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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
What type of disease does conjucntival hyperemia suggest?
- surface diseases | - Allergen, distichia
26
Subconjunctival hemorrhage - what does it suggest?
- Some sort of coagulopathy
27
How can you differentiate surface vs intraocular disease with episcleral injection?
- Larger, more angry vessels suggests intraocular disease | - Surface vessels suggest surface disease
28
What are the two most common causes of conjunctivitis in dogs?
- KCS | - Allergies/irritants
29
Other causes of conjunctivitis in dogs
- KCS and allergies/irritants are the MOST COMMON! - Foreign body - Corneal ulcer, aberrant cilia, retrobulbar disease - Dental/oral disease - Infectious agent - CHV1
30
Most common causes of conjunctivitis in cats?
- INFECTION - Herpesvirus FHV1- - Chlamydia
31
Other causes of conjunctivitis in cats
- bartonella, calici, mycoplasma - Trauma - Corneal ulcer (usually viral) - FB - Allergies (consider if you've ruled out everything else - Dental/oral disease
32
What history questions should you ask for conjunctivitis?
- Duration - Current or prior medications** - Change in diet or environment - Concurrent illness (HAC, DM)
33
Diagnostic steps for conjunctivitis
- 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
Who gets follicular conjunctivitis?
- Dogs under 24 months of age
35
What should you rule out prior to diagnosing follicular conjunctivitis
- Everything - Distichia, ectopic cilia - Foreign body - Entropion, KCS
36
Causes of follicular conjunctivitis?
- Immune stimulation and possible allergies in the diet
37
Clinical signs of follicular conjunctivitis?
- Mild discomfort - Ocular discharge - Cobblestone appearance behind the third eyelid
38
How does follicular conjunctivitis respond to topical abx and steroid?
- Responds well, but will recur when treatment stops
39
Treatment for follicular conjunctivitis?
- 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
If a horse has conjunctivitis, what should you assume until proven otherwise?
- CORNEAL ULCER - 9/10 there will be a corneal ulcer, so you MUST LOOK FOR IT - It will be hard to see
41
Conjunctivitis and periodontal disease - appearance
- The eye might look fine (no hyperemia) | - Pus coming out of the skin near the eye but the eye looks okay
42
Retrobulbar abscess/cellulitis appearance
- Periorbital swelling, elevated 3rd eyelid, pain opening mouth
43
Retrobulbar neoplasia appearance
- Periorbital swelling, elevated 3rd eyelid, +/- painful
44
How to diagnose abscess vs neoplasia for retrobulbar?
- May need imaging to try and differentiate | - For neoplasia, ultimately biopsy
45
Retrobulbar cellulitis causes
- Tooth root abscess - Foreign body - Bony orbit is soft, and the teeth are quite close
46
Retrobulbar cellulitis signs
- Conjunctivitis | - Swelling and redness behind last molar
47
Diagnosis for retrobulbar cellulitis
- Examine mouth for dental disease | - Dental radiographs
48
Treatment for retrobulbar cellulitis
- Treat the underlying problem | - Topical and broad spectrum abx and NSAIDs
49
Hemorrhage in the conjunctiva- what to look for?
- Immune mediated disease like hemolytic anemia - Can look for trauma - Look for anticoagulant rodenticide
50
Infectious causes of canine conjunctivitis
- Canine distemper virus - Canine adenovirus CAV 1 (not usually seen) - Canine herpes virus CHV1 - Bacterial infections usually secondary
51
Ocular signs seen with canine distemper virus?
- Inflammation - copious suppurative exudate - KCS - SYstemic illness
52
What to do if a patient has conjunctivitis as well as signs of allergies (foot licking, pruritus, otitis)?
- Treat the derm issues first - Often have blepharitis - Consider exclusion diet, fatty acids, NSAIDs, antihistamine, dermatologist referral
53
Treatment options for allergic conjunctivitis in dogs
- Topical steroids (BNP-HC might be best as it's a weak steroid vs NPDex - NSAIDs (diclofenac) - Antihistamines (ketotifen)
54
Steroids for treatment of conjunctivitis - precautions ********** KNOW THIS FOREVER *******
- 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
Topical steroids in cats
- AVOID AVOID AVOID - Conjunctivitis in cats usually caused by an infectious agent - HUGE PROBLEMS
56
FVRCP intranasal treatment for Feline Herpes
- Intranasal FVRCP thought to give a local IgA response
57
Why do cats with herpesvirus end up getting conjunctivitis?
- It hangs out in the trigeminal ganglion | - Immunosuppression --> immune signs in the eye
58
Rabbits with conjunctivitis
- Dacryocystitis from dental disease needs to be ruled out as the primary cause
59
Differentials for diffuse subconjunctival hemorrhage and tiny pupil
- Trauma, coagulopathy, neoplasia, immune-mediated condition
60
Differentials for a pale conjunctiva with chemosis
- Might be stomach worms leading to hypoproteinemia?
61
What are reasonable differentials for epiphora? in a white poodle
- Imperforate punctas - Trichiasis - Meibomian gland dysfunction (lipid layer)
62
Differentials for a dog with excessive tearing and blepharospasm and inspissated Meibomian glands?
- loss of lipid layer | - Not sure?

Ophthalmology (8 decks)

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