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VETM 530: Ophtho > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

what do you see

A

epiphora: tear staining on the face originating from the medial canthus

tears flow onto the face, stains the hair, and can cause moist dermatitis

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2
Q

what causes epiphora?

A

increased production from irritation
decreased outflow from an obstruction of nasolacrimal system

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3
Q

what is imperforate puncta? how do you treat?

A

the lower tear duct opening has not developed, can cause epiphora due to decreased tear drainage

open the imperforate puncta and give topical steroids to prevent closure

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4
Q

what is dacryocystitis? how do you treat?

A

inflammation of the nasolacrimal duct and it blocks the nasolacrimal system.

can be caused by an obstruction like a grass awn, neoplasm, dental disease, facial bone fractures, etc.

tx: flush the NL system, give topical steroids/antibiotics, but can reoccur. do not use long term oral antibiotics

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5
Q

canine conjunctivitis is often caused by….
you’ll see…

A

allergies–>associated with atopic dermatitis

will see chemosis (edema of conjunctiva) and hyperemia

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6
Q

how should you treat allergic canine conjunctivitis?

A

treat underlying atopy
topical steroids and anti histamine (Pataday 0.2% 1-2x daily, these are antihistamine drops)

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7
Q

list some causes of feline conjunctivitis

A

herpesvirus: will also have URT dz
chlamydophila felis: mostly chemosis
mycoplasma: uncommon

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8
Q

a cute wittle kimten comes to you with conjunctivitis. will you treat this cat?

A

assuming it’s herpes, no, it is self limiting

if the cat doesn’t improve and I think it might be chlamydia, I would give oral doxycyline for 4 weeks 2x day

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9
Q

what is this? it is pathognomonic for…

A

a dendritic ulcer: you can see the branching fluorescin stain in the superficial cornea and some corneal vessels laterally

pathognomonic for feline herpesvirus keratitis, often with concurrent conjunctivitis

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10
Q

how can you treat feline herpesvirus keratitis?

A

can give antivirals

systemic: famciclovir
topical: cidofovir, trifluridine, idoxuridine

oral lysine (no real evidence it works tho)

could do topical broad spec antibitiocs

warn owners that recurrance is common

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11
Q

what is neonatal ophthalmia?

A

primary FHV infection with secondary bacterial infection before the eyelids open, may be discharge

give topical antibiotics and open the eyelids to give this

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12
Q

what do you see? what is the cause?

A

corneal sequestrum: lateral central black superficial lesion with vessels encircling

this is a necrotic cornea, this is unqiue to the cat, most often in brachy cat breeds. can be a primary dystrophy or after a corneal ulceration/irritation

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13
Q

what do you see?

A

a corneal sequestrum caused by lower entropion, can see vessels encircling the lesion

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14
Q

what things determine the treatment plan for a corneal sequestrum in a cat?

A

level of discomfort and the depth

if comfortable and it’s superficial, let it slough naturally! steroids and antibiotics have no effect on these ones! this process can take months to years

if its painful and/or deep, do a superficial keratectomy (remove it), +/- a conjunctival graft, corneoconjunctival transposition, corneal transplant

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15
Q

this is a cat. what do you see, what is #1 ddx and how will you confirm?

A

eosinophilic keratitis: pink with white deposits on the surface, superficial blood vessels on lateral cornea

this is a proliferative disease of the superficial cornea. there is NO association with eosinophilic granuloma complex

do cytology of corneal scrapings revealing lymphocytes, eosinohpils, mast cells, neutrophils

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16
Q

how do you treat eosinophilic keratitis?

A

0.1% dexamethasone or 0.1% prednisolone QID initially

cyclosporin or tacrolimus and taper slowly

recurrance is common

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17
Q

true or false: cats with eosinophilic keratitis respond very fast to treatment

A

true! within 2 weeks they can be normal!

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18
Q

this is a 12yo shiz tzu. what do you see? ddx?

A

corneal degeneration: dense white corneal opacity rim around a clear zone, some white areas. the clear zones are areas in which calcium has flaked off and this dog had previous ulcers.

usually will have a gritty look to them, calcium and/or lipid deposits, flakes can cause an ulcer too

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19
Q

what is this and how do you treat it

A

corneal degeneration: can see the grittty mineral appearance, there is also a desmetocele

treatment:
1) remove the mineral either by doing a keratectomy + corneoconjunctival transportation (best option) or a corneal burr
2) EDTA to get rid of mineral (doesn’t work great), requires the epithelium to be absent and often used with the burr
3) lubricants

DO NOT USE topical steroids

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20
Q

this dog had corneal degernation. what treatment was done?

A

corneaoconjunctival transportation, essentially moving the limbus down. super effective for non healing mineralization or descmetoceles

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21
Q

what is this? treatment?

A

corneal dystrophy: fat deposit, does not cause vision issues, not painful, often in young dogs, we don’t really know why they happen, usually bilateral

can leave alone or give cyclosporin to get rid of them but it takes 6-12 months

DO NOT USE TOPICAL STEROIDS

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22
Q

what do you see here? cause?

A

endothelial dystrophy: can see OU temporal blue/white cloudiness. essentially the endothelial cells start to die off earlier than they should, and the cells can no longer pump fluid out of the cornea to keep it dehydrated so you get corneal edema. endothelial cells cannot be replaced.

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23
Q

true or false: endothelial dystrophy begins medial and moves lateral

A

false! starts lateral and moves medial

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24
Q

what are 2 common sequelae to endothelial dystrophy?

A

bullae (fluid filled sacs) due to fluid accumulation

superficial ulceration due to fluid sac rupture

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25
Q

how do you treat endothelial dystrophy?

A

thermokeratoplasty: cauterize the superficial cornea to limit edema (burn the cornea), used when ulcers are present, and this heals ulcers in 90% of cases within 2-4 weeks

keratectomy + conjunctival graft: this slows down/stops progression and can improve corneal edema, the graft is placed on lateral 3rd of the cornea

can do corneal transplant but riskier and harder to find donator corneas

hypertonic saline to suck fluid out of cornea: brian doesn’t do this

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26
Q

what do you see here?

A

corneal edema with a superficial ulcer

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27
Q

what do you see here?

A

this is thermokeratoplasty to treat ulcers/endothelial dystrophy: cauterize the cornea to get blood vessels to come in and heal the ulcer. ulcers usually do not recurr if you do this.

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28
Q

what is the difference between endothelial dystrophy and endothelial degeneration

A

endothelial dystrophy: the cells start to die off earlier than they should

endothelial degeneration: something is damaging the endothelial cells, such as
- anterior uveitis, glaucoma, trauma, endothelitis (rare)

treat the underlying disease and cause of damage, although damage may be permanant

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29
Q

this cat was normal yesterday. what is this?

A

bullous keratopathy: extreme corneal cloudiness and bullae over the medial cornea

this can occur in hours! can be focal or diffuse, not very common, can cause perforation but rare

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30
Q

what is this? what is the cause? treatment?

A

bollous keratopathy: causing protrusion of the cornea

cause is unknown, thought to be an endothelial cell malfunction. a lot of these cats have chronic uveitis and are on topical steroids.

tx: stop topical steroids, place a 3rd eyelid flap, leave flap for 2 weeks and givetopical antibiotic while flap is there,and the prognosis is very good

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31
Q

cats on what drug have an increased risk of bullous keratopathy?

A

cyclosporin

we dont know why

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32
Q

what is this ocular condition called?

A

macropalpebral fissure syndrome: OU laterally displaced globes, lateral strabismus, extensive showing of sclera, large eyelid opening resulting in inability to close eyelids properly (lagophthalmia)

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33
Q

this is a pug, how did this lesion happen?

A

this is macropalpebral fissure syndrome and corneal irritation leading to hyperkeratosis/corneal pigment (the eye trying to protect itself)

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34
Q

this is a pug. what do you see here?

A

macropalpebral fissure syndrome! medial entropion causing irritation of the cornea

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35
Q

what is going on in this pug?

A

chronic macropalpebral fissure syndrome leading to severe hyperpigmentation of the cornea and consequent blindness (eye trying to protect the cornea)

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36
Q

name 3 causes of macropalpebral fissure syndrome leading to corneal irritation

A

lagophthalmia
entropion
nasal folds (brian says this is fake news)

37
Q

you have a french bulldog with macropalpebral fissure syndrome. what treatment options do you have?

A

medial canthoplasty: narrow the eyelid opening, helps eliminate entropion

increase tears: cyclosporin, keep cornea moist

38
Q

true or false: once corneal pigmentation is present, there is no way to get rid of it

A

true

39
Q

a german shepherd presents with this. ddx?

A

pannus/immune keratitis: can see ventral superficial corneal pigmentation and some blood vessels

40
Q

the variant of pannus causing inflammation of the 3rd eyelid (same cause as pannus), is called

A

Plasmoma: hyperemia, cobblestone appearance and depigmentation of 3rd eyelid

41
Q

what is this?

A

plasmoma

42
Q

true or false: pannus is painful

A

false

43
Q

is pannus more severe in younger or older animals?

A

younger

44
Q

risk factors for pannus

A

breed: GSD or greyhounds
environment: high elevations and UV radiation

45
Q

how do you treat pannus/immune keratitis?

A

controllable but not curable

topical dexamethasone, cyclosporin, tacrolimus all QID and then decrease

can use subconjunctival triamcinolone which is a long lasting steroid injection

give them the cute doggy goggles like Trigger to help avoid UV

46
Q

what are the 3 steps to manageing a corneal ulcer?

A

1) determine the cause
2) medical treatment
3) protect and support the cornea

47
Q

list 5 things that can cause corneal ulcers

A

trauma, alkali shampoo or acids, trichiasis, distichiasis, ectopic cilia, infections (usually bacterial), entropion, foreign bodies, KCS, endothelial dystrophy/degeneration, anterior stromal calific degeneration

48
Q

how to diagnose corneal ulcers

A

fluorescin stain

49
Q

list the different kinds of corneal ulcers

A

superficial
refractory
stromal
descmetocele
melting
perforation

50
Q

superficial corneal ulcers are confined to _____ and are classified as either ____ or _____

A

loss of the epithelium

simple, refractory

51
Q

clinical signs of a superficial corneal ulcer

A

squinting, epiphora, discharge, enopthalmos, hyperemic conjunctiva and 3rd eyelid elevation

52
Q

Fido has a superficial corneal ulcer, how are you gonna treat him? prognosis?

A

topical broad spec antibiotics to prevent infections

should heal in 4-7 days and if it doesn’t, go looking for an underlying cause

53
Q

wot dis

A

a refractory ulcer–>a superficial ulcer that has not healed. the epithelium is peeling off and nit adhering to underlying anterior stroma

you need to go looking for a cause

54
Q

wot dis?

A

a refractory ulcer–>the stain is going underneath the epithelium and this is not normal! the epithelium is loose and not adhereing to the anterior stroma

55
Q

true or false: in most cases causes of a refractory ulcer are not identified

A

true

56
Q

how do you diagnose a refractory ulcer?

A

if its an ulcer in a middle to old aged patient that doesnt heal in 7-14 days, it should be suspected to be refractory/indulent

if it has epithelium that isn’t adhering to the underlying stroma=refractory

if the stain migrates underneath the epithelium and creates a halo around the ulcer

57
Q

what breed loves to get refractory ulcers

A

boxers

58
Q

a boxer named Mr. Bingley comes to you with a refractory ulcer. what initial treatment options are there?

A

1) debridement with a DRY cotton swab and topical anesthetic to remove all the non adherent epithelium

2) treatment
a: grid keratotomy: superficial incisions in the anterior cornea over the ulcer with a 22G needle
OR
b: diamond burr debridement to remove superficial stroma

80% success rate the first time, 99% after the second time

59
Q

how will you treat a refractory ulcer than is non responsive to grid/burr treatment?

A

superficial keratectomy: remove the abnormal anterior stroma and requires GA

60
Q

a stromal ulcer/descmetocele is one that…

A

invades into the stroma of the cornea and sometimes all the way to descemet’s membrane

usually stroma is lost due to bacterial infection

61
Q

what is different about diagnosis of a stromal ulcer compared to a superficial one?

A

if it’s a descmetocele, it won’t take up stain, only the stroma will uptake the stain

62
Q

how to treat a stromal ulcer?

A

initially, just like a superficial one: broad spec antibiotics for 7 days ish

for deeper ones you may need to do more

63
Q

wot dis?

A

3 different stromal ulcers that are healing

can see blood vessels coming in: indicative of healing

64
Q

what is this

A

a healing ulcer (can tell bc all the blood vessels)

65
Q

what dis? how treat?

A

a descmetocele–>this wont pick up stain, this is an ocular emergency

tx: requires corneal reinforcement, either conjunctival graft or corneoconjunctival transportation

66
Q

what dis

A

a conjunctival graft to help heal an ulcer

67
Q

what dis? what causes this?

A

a melting ulcer (keratomalacia) with some hypopeon and uveitis

from excessive levels of proteolytic enzymes. these come from bacteria, fungi, and yeast

DO NOT USE STEROIDS! they increase the effects of proteases

68
Q

a dog named Lizard comes to you with a goopy eye and the owner says shes been bothered by it for a while now. you take a look and suspect a melting ulcer. what diagnostics will you recommend?

A

cytology: put in topical anesthetic and use the blunt end of a scalpel. this will help you determine the cause (cocci, rods, yeast, etc)

69
Q

you do a fluorscin stain on a dog and you see this. what treatment will you recommend?

A

melting ulcer

requires aggressive medical therapy
- broad spec antibiotics (NOT tobrex, need moxifloxacin, oflaxacin, ciprofloxacin)
- anti-collagenase therapy like serum or doxycycline (anti-protease) until the melting has stopped

can also do surgery: conjunctival graft, esp if the ulcer looks like it could rupture or is not getting better with medical management

70
Q

what is this and what is the treatment? prognosid?

A

corneal perforation: can see central area od red tissue which is a fibrin plug

tx: this is an emergency, needs surgery, either a conjunctival graft or corneoconjunctival transposition + collagen

prognosis depends on the size, smaller = better prognosis for the eye

71
Q

this is an english bulldog. what dis? what has caused this? How will you treat this dog?

A

a dermoid
it is a congenital problem
tx: keratectomy, excellent prognosis

72
Q

what dis? prognosis?

A

a dermoid: hairs coming from conjunctiva

prognosis is excellent and you just take this off

73
Q

describe what’s going on here in this cat

A

this is persistent pupillary membrane. it should normally regress by 6 months of age. they are not painful and dont need treatment. if it’s still there after 6 months it’s not going away but it’s not worrysome

74
Q

not only can persistent piupillary membranes be iris to iris, they can also be

A

iris to lens and iris to cornea

75
Q

if a persistent pupillary membrane is from iris to cornea you get _____ and if its from iris to lens you get _____

A

leukoma (opacity)
cataract

76
Q

4 yo DSH with red eyes for 3 days and had aqueous flare. this cat also had low IOP OU. what is this?

A

anterior uveitis

77
Q

what is aqueous flare?

A

when there’s more protein in the aqueous humor which increases tubidity and decreases visual acuity and it’s usually indicative theres some uveitis going on

78
Q

why do /patients with anterior uveities have a low IOP

A

reduced prodctuon of aqueous humor by the ciliary body when it’s inflammaed

79
Q

why do patients with anterior uveitis have miosis?

A

prostaglandins are released due to inflammation and the pupillary sphincter muscle has PG receptors on it causing miosis

80
Q

why do patients with uveitis get corneal edema?

A

the corneal endothelium normally removes fluid from the corneal stroma, however these endothelial cells require aqeous humor to function and become malnourished with less aqeous humor around.

also happens due to inflammatory mediators

81
Q

what is this?

A

keratic precipitates: inflammatory cells tat indicate the patient has or had anterior uveitis

82
Q

what is this?

A

can see black areas on the aterior lens capsule and places where the iris is stuck to the anterior lens capsule and this is called=posterior synechiae

83
Q

_____ is the most common cause of significant cataracts in horses and cats

A

anterior uveitis

84
Q

wot dis

A

a melting ulcer with a hypopyon too

85
Q

what causes anterior uveitis in cats most commonly? (in order)

A

immune mediated/idipathic 90% of cats
neoplasia either intraocular (rare) or systmeic (lymphoma)
lens induced uveitis (more common in dogs)
infections (FIV, FeLV, FIP, toxoplasma, etc)

86
Q

what causes anterior uveitis in dogs?

A

algal
bacteria
fungal
rickettskial
viral
protozoan
immune mediated
parasitic
neoplastic

87
Q

systemic blasto causing uveitis is rare in cats but how do you treat it?

A

oral itraconazole and then some topical prednisolone eye drops to reduce inflammation

88
Q

you send a cat with anterior uveitis home with pred drops and some meloxicam for pain. 2 weeks later the cat is “feeling” much better and has gained weight, but her OS IOP is now 62 and the eye is big! and she seems blind :( what options are there for this cat?

A

removal of the eye :(

89
Q

what is iris bombé?

A

when there’s anterior uveitis that results in fibrin formation which allows the iris to stick to the lens (posterioer synechiae) which prevents aqueous humor flowing through the pupil. the iris then gets pushed forwards and sticks to the cornea and completely blocks off the iridocorneal angle. this spikes the IOP causing glaucoma and the prognosis is very poor

VETM 530: Ophtho (3 decks)

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