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Ophthalmology Flashcards

1
Q

Eyelid mass on dog - ddx - malignant or benign?

A

Benign usually.

Adenoma, adenocarcinoma, papilloma, benign melanoma

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2
Q

Eyelid mass on cat - ddx - malignant or benign?

A

Malignant

SCC

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3
Q

What are two approaches to treating entropion?

A
  • Hotz Celsus sx

- Eyelid tacking

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4
Q

A puppy presents with ectropion what is one easily implemented treatment?

A

Viscotears - lubrication

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5
Q

What are two abnormal exit points of eyelashes?

A
  • through meiobium gland (Distchia)

- through palpebral conjunctiva (Ectopic cilia)

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6
Q

List 4 treatments for ectopic cilia

A
  • plucking
  • cryotherapy
  • electrolysis
  • transpalpebral resection
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7
Q

what is trichiasis?

A

normal eyelash in a normal position but rubbing on the surface of the cornea

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8
Q

What solution is suitable to clean a eyelid laceration?

A

Dilute betadine solution

not chlorhex or betadine scrub

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9
Q

What is normal IOP?

A

12-24mmHg

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10
Q

What does a hyper-reflective retina suggest?

A

thinning of the retina/degeneration or detachment

usu. chronic disease

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11
Q

what does a hypo-reflective retina suggest?

A

oedema, sub-retinal effusion (retinal detachment), cellular infiltrate, fibrosis
Usu. acute disease

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12
Q

How does a feline eyelid mass resection differ from a dog?

A

in dog - usu benign thus 1mm margin is appropriate.

in Cats - malignant - wide margins - eye enucleation

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13
Q

What concentration of betadine solution can be used to flush the eye?

A

1:100

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14
Q

What is ankyloblepharon?

A

delayed opening of eyelids in puppies or kittens (>10d).

Usu. secondary to infection.

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15
Q

How do you treat ankyloblepharon?

A

Bathing lids w/ warm saline and gently prise open.

Flush saline and tx. infection.

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16
Q

common cause of feline conjunctivitis

A

herpes

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17
Q

common cause of feline chemosis

A

chlamydia

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18
Q

common cause of canine conjunctivitis

A

allergic, FB, eyelid abnormality

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19
Q

What topical ABs are used to treat a 2nd staph infection in dogs?

A

Chloramphenicol, fusidic acid, neomycin, polymxin

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20
Q

name steroids used to treat follicular conjunctivitis

A 
dexamethasone (Maxidex)
potentiated prednisolone (predforte)
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21
Q

name a topical steroid given TID to tx conjunctivitis in dogs

A

hydrocortisone

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22
Q

List 3 drugs used to treat chlamydia in cats

A

Doxycycline
Azathioprine
Topical Chloramphenicol

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23
Q

What dose of famciclovir do you use to treat herpes associated with conjunctivitis and keratitis?

A

90mg/kg BID

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24
Q

what is dacryocystitis?

A

infection of the lacrimal system

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25
Q

what size catheter is used to flush the lacrimal system

A

22-24G nasolacrimal canula OR IV catheter w/ stylet removed

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26
Q

How many days should it take for an uncomplicated ulcer to heal?

A

4-7 days

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27
Q

Diagnosis of a superficial ulcer

A

fluorescein positive (no to minimal oedema)

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28
Q

List 4 arms of tx. of a superficial ulcer

A
  1. Remove inciting cause
  2. Protect w/ lubrication
  3. Protect from infection (Chloramphenicol, fusidic acid, triacin TID)
  4. Pain relief (systemic NSAIDs)
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29
Q

when does a superficial ulcer become an indolent ulcer?

A

if a superficial erosion has not healed in 7days

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30
Q

What is the difference between a primary and secondary indolent ulcer?

A
  1. Primary - result of a defect in the basement mb and epithelial cell adhesion/poor hemidesmosome formation
  2. Secondary - due to a underlying dz; eyelid deformity, ectopic cilia, KCS
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31
Q

How long does an indolent ulcer take to heal?

A

weeks - months

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32
Q

How frequently should you debride an ulcer w/ a Q-tip?

A

not more than q10d.

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33
Q

Diamond burr keratectomy can not be used for cats or dogs?

A

cats

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34
Q

Contraindications of a grid/punctate keratotomy

A
  • infected/oedematous

- not in cats dt sequestrum formation risk

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35
Q

which ABs have toxicity to epithelialisation?

A

aminoglycosides

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36
Q

Common findings on CE assoc. w/ stromal ulcers

A
  • oedema
  • corneal vascularisation
  • miosis
  • hypopyon
  • uveitis
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37
Q

How do you treat a stromal ulcer?

A

Surgical - conjunctival graft

Medical - sloughing of necrotic tissue and healing via vascularisation w/ aggressive ABs

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38
Q

Actions taken to medically treat a stromal ulcer

A
  1. Topical ABs (potent) - Ocuflox (Fluroquinalone) or gentamicin q1-2hs + triacin/fusidic acid if B-haemolytic Streps
  2. Systemic ABs - doxycycline
  3. Topical atropine 1 drop BID til pupil well dilated
  4. NSAIDs (systemic)
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39
Q

What bacteria are associated with a melting ulcer?

A

Pseudomonas, occ. B-haemolytic streps.

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40
Q

Use of topical corticosteroids on a stromal ulcer can lead to…

A

melting ulcer

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41
Q

List components of medical tx of melting ulcers

A
  1. ABs q2h Ocuflox + TID fusidic acid or chloramphenicol/Gentamicin
  2. Anticollagenase - serum in EDTA/ acetylcysteine
  3. Atropine BID (if reflex uveitis)
  4. Systemic ABs - doxycycline
  5. Systemic NSAIDs at MAX dose
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42
Q

CE of a descemetocoel shows what?

A
  1. cornea: oedema, vascularisation, non-staining defect
  2. secondary uveitis
  3. hypopyon
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43
Q

What reflexes test CN 5 and 7?

A
  • palpebral and corneal
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44
Q

What CNs are tested w/ PLRs?

A

CN 2 and 3

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45
Q

What CN are tested by the menace response?

A

2 and 7

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46
Q

What CN are tested by the dazzle response?

A

CN 2

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47
Q

What is the normal schirmer tear test value?

A

> 15mm

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48
Q

what process typically causes miosis?

A

uveitis

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49
Q

what process typically causes mydriasis?

A

glaucoma

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50
Q

Tx of immune-mediated KCS?

A
  1. cyclosporin eye drops
  2. Tacrolimus if cyclosporin ineffective
  3. 2nd infections - chloramphenicol
  4. Tear replacement - viscotears
  5. Steroid drops if pigment/vascular keratitis present
51
Q

what endocrine diseases are associated with KCS?

A

HypoT, HyperA, DM

52
Q

What drug is used to tx neurogenic KCS?

A

pilocarpine 1drop/2kg BID in food

53
Q

what is pannus?

A

Immune-mediated keratitis-lymphocytic/plasmacytic infiltration

54
Q

Pannus tx

A

cyclosporin 2% BID + predforte 6x daily

55
Q

tx of feline corneal sequestrums

A
  1. Medical lubrication
  2. Topical ABs and NSAIDs
  3. Can spontaneously slough OR surgical keratectomy +/- graft
56
Q

Technique to remove a corneal FB

A

25g needle to impale from a perpendicular angle OR moistened Q-tip to elevate edge and wipe off

57
Q

what are the 3 forms of corneal lipidosis?

A
  1. corneal dystrophy
  2. corneal lipid degeneration
  3. Arcus lipoides cornea
58
Q

CS of uveitis in the dog

A
  1. Red eye (or blue eye)
  2. Miosis/dyscoria
  3. Low iOP compared to other eye
  4. Aqueous flare
  5. Keratic precipitates
  6. Iritis
  7. Chronic uveitis causes increased pigment of iris close to pupil
59
Q

what is the most common cause of uveitis in dogs?

A

immune mediated

60
Q

what syndrome is associated with snowdogs?

A

uveodermatological syndrome w/ vitilago

61
Q

what are some infectious causes of uveitis in dogs?

A

toxoplasma, cryptococcus, Ehrlichia

62
Q

what systemic antibacterial could you use to treat Ehrlichia related uveitis?

A

doxycycline

63
Q

CS of uveitis in the cat?

A
  • normal iOP (18 +/-6)
  • colour change secondary to vasculitis in the iris
  • loss of round pupil
64
Q

infectious causes of uveitis in the cat

A 
toxoplasma
cryptococcus
FIP
FeLV
FIV
65
Q

what neoplasia is associated with uveitis in dogs and cats?

66
Q

uveitis tx

A
  1. Topical corticosteroid (maxidex/predforte)
  2. Atropine ointment/drops
  3. NSAIDs
67
Q

how can uveitis lead to lipid aqueous?

A

lipid from blood entering through abnormal uveal-aqueous-blood barrier

68
Q

what endocrinopathies are linked to lipid aqueous?

A

HyperT, hyperA, DM

69
Q

what ocular change can be associated with pancreatitis?

A

lipid aqueous

70
Q

list 3 common uveal masses

A
  1. Melanoma
  2. Ciliary body tumours
  3. Lymphoma
71
Q

what does an iris cyst look like?

A

brown, translucent, benign - can become free floating in anterior chamber

72
Q

DDx for hyphaema

A 
trauma (dogs)
systemic hypertension (cats)
coagulopathy
uveitis
intraocular neoplasia
chronic glaucoma
retinal detachment
73
Q

iris atrophy results in..

A

inability to constrict pupils –> squintingin bright light, no PLR response in visual dog

74
Q

what dog breeds are predisposed to primary glaucoma?

A

Basset, Cocker Spaniel, Samoyed, Aus. Cattle Dog

75
Q

what is the most common cause of primary glaucoma?

A

primary angle closure

76
Q

list 5 secondary causes of glaucoma

A
  1. Lens luxation (dogs)
  2. Lens swelling - cataracts (diabetic), phaeoclastic uveitis
  3. Uveitis (feline)
  4. Hyphaema
  5. Neoplasia
77
Q

what is a descemet streak?

A

stretch marks on globe as it enlarges w/ chronic glaucoma

78
Q

tx of primary glaucoma

A
  1. PG agonists - Latanoprost, travoprost, Bimatoprost (causes marked miosis)
79
Q

when is latanoprost contraindicated?

A

uveitis, lens luxation, CATS

80
Q

tx of secondary glaucoma

A
  1. CAIs - dorzolamine 2%, Brinzolamide 1%
  2. +/- Beta-blockers - Timolol
  3. Systemic NSAIDs
  4. Pred acetate topically (if no ulcers)
  5. Tx underlying disease
81
Q

list two surgical approaches to decrease aqueous production

A
  1. Cyclocryosurgery - ciliary body is frozen through the sclera
  2. Cyclophotocoagulation - a laser used to destroy ciliary body
82
Q

when is enucleation indicated?

A
  1. painful, non-visual eye
83
Q

what is a aphakic crescent associated with?

A

lens luxation/subluxation

84
Q

sequelae of lens luxation

A
  1. secondary glaucoma
  2. secondary retinal detachment
  3. luxated lens will develop cataracts
85
Q

what is nuclear sclerosis?

A

a normal ageing process - thickening and hardening of lens proteins with age (>7yo)

86
Q

what dog breeds are associated with hereditary cataracts?

A

Golden retrivers, min. schnauzers, cocker spaniels

87
Q

what are some common cause of cataracts in cats?

A

secondary to trauma, uveitis, diabetes (less common than dogs), retinal disease

88
Q

Define an incipient cataract

A

small opacity and vision is maintained <15% lens

89
Q

Define an immature cataract

A

vision impaired and fundus is seen indistinctly. A tapetal reflex is still seen,
15-99% of lens

90
Q

Define a mature cataract

A

entire lens is opaque w/ no tapetal reflex or fundus visible

91
Q

Define a hypermature cataract

A

the cortex may liquefy and permit visualisation of the fundus around the opacity
‘sparkles’ in the anterior lens

92
Q

what is vitreous hyalosis?

A

calcium/lipid floating in the vitreous

93
Q

what is synchysis scintillans?

A

cholesterol in the vitreous – snow globe effect

94
Q

what is the difference between a feline and canine optic disc?

A

feline is in the tapetal fundus - small round w/ no myelin

canine - margin of tapetal and non-tapetal fundus and has myelin +/- pigment around it making it look fluffier

95
Q

what diseases are associated with hypertensive retinopathies?

A
  • CKD, thyroid disease, DM, hyperA, Conns Dz, primary hypertension, hyperviscosity
96
Q

what dose of amlodipine for a cat w/ hypertension? Sys BP >170mmHg

A

Amlodipine 0.1-0.2mg/kg PO SID

97
Q

CS of progressive retinal atrophy

A
  • pupil may have a larger resting size than normal
  • PLRs may persist until v. late in dz
  • retinal vascular attenuation
  • hyper-reflective tapetum
98
Q

what drug can induce irreversible feline toxic retinopathy?

A

enrofloxacin

99
Q

what can cause young abbyssinian cats to go blind?

A

feline progressive retinal atrophy

100
Q

on a fundic exam of a cat you notice a bright spot lateral to the optic disk - top DDx?

A

taurine deficiency

101
Q

what is your typical signalment for sudden acquired retinal degeneration?

A

small, white fluffies, middle aged, female dogs

102
Q

list some infectious causes of chorioretinitis in the dog

A
  1. Bacterial - Erhlichia canis, Anaplasma platys
    2 Fungal - cryptococcus, aspergillus
  2. Protozoal - toxoplasma, neospora, leishmania
  3. Parasitic - toxocara
103
Q

list 3 immune-mediated causes of chorioretinitis in dogs

A
  • uveodermatologic syndrome
  • vasculitis
  • thrombocytopaenia
104
Q

List infectious causes of chorioretinitis in the cat

A
  1. Viral: FIP, FIV, FeLV
  2. Fungal: cryptococcus
  3. Protozoal: toxoplasma
  4. Parasitic: toxocara
105
Q

what are the clinical signs associated with acute chorioretinitis?

A

o Fluid,cells, protein exudate increase from choroid = hypo-reflective w/ vasculitis (haemorrhage/retinal detachment)
o Often focal
o Often active uveitis as well

106
Q

what is “Collie Eye anomaly”?

A

congenital disease which can affect the optic nerve, retina, choroid, sclera.
Can cause mild disease through to severe disease leading to retinal detachment

107
Q

why do you need to assess for Collie Eye in puppies <8wks old?

A

a pale spot in the choroid lateral to the optic disc is only visible before pigment if formed over the non-tapetal fundus

108
Q

list 3 causes of optic nerve disease

A
  • optic nerve atrophy (secondary to glaucoma, PRA)
  • optic neuritis
  • papilloedema
109
Q

list 4 anatomical structures that can cause central blindness if damaged

A
  1. Pre-chiasmal
  2. Chiasma
  3. optic Tract
  4. central
110
Q

CS assoc. w/ horners

A

miosis, enopthalmus, protis, 3rd eyelid protrusion, periorbital BV dilation

111
Q

what drug do you use to pharmacologically test which order neuron is effected in horner’s?

A

phenylephrine 1%

112
Q

Dazzle tests

A

o CN 2 (optic)

o CN 6 (abducens)

113
Q

Palpebral tests

A 
o	CN5 (trigem)
o	CN 7 (facial)
114
Q

PLR tests

A

o CN 2 (optic)
o CN 3 (oculomotor)
o Parasympathetic

115
Q

Menace tests

A

o CN 2 (optic)
o CN 7 (facial)
o CN 6 (Abducens)
o *note: learned response, not present until > 12w

116
Q

Vestibulo-ocular tests

A

CN 8 (eye tracking…)

117
Q

Obstacle course tests

A

CN 2 (optic)

118
Q

what can cause retrobulbar abscesses?

A

FB migration (grass seeds), stick injuries, tooth root infections (upper molars)

119
Q

tx of a retrobulbar abscess

A
  • Lance and drain via small stab incision behind last upper PM (4) and using blunt closed forceps (no sharp instruments!). Create a draining tract from the retro-bulbar space.
  • Appropriate antibiotics ideally based on C&S.
  • FB materials can sometimes autolyse (grass seeds) vs. FB sx  referral
120
Q

Ddx for a retrobulbar abscess

A
  • neoplasia, cysts, myositis, mucocoele, retro-bulbar haemorrhage
121
Q

what causes dogs to look like they have a headache?

A

eosinophilic/extraocular muscle myositis

122
Q

tx of extraocular muscle myositis

A

immunosuppressive pred systemic

+ gabapentin (pain)

123
Q

Prognosis for vision in proptosis in cat vs dog

A

poor in cats

guarded in dogs (better in brachys)

124
Q

tx for proptosis

A
  • lubricate
  • lateral canthotomy to give room to replace eye
  • suture lids together w/ mattress sutures (using meiobium gland openings) tarsorraphy.

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