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Applied Clinical Veterinary Nursing > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

what are the top 4 signs of eye pain?

A

blepharospasm (increased blink rate)

reduced palpebral fissure

ocular discharge/epiphora

hyperaemia (redness)

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2
Q

what are the main local signs of eye pain?

A

photophobia

miosis

third eyelid protrusion

head-shyness

self-trauma/rubbing

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3
Q

what are the systemic signs of eye pain?

A

reduced appetite

quiet/subdued

depressed/lethargic

headache?

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4
Q

what are the main streps in triaging eye pain?

A

identify systemic signs

brief description of ocular signs

establish onset and duration

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5
Q

when should patients with suspected eye pain be assessed?

A

sam day as identified if possible

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6
Q

what eye condition may affect pain scoring?

A

blepharospasm, especially in cats/horses - must be taken into account

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7
Q

how can we treat scratchy dry lids?

A

lubrication with HA drops

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8
Q

how can we treat an acutely painful indolent ulcer?

A

bandage contact lens

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9
Q

how can we treat cramping spasm uveitis?

A

atropine/cyclopentolate drops (relieves pressure and relaxes iris)

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10
Q

how can we treat the chronic searing ache of intractable glaucoma?

A

enucleation - can’t be treated medically

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11
Q

how can we treat the dull ache experienced with orbital swelling?

A

NSAIDS +/- opioids

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12
Q

how can we treat eye pain with an unknown cause (cannot open eye to examine)?

A

local/sedation/GA? - cause must be identified

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13
Q

how should we handle patients with reduced vision/blindness/painful/fraglle eyes?

A

guide carefully, avoiding bumps

talk to them

go slowly, introduce hands to body before head

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14
Q

how can we handle these patients appropriately for examination?

A

assess temperament - requires proximity to face

keep steady and calm

end of table

reward and reassure

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15
Q

what are the main causes of vision loss?

A

cataracts

glaucoma

SARDS

toxins

progressive retinal atrophy

brain disease/trauma

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16
Q

what can cause cataracts?

A

can be inherited or due to diabetes

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17
Q

why does glaucoma occur?

A

primary - inherited genetic defect

secondary to intraocular neoplasia, uveitis, lens luxation

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18
Q

how is glaucoma managed?

A

medically managed initially

can have surgical shunt implant, laser TSCP/ECP but will ultimately require enucleation

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19
Q

what is SARDS and how is it diagnosed?

A

sudden acquired retinal degeneration syndrome

diagnosed via electroretinogram - flat line

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20
Q

how is SARDS treated?

A

no treatment available

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21
Q

what toxins can cause vision loss?

A

ivermectin poisoning

enrofloxacin in cats

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22
Q

how does progressive retinal atrophy progress?

A

night vision is lost first, then day vision

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23
Q

how is progressive retinal atrophy diagnosed?

A

simple maze test with light off and on

ERG will show rods not responding if night vision is lost

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24
Q

how do patients adapt to vision loss?

A

usually adapt well - smell and hearing are more important than vision

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25
Q

how can we give advice on owner homecare for patients with vision loss?

A

online forums can be good

buster collars/guide leads/bump bars in house

doggles/rex-specs to protect eyes

sound/voice commands important

behaviour modification training

lead walks offer more support - act as reverse guide dog

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26
Q

why is it important to treat eye ulcers?

A

very painful

infection risk

risk of keratomalacia (‘melting’)

perforation –> endophthalmitis –> glaucoma –> phthisis –> blindness

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27
Q

can ulcer heal without treatment?

A

very simple ulcers generally heal in around 7 days without treatment

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28
Q

what does the cornea consist of?

A

transparent stratified squamous epithelium

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29
Q

what is the limbus?

A

transition zone between the cornea and sclera

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30
Q

where are the stem cells located in the eye?

A

limbus

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31
Q

what is contained in the limbus of the eye?

A

stem cells

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32
Q

what is the sclera?

A

fibrous tunic of the eye

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33
Q

what is the role of the sclera?

A

gives globe rigidity

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34
Q

what are the stages of ulcer formation?

A

superficial
deep
descemetocoele
perforation

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35
Q

how are ulcers classified?

A

by depth of stroma affected

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36
Q

what does a descemetocoele look like when stained with fluoroscein?

A

donut

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37
Q

what % stromal loss is considered fragile eye?

A

> 50%

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38
Q

what makes an eye extremely fragile?

A

if ulcer down to descemets layer

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39
Q

why should you avoid increasing IOP?

A

could cause rupture

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40
Q

what could cause a fragile eye to rupture?

A

increase in IOP

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41
Q

what can cause an increase in IOP?

A

barking

jugular blood sampling

coughing/vomiting

pulling on collar

firm restraint

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42
Q

which breeds are often affected by fragile eyes?

A

brachycephalic breeds

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43
Q

how can we handle patients with fragile eyes to avoid raising iop?

A

avoid pressure on neck or lids

avoid jugular sampling - increased venous pressure = increased IOP

avoid stress, keep calm

question whether need to do STT/IOP/cytology

keep eye area clean

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44
Q

what is a SCCED?

A

spontaneous chronic corneal epithelial defect

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45
Q

what treatments are available for SCCED?

A

algar brush, grid
superficial keratectomy (100% success)

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46
Q

what is a superficial keratectomy?

A

removal of top layer of cornea

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47
Q

what treatments are available for stromal ulcers?

A

medical or surgical graft

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48
Q

what treatments are available for melting ulcers?

A

intense medical initially
+/- corneal cross-linking
corneal graft surgery

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49
Q

what treatments are available for desmetocoeles?

A

structural support imperative

corneo-conjunctival transposition (graft)

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50
Q

what treatments are available for perforation?

A

suture closed/patch/graft

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51
Q

what is the risk of perforation?

A

risks endophthalmitis

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52
Q

what are the inpatient considerations for eye surgery?

A

low stress

smooth pre-surgical preparation

smooth recovery post-op

reversal/repeat of premedicants?

horses - stables dark for atropine

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53
Q

what post-op care should be considered after eye surgery?

A

harness walks only

no jugular samples

buster/soft collar

closely monitor and treat pain

keep wounds clean and dry

keep patient calm

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54
Q

what types of trauma are ocular emergencies?

A

sharp trauma

blunt trauma

proptosis

penetrating foreign body

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55
Q

what is proptosis?

A

eyelids trapped behind globe

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56
Q

what are our priorities with ocular emergencies?

A

cardiovascular stability - ABC

analgesia

ocular surface support - lubrication

prevent further trauma - stabilise any FBs

buster collar to prevent self-trauma

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57
Q

what injury is common in puppies?

A

cat claw injuries - puppies don’t develop menace response until 8-12 weeks

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58
Q

what can happen to the eye with cat claw injuries?

A

corneal laceration

lens puncture/capsular tear

cataract formation

induction of lens-induced uveitis

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59
Q

how can cat claw injuries be treated?

A

cataract surgery with phaecoemulsification

corneal laceration repair

treat uveitis medically

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60
Q

what does glaucoma look like?

A

blue cornea, red sclera and conjunctiva

blindness and pain

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61
Q

what does chronic glaucoma look like?

A

buphthalmic eye. globe is stretched, looks enlarged

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62
Q

what is normal IOP?

A

10-25mmHg

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63
Q

what is glaucoma IOP?

A

> 30mmHg

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64
Q

why is glaucoma an emergency?

A

blindness in 24-48 hours

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65
Q

what could cause exophthalmos?

A

FB - could go in to orbit and cause retrobulbar abscess/cellulitis

dental work - elevator slip trauma

stick injuries - chewing/running into

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66
Q

what are the signs of retrobulbar mass/exophthalmos?

A

pain on opening mouth

exophthalmic eye

excessive conjunctiva is visible (esp third eyelid)

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67
Q

what is the function of lubricant eye drops?

A

protect, soothe, support healing

68
Q

what is the role of antibiotic eye drops?

A

treatment or prophylaxis

69
Q

what classes of anti-inflammatory eye drops are commonly available?

A

NSAIDs or steroids

70
Q

what are immune modulator eye drops used for?

A

treatment of immune-modulate disease

71
Q

what is the tole of anti-glaucoma drugs?

A

lower pressure in the eye

72
Q

what do mydriatic eye drops do?

A

dilate the pupil e.g. atropine

73
Q

what are anaesthetic eye drops used for?

A

diagnostics
pre-op

74
Q

what classes of eye drops are used in practice?

A

lubricants
antibiotics
anti-inflammatories
immune modulators
anti-glaucoma drugs
mydriatics
local anaesthetics

75
Q

what are serum eye drops made from?

A

fresh frozen plasma or serum - can be patients own or from donor animal (fresh)

76
Q

what are the steps involved in making serum eye drops?

A

defrost plasma if frozen

place needle free fluid spike into plasma bag

draw up 3mls and transfer into bottles

77
Q

what is important to remember when making serum eye drops?

A

keep process as sterile as possible - gloves, very clean table/sterile drape

78
Q

where should serum eye drops be kept?

A

freezer - defrost in pocket for days use, store refrigerated

79
Q

how long can serum eye drops be kept in the fridge?

A

max 3 days

80
Q

what can serum eye drops be used for?

A

melting ulcers

prevention of keratomalacia

81
Q

what are the considerations for administering eye drops?

A

clean any discharge

one drop is enough

leave 10 mins between each drop

leave 60 mins between each gel and ointment

don’t touch surface of eye with nozzle or finger

82
Q

what is the order of administration of eye medications dependent on?

A

viscosity

83
Q

how long should be left between aqueous drops and suspensions?

A

10 mins

84
Q

how long should be left between suspensions and gels?

A

10 mins

85
Q

how long should be left between gels and ointments?

A

60 mins

86
Q

what is the role of ocular lubricants?

A

support healing all ocular surface disease

reduce evaporation

prevent ulceration pre-operatively

replace missing tears in KCS patients

provide comfort

87
Q

what patient factors should we consider when preparing for ocular surgery?

A

physical mobility

systemic health - blood required?

conformation/concurrent BOAS

ocular complaint - eye drops required?

where/when should IV catheter be placed?

diabetic - insulin?

88
Q

what are the anaesthetic induction considerations for ocular surgery?

A

smooth induction is ideal

monitoring equipment at back end if possible

armoured ET tubes and T connectors - non-kinking

neuromuscular blockade and ventilation may be required

89
Q

what should be involved in clipping for eyelid surgery?

A

wear gloves

apply copious amounts of lubricating gel to the eye(s)

use small, clean sharp clippers, sharp scissors for eyelashes

clip area required as close to the skin as possible without causing irritation

flush hairs and lubricant away with saline

90
Q

is clipping required for globe surgery?

A

no

91
Q

what solution should be used for surgical preparation of the eye?

A

povidone iodine solution

never iodine scrub or tincture

92
Q

what dilution povidone iodine solution should be used for the globe?

A

1:50 povidone iodine to sterile saline

93
Q

what dilution povidone iodine solution should be used for the eyelids?

A

1:10 povidone iodine to sterile saline

94
Q

what contact time is required for povidone iodine solution?

A

2 mins, then flush out with saline

95
Q

what equipment might be required for ocular surgery?

A

surgical equipment

patient drapes (varied)

surgeons chair

gown, gloves, chair and equipment drapes

prepared saline flush

96
Q

what extra equipment might be seen for ocular surgery at referral level?

A

operating microscope, sterile handles

ventilator and ‘muscle stim’ if NMB used

phaecoemulsification machine for cataract surgery

97
Q

what surgical kits/consumables might be required for ocular surgery?

A

lid kit
corneal kit
phaeco kit

suture materials -
8.0 or 9.0 vicryl, spatulated need for cornea
5.0 or 6.0 vicryl for lids

stay suture material

98
Q

what type of block should be considered for enucleation?

A

local retrobulbar block

99
Q

what are the surgical techniques for enucleation?

A

trans-conjunctival - 2 phase

transpalpebral for en-bloc removal, suture first

100
Q

what is the oculo-cardiac reflex?

A

reflex bradycardia on eye pressure (vagus)

101
Q

why should surgeons avoid traction on the optic chiasm during enucleation surgery?

A

avulsion can blind fellow eye - especially in cats (shorter nerves)

102
Q

what are the management options for haemorrhage during ocular surgery?

A

collagen pads
powders (surgicel snow)
adrenaline
pressure

103
Q

what surgeries may be done in the general eye area?

A

entropion

mass removal

rhytidectomy

distichasis/ectopci cilia

media canthoplasty (pugs)

cherry eye surgery

lip to lip transpositions

parotid duct transposition

104
Q

what surgical technique may be used to treat entropion?

A

Hotz-celcus technique

105
Q

what surgical technique may be used for eyelid masses?

A

wedge excision

106
Q

what techniques may be used to treat distichasis/ectopic cilia?

A

cryosurgery or electrolysis

107
Q

what does distichasis mean?

A

extra eyelashes

108
Q

what technique may be used to treat cherry eye?

A

pocket technique

109
Q

why might a parotid duct transposition be performed?

A

for dry eye

110
Q

what surgery might be used to treat dry eye?

A

parotid duct transposition

111
Q

what is the main consideration for corneal surgery?

A

horizontal eye positioning - central eye often used

ventilator and NMB required

112
Q

what is the goal of corneal surgery?

A

removal of damaged cornea

113
Q

what techniques may be used for corneal surgery?

A

free or advancement graft e.g. CCT

114
Q

what is the most common cause of blindness in veterinary patients?

A

cataracts

115
Q

can cataracts be inherited?

A

yes - identifiable via BVA/KC/ISDS eye scheme

116
Q

how can cataracts be acquired?

A

through diabetes mellitus

117
Q

what preparation tests must be done before cataract surgery?

A

gonioscopy to check for glaucoma risk post-op

ERG to check functional retina before go-ahead

U/S for tumour check/angle check

finances arranged

118
Q

what does gonioscopy do?

A

assess drainage angle of eye

119
Q

what is gonioscopy used for?

A

looking for signs of inherited glaucoma

120
Q

how can gonioscopy be performed?

A

patient conscious
LA drops required

referral level technique

121
Q

can patients be conscious for ocular ultrasound?

A

yes

122
Q

what anaesthetic can be used for ocular ultrasound?

A

local proxymetacaine

123
Q

what can be seen with ocular ultrasound?

A

assessment of structures of eyes

lens structure, cataracts , retinal detachment, retrobulbar mass, foreign body

124
Q

which lubrication gel is good for eye US?

A

optilube

125
Q

what is an electroretinogram?

A

records retinal response to light stimulus

126
Q

why is electroretinogram performed?

A

allows us to assess if the retina is functional

127
Q

can the patient be conscious for electroretinogram?

A

can be done conscious or sedated

128
Q

what is the likelihood of a patient with diabetes developing cataracts?

A

50% develop within 6 months

75-80% within a year

129
Q

what are the risks of diabetic cataracts?

A

risk of lens capsule rupture and lens induced uveitis

130
Q

does diabetes have to be well controlled before cataract surgery?

A

no

131
Q

what is the advantage of performing cataract surgery?

A

restores vision - success rates often 85%+

132
Q

what type of surgery is cataract surgery?

A

intra-ocular surgery

133
Q

what is involved in pre-op work-up for cataract surgery?

A

electroretinogram

high frequency U/S of drainage angle and screen for detached retina/masses etc

gonioscopy to assess glaucoma risk

full blood and workup to check for comorbidities

134
Q

what are the disadvantages of cataract surgery?

A

high post-op commitment

expensive - £5000 both eyes

impact of aftercare on home life - lifelong meds

lifelong rechecks q3m

135
Q

what is phaecoemulsification surgery used to treat?

A

glaucoma

136
Q

what is involved in post-op care after phaecoemulsification?

A

medications - up to 12x daily in first week

keep quiet for 2 weeks

topical steroids and NSAIDs to control uveitis

abs until wounds heal

lubricants for comfort

137
Q

what are common anaesthesia risk factors for the ophthalmic patient?

A

mostly tend to be older patients

co-morbidities common

brachys are 25% caseload at referral

cardiac

138
Q

what are the options for analgesia for ophthalmic patients?

A

topical proxymetacaine - diagnostic only

local - skin line or retrobulbar

systemic NSAIDs/opioids/CRI

139
Q

why might a neuromuscular blockade be used in ocular surgery?

A

to achieve a central eye - paralysis of extra-ocular muscles

140
Q

why are ophthalmic patients often on ventilators under GA?

A

neuromuscular blockade also paralyses intercostals –> paralyses breathing

141
Q

what NMB is commonly used in ocular surgery?

A

atracurium

142
Q

how is the duration of action of atracurium?

A

15-35 mins

143
Q

how is atracurium given?

A

dilute in saline and give slowly IV to prevent histamine release

144
Q

what should be monitored closely in patients who have had NMB for ocular surgery?

A

avoidance of hypothermia, acidosis and hypokalaemia (prolongs)

145
Q

what is the advantage of using atracurium in ophthalmic surgery?

A

non-cumulative, so safe in heptic and renal patients

146
Q

what abnormalities are seen with brachycephalic ocular syndrome?

A

lower medial entropion

shallow orbit

macropalpebral fissure

lagopthalmos

medial carancular trichiasis

pigmentary ketasis

epiphora from kinking of the N-L canaliculi

147
Q

what does lagophthalmos mean?

A

sleeping with lids incompletely closed

148
Q

what can epiphora in brachycephalic ocular syndrome be exacerbated by?

A

other concurrent issues such as dry eye disease or distichiasis

149
Q

what are the considerations for diabetic patients having ophthalmic surgery?

A

monitor glucose throughout day - starve AM and withhold insulin

avoid hypoglycaemia

elevated fluid requirement

150
Q

what are the risks with diabetic patients undergoing ocular surgery?

A

increased risks of:
systemic hypertension
dry eye
delayed healing
infection

151
Q

how can we improve client communication and efficiency with regards to ophthalmic care?

A

educating owners about conditions

training clients to be effective with drops and training dog with rewards

habituation of brachy puppies to daily lubricants

easy tests to monitor or start tear supplements earlier

support medication compliance

152
Q

what are the 3 layers of the tear film?

A

lipid layer

aqueous layer

mucus layer

153
Q

what is the function of the lipid layer of the tear film?

A

prevents evaporation

aids distribution

154
Q

what is the function of the aqueous layer of the tear film?

A

supplies corneal nutrition

antibacterial properties

removal and remodelling - proteases and antiproteases

155
Q

what is the function of the mucus layer of the tear film?

A

lubrication

refractive properties

anchors aqueous layer to cornea

156
Q

what is keratoconjunctivitis sicca?

A

deficiency of aqueous tear

157
Q

does KCS develop quickly?

A

no - insidious onset

158
Q

what breed groups are predisposed to KCS?

A

terriers

brachys

spaniels

bloodhounds, samoyeds

159
Q

what quantitative tests are available for KCS?

A

schirmer tear tests and concurrent clinical signs

160
Q

what is the normal range for the STT?

A

15-25mm/min

161
Q

at what STT reading might we start to suspect KCS?

A

10-14mm/min

162
Q

what STT reading is considered moderate KCS?

A

6-10mm/min

163
Q

what STT reading is considered severe KCS?

A

0-5mm/min

164
Q

what are the common clinical signs of KCS?

A

strings of adherent mucus

poor corneal clarity

poor corneal shine/poor Purkinje reflex

low STT reading

165
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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