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Small Animal Final Year > Ophthalmic Exam > Flashcards

Ophthalmic Exam Flashcards

1
Q

What are westies predisposed to?

A

Dry eye - keratoconjunctivitis sicca

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2
Q

What are terriers predisposed to?

A

Lens luxation

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3
Q

What is hyphaema?

A

Blood in anterior chamber

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4
Q

What would you suspect of a puppy with hyphaema?

A

Congenital anomaly

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5
Q

What wold you suspect with a 12 yo dog with hyphaema?

A

Intraocular neoplasm

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6
Q

What would you suspect with 12 yo cat with hyphaema?

A

Systemic hypertension

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7
Q

What history should we find out about the ophthalmic history?

A
  • When did the problem start?
  • Sudden or gradual in onset?
  • Is it progressive?
  • One eye or both eyes?
  • Pain?

–Closing eye (blepharospasm) ‘winking and blinking’?

–Rubbing eye(s) with paw or on carpet?

•Vision?

–Any difference in day vs night?

–What is vision like in unfamiliar surroundings?

•Change in appearance of eye?

–E.g. redness, discharge…

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8
Q

How do you start an ophthalmic exam?

A

From a distance

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9
Q

What can we do as part of the hands off ophthalmic exam? (7)

A
  • Symmetry of face
  • Symmetry between eyes
  • Ocular discharge
  • Eye(s) open or closed
  • Size of palpebral fissure
  • Position of third eyelid
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10
Q

What can be seen?

A

Different iris colour

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11
Q

What can be seen here?

A

Left sided facial nerve paralysis and vestibular syndrome

Left head tilt, drooping of left lip

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12
Q

What is this?

A

Globe rupture secondary to an intraocular melanoma,

copious black discharge

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13
Q

What is this?

A

Cat with Horner’s syndrome

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14
Q

What can you do as part of the hands on eye exam? (5)

A
  • External anatomy
  • Palpation
  • Look under upper eyelid
  • Examine anterior surface of third eyelid
  • Retropulsion
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15
Q

Label

A
  1. Upper eyelid with lashes
  2. Third eyelid
  3. Medial canthus
  4. Iris
  5. Lower eyelid, no lashes
  6. Limbus
  7. Sclera
  8. Conjunctiva
  9. Lateral canthus
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16
Q

What can be seen?

Describe the use

A

Purkinje image or corneal ‘reflex’

Provides information on tear film and surface contour

Two white areas – rfeflection of light on the surface. E.g. lights in room, torch or camera.

Surface health of the eye!!

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17
Q

What is this?

A

Purkinje image

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18
Q

What is this?

A

Corpora nigra (granula iridca)

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19
Q

What does this show?

A

Anterior third eyelid

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20
Q

What can be seen?

A

Palpation (orbital rim)

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21
Q

What are the basic eye reflexes? (5)

A
  • Palpebral reflex
  • Menace response
  • Dazzle reflex
  • Pupillary light reflexes
  • Vestibulo-ocular reflex
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22
Q

Palpebral reflex:

A) What is the afferent pathway?

B) What is the efferent pathway?

C) What is the stimulus?

D) What is the normal response?

A

A) Trigeminal nerve (CN V)
Ophthalmic branch for medial canthus
Maxillary branch for lateral canthus

B) VII

C) Touch gently the medial canthus and lateral canthus

D) Blink (VII)

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23
Q

Menace response:

A) What is the afferent path?

B) What is efferent path?

C) What is the stimulus?

D) What is the normal response?

A

A) II

B) VII and involves cerebellum

C) Quick, threatening gesture to each eye in turn

D) Stimulated eye should blink

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24
Q

When is the menance response present:

A) In Puppy/kitten?

B) Foals?

A

A) 12 weeks

B) 1-2 days

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25
Q

Which animal is a menance response being abnormal normal?

A

Rabbits

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26
Q

Dazzle reflex:

A) What is the reflex?

B) What does it assess?

C) What is the afferent path?

D) What is the efferent path?

A

A) Subcortical relfex

B) Eye’s ability to detect light

C) Retina, II, rostral colliculus, subcortical connections

D) VII

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27
Q

Dazzle relfex:

A) What is the stimulus?

B) What is the normal response?

A

A) Very bright focal light shone into one eye

B) Both eyes blink and possible head withdrawal

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28
Q

PLR:

A) What is the afferent path?

B) What is the efferent path?

C) What is the stimulus?

D) What is the normal response?

A

A) II

B) PNS fibres in III to pupillary constrictor muscle

C) Light shone in one eye

D) Pupil constricts

–Pupil on same side as light constricts

DIRECT PLR

–Contralateral pupil constricts

INDIRECT or CONSENSUAL PLR

•NB indirect PLR is less obvious than direct PLR

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29
Q

Name 2 reasons for a false negative result of PLR (3)

A

–Weak light source in daylight

•Not strong enough to elicit PLR

–Animal scared/stressed

•High level of SNS tone

–Iris atrophy

•Age-related atrophy of iris musculature

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30
Q

What is the issue of a Positive PLR?

A

Not always consistent with vision

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31
Q

What does adrenaline do to the pupil?

A

Dilate

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32
Q

What is this?

A

Atrophy of iris tissue results in ‘lace-like’

Appearance, large resting pupil size and

or absent PLR

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33
Q

Schirmer tear test (STT):

A) What measurement is this for?

B) What does it measure?

A

A) Quantitative measurement of tear production

B)Measures aqueous part of tear film (3 parts to the tear film)

Measures basal and reflex tear production

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34
Q

Where do you put the STT and why?

A

Correct positioning
Lateral third
Too medial- wont get reflex as third eyelid in the way

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35
Q

STT values (dogs):

A) What is normal?

B) What is diagnostic of dry eye?

C) What is diagnostic if clinical signs are present?

D) What is an over production?

A

A) 15-22mm/min

B) <10

C) 10-15

D) >25

36
Q

Cat STT:

A) What should each eye be?

B) What is the textbook answer?

C) What is common?

A

A) same

B) 17mm/min

C) 5-10

37
Q

Distant direct ophthalmoscopy:

A) what do you set the scope to?

B) How does it work?

C) What is it used for?

A

A) 0

B) Uses light reflected from tapetal fundus to highlight visual axis

C) Assesses pupil size and clarity of visual axis

38
Q

What is the method for a distant direct ophthalmoscope?

A
  • Stand at arm’s length from patient
  • Set o’scope on 0 dioptres
  • Look upwards to pick up tapetal reflex
39
Q

How do you visualise the tapetal fundus?

A

Look dorsally

40
Q

What is the normal tapetal reflection?

A

Most common colours are green, yellow, blue but red can be normal

41
Q

Discuss

A

L – repeat bleeds into eye over months and have glaucoma and the eye pressure is high. No tapetal reflex and old haemorrhage in the eye.
R – not quite normal. Pupil dilated. Yellow/green which is good. Clear. Vitrious is probs okay. Opacity in anterior chamber – blood clot

42
Q

How do you do a close direct ophthalmoscope?

A

Close to the animal

43
Q

What is this?

A

Monocular indirect ophthalmoscopy

44
Q

What is this?

A

Binocular indirect ophthalmoscopy

45
Q

What tools are used in Indirect ophthalmoscopy?

A

•Focal light source

–Pen torch

–Finhoff transilluminator

•Condensing lens

–20 Diopter

–2.2 Panretinal lens

46
Q

Fluorescein dye:

A) What is it?

B) How does it work?

C) When is it used?

A

A) Orange dye that turns green in alkaline conditions

B) Stains corneal stroma green

C) Very commonly used to diagnose corneal ulcers

47
Q

What does this show?

A

Negative fluorescein staining
Doesn’t stick to the cornea
No ulcer

48
Q

What does this show?

A

Positive fluorescein staining
Large ulcer – no epithelium and it adheres

49
Q

What is thenormal IOP in:

A) Dogs and cats?

B) Horse?

C) Rabbit?

A

A) 15-25 mmHg in the dog and cat

B) 17-28 mmHg in the horse

C) 15-20 mmHg

50
Q

What is the difference in IOP in two eyes which is considered abnormal?

A

>10mmHg

51
Q

What are the 4 mehods of tonometry?

A

–Digital tonometry

–Indentation tonometry (SCHIOTZ TONOMETER)

–Rebound tonometry (TONOVET®)

–Applanation tonometry (TONOPEN®)

52
Q

What is ued prior to using Indentation tonometry?

A

Local anaesthetic

53
Q

What does Indentation tonometry measure?

A

Measures degree of indentation of metal rod on cornea

54
Q

What is a major benefit of using an Applanation tonometry?

A

Can be used at any angle

55
Q

How does Applanation tonometry work?

A

Small footplate, covered by disposable latex tip,

flattens (‘applanates’ hence name) a given surface

area of cornea

Works on the principle of pressure = force/area

56
Q

What is the difference about using a rebound tonometry rather than applanation and indentation tonometry?

A

Local anaesthetic drops are not required

57
Q

How does rebound tonometry work?

A

Instrument measures deceleration of probe

as it rebounds (hence name) from cornea.

Metal probe has small spherical plastic tip so

area of contact with cornea is very small;

probe is disposable

Interchangable pin

Blob on end – touch cornea and bounce off

Measure the deceleration

58
Q

What is this?

A

Indentation tonometry

59
Q

What is this?

A

Applanation tonometry

60
Q

What is this?

A

Applanation tonometry

61
Q

What is this?

A

Rebound tonometry

62
Q

What is this?

A

Rebound tonometry

63
Q

Name 3 tests for vision (4)

A

•Obstacle course

–Consulting room furniture

  • Lights on (photopic conditions)
  • Lights off (scotopic conditions)
  • Stairs
  • Unfamiliar surroundings
  • Tracking reflex
64
Q

Tracking reflex:

A) What is the afferent path?

B) What is the efferent path?

C) How is it done?

A

A) II

B) III, IV, VI, VIII

C) Get the animal to follow cotton wool

65
Q

Visual placing response:

A) What is done?

B) What is the normal response?

A

A) Suport thorax, bring towards table top

B) Place both forepaws on table before carpi touch surface

66
Q

Corneal reflex:

A) What is it used for?

B) What is the afferent path?

C) What is the efferent path?

D) What is the stimulus?

E) What is the normal response?

A

A) Assess corneal sensation

B) V opthalmic branch

C) VI and VII

D) Wisp of cotton wool or cotton bud gently touched to cornea, outside of line of vision

E) Normal response: globe retracted (VI) and blink (VII)

67
Q

What is the Jone’s test?

A
  • Assessment of patency of tear duct
  • Passage of fluorescein dye to nostril
  • Apply fluorescein to both eyes as normal
  • Observe for a few minutes….
68
Q

Give 3 reasons as to why there may be a false negative with the Jone’s test?

A

–Dog licks nose

–Accessory openings in mouth

  • Open mouth to look for green dye on tongue
  • Especially in brachycephalic breeds

–Insufficient dye applied

–Head too elevated

–Insufficient time

69
Q

How is a seidal test done?

A
  • Fluorescein dye applied to eye, not flushed
  • Aqueous humour leakage detected by clear fluid ‘pushing’ fluorescein away from site of concern
70
Q

Give 2 uses of seidal test (3)

A

–Following removal of a corneal FB

–Corneal laceration e.g. cat scratch

–Suspicion of perforated corneal ulcer

71
Q

Discuss this seidal test

A

Leaking – black area is aqueous humour pushing away Good for a cat scratch injury

72
Q

Name 3 infections we may use a swab for in a cat. Which are the two most important?

A

–Chlamydophila felis

–Feline herpesvirus-1 infection

–Mycoplasma felis

–Feline calicivirus

  • Bordetella bronchiseptica
73
Q

How do you take a conjunctival swab?

A

Apply local anaesthetic eye drops

Retropulse globe through upper lid to protrude TEL

Roll swab several times in front of TEL

74
Q

Where do you swab for:

A) Conjunctivitis?

B) Corneal ulcer?

A

A) Conjunctival sac

B) Cornea

75
Q

Why do cats need GA for Nasolacrimal flush?

A

Very small punctal opening

76
Q

How would you do a Nasolacrimal flush?

A
  • Cannulate upper punctum
  • Attach 2ml syringe of saline/water
  • Flush gently, look for fluid at lower punctum
  • Occlude lower punctum
  • Continue flushing, head down slightly
  • Look for fluid a ipsilateral nostril
77
Q

Which species only have 1 punctum?

A

Rabbit - lower

78
Q

What is a common problem with rabbit tear ducts?

A

Dacryocystitis (inflammation +/- infection of tear duct)

79
Q

Vestibulo-ocular reflex:

A) What is the stimulus?

B) What is the normal response?

A

A) Change in had position

B) Both eyes move together

80
Q

What is Vestibulo-ocular reflex independant of?

A

Vision

81
Q

How do you do a Vestibulo-ocular reflex in cattle and why?

A
  • Cattle roll eyes downwards dramatically when you try to examine them
  • Roll head down, not up, to make the eye turn upwards
82
Q

Gonioscopy:

A) What is it an assessment of?

B) What do you look for?

A

A) Iridocorneal drainage angle

B) Predisoposition of glaucoma

83
Q

What is slit lamp biomicroscopy used for?

A
  • Excellent illumination and magnification of eye surface
  • Slit beam of lights helps to e.g. judge depth and localise lesions
84
Q

What is this?

Using a Slit-lamp biomicroscopy

A

Deep corneal ulcer

85
Q

A) What is an Electroretinography used for?

B) How does it work?

A

A) Assessment of retinal function

B)

  • Corneal electrode = contact lens
  • Skin electrodes, light source
  • Electrode on eye and under skin – connect to PC

Small Animal Final Year (317 decks)

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