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Ophthalmology > Lacrimal System > Flashcards

Lacrimal System Flashcards

1
Q

Go over cards for first part of lecture

A

this is your reminder to just do it

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2
Q

Action of cyclosporine and tacrolimus

A
  • Interfere with interleukin 2 produced by T helper cells
  • They are immunosuppressive and should only be applied in small amounts
  • Act by suppressing the immune disorder affecting the lacrimal gland as well as direct stimulation of tears
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3
Q

Cyclosporine and tacrolimus with corneal ulcers

A
  • In contrast to steroids, they do NOT interfere with corneal healing and can be used with corneal ulcers
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4
Q

Tear replacements for KCS

A
  • There are a number of replacements
  • She prefers the ones with hyaluronic acid
  • Have to get the gunk out of the eye first
  • Solution before ointment
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5
Q

What are goals of tear replacements?

A
  • Keep cornea moist and reduce surface tension
  • Prevent corneal pigmentation
  • Protect
  • Nourish
  • Comfort
  • Aid in vision (remember decreased tear production will blur your vision)
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6
Q

Topical steroids in patients with KCS

A
  • DO NOT DO IT
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7
Q

N-acetylcysteine with KCS

A
  • Can be added to break up the mucus in the gunk
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8
Q

Referring patients with KCS

A
  • When advanced or non-responsive to traditional therapies, refer to an ophthalmologist
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9
Q

Which drug would you use for neurogenic KCS, and how would you administer it?

A
  • Pilocarpine 2%
  • 1 drop per 20# on FOOD
  • Systemic action

Can increase oral dose very slowly until GI signs appear, then reduce

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10
Q

How does pilocarpine act to help KCS?

A
  • Stimulates parasympathetic input to lacrimal gland
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11
Q

Parotid duct transposition - when to do?

A
  • Salvage procedure after all treatment options have failed
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12
Q

What are some caveats for parotid duct transposition?

A
  • Must have normal salivary gland function

- Minerals from saliva may irritate cornea, and the pH is different

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13
Q

How common is KCS in cats?

A
  • Not common
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14
Q

Schirmer tear test normal in cats

A
  • 12-25mm/min

- HOWEVER, she doesn’t really like to do STT in cats because theirs fluctuate

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15
Q

Usual cause of KCS in cats

A
  • USUALLY NOT IMMUNE-MEDIATED

- Usually associated with inflammation (herpes virus infection) and resolves when inflammation resolves

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16
Q

Treatment for KCS in cats

A
  • Keep eye moist

- Don’t put on cyclosporine

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17
Q

KCS in horses - what causes generally?

A
  • Trauma to Cranial nerve VII
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18
Q

STT in horses

A
  • Variable

- May be very high or as low as 12 mm/min

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19
Q

When might you clinically be suspicious of KCS in a horse?

A
  • Corneal ulcer without epiphora
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20
Q

Fornix

A
  • Cul de sac between the palpebral conjunctiva and bulbar conjunctiva
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21
Q

Limbus

A
  • Corneal/scleral junction
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22
Q

What is conjunctivitis?

A
  • It is NOT a diagnosis

- MUST find the underlying cause

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23
Q

Chemosis

A
  • Edema
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24
Q

Conjunctival hyperemia

A
  • congestion of the capillaries
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25
Q

What type of disease does conjucntival hyperemia suggest?

A
  • surface diseases

- Allergen, distichia

26
Q

Subconjunctival hemorrhage - what does it suggest?

A
  • Some sort of coagulopathy
27
Q

How can you differentiate surface vs intraocular disease with episcleral injection?

A
  • Larger, more angry vessels suggests intraocular disease

- Surface vessels suggest surface disease

28
Q

What are the two most common causes of conjunctivitis in dogs?

A
  • KCS

- Allergies/irritants

29
Q

Other causes of conjunctivitis in dogs

A
  • KCS and allergies/irritants are the MOST COMMON!
  • Foreign body
  • Corneal ulcer, aberrant cilia, retrobulbar disease
  • Dental/oral disease
  • Infectious agent
  • CHV1
30
Q

Most common causes of conjunctivitis in cats?

A
  • INFECTION
  • Herpesvirus FHV1-
  • Chlamydia
31
Q

Other causes of conjunctivitis in cats

A
  • bartonella, calici, mycoplasma
  • Trauma
  • Corneal ulcer (usually viral)
  • FB
  • Allergies (consider if you’ve ruled out everything else
  • Dental/oral disease
32
Q

What history questions should you ask for conjunctivitis?

A
  • Duration
  • Current or prior medications**
  • Change in diet or environment
  • Concurrent illness (HAC, DM)
33
Q

Diagnostic steps for conjunctivitis

A
  • History***
  • Ocular exam (look for conformational abnormalities, distichia, trichiasis, masses, and ectopic cilia)***
  • STT (in a dog)***
  • Fluorescein stain***
  • Explore conjunctival sac and behind TEL (proparacaine needed)
  • Nasolacrimal flush
  • Collect samples for cytology, culture, and sensitivity
  • Examine oral cavity
  • Biopsy of conjunctival tissue
  • R/o Systemic disease
  • Response to treatment
34
Q

Who gets follicular conjunctivitis?

A
  • Dogs under 24 months of age
35
Q

What should you rule out prior to diagnosing follicular conjunctivitis

A
  • Everything
  • Distichia, ectopic cilia
  • Foreign body
  • Entropion, KCS
36
Q

Causes of follicular conjunctivitis?

A
  • Immune stimulation and possible allergies in the diet
37
Q

Clinical signs of follicular conjunctivitis?

A
  • Mild discomfort
  • Ocular discharge
  • Cobblestone appearance behind the third eyelid
38
Q

How does follicular conjunctivitis respond to topical abx and steroid?

A
  • Responds well, but will recur when treatment stops
39
Q

Treatment for follicular conjunctivitis?

A
  • RULE OUT UNDERLYING CAUSE OR ULCER FIRST
  • Start with BNP-HC or NSAID (diclofenac)
  • May need NPDex if not responsive (start out high then taper to lowest effective interval)
  • Exclusion diet like Z/D may be helpful
40
Q

If a horse has conjunctivitis, what should you assume until proven otherwise?

A
  • CORNEAL ULCER
  • 9/10 there will be a corneal ulcer, so you MUST LOOK FOR IT
  • It will be hard to see
41
Q

Conjunctivitis and periodontal disease - appearance

A
  • The eye might look fine (no hyperemia)

- Pus coming out of the skin near the eye but the eye looks okay

42
Q

Retrobulbar abscess/cellulitis appearance

A
  • Periorbital swelling, elevated 3rd eyelid, pain opening mouth
43
Q

Retrobulbar neoplasia appearance

A
  • Periorbital swelling, elevated 3rd eyelid, +/- painful
44
Q

How to diagnose abscess vs neoplasia for retrobulbar?

A
  • May need imaging to try and differentiate

- For neoplasia, ultimately biopsy

45
Q

Retrobulbar cellulitis causes

A
  • Tooth root abscess
  • Foreign body
  • Bony orbit is soft, and the teeth are quite close
46
Q

Retrobulbar cellulitis signs

A
  • Conjunctivitis

- Swelling and redness behind last molar

47
Q

Diagnosis for retrobulbar cellulitis

A
  • Examine mouth for dental disease

- Dental radiographs

48
Q

Treatment for retrobulbar cellulitis

A
  • Treat the underlying problem

- Topical and broad spectrum abx and NSAIDs

49
Q

Hemorrhage in the conjunctiva- what to look for?

A
  • Immune mediated disease like hemolytic anemia
  • Can look for trauma
  • Look for anticoagulant rodenticide
50
Q

Infectious causes of canine conjunctivitis

A
  • Canine distemper virus
  • Canine adenovirus CAV 1 (not usually seen)
  • Canine herpes virus CHV1
  • Bacterial infections usually secondary
51
Q

Ocular signs seen with canine distemper virus?

A
  • Inflammation
  • copious suppurative exudate
  • KCS
  • SYstemic illness
52
Q

What to do if a patient has conjunctivitis as well as signs of allergies (foot licking, pruritus, otitis)?

A
  • Treat the derm issues first
  • Often have blepharitis
  • Consider exclusion diet, fatty acids, NSAIDs, antihistamine, dermatologist referral
53
Q

Treatment options for allergic conjunctivitis in dogs

A
  • Topical steroids (BNP-HC might be best as it’s a weak steroid vs NPDex
  • NSAIDs (diclofenac)
  • Antihistamines (ketotifen)
54
Q

Steroids for treatment of conjunctivitis - precautions ** KNOW THIS FOREVER ***

A
  • Hydrocortisone can be used for conjunctival inflammation
  • Steroids SHOULD NOT BE USED WITH CORNEAL ULCERS
  • Dexamethasone and pred acetate are more potent, penetrate the cornea, and promote corneal melting if an ulcer is present
55
Q

Topical steroids in cats

A
  • AVOID AVOID AVOID
  • Conjunctivitis in cats usually caused by an infectious agent
  • HUGE PROBLEMS
56
Q

FVRCP intranasal treatment for Feline Herpes

A
  • Intranasal FVRCP thought to give a local IgA response
57
Q

Why do cats with herpesvirus end up getting conjunctivitis?

A
  • It hangs out in the trigeminal ganglion

- Immunosuppression –> immune signs in the eye

58
Q

Rabbits with conjunctivitis

A
  • Dacryocystitis from dental disease needs to be ruled out as the primary cause
59
Q

Differentials for diffuse subconjunctival hemorrhage and tiny pupil

A
  • Trauma, coagulopathy, neoplasia, immune-mediated condition
60
Q

Differentials for a pale conjunctiva with chemosis

A
  • Might be stomach worms leading to hypoproteinemia?
61
Q

What are reasonable differentials for epiphora? in a white poodle

A
  • Imperforate punctas
  • Trichiasis
  • Meibomian gland dysfunction (lipid layer)
62
Q

Differentials for a dog with excessive tearing and blepharospasm and inspissated Meibomian glands?

A
  • loss of lipid layer

- Not sure?

Ophthalmology (8 decks)

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