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Opthalmology > Ophthalmic Exam > Flashcards

Ophthalmic Exam Flashcards

1
Q

What are the components to an ocular exam?

A
  • History
  • Diagnostic tests
  • Neuro-ophthalmic examination
  • Dilation with mydriacyl
  • Distant examination
  • Orbital, adnexal, ocular and fundic examination
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2
Q

What is most important components of the ophthalmic history?

A
  • Presenting complaint
  • Duration
  • Current/past eye medications: response to medication
  • Ocular pain
  • Vision loss: worse in day or night? Progressive?
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3
Q

What diagnostic tests should EVERY ophthalmic exam include?

A
  • Schirmer tear test
  • Tonometry
  • Fluorescein stain
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4
Q

What are the 3 key points to every ophthalmic exam?

A
  • Test and examine ALL animals on the table: need to behave and be still; held properly; you need to be eyelevel or lower
  • Don’t skip a diagnostic test: dilate the eyes
  • Always test and examine BOTH eyes!
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5
Q

What does the schirmer tear test measure?

A
  • Measure tears: function of lacrimal and third eyelid gland
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6
Q

Describe the technique to use a schirmer tear test?

A
  • Place in the conjunctival sac for 1 min
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7
Q

What are the normal values for dogs, cats and horses?

A
  • Dogs: >10mm/min = normal; 10 mm/min = normal
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8
Q

What are the key points to the schirmer tear test?

A
  • Do before any topical drops or irritation
  • Don’t touch the body of the strips
  • Read it right away
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9
Q

What does tonometry measure?

A
  • Intraocular pressure
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10
Q

What are the 3 different devices used in tonometry?

A
  • Tonovet: indentation - rebound
  • Tonopen: applanation
  • Schiotz: indentation
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11
Q

What are the normal values for tonometry in dogs, cats and horses?

A
  • Dog and cat: 10-25 mmHg; 30 = glaucoma

- Horses: 15-35 mmHg; >35 = glaucoma

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12
Q

What are the key points to tonometry?

A
  • Not holding the animal properly can falsely elevate pressures
    o Keep the head up straight
    o No pressure on the neck
    o Avoid struggling with the animal
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13
Q

Why do we use fluorescein stain?

A
  • To detect corneal epithelial defects
  • Assess periocular tear film
  • Test for nasolacrimal patency
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14
Q

Describe the technique of using fluorescein stain?

A
  • Apply a drop to the conjunctiva and flush the excess with sterile saline
  • Evaluate with a cobalt blue light
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15
Q

Why do ulcers fluoresce?

A
  • The stain is absorbed by the corneal stroma if the epithelium is disrupted
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16
Q

How do you know if the nasolacrimal system is patent?

A
  • If you see stain at the nares = patent
17
Q

What are the key points when using fluorescein stain?

A
  • Don’t store in a syringe with saline on the counter for repeated use: contamination
  • Don’t touch the strip to the cornea: the cornea will absorb the stain
  • Rinse well
  • Do at the very end of the exam
18
Q

What are the main reflexes tested for in the neuro-ophthalmic exam?

A
  • Menace: CN II and CNVII (orbicularis oculi)
  • Pupillary light reflex: CN II and CN III (iris constrictor muscle)
  • Palpebral reflex: CN V and CNVII (orbicularis oculi)
  • Occulocephalic reflex: CN II, VIII and III, IV and VI (extraocular muscles)
19
Q

What are the key points to the menace response?

A
  • Not reliable in young animals as it is a learned response
  • Don’t be too close to the eye
  • Make sure you are intimidating enough
20
Q

What are the key points to the PLR?

A
  • Use a transilliuminator
  • Look for direct and consensual reflex
  • Assess pupil symmetry
21
Q

What are the key points for the palpebral reflex?

A
  • Come from below the eyelid to prevent the animal from seeing your finger
22
Q

What is the key point for occulocephalic reflex?

A
  • Lift the forehead skin to see the sclera
23
Q

Why do we need to dilate the eye? What do we use?

A
  • Necessary for complete ophthalmic exam
  • Lets you fully examine the lens and fundus
  • Tropicamide: mydriasis in 20-30 mins and lasts for 4-6 hours
24
Q

What are the contraindications to dilating the eye?

A
  • Elevated Intraocular pressure

- For abnormal PLRs, anisocoria, and iridal lesions: make sure you examine the animal before the onset of dilation

25
Q

When do you use topical anesthetic?

A
  • Prior to indentation or applanation tonometry
  • Prior to nasolacrimal flush
  • Prior to cytology/biopsy
26
Q

What drug do we use as a topical anesthetic?

A
  • Proparacaine: 1 to 2 drops provide anesthesia in 20 secs and lasts 20 mins
27
Q

How would you administer eye drops to a patient?

A
  • Place the chin up with the non-dominant hand
  • Rest the dominant hand on the head
  • Keep the bottle far away from the eye to avoid contamination
  • Administrator’s fist is used to pull the upper eyelid skin back to help keep the upper eyelid open
28
Q

What are some ancillary diagnostic tests used and why?

A
  • Nasolacrimal flush: to evaluate patency

- Culture and sensitivity: indicated in deep and melting ulcers (generally bacterial)

29
Q

What are some key points to a C&S?

A
  • Take early in the exam
  • Avoid the eyelids
  • Use a sterile Q-tip
30
Q

What are the components to a systematic ophthalmic exam?

A
  • Orbit
  • Eyelids
  • Conjunctiva
  • Cornea
  • Anterior chamber
  • iris
  • lens
  • fundus
31
Q

Why do we examine the anterior chamber?

A
  • Looking for depth and clarity
    o Aqueous flare: protein or particles taking up light
  • Must turn off the lights and look from the side
32
Q

What are he two different ways to do a fundic exam?

A
  • Direct ophthalmoscopy

- Indirect ophthalmoscopy

33
Q

Why do we do a fundic exam?

A
  • Want to look at the retina, optic disk and vessels to look for any abnormalities
34
Q

How is the equine ophthalmic exam different from small animals?

A
  • Require sedation and akinesia (must block the eyelid movements)
    o Xylazine, detomidine, butorphanol
35
Q

How do you provide akinesia?

A
  • Auriculopalpebral nerve block
    o Anterior to the base of the ear
    o Lateral to the highest portion of caudal zygomatic arch
    o Where the palpebral nerve lies on zygomatic arch caudal to frontal bone

Opthalmology (3 decks)

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