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SA Ophthalmology-Neurology > Final - Opthalmology Portion > Flashcards

Final - Opthalmology Portion Flashcards

1
Q

Cloudiness in the eye may be localized to what structures?

A

Cornea, Anterior chamber, Lens, Posterior segment (vitreous and retina)

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2
Q

What are the 4 conditions associated with a cloudy eye in the cornea?

A

Edema, Scar/Fibrosis, Lipid, Mineral

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3
Q

Corneal edema can be caused by what two conditions of the eye?

A

Ulceration and Endothelial Dysfunction

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4
Q

Endothelial dysfunction can lead to what other conditions of the eye?

A

Anterior uveitis, glaucoma, endothelial degeneration, localized dysfunction

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5
Q

What conditions of the eye cause corneal scarring or fibrosis?

A

Prior ulcer/trauma, chronic exposure, chronic abrasion

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6
Q

Chronic exposure of the eye is caused from what two conditions?

A

Lagophthalmos and KCS

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7
Q

Chronic abrasion of the eye can be caused by what three conditions?

A

Entropion, Distichia, Ectopic cilia

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8
Q

What causes lipid degeneration?

A

Prior keratitis, infiltrative corneal disease, topical corticosteroids, systemic metabolic disease

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9
Q

What two causes leads to a corneal lipid (lipid keratopathy)?

A

Lipid dystrophy and lipid degeneration

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10
Q

What are the two causes of corneal mineralization?

A

Degeneration (age related or ocular disease) and Metabolic (systemic metabolic disease)

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11
Q

Ocular pain related to a cloudy cornea is caused by what?

A

Edema

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12
Q

What is the difference between aqueous flare and lipid flare?

A
  • Aqueous flare is caused by uveitis
  • Lipid flare is caused by metabolic/hyperlipidemia +/- uveitis
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13
Q

Lipid flare and aqueous flare is localized to what part of the eye?

A

Anterior chamber

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14
Q

What will you see when focal light source is directed through the anterior chamber if you suspect aqueous flare?

A

Tyndall effect

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15
Q

What dealing with the lens what two conditions are you worried about?

A

Cataracts and Nuclear sclerosis

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16
Q

When you are worried about the posterior segment of the eye, what two structures are you referring to?

A

Vitreous and Retina

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17
Q

What issues are associated with the vitreous vs. the retina?

A
  • Vitreous = vitreous haze due to inflammation, asteroid hyalosis, synchesis scintillans
  • Retina = retinal detachment
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18
Q

Study photo

A

Look up something you don’t understand

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19
Q

What are the 3 basic events that happen during intraocular inflammation?

A

Increased blood supply, augmented vessel permeability, white blood cell migration

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20
Q

Inflammation is generated by what 3 things?

A

Release of chemical mediators, presence of certain pathogen-associated molecules, and release of pro-inflammatory molecules by immune cells

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21
Q

What are some ocular clinical signs you will see with uveitis?

A

Aqueous flare, ciliary flush, corneal edema, episcleral injection, hyphema, hypopyon, keratin precipitates, miosis, rubiosis irides, synechiae

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22
Q

This is defined as 360 degree vascularization

A

Ciliary flush

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23
Q

This is defined as fluid buildup within the stroma caused by altered function of the corneal endothelium

A

Corneal edema

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24
Q

This is pupillary constriction and painful spasm of the ciliary body muscular

A

Miosis

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25
Q

This is defined as the adherence of the iris to the cornea (anterior) or lens (posterior) lead by inflammatory cells, fibrin, and fibroblasts

A

Synechiae

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26
Q

This is defined as protein in aqueous humor (anterior chamber) - disruption of BAB and viewed as a hazy anterior chamber

A

Aqueous flare

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27
Q

This is defined as WBCs in aqueous humor (anterior chamber) particularly neutrophils

A

Hypopyon

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28
Q

This is defined as RBCs in the aqueous humor (anterior chamber)

A

Hyphema

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29
Q

This is defined as inflammatory cells, fibrin, and iris pigment adhered to endothelium (innermost layer of cornea)

A

Keratic precipitates

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30
Q

This is the injection of the iridal blood vessels

A

Rubiosis irides

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31
Q

This is defined as low intraocular pressure

A

Hypotony

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32
Q

What ocular structure is responsible for aqueous humor production?

A

Ciliary body

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33
Q

What are some potential complications of intraocular inflammatory diseases?

A

Synechiae, Iris bombe, corneal edema and degeneration, cataracts, lens instability, vitreous degeneration, retinal detachment, secondary glaucoma, phthisis bulbi

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34
Q

What are the common clues that lead to uveitis?

A

Miosis, low IOP, aqueous flare, hypopyon, hyphema

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35
Q

What are 3 primary causes of ocular disease?

A

Cataracts, lens rupture, corneal ulcer

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36
Q

Idiopathic uveitis is more common what species?

A

Cats

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37
Q

What are general causes of uveitis?

A

Primary ocular disease, idiopathic, trauma, ocular manifestations of systemic diseases

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38
Q

What are common causes of uveitis in dogs?

A

Infectious, Len-induced (phaolytic or phacoclastic), reflex uveitis

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39
Q

This is defined as soluble lens protein that leaks through an intact lens capsule (cataract)

A

Phacolytic uveitis

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40
Q

This is defined as the sudden exposure of intact lens protein (lens capsule tear - trauma)

A

Phacoclastic uveitis

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41
Q

Reflex uveitis is associated with what structures of the eye?

A

Cornea and sclera

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42
Q

What is the common primary neoplasia that causes uveitis in dogs?

A

Melanoma

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43
Q

What is the most common metastatic neoplasia that causes uveitis in dogs?

A

Lymphoma

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44
Q

Pigmentary uveitis is also known as what?

A

Golden retriever uveitis

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45
Q

What are breed specific causes of uveitis?

A

Uveodermatologic syndrome and Pigmentary uveitis (golden retriever uveitis)

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46
Q

What is a metabolic cause of uveitis?

A

Hyperlipidemia

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47
Q

What are common infectious causes of uveitis in cats?

A

Viral (FeLV, FIP, FHV-1), Bacterial (Bartonella), Fungal (Histoplasma, Blastomyces, Coccidioides), and Protozoal (Toxoplasma)

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48
Q

What is metabolic cause of uveitis in cats?

A

Systemic hypertension

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49
Q

What is the most common neoplastic cause of uveitis in cats?

A

Lymphoma

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50
Q

In cases of uveitis, when should you do ultrasound?

A

ONLY if you cannot see past the iris and lens

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51
Q

What are the treatment goals for uveitis?

A

Control pain, prevent sequelae, stabilize and restore blood-aqueous barrier, and treat the underlying cause when possible!

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52
Q

Name some topical treatments for uveitis

A
  • Topical anti-inflammatories: corticosteroids (prednisolone acetate, dexamethasone), non-steroidal anti-inflammatories (diclofenac, ketorolac)
  • Topical atropine (mydriatic and cycloplegic)
53
Q

When are corticosteroids contraindicated in uveitis cases?

A

Potentiate infections, decrease wound healing, ulcerative keratolysis, corneal lipid/calcium deposition

54
Q

When is atropine contraindicated in cases of uveitis?

A

Lens instability, glaucoma, dry eye

55
Q

In cases of uveitis treatment, what do you need to have checked before administering system steroids?

A

Diagnostics, because CS can be exacerbated by suppressing the immune system

56
Q

This is a Multifactorial disease that is characterized by elevation of intraocular pressure incompatible with ocular health. It cause irreversible vision loss through optic nerve and ganglion cell death

57
Q

This type of glaucoma is defined as heritable/breed-related abnormality of aqueous drainage angle

A

Primary glaucoma

58
Q

This type of glaucoma is defined as numerous causes of secondary drainage angle obstruction

A

Secondary glaucoma

59
Q

What are some causes of canine secondary glaucoma?

A

Lens luxation, uveitis, hyphema, intraocular neoplasia, melanocytic glaucoma (cairn terrier), Pigmentary uveitis (golden retrievers), pseudophakia/aphakia, trauma

60
Q

(T/F) Primary glaucoma is common in cats

A

False! It is rare

61
Q

What is the most common cause of secondary glaucoma in cats?

A

Uveitis, due to the misdirection of aqueous humor (unique to cats)

62
Q

What are 3 mechanisms of vision loss in glaucoma?

A

High intraocular pressure, optic nerve ischemia, neurotoxic events

63
Q

What are acute clinical signs of glaucoma?

A

Blepharospasm, corneal edema, episcleral injection, dilated pupils, variable vision

64
Q

What are chronic signs of glaucoma?

A

All acute signs, buphthalmos, haab’s striae, lens subluxation, cupped optic nerve

65
Q

How do you diagnose glaucoma?

A

Clinical signs, history/signalment, IOP, gonioscopy

66
Q

What is the considered the primary means of diagnosing and assessing glaucoma therapy?

67
Q

Gonioscopy helps determine the likelihood of what based upon angle morphology?

A

Primary glaucoma

68
Q

What are the goals of glaucoma therapy?

A

Maintenance of vision, patient comfort, prophylaxis in “at risk” eyes

69
Q

Name the classes of drug used to treat glaucoma

A
  • systemic hyperosmotic medications
  • carbonic anhydrase inhibitors
  • miotics
  • prostaglandin analogues
  • b-adrenergic blocking agents
70
Q

What drug do you want to use for emergency management of glaucoma topically and systemically?

A
  • Topically = Latanoprost
  • Systemically = IV mannitol or oral glycerin (hyperosmotics)
71
Q

What drug class do you want to use for maintenance medications that is the most useful single drug class in all types of glaucoma?

A

Carbonic Anhydrase Inhibitors

72
Q

What are some examples of carbonic anhydrase inhibitors?

A

Dorzolamide and Brinzolamide

73
Q

What is another maintenance medication for glaucoma besides CAIs?

A

Miotics (topical)

74
Q

When should you avoid using a miotic as a maintenance medication for glaucoma?

A

When the glaucoma is secondary to uveitis or anterior lens luxation

75
Q

What are some examples of topical miotics?

A

Demarcarium bromide and Pilocarpine

76
Q

Name 3 prostaglandin analogues and what is important about them?

A

Latanoprost, Travoprost, and Bimatoprost
- They are NOT effective in cats

77
Q

A topical B-blocker used as a glaucoma medication is for what stage of treating glaucoma?

A

Maintenance medication that is also useful in prophylaxis of at-risk eyes

78
Q

Name 2 topical B-blockers

A

Timolol maleate and Betxolol

79
Q

A high normal IOP is considered what in glaucoma patients?

A

Undesirable; < 15-20 mmHg is ideal

80
Q

With medical prophylaxis of glaucoma in the second eye, what classes of drugs are you using?

A

Topical miotics, CAIs, and B-blockers

81
Q

What drug class is contraindications when treating glaucoma?

A

Topical MYDRIATIC (atropine, tropicamide)

82
Q

What does surgical management of glaucoma do?

A

Decrease aqueous production or increase aqueous outflow

83
Q

The long-term visual prognosis of glaucoma patient is what?

84
Q

What are the salvage procedures that can be performed?

A

Enucleation, Evisceration/Intrascleral prosthesis, Chemical ciliary body ablation

85
Q

Chemical ciliary body ablation can only be done in what type of eyes for glaucoma patients? What drug is being injected?

A

BLIND eyes; Gentamicin

86
Q

What are some causes of corneal ulcers?

A

Trauma, Corneal abrasion due to adnexal disease, tear film deficiency, exposure keratitis, infection

87
Q

What 3 types of ulcer are still able to heal?

A

Acute superficial ulcer, mid-stromal ulcer, deep stromal ulcer

88
Q

Corneal ulcers generally heal within how many days?

89
Q

What is always indicated when diagnosing corneal ulcers?

A

Searching for underlying cause and STT

90
Q

What tests are specifically indicated when diagnosing corneal ulcers?

A

Corneal culture and cytology

91
Q

What are the specific causes of delayed corneal healing?

A

Corneal infection, unresolved source of corneal abrasion (Distichia, ectopic cilia, Entropion, foreign body), KCS, exposure keratitis, neutrophic keratitis, SCCED

92
Q

What is the cause of a primary infectious ulcer in a cat?

A

Herpesvirus

93
Q

What does a secondary corneal infection result in?

A

Progressive destruction of corneal stroma

94
Q

This is defined as the inward rolling of eyelids causing hairs to abrade cornea

A

Entropion (conformational or spastic Entropion)

95
Q

This is the single or multiple abnormal hairs protruding from meibomian gland openings of eyelids that may or may not cause clinical problems

96
Q

This is abnormal hairs protruding through conjunctival surface of the eyelid that is ALWAYS symptomatic

A

Ectopic cilia (most common in young dogs and toy breeds)

97
Q

This is a common cause of corneal ulcers and delayed healing in dogs and is readily diagnosed by STT

98
Q

Conformational exophthalmos, inability to blink due to facial paralysis, exophthalmos due to orbital disease, buphthalmos due to glaucoma are all causes of what?

A

Exposure keratitis

99
Q

This is the loss of corneal sensation that results in spontaneous non-healing ulceration

A

Neutrophic keratitis (ophthalmic branch of the trigeminal nerve)

100
Q

This is characterized by a chronic, non-healing superficial corneal ulcer for which NO underlying cause can be determined (middle aged dogs most commonly affected)

A

Spontaneous Chronic Corneal Epithelial Defect (SCCED)

101
Q

What type of ulcer can be approached medically and surgically?

A

Deep stromal ulcer

102
Q

What are the goals of medical therapy for a corneal ulcer?

A
  • Prevent/control infection
  • Prevent/control collagenolysis
  • Increase patient comfort
  • Promote corneal healing
103
Q

Describe plan for an acute superficial ulcer

A
  • Diagnostics: rule out underlying conditions
  • Tx: topical broad spectrum abx, topical atropine, analgesic PRN
  • Follow-up: recheck q 2-3 days, stain to monitor ulcer size
104
Q

A chronic ulcer is defined as an ulcer that has not healed within how many days?

105
Q

What are the 3 characteristics that lead to a SCCED diagnosis?

A

Chronic clinical course, lack of identifiable cause, clinical appearance

106
Q

What are some clinical characteristics of SCCED?

A

Chronic superficial corneal ulcer, epithelial lip (flourescein staining pattern), variable corneal pain and vascularization

107
Q

(T/F) animals with SCCED rarely develop infections

108
Q

The following is pathogenesis understood for what condition:
- hyalinized acellular anterior corneal stroma prevents corneal epithelial adhesion
- epithelial non-adherence usually extends well beyond obvious region of ulcer

109
Q

How is SCCED treated?

A

Epithelial debridement, surgical procedures such as anterior stromal puncture (grid keratotomy and burr keratotomy) and superficial keratectomy

110
Q

What part of treating SCCED is mandatory?

A

Epithelial debridement

111
Q

During an anterior stromal puncture for treating SCCED, exposure to what facilitates epithelial adhesion complex formation?

A

Type I collagen

112
Q

For a SCCED follow-up, if it is not healed with what time frame what should you do next?

A

2-3 weeks; sx tx should be repeated if not healed

113
Q

Describe the diagnostic plan for mid-stromal ulceration

A
  • Diagnostics: investigate underlying factors, corneal C&S and cytology
  • Tx: topical broad spectrum abx, protease inhibitors, topical atropine, analgesics PRN
  • Follow-up: q 24 hours, then 48 hours
114
Q

Describe a plan for deep stromal ulcers/melting ulcers

A
  • Diagnostics: investigate risk factors, corneal C&S and cytology
  • Tx: topical broad spectrum abx, protease inhibitors, topical atropine, analgesic PRN
  • Follow-up: hospitalize or recheck q 24h
115
Q

Describe a plan for descemtocele s

A
  • Diagnostics: corneal cytology to culture (obtained from ulcer EDGES), STT
  • Tx: SURGERY (conjunctival flap, CCT), topical abx
  • Follow-up: recheck at 1 and 3 weeks, discontinue abx at 3 weeks, trim flap at 4-6 weeks
116
Q

What are the pre-operative treatments for a corneal perforation?

A
  • Topical broad spectrum abx
  • Topical atropine
  • Systemic broad spectrum abx
  • Systemic anti-inflammatory
117
Q

This clinical sign of the eye is a common presentation of systemic disease

118
Q

This is defined as diffuse redness or small network of vessels of either the bulbar or palpebral conjunctiva

A

Conjunctival hyperemia

119
Q

This is the distinct, relatively straight vessels that are adherent to the sclera

A

Episcleral injection

120
Q

This is the loss of physiologic corneal transparency where the vessel type/location is defined by its appearance

A

Corneal neovascularization (deep/Stromal vessels, superficial vessels, and 360 degree deep neovascularization)

121
Q

What are the two types of hemorrhage (blood outside of vessels) in the eye?

A

Subconjunctival hemorrhage and Hyphema

122
Q

You will often see long, branching corneal vessels and conjunctival hyperemia with what condition?

A

Superficial keratitis/KCS

123
Q

With an intraocular disease, what kind of redness will you see?

A

Episcleral injection, conjunctival hyperemia, 360 degree deep corneal vessels

124
Q

What are the most important immediate rule out for red eye before treating empirically?

A

Corneal ulcer, dry eye, glaucoma, uveitis

125
Q

Classify mild and dramatic anisocoria

A

Mild = afferent and Dramatic = efferent

126
Q

What are non-neurological causes of mydriasis and miosis?

A

Mydriasis = iris atrophy, glaucoma, pharmacologic
Miosis = uveitis, keratitis, posterior synechia, pharmacologic

127
Q

This is a hereditary, degenerative disorder of the rods and cons. Secondary cataract formation is common

A

Progressive retinal atrophy

128
Q

This usually presents as a complete loss of vision in dogs that is commonly bilateral

A

Canine Optic Neuritis

SA Ophthalmology-Neurology (2 decks)

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