Ophthalmic exam

Question 1

What do you look at in hands off observation?

Answer 1

Facial/ocular symmetry Vertical height of the eye Angle of medial meniscus Distance from the medial meniscus to the centre of the pupil Anterior displacement/deviation Same colour

Question 2

When in the examination would you perform the Schrimer Tear Test-1 (STT-1)?

Answer 2

Before use of light or any eyelid manipulation

Question 3

How long should you leave the paper in the eye for an STT-1?

Answer 3

1 minute

Question 4

How do you interpret the STT-1?

Answer 4

>15mm/min is normal but <10mm/min is low

Interpret in context e.g. one condition causing dry eye and one causing excess production could result in a normal reading

Compare both eyes and if drastically different then suspect underlying pathology

Question 5

What are the different parts of the ophthalmoscope?

Answer 5

Question 6

What anterior structures of the eye can you see in transillumintaion?

Answer 6

Details of the eyelid, conjunctiva and third eyelid

Cornea, iris and lens are transilluminable

Question 7

What reflexes can you test with transillumination?

Answer 7

Dazzle reflex and PLR

Question 8

What can you see whilst using the slit beam?

Answer 8

Contour and lesion depth

Surface contour of cornea, iris and anterior lens

Layers of the cornea to see ulcer depth and cataract localisaion in the lens

Quality of the aqueous humour in the anterior chamber

Question 9

What changes can be seen in the anterior chamber?

Answer 9

Aqueous flare/Tyndal effect = swirling of keratic precipitates

Keratic precipitates once settled at ventral aspect of the eye

Hyphema and hypopion

Posterior/anterior synechia

Anterior lens luxation

Anterior presentation of the vitreous

Question 10

What do you look at in distant direct ophthalmoscopy?

Answer 10

Tapetal reflection, pupil symmetry and use retroillumination

Question 11

How do you illicit the tapetal reflection?

Answer 11

Lens at neutral setting up at your eye with animal at arms length and angle until the eyes reflect/shine back at you

Question 12

What does senile iris atrophy look like?

Answer 12

Ragged edges of the pupil in old dogs

Question 13

How do you differentiate between nuclear sclerosis and cataracts?

Answer 13

On retroillumination nuclear sclerosis is transparent but cataracts appear black

Question 14

How do you perform close direct ophthalmoscopy?

Answer 14

<2 cm away from patient with your pupil, instrument and animals pupil aligned

Use right eye to right eye and left eye to left eye

Locate optic disc and divide into uaters then make a mental collage of the big picture

Question 15

What happens if you scroll through the magnification of the lens?

Answer 15

Focus on different parts of the eye

The lens is +10-15

Question 16

How do you perform indirect ophthalmoscopy?

Answer 16

Use ophthalmoscope by the eye not looking through it with a 300 lens infront of the animal’s eye

Question 17

What image does indirect ophthalmoscopy give?

Answer 17

Inverted L to R virtual image with a larger field of view that is less magnified

Question 18

What image can you see with a panoptic ophthalmoscope?

Answer 18

Same as indirect ophthalmoscopy but without the image being inverted

Question 19

How do you perform fluoroscein staining?

Answer 19

Wet strip and drop dye onto the dorsal conjunctiva and in order to see if there are any ulcers rinse thoroughly and examine corneal surface under the blue light

Question 20

What does the fluoroscein stain?

Answer 20

Stroma

Question 21

What is a Jones Test?

Answer 21

Use fluoroscein but don’t rinse wait for a few minutes and see if stain flows out of nose and again use blue light

Question 22

What is tonometry?

Answer 22

Tests eye pressure

Helps distinguish between glaucoma (high pressure) and uveitis (low pressure)

Question 23

What is normal intra-ocular pressure?

Answer 23

12-22mmHg

Question 24

What is conioscopy and what does it measure?

Answer 24

Specialists tool that looks at the iridocorneal angle