Nasolacrimal/Conjunctiva Flashcards by Ashley Caprio

Conjunctival anatomy

stratified squamous to columnar non-keratinizing epithelium

goblet cells! (produce tear film)

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Third eyelid is in the _______ portion of the eye

ventro medial

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support structure for TE

T shaped cartilage

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Breakdown of ______ leads to TE prolapse

T shaped cartilage

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secretory components of the nasolacrimal apparatus?

orbital lacrimal gland

gland of TE

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Upper and lower eyelid puncta enter canaliculi and connect at the _________.
Then the Nasaolacrimal duct opens into the _____.

lacrimal sac

nasal vestibule

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tear overflow results from

overproduction or decreased drainage

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layers of the tear film and what they do

outer oil layer (prevents evaporation)
aqueous layer (Moisturize me!! -put the lotion on the skin or else it gets the hose again)
Deep Mucous Layer (smooths irregularities of the epithelial cells)

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7 Functions of the Tear film

S SMOOTH ocular surface for light refraction
L Lubrication
I Give INFLAMMATORY cells access to cornea
P defend from Pathogens

O provide OXYGEN and nutrients
R REMOVE waste products and debris

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The STT is a _______ test

quantitative

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Fluorescein stain

hydrophilic

identifies ulcers, stability of tear film

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Rose Bengal/Lissamine Green

tests tear film integrity/quality
Conj and corneal epithelium retain stain if mucin is deficient
(can indicate KCS, viral keratitis, fungal keratitis)

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Tear Film Break-Up Time

indicates tear stability, hold eye open after applying fluorescein and blinking, observe first break in tear film under cobalt-blue light
*< 10 sec is abnorma. If abnormal it might indicate globlet cell dysfunction

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normal epithelial cells from a corneal cytology

often in sheets with round/oval nuclei, basophilic cytoplasm

Inclusions or bacteria are abnormal findings

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common inclusions to see on corneal cytology?

chlamydia in cats with acute conjunctivitis
herpes least common
multiple basophilic inclusions suggests Mycoplasma
(don’t confuse with melanin granules!)

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what do lymphoid follicles in conjunctiva suggest?

chronic conjunctivitis

or immune mediated disease

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clinical signs of conjunctivitis

signs vary but hyperemia, chemosis (swelling) , discharge, blepharospasm.
(no fluoresceine retention?)

how do you diagnose primary conjunctivitis?

by excluding secondary conjunctivits

how does ocular discharge change with progression of conjunctivitis?

serous - early and mild
mucoid - chronic KCS!!!
purulent - bacterial

Differing Etiologies of conjunctivitis?

KCS
Allergic
Bacterial
Viral
Parasitic
Physical irritation/trauma
intraocular disease uveitis
systemic illness

most common cause of conjunctivitis in dogs

vs. cats?

dogs - secondary (dry eye, allergy, follicular (antigenic), environmental
cats - primary (usually infectious)

uncommon conjunctivitis dobermans get

ligneous

Treatment for conjunctivitis

depends on etiology....
Tear stimulants
anti viral tx
topical anti-inflammatories 
topical abx
topical lubricants

common in young, stressed, immunocompromized cats

FHV-1 - conjunctivits

sequela of chronic conjunctivitis

discomfort, follicles, tear film abnormalities | symblepharon - adhesions to itself or cornea

conjunctival hemorrhage

trauma (especially strangulation) | bleeding disorders

KCS stands for?

kerato conjunctivitis sicca

KCS

quantitative tear deficiency, looks like eye boogers (blepharospasm, hyperemia, mucoid ropy tenacious discharge, ulcers, dry appearance, dull cornea with neovascularization, dry crusting mucus, blepharitis,loss of vision)

Cause of Most KCS in dog? | other causes?

- immune mediated (affecting the glands) | - congenital, drug related(SULFA DRUGS, phenazopyradine, atropine), traumatic, neurologic, distemper, TE ectomy

Same dogs predisposed to KCS are predisposed to _____.

TE prolapse | bulldogs, westies, cockers, pugs, dachshunds

topicals that increase tear production in 80% of cases

Cyclosporine (1-2%) and Tacrolimus (.02%) | -have T helper cell inhibitory activity

Mucinolytics (drugs that break up mucus so drug can get in the eye better)

use as infrequently as possible! its protecting the eye! Clean eyes with saline first *Acetylcystein can be used 2-4x/day for excessive mucous

surgical treatment for KCS

parotid duct transposition patial permanent tarsorrhaphy/canthoplasty punctal occlusion

Ephiphora

flow of tears onto face resulting from decreased drainage/tear flow disruption (NLD obstruction)

why do tears stain brown?

something about porphyrins and the UV light conversion

How to flush the NLD

use topical anesthesia, identify the punctum and use a small gauge catheter

small dog epiphora

small dogs and brachycephalic cats medial canthal entropion, irritation causes excessive tear production, obstruction, facial folds ..... its a multifactorial disease

medial canthal pocket syndrome

large dogs with deep orbits, nasal fornix is large and traps debris causing conjunctivitis, mucous at medial canthus (especially dobbies and labs)

Cherry eye

prolapsed TE, can progress to KCS, don't amputate gland!

Neoplasia conjunctiva

both - Melanoma,SCC, lymphoma bulbar/palpebral also gets - hemangioma, Mast cell TE also gets - Adenocarcinoma