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Applied Clinical Veterinary Nursing > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What are some signs of eye pain?

A

Blepharospasm (increased blink rate)
Reduced palpebral fissure (blink/wink)
Ocular discharge / epiphora
Hyperaemia (redness)
Photophobia
Miosis (small pupil)
Third eyelid protrusion
Head-shy/self-trauma

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2
Q

How should we triage ocular patients?

A

Systemic signs e.g. reduced appetite, subdued/depressed, lethargic
Brief description of ocular signs
Onset and duration
Be careful - owners cannot always identify pain or severity accurately

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3
Q

How can we manage ophthalmic pain?

A

Medical options - topical and systemic
Surgical options
Treat the cause!

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4
Q

How should we handle ophthalmic patients for examination?

A

Assess temperament
Keep steady and calm
Hold at end of table
Reward and reassure
Nurse restraint!

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5
Q

What are some causes of vision loss?

A

Cataracts - inherited or diabetic
Glaucoma - primary inherited / secondary to intraocular neoplasia, uveitis, lens luxation
SARDS (sudden acquired retinal degeneration syndrome)
Toxins - ivermectin, enrofloxacin
PRA (progressive retinal atrophy)

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6
Q

Why do we need to treat ulcers?

A

Pain
Infection risk
Risk of keratomalacia (melting)
Perforation, endophthalmitis, glaucoma, phthisis, blindness

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7
Q

What are the classifications of ulcers?

A

By depth of stroma affected
Superficial
Deep
Descemetocoele
Perforation

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8
Q

What post-op care should we provide for ophthalmic patients?

A

Harness walks, no jugular samples (raised IOP)
Buster collar to prevent self trauma
Recognise, monitor and treat pain
Administer eye medications
Keep wounds clean and dry
Keep patient calm

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9
Q

What traumas are an ocular emergency?

A

Sharp trauma
Blunt trauma
Proptosis (eyelids trapped behind globe)
Penetrating FBs

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10
Q

What are our priorities with ocular emergencies?

A

Cardiovascular stability - ABC
Analgesia
Ocular surface support - lubrication
Prevent further trauma, stabilise any FBs and use Buster collar
Stabilise, assess, plan, treat

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11
Q

Describe a cat claw injury.

A

Puppies develop menace response at 8-12 weeks, meets defensive cat
Corneal laceration
Lens puncture / capsular tear
Cataract formation
Induction of lens-induced uveitis

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12
Q

How can we treat cat claw injuries?

A

Cataract surgery with phaecoemulsification
Corneal laceration repair
Medical treatment of uveitis

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13
Q

Describe uveitis.

A

Trauma causes inflammation in eye
Blood-ocular barrier breakdown = uveitis
Inflammation damages delicate structures
Systemic disease can cause uveitis
Urgent treatment needed once recognised

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14
Q

Describe glaucoma.

A

Blue cornea, red sclera and conjunctiva
Blindness in 24-48hrs, pain
Chronic = globe stretched/enlarged, remains in normal position within orbit
Can be post-op complications after cataract surgery
High IOP (>30mmHg)

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15
Q

What can cause retrobulbar masses and exophthalmos?

A

FB could go into orbit and cause retrobulbar abscess/cellulitis
Recent dental work - elevator slip trauma
Stick injuries from chewing/running into

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16
Q

What are the signs of retrobulbar masses and exophthalmos?

A

Pain on opening mouth
Exophthalmic eye (pushed forward)
Excessive conjunctiva visible esp. 3rd eyelid

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17
Q

What are the different types of eye drops and what are they used for?

A

Lubricants - protect, soothe, support healing
Antibiotics - treatment/prophylaxis
Anti-inflammatories - NSAIDs/steroids
Immune modulator - immune-mediated disease
Anti-glaucoma drugs - lower pressure
Mydriatics - dilate pupil
Local anaesthetic - diagnose/pre-op

18
Q

How can we make serum eye drops?

A

From FFP or serum
Patient’s own, donor animal fresh or FFP

19
Q

How long should we leave between drops and gels/ointments?

A

Leave 10mins between each drop
Leave 60mins between each gel/ointment

20
Q

What order should drops be administered in?

A

Watery aqueous drops first, wait 10 mins
Suspensions, wait 10 mins
Gels, wait 60 mins
Ointments last

21
Q

What are the benefits of eye lubricants?

A

Support healing of all ocular surface disease
Nutrition of cornea through tears
Reduce evaporation
Prevent ulceration post-op
Replace missing tears
Comfort!

22
Q

What patient factors should we consider when preparing for ophthalmic surgery?

A

Physical mobility, systemic health - often young/old patients
Conformation/concurrent BOAS
Ocular complaint - medications needed before surgery?
IV catheter in back leg?
Diabetic patients - insulin or not?

23
Q

What anaesthetic and positioning considerations should we have for ophthalmic surgery?

A

Smooth induction
Patient as still and steady as possible!
Monitoring equipment at back end wherever possible
Armoured ET tubes and T connectors
Neuromuscular blockade and ventilation

24
Q

How can we prep the eye for lid surgery?

A

Wear gloves
Apply copious amounts of lubricating gel to eye
Use small, clean, sharp clippers
Sharp scissors for eyelashes
Clip area as close to skin as possible without causing irritation
Flush hairs and lube away with saline

25
Q

What solutions should we use for scrubbing the eye area?

A

Povidone iodine solution
Diluted with sterile saline
1:50 for globe
1:10 for eyelids
2 minute contact time
Flush with sterile saline to prevent corneal toxicity

26
Q

What considerations should we have for enucleation surgery?

A

Consider local retrobulbar block
Oculo-cardiac reflex (reflex bradycardia on eye pressure)
Avoid traction on chiasm (avulsion can blind other eye)
Haemorrhage - haemostasis options

27
Q

List some general eye area surgeries.

A

Entropion, mass removal
Rhytidectomy (face-lift)
Medial canthoplasty (pugs)
Cherry eye
Parotid duct transposition (dry eye)

28
Q

Describe corneal surgery.

A

Horizontal eye positioning (central eye often used)
Ventilator and NMBs
Remove damaged cornea
Free / advancement graft

29
Q

What assessments should we carry out before cataract surgery?

A

Gonioscopy to check glaucoma risk post-op
ERG to check for functional retina
Ultrasound for tumour/angle check
Post-op medication practicality

30
Q

What is gonioscopy?

A

Assess drainage angle
Looking for signs of inherited glaucoma
Patient conscious - LA drops

31
Q

Describe ocular ultrasound?

A

Patient can be conscious - local proxymetacaine desensitises cornea
Lots of gel e.g. Optilube
Assess structures of eye - lens structure, cataracts, retinal detachment, retrobulbar mass, FB

32
Q

Describe ERG (electroretinogram).

A

Records retinal electrical response to light stimulus
Allows assessment of retina function
Patient conscious/sedated

33
Q

What pre-op assessments should we carry out before ophthalmic surgery?

A

ERG
High-frequency ultrasound
Gonioscopy
Full bloods and urinalysis to check for comorbidities
Owners - cost, aftercare, lifelong medications and rechecks

34
Q

Describe typical post-op medications for ophtho patients.

A

Up to 12x daily in first week
Steroids and NSAIDs topically to control uveitis
Glaucoma medications to minimise IOP spike
Antibiotics until wounds heal
Lubricants for comfort

35
Q

Describe the role of NMBs in ophthalmic surgery.

A

‘Central eye’ achieved by paralysing extraocular muscles
Also intercostals - need to manually ventilate patient
Atracurium non-cumulative so safe in hepatic/renal patients

36
Q

What is brachycephalic ocular syndrome?

A

Lower medial entropion
Shallow orbit, relative exophthalmos
Macropalpebral fissure (excessive limbal/scleral exposure)
Lagophthalmos (sleeping with lids incompletely closed)
Medial caruncular trichiasis
Nasal fold trichiasis
Pigmentary ketatitis
Epiphora

37
Q

What risks are elevated for diabetic ophthalmic patients?

A

Systemic hypertension
Dry eye
Delayed healing
Infection

38
Q

What are the three layers of the tear film and what are their functions?

A

Lipid layer - prevents evaporation, aids distribution
Aqueous layer - supplies corneal nutrition, antibacterial properties, removal and remodelling (proteases and antiproteases)
Mucus layer - lubrication, refractive properties, anchors aqueous layer to cornea

39
Q

What is keratoconjunctivitis sicca?

A

Majority of cases are immune-mediated adenitis of lacrimal glands
OR deficiency of aqueous tear

40
Q

How can we diagnose KCS?

A

Schirmer Tear Test
AND concurrent clinical signs

41
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

42
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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