Ophthalmology 1 Flashcards
1
Q
What are the top 4 signs of eye pain?
A
- blepharospasm
- reduced palpebral fissure
- ocular discharge/epiphora
- hyperaemiaw
2
Q
What is hyperaemia?
A
increased redness
3
Q
What is blepharospasm/
A
increased blink rate
4
Q
What would you see with reduced palpebral fissure?
A
blink/wink
5
Q
What are the local signs of pain?
A
- photophobia
- misosis
- third eyelid protrusion
- head-shy
- self-trauma/rubbing
6
Q
What is photophobia?
A
avoiding light
7
Q
What is miosis?
A
small pupil
8
Q
What are systemic signs of eye pain/
A
- reduced appetite
- quiet/subdued
- depressed
- headache?
9
Q
How would you triage a patient for pain?
A
- systemic signs
- brief description of ocular signs
- onset
- duration
10
Q
How can a pain score be difficult?
A
the result will be affected by blepharospasm, squinting changes the patients facial expression
11
Q
What does a patient have to score for additional analgesia on an ophthalmic pain score?
A
3 or above
12
Q
How do you manage ophthalmic pain?
A
- medical options - topical and systemic
- surgery
13
Q
How might you treat scratchy dry lids?
A
lubrication with HA drops
14
Q
How might you treat acutely painful indolent ulcers?
A
bandage contact lens
15
Q
How might you treat cramping spasm uveitis?
A
atropine/clycopentolate drops
16
Q
How might you treat chronic searing ache of intractable glaucoma?
A
Enucleation
17
Q
How might you treat dull ache orbital swelling?
A
NSAIDs +/- opioids
18
Q
How might you treat an eye that cannot be opened to examine?
A
local anaesthetic, sedation or GA
19
Q
How would you handle a blind patient to make them feel comfortable?
A
- talk to them
- go slowly
- guide them
- avoid bumps
20
Q
How would you handle a patient who is blind of visually impaired for a clincial exam?
A
- assess temperament
- keep steady
- keep calm
- examine at the end of the table
- reward and reassure
21
Q
What types of cataract are there?
A
inherited or diabetic
22
Q
What type of glaucoma is there?
A
primary inherited genetic defect or secondary to intraocular neoplasia, uveitis, lens luxation
23
Q
How would you treat glaucoma?
A
medical management intially, surgical shunt implant, laser TSCP/EPC ultimately enucleation
24
Q
What is SARDS?
A
sudden acquired retinal degeneration syndrome
25
How would you confirm SARDS?
electroretinogram
26
What toxins can cause vision loss?
ivermectin poisoning, enrofloxicin in cats
27
What is PRA?
progressive retinal atrophy
28
What happens with PRA?
night vision goes then day vision
29
What else can cause vision loss?
brain disease and trauma
30
How can you advise owners who have a blind dog?
- facebook forums with other owners with blind pets
- RSPCA tips
- buster collars, guide leads, bump bars to prevent injury
- doggles/rex-specs
- sound/voice commands
- behavioural modification training
- lead walks offer more support - reverse guide dog
31
Why do we need to treat eye ulcers?
- painful
- infection risk
- risk of keratomalacia 'melting'
- perforation - endophthamitis - glaucoma- phtthisis - blindness
32
What is the cornea made of?
transparent stratified squamous epithelium
33
What is the limbus?
transition zone, stem cells
34
What is the scelera?
gibrous tunic, gives globe rigidity (white part of the eye)
35
What percentage stromal loss is classed as fragile eye?
>50%
36
When is fragile eye extremely fragile?
is the loss has gone down to the descemet layer
37
What can raise intracranial pressure and put the patient at risk of rupture?
barking, jugular blood samples, coughing/vomiting, pulling on collar, firm restraint
37
How would you handle patients with fragile eye?
- avoid pressure on neck or lids
- increasing intraocular pressure causes increase in venous pressure
- avoid stress
- meds
- keep eyes clean
- schirmir tear test or intraocular pressure test or cytoloy?
37
How would you treat spontaneous chronic corneal epithelial defect?
algar brush, grid superficial keratectomy
38
Why should you never do a grid superficial keratectomy on a cat?
risk of corneal sequestrum formation
39
How would you treat stromal ulcers and feline sequestrum?
medical or surgical graft
corneo-conjunctival transposition, biopsies collagen, amnion, tutopatch
40
How would you treat melting ulcers?
intense medical initially +/- corneal cross linking or corneal graft surgery
41
How would you treat descemotocoeles?
tectonic.structural support imerative, corneo-conjunctival transposition
42
How would you treat perforation?
risk endophthalmitis, suture closed/patch/graft
43
What considerations should you consider with inpatients?
- low stress
- smooth pre-surgical preparation
- smooth recovery post-op
- reversal or repeat of premedication
- cats in separate wards
- horses in dark stables
44
What post-operative care should you provide to patients who have had eye surgery?
- harness walks only
- no jugular samples
- buster/soft collar
- recognise, monitor and treat pain
- administer eye medication
- keep wounds clean and dry
- keep patient calm
45
What trauma is an ocular emergency?
- sharp trauma
- blunt trauma such as RTA or run into wall
- proptosis
- penetrating foreign body
46
What is proptosis?
eyelids are trapped behind globe so the eye will appear pushed forward
46
What are the priorities with ocular emergencies?
- cardiovascular stability
- analgesia
- ocular surface support (lubrication
- prevent further trauma
- buster collar to prevent self-trauma
- stabilise - assess - plan - treat
46
When do puppies develop a menace response?
8-12 weeks
47
What can happen if a puppy obtains a cat claw injury?
corneal laceration, lens puncture or capsular tear
48
What can a cat claw injury cause?
cataract formation, lens induced uveitis
49
How would you treat a cat claw injury?
cataract surgery, corneal laceration repair and uveitis medically treated
50
How does a non-traumatic glaucoma look?
blue cornea, red sclera and conjunctiva
51
What does chronic glaucoma look like?
buphthalmic eye, stretched globe making it look enlarged
52
What measurement is high intraocular pressure?
>30mmHg
53
What is normal intraocular pressure?
10-25mmHg
54
What are the signs of retrobulbar mass?
- pain on opening mouth
- exophthalmic eye
- excessive conjunctiva visible, especially 3rd eyelid
55
What do lubricants do?
protect, soothe, support healing
56
What are antibiotics used for?
treatment or prophylaxis
57
What anti-inflammatories can be used?
NSAIDs or steroids
58
What do mydriatics do?
dilate the pupil
59
What do anti-glaucoma drugs do?
lower pressure
60
What are immune modulator drops used for?
immune mediated disease
61
What would local anaesthetic eye drops be used for?
diagnosis or pre-op
62
What are serum eye drops made from?
fresh frozen plasma or serum
63
How do you use serum eye drops?
- defrost frozen plasma
- place needle-free fluid spike on plasma bag
- draw up 3mls of plasma using a syringe and transfer into bottles before placing the cap onto the bottles
- once completed store bottles or syringes in the freezer
- defrost in pocket for days of use then store in the fridge
64
What are serum eye drops used for?
melting ulcers, or to prevent keratomlacia
65
How long should you leave between each eye drop?
10 minutes
66
How long should you leave between ointment and gel?
60 minutes
67
What is the order of eye drops you should follow?
1. watery aqueous drops
2. suspensions
3. gel
4. ointment
68
What is an example of an aqeous eye drop?
chloramphenicol 0/5%
69
What is an example of a suspension eye drop?
pred forte
70
What is an example of a gel eye drop?
clinitas
71
What is an example of an ointment eye drop?
optimmune
72
What are lubricants used for?
- supporting healing ocular surface disease
- nutrition of cornea through the tears
- reduce evaporation
- prevent ulceration perioperatively
- replace missing tears in dry eye
- comfort
