

Hyphema

Orbital fractures

Poor owner compliance

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33
Q

What is the fibrocartilagenous layer of the eyelid that contains the meibomonian glands? What do the meibomonian glands produce?

A

Tarsus

Lipid/Sebum, outermost layer of the 3 layer tear film

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34
Q

What is dropping of the eyelids called? What is incomplete eyelid closure called?

A

Ptosis

Lagophthalmos

35
Q

What is the condition called in which the eyelid margins roll in such that hairs are touching the ocular surface?

A

Entropion

36
Q

What is the outward rolling of the eyelids called?

A

Ectropion

37
Q

What is the term for squinting involuntarily or excessively?

A

Blepharospasm

38
Q

What is the surgical procedure in which the eyelids are sutured together?

A

Tarsorrhaphy

39
Q

What is it called when hairs growing on normal skin reaches the corneal and/or conjunctival surface (for example from the nasal folds in brachy breeds)?

A

Trichiasis

40
Q

Which is the correct order from the outside to inside of the eyelid?

a. Skin - Tarsus and Meibomian glands - Muscle- Conjunctiva
b. Tarsus and Meibomian glands - Muscle- Conjunctiva- Skin
c. Skin - Muscle- Tarsus and Meibomian glands - Conjunctiva

A

c. Skin - Muscle- Tarsus and Meibomian glands - Conjunctiva

41
Q

What is the main function of eyelid skin?

A

Sensory protection

42
Q

Which muscle(s) close(s) the eyelids? Which muscle(s) open(s) the upper eyelid?

What does dysfunction of those muscles cause?

A

Close- Orbicularis oculi

Dysfunction= Lagohthalmos

Open upper- Levator palpebrae superioris, Mueller’s Muscle

Dysfunction= Ptosis

43
Q

Entropion is an abnormal relationship of the eye in relation to the eyelids. What must you identify before treating this?

A

The cause of the imbalance

44
Q

Permanent correction of anatomic entropion may not ne necessary until _____ months of age.

A

6-9

45
Q

How can anatomic and blepharospasm entropion be differntiated? Why is this important to do before treating?

A

Use proparacaine drops to remove ocular pain which induces blepharospasm.

If you fail to assess the spastic component it can lead to overcorrection and ectropion

46
Q

What surgery is the permanent correction for entropion?

A

Modified Hotz-Celus (rolls out eyelid)

47
Q

Clinical signs of Horner’s syndrome are due to disruption of three target sites of the sympathetic nerve. What are these?

A

Upper eyelid- Mueller’s muscle

Iris- Iris dilator muscle

Periorbital cone- Circumferential smooth muscles

48
Q

What is the most common cause of Horner’s?

A

Idiopathic- Post ganglionic

49
Q

What is used to diagnose Horner’s syndrome?

A

Dilute phenylephrine (0.1%) 1 drop OU

50
Q

What are the arrows indicating? How is it treated if it is causing problems? What else is that treatment used for?

A

Distichia

Tx: Cryoepilation (followed by plucking hairs out)

Often requires multiple treatments

Also used to treat ectopic cilia

51
Q

T/F: Canine eyelid tumors are usually benign while cat eyelid tumors are usually malignant.

A

True

Most common in dog= meibomian gland adenoma

52
Q

What are the 4 key concepts of the closure of eyelid margin defects?

A
  1. Limited debridement
  2. Closure must be perfect - use figure 8 suture pattern at margin
  3. Avoid full thickness suture bites
  4. Tarsus = holding layer
53
Q

What will an untreated prolapsed gland of the third eyelid (Cherry eye) cause?

A

Chronic conjunctivitis

Keratoconjunctivitis sicca

54
Q

What are the 2 common techniques to treat a prolapsed gland of the third eyelid?

A

Morgan pocket technique

Orbital tacking

55
Q

What is the area where the palpebral conjunctiva meet the bulbar conjunctiva?

A

Conjunctival fornix

56
Q

What is the common response to ocular irritation resulting in the overproduction of tears?

A

Epiphora

57
Q

What do you call a permanent adhesion between the conjunctiva and the cornea?

A

Symblepharon

58
Q

What are the non-perfused corneal blood vessels that provide evidence of previous keratitis?

A

Ghost vessels

59
Q

What is chemosis?

A

Edema of the conjunctiva

60
Q

What test do you use when you suspect KCS?

A

Schirmer Tear Test

61
Q

What are the blue arrows pointing at? What does the presence of these indicate?

A

Lymphoid Follicles (on the palpebral surface of the 3rd eyelid)

Indicate primary conjunctivitis

62
Q

Blepharospasm, epiphora, mucoid discharge, and hyperemia in a young dog with atopy, indicates what disease process?

A

Allergic conjunctivitis

63
Q

In addition to treating the underlying cause, how do you treat allergic conjunctivitis?

A

Topical anti-inflammatories

e.g. Steroid (Neomycin-Polymycin-Dex), NSAID (Diclofenac 0.1%), T-Cell Inhibitor (Cyclosporin 0.2%)

64
Q

What are the 3 layers of tear film? What are the 3 main funcitons?

A

Layers: Lipid/oil (Meibomian glands), Aqueous (lacrimal gland of 3rd eyelid), Mucinoid (innermost; Conjunctival goblet cells)

Functions: Nourish, Cleanse, Protect the ocular surface

65
Q

What is the most common cause of KCS? What canine virus is associated with KCS?

A

Immune-Mediated destruction

Distemper

66
Q

_______ KCS is an aqueous deficiency. It is diagnosed with clinical signs and when the STT is _____mm/min.

A

Quantitative

<15mm/min

67
Q

Qualitative KCS is ____ or ____ deficiency. It is diagnosed with clinical signs and a STT _____ mm/min.

A

Lipid

Mucin

>/=15 mm/min

68
Q

What dog breeds are associated with KCS?

A

Toy breeds

Brachycephalic breeds

Cocker Spaniels

69
Q

T/F: KCS is often bilateral.

A

True

70
Q

These are images of an eye affected by KCS. List the pathologies you can see.

A

Hyperemia

Mucopurulent discharge

Severe superficial neovascularization

71
Q

A dog with severe mucopurulent discharge requires fluroescein staining. What must you do before applying the stain?

A

Wash away all discharge (so you don’t miss the lesion)

72
Q

What part of the cornea commonly shows signs of keratitis and why?

A

Dorsal cornea

Remaining tear film protects the ventral cornea (gravity)

73
Q

What is the treatment for the majority of KCS cases? How long is the course of treatment?

A

Topical cyclosporin (Optimmune)

Treatment is lifelong - controls but does not cure

74
Q

What are the 4 objectives of KCS treatment?

A
  1. Replace tears (Artifical tears)
  2. Stimulate more tears (Cyclosporin)
  3. Anti-inflammatory therapy (Cyclosporin)
  4. Antibiotic therapy (Temporary)
75
Q

What is the most common cause of feline conjunctivitis and keratitis? Why?

A

Feline Herpesvirus

The virus has epithelial tropism

76
Q

What form of herpesvirus disease becomes reactivates due to environmental stress?

A

Recrudescent disease

77
Q

What are 2 specific and 2 very specific FHV-1 clinical signs?

A

Specific: URI (more common with primary infections), Hyperemia

Very specific: Conjunctival and possible corneal epithelial ulceration (Dendritic ulceration= pathognomic), Symblepharon

78
Q

T/F: If you observe conjuctivitis and evidence of present of historic keratitis, then consider FHV-1 over other causes of feline conjunctivitis.

A

True

79
Q

What is the treatment for FHV-1?

A

Antiviral therapy: Topical cidofovir, Oral famciclovir

Supportive care (for ulceration): Topical erythromycin

80
Q

What obligate intracellular bacteria causes conjunctivitis in young and/or stressed cats?

A

Chlamydia

(2nd most common cause of conjunctivitis behind FHV-1)

81
Q

What is the most specific clinical sign associated with chlamydial conjunctivitis?

A

Chemosis

(Chemosis is for Chlamydia)

82
Q

What will cytology with chlamydial conjunctivitis reveal?

A

Intracytoplasmic inclusion bodies

83
Q

T/F: Chlamydial conjunctivitis causes corneal or conjunctival ulceration.

A

False!

SAM 2 scs RUSVM (14 decks)

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