Ophthalmology 2

Question 1

What patient factors should be considered in preparation for eye surgery?

Answer 1

• physical mobility
• systemic health - bloods?
• conformation/concurrent BOAS
• ocular complant - eye drops?
• where and when place IVC
• insulin or not to diabetic patients?

Question 2

What is important for anaesthesia during eye surgery?

Answer 2

• smooth induction ideal
• vacuum bags prevent movement
• neurmuscular blockage and ventilation
• non-kinking ‘armoured’ ET tubes and T connectors

Question 3

How should you clip the eye for surgery?

Answer 3

• wear gloves
• apply copious amounts of lubriacting 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

Question 4

What surgery is clipping not required?

Answer 4

globe surgery

Question 5

How do you surgically prep the eye?

Answer 5

• povidone iodine solution always
• never povidone scrub or tincture
• gauze swabs and sterile saline to remove gel and hair from eyes
• prep globe first the eyelids

Question 6

What dilution of iodine should youuse for globe surgery?

Answer 6

1 part povidone iodine:50 parts sterile saline

Question 7

What iodine dilution would you use for eyelid surgery?

Answer 7

1 part povidone iodine:10 parts sterile saline

Question 8

What is the contact time for using iodine on the eye area?

Answer 8

2 minutes then flush out

Question 9

What eqipment do you need on the trolley for ocular surgery?

Answer 9

• patient drapes (fenestrated, sticky, drape tape +/- pouch)
• surgeons chair
• gown gloves, chair and equipment drapes
• prepare saline flush
• operating microscope with sterile handles
• ventilator and muscle stim if neurmuscular blockade used
• phacomulsification machine for cataract surgery

Question 10

What surgical kits do you need for ocular surgery?

Answer 10

lid kit, corneal kit, phaeco kit and suture materials

Question 11

What suture materials are recommended for ocular surgery?

Answer 11

• 8/0 or 9/0 vicryl, spatulated needle for cornea
• 5/0-6/0 vicryl for lids
• stay suture material

Question 12

What are the considerations for enucleation surgery?

Answer 12

• local retrobulbar block?
• trans-conjunctival 2 phase
• transpalpebral for en-bloc, suture first
• oculo-cardiac reflex
• avoid traction on chiasm
• haehorrhage
• histology recommended

Question 13

What is the oculo-cardiac reflex?

Answer 13

reflex bradycardia on eye pressure (vagus)

Question 14

Why should you avoid traction on the chiasm?

Answer 14

avulsioon can blind fellow eye especially in cats

Question 15

What are common eye/around the eye surgeries?

Answer 15

• entropian, mass removal
• rhytidectomy (facelift for droopy dogs)
• distichasis/ectopic cilia with cryosurgery or electrolysis
• cherry eye
• lip to lid transpositions
• parotid duct transposition for dry eye

Question 16

How would you position the eyes for corneal surgery?

Answer 16

horizontal positioning

Question 17

What happens during corneal surgery?

Answer 17

removal of the damaged cornea

Question 18

What is a common cause of blindness?

Answer 18

cataracts

Question 19

What can you do post-op to check the risk of glaucoma?

Answer 19

gonioscopy

Question 20

What can you do to check functional retina before cataracts surgery?

Answer 20

ERG - electroretinogram

Question 21

What does a gonioscopy do?

Answer 21

assess drainage angle

Question 22

What is a gonioscopy looking for?

Answer 22

signs of inherited glaucoma

Question 23

What can local can you use when doing an ocular ultrasound to desnsitise the corneal?

Answer 23

proxymetacaine

Question 24

What would you do an ocular ultrasound for?

Answer 24

assess the structures of the eye, cataracts, retinal displacement, retrobulbar mass, foreign body

Question 25

What does a electroretinogram assess?

Answer 25

if the retinal is functional

Question 26

What percentage of dogs with diabetes develop diabetic mellitus cataract within 6 months?

Answer 26

50%

Question 27

What percentage of patients with diabetes mellitus develop cataracts within a year?

Answer 27

75-80%

Question 28

What can diabetic cataract ucase?

Answer 28

ruptured lens capsule, lens induced uveitis

Question 29

What does cataract surgery do?

Answer 29

restores vision

Question 30

What are the success rates for cataract surgery?

Answer 30

85%+

Question 31

What pre-op assessment would you do for cataract surgery?

Answer 31

- electro-retinogram - high frequency ultrasound of drainage angle and sreen for detached retina/masses - gonioscopy - full blood and urine workup

Question 32

How long do you give medications for phaeco aftercare?

Answer 32

up to 12 times daily in the first week

Question 33

What drugs control uveitis?

Answer 33

NSAIDs and steroids

Question 34

What can you give to minimise intraocular pressure spike?

Answer 34

glaucoma medications

Question 35

How long do you give antibiotics?

Answer 35

until wounds heal

Question 36

What are the risk factors associated with anaesthesia for the ophthalmic patient?

Answer 36

- variety of ages, tend to be older - co-morbidities - brachycephalics are 25% caseload at referal - cardiac

Question 37

What analgesia plan is optimal for these patients?

Answer 37

-topical proxymetacaine diagnostic only - local skin line or retrobulbar - systemic NSAID/opioids/CRI

Question 38

How do you achieve a 'central eye'?

Answer 38

paralysis extraocular muscles

Question 39

How long does atracurium last?

Answer 39

15-35 minutes

Question 40

What should you avoid with neuromuscular bloackade?

Answer 40

hypothermia, acidosis andhypokalaemia

Question 41

When should you ventilate?

Answer 41

- if intercostal paralysis used - until patient spontaneous breathing

Question 42

What is relative exophthalmos?

Answer 42

bulging eye

Question 43

What is seen in brachycephalic ocular syndrome?

Answer 43

- lower medial entropian - shallow orbit and relative exophthalmos - macropalpebral fissure - lagophthamos - medial caruncular trichiasis - pigmentary ketatiitis - nasal fold trichiasis - epiphora from kinking of the N-L canaliculi and obscuring punctum

Question 44

What is macropalpebral fissure?

Answer 44

excessive limbal or sceral exposure

Question 45

What is lagophthalmos?

Answer 45

sleeping with lids incompletely closed

Question 46

What can you do to help a patient with compromised airway?

Answer 46

- pre-oxygenate and provide O2 nasal prongs or nasal catheter in recovery - keep cool - reduce stress - late admission, early discharge - upper respiraory tract obstruction at recover - late extubation

Question 47

How can regurge risk be decrease?

Answer 47

if starvation is shorter

Question 48

What can you use to reduce pain and ulceration with regurge?

Answer 48

omeprazole

Question 49

What is a hiatial hernia?

Answer 49

when the stomach slides into the chest

Question 50

What do opioids do?

Answer 50

reduce GI motility

Question 51

How can you increase peristalsis/

Answer 51

keep the patient moving

Question 52

How do you nurse a diabetic patient?

Answer 52

- monitor glucose - starve in the morning and withold insulin - avoid hypoglycaemia - elevated fluid requirement

Question 53

What increased risks are there with diabetic patients?

Answer 53

- systemic hypertension - dry eye - delayed healing - infection

Question 54

What client communication is important with ophthalmic patients?

Answer 54

- client expectations managed -training clients to be effective with eye drops - training dog with reward for drops - habituate brachcephalic puppies to daily lubricants in yourh so accept well when treatment needed later - easy tests to monitor or start tear supplementation earlier - brachys 3.6x more likely Keratoconjunctivitis Sicca (KCS)

Question 55

What can you do in primary care nurse clinics?

Answer 55

- monitor normal patients to see what is normal compared to abnormal - educate owners on conditions - supportive medication compliance -positive reinforcement training to accept eye drops

Question 56

What does the lipid layer do?

Answer 56

prevents avapouration and aids distribution of tears

Question 57

What does the aqueous layer do?

Answer 57

supplies corneal nutrition, antibacterial properties and removal and remodelling of proteases and antiproteases

Question 58

What does the mucous layer do?

Answer 58

lubrication, refractive properties and anchors aqueous layer to cornea

Question 59

What is keratoconjunctivitis sicca?

Answer 59

deficiency of aqueous tear

Question 60

What diagnostic tests can be done for KCS?

Answer 60

schirmer tear test

Question 61

What is normal range for schirmer tear test?

Answer 61

15-25mm/min

Question 62

What is early suspicion of KCS on schirmer tear test?

Answer 62

10-14mm/min

Question 63

What is moderate KCS on schirmer tear test?

Answer 63

6-10mm/min

Question 64

What is severe KCS on schirmer tear test?

Answer 64

0-5mm/min

Question 65

What are common clinical signs of KCS?

Answer 65

- strings of adherent mucus - poor corneal clarity - poor corneal shine/poor purkinje reflex - low schirmer tear test

Question 66

How can you reduce the risk of regurge and reflux nutrition wise?

Answer 66

feed a low fat meal either orally or through NG tube for gastric decompression

Question 67

What is pigmentary keratosis?

Answer 67

brown-black discolouration in the eyes surface due to deposition of pigmented melanin granules

Question 68

How can you prevent histamine realse with administration of neuromuscular blockade?

Answer 68

dilute in saline and give slowly IV

Question 69

What patients are safe with neuromuscular blockade due to it being non-cumulative?

Answer 69

hepatic and renal patients