Ophthalmic and otoscopic examination

Question 1

Name the device that measures intraocular pressure

Answer 1

Tonometer

Question 2

What can be used to dilate the pupil?

Answer 2

Mydriatics

Question 3

What can be used to test tear production?

Answer 3

Schirmer tear test strips

Question 4

Name the dye used to highlight corneal defects

Answer 4

Fluorescein

Question 5

Give some example features of all ophthalmoscopes

Answer 5

Beam selectors
Lens magazine
Brightness dial

Question 6

What is the function of the beam selector on an ophthalmoscope?

Answer 6

Alter the shape of the light beam for different uses

Question 7

What shapes can the light beam be altered to in an ophthalmoscope, what is each shape used to look at?

Answer 7

• circular: whole pupil
• slit beam: anterior segment
• half moon: Useful if there is an obstruction preventing light travelling to the fundus
• Graticule/grid: useful for location and measurement of lesions

Question 8

What 3 colours can the light beam be changed to, what is the function of each?

Answer 8

White - used for most of the exam
Cobalt blue - used with fluorescein dye to highlight corneal defects
Red free filter - used to examine vasculature and retinal nerve fibres

Question 9

What is the lens magazine on an ophthalmoscope?

Answer 9

Alters the lens strength for visualisation of structures at different levels within the eye

Question 10

The unit of measurement representing the optical power of a lens is known as a…?

Answer 10

Dioptre

Question 11

Describe the first stage of an opthalmic exam

Answer 11

Observation
- from a distance, in normal light
- behaviour, posture, movement
- Is the patient exhibiting any abnormal signs such as:
Blepharospasm - closure of eyelids (looks like squinting) or excessive blinking
Epiphora – overflow of tears
Photophobia – sensitivity to light
- Is the face symmetrical, and is the position of the globe normal?

Question 12

Describe the second stage of an opthalmic exam

Answer 12

Hands on, normal light
- Examine the eyelids and bulbar and palpebral conjunctiva.
- You can protrude the nictitating membrane
(3rd eyelid) by gently pulling down the lower lid and applying gentle digital pressure to the globe through the upper lid
- Observe pupil size and symmetry
- Menace response in both eyes
- Asses the corneal light reflex

Question 13

Describe the third stage of an opthalmic exam

Answer 13

Hands on, lights off

- Using a pen torch alone or with magnification, examine the eye systematically

Question 14

In the hands on, lights off stage of an ophthalmic exam, which parts of the eye are being assessed?

Answer 14

• Adenexa – examine the lid margins and conjunctiva in detail
• Cornea – is it clear and smooth? Note any lesions
• Anterior chamber – use the torch at various angles to trans illuminate the chamber and look for any abnormal contents
• Iris – check colour, texture, pupil margin and pupil shape
• Lens – a limited examination of the lens is possible using this method, but more detailed examination will require medical dilation of the pupil.

Question 15

Name the two tests, that take place in the third stage of an ophthalmic exam, that require a more concentrated light beam

Answer 15

• Pupillary light response

- Dazzle response

Question 16

Describe the fourth stage of an ophthalmic exam

Answer 16

It is worth practicing using both eyes, as ideally you want to be eye to nose with your patient.
Place your free hand under the animals chin and stand at arm’s length from the head.
Set your ophthalmoscope to +1D or +2D and look through the visualiser straight into the pupil to
appreciate the tapetal reflex – the greenish reflection from the tapetum.

Question 17

In older animals, what is a common finding on distant direct opthalmoscopy, how does it present?

Answer 17

Nuclear sclerosis - shows as a refractile (shiny) ring or circle within the lens

Question 18

What is the 5th stage of an ophthalmic exam?

Answer 18

• Close direct ophthalmoscopy
• used to examine the fundus, and then the more anterior structures of the eye, in detail
• Position the ophthalmoscope close to the patient’s eye, then place your own eye on the visualiser - the scope should touch your face.
• Locate the optic disc – assess the shape, size, position and colour
• Examine retinal blood vessels

Question 19

How does the position of the optic disc differ in dogs, cats and horses?

Answer 19

Dog: At tapetal/non-tapetal junction
Cat: In tapetal area
Horse: In non-tapetal area

Question 20

When begining at otoscope examination what needs to be considered?

Answer 20

• diseased ears can be painful
• be gentle at all times
• ensure food restraint

Question 21

What are the two distinct regions of the ear canal?

Answer 21

Vertical canal

Horizontal canal

Question 22

Describe the basic steps of an otoscope exam, including how to examine the vertical and horizontal canals

Answer 22

• Gently lift the pinna and examine the external opening to the ear canal - note any discharge or inflammation
• Gently introduce the speculum of the otoscope into the ear canal
• The first part of the canal is the vertical canal, so at this point your otoscope speculum should be angled downwards
• To visualise the horizontal canal you will need to alter the angle of the speculum, from vertical to horizontal, so that it is around 90o to the patient’s skull.

Question 23

What ca be visualised at the end of the horizontal canal?

Answer 23

The tympanic membrane

Question 24

Name the 5 stages of an ophthalmic exam

Answer 24

1: Observation
2: Hands on, normal light
3: Hands on, darkened room
4: Distant direct ophthalmoscopy
5: Close direct ophthalmoscopy

Question 25

At what age does the menace response develop?

Answer 25

12 weeks of age