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RUSVM Small Animal Medicine II 2017 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

OS

A

Left Eye

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2
Q

OD

A

Right Eye

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3
Q

OU

A

Both Eyes

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4
Q

What does the cotton ball test assess?

A

Vision - needed to track the cotton ball

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5
Q

Phototopic Maze Test

A

Tests vision in bright and navigating

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6
Q

Scotopic Maze

A

Tests navigating the maze in dim light

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7
Q

What cranial nerves are assessed with the Palpebral reflex?

A 
CN V (afferent)
CN VII (efferent)
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8
Q

What cranial nerves are assessed with the Menace response?

A 
CN II (afferent)
CN VII (efferent)
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9
Q

What cranial nerves are assessed with the Pupillary light reflex?

A 
CN II (afferent)
CN III (efferent)
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10
Q

What cranial nerves are assessed with the Dazzle Reflex?

A 
CN II (afferent)
CN VII (efferent)
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11
Q

What cranial nerves are assessed with the Oculocephalic reflex?

A 
Intact CN II
peripheral and central vestibular components
CN III
CN IV
Cn VI
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12
Q

What cranial nerves are assessed with the Corneal reflex?

A 
CN V (afferent)
CN VI and VII (efferent)
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13
Q

What are the guidelines for a normal Schirmer Tear Test for a dog?

A

greater than 15mm wetting/minute

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14
Q

What are the three common uses of Fluorescein stain?

A

Diagnosis and characterization of corneal ulceration
Demonstration of nasolacrimal patency (Jones Test)
Demonstration of corneal performation (Seidel Test)

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15
Q

What does the Jones Test assess?

A

Demonstration of nasolacrimal patency

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16
Q

What does the Seidel Test assess?

A

Demonstration of corneal perforation

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17
Q

What does a positive Jones Test demonstrate?

A

nasolacrimal patency

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18
Q

What does Tonometry measure?

A

intraocular pressure in mmHg

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19
Q

What is a normal reading for Tonometry for cats and dogs?

A

10-20mmHg

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20
Q

What is the diagnosis for a Tonometry reading of greater than 25mmHg with vision loss?

A

Glaucoma

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21
Q

What is the diagnosis for low intraocular pressures?

A

Uveitis

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22
Q

Adnexa

A

everything that supports the eyeball

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23
Q

Specular Reflection

A

Mirror-like feature of the eye

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24
Q

What does a disturbance of the Specular reflection mean?

A

Irregularity of the ocular surface

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25
Boney orbit
a part of the adnexa, the conical boney structure that contains the eyeball and periorbital cone
26
Periorbital cone
Supportive cone like structure that contains the eyeball, extraocular muscles, fat, vessels, nerves, and fascia that reside within the orbit
27
Orbital Ligament
ligamentous structure that forms the lateral boundary of the boney orbit in cats and dogs
28
Exopthalmus
Abnormal protrusion of the eye from the orbit. The position is abnormal. The globe size is normal
29
Buphthalmos
"cow eye" but refers to the abnormal enlargement of the eyeball
30
What causes Buphthalmos?
glaucoma
31
Enophthalmos
Abnormal recession of the eye within the orbit
32
Strabismus
deviation of one or both eyes, so that both eyes are not directed at the same object
33
Horner's Syndrome
sympathetic denervation to the eye and ocular adnexa.
34
What are the clinical signs of Horner's Syndrome?
Enophthalmos Ptosis Miosis Protrusion of the third eyelid
35
Microphthalmos
a congenitally small and malformed globe
36
Phthisis bulbi
an acquired shrunken globe, most often from severe or chronic inflammation
37
Proptosis
Anterior displacement of the globe such that the eyelids are caught behind the equator of the globe
38
What can induce orbital or periorbital disease?
Dental disease especially from the carnassial tooth
39
What can cause displacement of the globe?
Inflammation of the Zygomatic salivary gland
40
What can cause temporary or permanent blindness in cats?
The use of Mouth Gags
41
What is different about orbital anatomy of the dog and cat?
Open orbit with an orbital ligament
42
What is different about orbital anatomy in ruminants and horses?
Closed orbit
43
What are the clinical signs associated with Exophthalmos?
``` Third eyelid protrusion Facial swelling Soft palate bulging Pain opening mouth Fever ```
44
What is the most common cause of exophthalmos?
Orbital volume imbalance
45
What is a non-painful cause of Exophthalmos?
Orbital neoplasia
46
What causes acute onset painful Exophthalmos in working dogs and stick chewers?
Orbital Cellulitis
47
What can causes Lateral deviation in orbital disease?
Tumor involving the third eyelid
48
Strabismus
deviation of one or both eyes, so that both eyes are not directed at the same object
49
What are the treatments for Orbital Neoplasia?
Globe sparing: Radiation Surgical exploration Chemotherapy Globe removal: Enucleation Exenteration
50
Exenteration
removal of the eye and all orbital contents
51
What are the treatment approaches for Orbital cellulitis?
NSAIDs Antibiotics Surgical exploration and/or drainage
52
What are the common clinical signs of Enophthalmos?
Facial muscular loss (unilateral or bilateral) Third eyelid protrusion Entropion
53
What are the three common mechanisms of Enophthalmos?
Orbital volume imbalances Active globe retraction Passive glove retraction
54
What are the common causes of Enophthalmos?
``` Dehydration Emaciation or cachexia Myopathies Space occupying lesions anterior to the globe Ocular pain Horner's Syndrome ```
55
What are the congenital Strabismus?
Divergent strabismus in brachycephalic dogs Convergent strabismus in Siamese Cats Ventrolateral divergent strabismus in Hydrocephalus
56
What are the acquired causes of Strabismus?
Mechanical or nervous dysfunction of any rectus muscle | Imbalance of orbital volume
57
What are the two considerations in the prognosis of Proptosis?
Vision? | Globe retention?
58
Tarsus
The fibrocartilagenous layer of the eyelid that contains the meibomonian glands. This is the holding layer for surgical eyelid closure
59
Meibomian glands
These are glands within the tarsal layer of the eyelid that produce lipid, or sebum, to the tear film, This is the outermost, or most external layer of the three-layered tear film
60
Lateral canthus
the lateral, or temporal convergence of the upper and lower eyelids
61
Medial canthus
the medial, or nasal convergence of the upper and lower eyelids
62
Palpebral fissure
the area outlined by the upper and lower eyelid margins
63
Ptosis
drooping of the eyelids (most often evident by upper eyelid drooping) cause by sympathetic denervation to the eyelid.
64
Lagophthalmos
incomplete eyelid closure/coverage of the eyeball
65
Eyelid margin
identified by the"grey line" of Meibomian gland orifices. This is an important landmark to identify when closing the eyelid surgically
66
Entropian
rolling in the eyelid margin such that hairs are touching the ocular surface
67
Ectropion
the outward rolling of the eyelids. Animal will often develop exposure keratitis or conjunctivitis due to the poor ability of the eyelids to completely close over the ocular surface
68
Blepharospasm
Spasm of the orbicularis oculi muscle resulting in eyelid closure. AKA squinting
69
Tarsorrhaphy
A surgical procedure in which the eyelids are sutured together. This can be temporary or permanent, and can be partial (closing only a portion of the eyelid) or complete (closing the entire eyelid)
70
Trichiasis
Hairs growing from normal skin reach the corneal and /or conjunctival surface. Technically speaking, entropion causes trichiasis, however, trichiasis is most often used to describe hairs from the nasal folds (nasal fold trichiasis) that are directed toward the eye in brachycephalic dog breeds.
71
Distichia
cilia (eyelashes) which emerge from Meibomian (tarsal) glands.
72
Ectopic cilia
cilic (eyelashes) protruding through the palpebral conjunctiva. These hairs typically cause severe, intermittent pain and often cause corneal ulceration. They most commonly arise from the 12 o'clock eyelid position
73
What muscle closes the eyelids like a zipper?
Orbicularis oculi
74
What Cranial nerve innervates the Orbicularis oculi?
CN VII
75
What is caused by dysfunction of the CN VII?
Lagophthalmos
76
What muscle is innervated by the CNIII to open the upper eyelid?
Levator palpebrae superioris
77
What nerve innervates the Levator palpebrae superioris?
CN III
78
What is caused by dysfunction of the CNIII?
ptosis
79
What muscle opens the upper eyelid due to the sympathetic nervous system?
Muller's muscle
80
What is caused by dysfunction of the Muller's muscle?
ptosis
81
What layer supports the Meibomian glands?
tarsus layer
82
Anatomic entropion
the eyelids are not appropriately conformed to the eye and its presence is unrelated to ocular pain
83
Blepharospasm associated entropian
ocular pain stimulates active glove retraction and an altered eyelid to eye relatioship
84
What are the hereditary causes of Anatomic entropion?
Abnormal canthus in brachycephalic dogs Abnormal palpebral fissure in Hounds and giant breeds Excessive facial folds in Shar Pei
85
What are the acquired causes of Anatomic entropion?
Enophthalmos | Blepharospasm that alters anatomy
86
What should you consider with Anatomic Entropion caused by Blepharospasm?
Chronic corneal ulceration Dry eye Conjunctivitis
87
How do you differentiate anatomic and blepharospasm entropion?
Take away the ocular pain that induces blepharospasm
88
What is a common cause of Entropion in foals?
Septic dehydration
89
What is a temporary treatment for Entropion?
Viscous lubrication Eyelid tacking Partial temporary tarsorrhapy
90
What is a permanent treatment for Entropion?
Modified Hotz-Celsus - rolls out the eyelid
91
What is a common cause of Ectropion?
Iatrogenic: aggressive entropion correction Hereditary: Hounds and giant breeds
92
What are 4 common causes of Lagophthalmos?
Breed variation Exophthalmos Buphthalmos CN V or CN VII dysfunction
93
What is caused by secondary eye exposure from Lagophthalmos?
Keratoconjunctivitis
94
How do you treat Lagophthalmos temporarily?
Lubrication or temporary tarsorrhaphy
95
How do you treat Lagophthalmos permanently?
permanent partial tarsorrhaphy or canthoplasty
96
What nerve innervates the eyelid for sensory?
CN V (maxillary or ophthalmic branches
97
What nerves innervate the 3 muscles of the eyelid?
``` CN III (Open) CN VII (close) ```
98
What causes an abnormal palpebral reflex?
CN V | CN VII
99
What are the clinical signs of Horner's Syndrome?
Miosis Enophthalmos Protrusion of the third eyelid Ptosis
100
What causes the clinical signs of Horner's Syndrome?
Disruption of innervation to the Muller's Muscle, Iris dilator, or Periorbital cone
101
What are the common causes of Horner's Syndrome?
Otitis Nasopharyngeal polyps Iatrogenic: venipuncture or feeding Idiopathic
102
How do you diagnose Horner's Syndrome?
Dilute phenylephrine (0.1%). 1 drop to both eyes
103
What three conditions cause irritation to the cornea or conjunctiva?
Trichiasis Distichiasis Ectopic Cilia
104
What breeds are commonly affected by Trichiasis?
Brachycephalic
105
What is the treatment for Trichiasis?
Lubrication | Facial fold resection
106
In what breeds would you find Distichia?
Cockers Poodles Sheepdogs
107
What is the treatment for Distichia?
Cryotherapy and plucking of the hairs
108
What breed is Ectopic cilia common in?
Brachycephalic breeds
109
How do you treat Ectopic cilia?
Cryotherapy with hairs sharply excised
110
What type of tumor is Canine eyelid tumors?
benign
111
What type of tumor is feline eyelid tumors?
malignant
112
What is the most common eyelid tumor in dogs?
Meibomian gland adenoma
113
What are the surgical considerations for removing Canine eyelid tumors?
Irritation to the ocular surface? Size Location
114
How do you treat Canine eyelid tumors?
Debulk and cryotherapy | Complete excision
115
What are the 4 key concepts to closure of eyelid margin defects?
1. Limited debridement 2/ Closure must be perfect 3. Avoid full thickness suture bites 4. The tarsus is holding layer
116
What is important about the figure 8 suture pattern used to correct eyelid margin defects?
Knot and suture are directed away from the cornea
117
What is the purpose of the third eyelid cartilage?
Gives the third eyelid shape and structure Performs a squeegee like function Supports the gland of the third eyelid
118
What is caused by Prolapse of the third eyelid?
Chronic conjunctivitis | Keratoconjunctivitis sicca
119
What is the treatment for prolapse of the third eyelid?
Morgan pocket technique | Orbital tacking
120
Conjunctival fornix
The area where palpebral conjunctiva meets bulbar conjunctiva
121
Palpebral and Bulbar conjunctiva
Conjunctiva that lines the inner surface of the eyelid and the anterior aspect of the globe respectively
122
Epiphora
Abnormal overproduction of tears. This is common response to ocular irritation
123
Conjunctival lymphoid follicles
a response to non-specific antigenic stimulation. Presence of these follicles anywhere but the bulbar surface of the third eyelid is considered abnormal and consistent with a diagnosis of conjunctivitis
124
Goblet cells
These are present in conjunctival epithelium and have produce the innermost mucus layer of the three-layered tear film. Patients with conjunctivitis will often overproduce mucus, conventionally referred as mucus discharge
125
Mucoid discharge
a very common clinical sign with conjunctivitis
126
Mucopurulent discharge
most commonly found in cases of keratoconjunctivitis sicca (KCS), due to loss of the aqueous portion of the tear film which then causes mucus overproduction, bacterial overgrowth and subsequent white blood cell recruitment. This is a classic feature of KCS and will be very important to remember
127
Conjunctival hyperemia
describe congestion of the superficial vessels of the conjunctiva. Predominance of this finding suggests superficial disease. For instance, tear film disorders (KCS), primary conjunctivitis, eyelid disorders causing secondary conjunctivitis, a response to superficial cornea ulceration etc.
128
Episcleral injection
congestion of deep conjunctival vessels known as episcleral vessels. Predominance of this clinical signs suggests deeper disease processes. For instance uveitis, glaucoma, and deep/complicated corneal ulceration
129
Keratitis
Inflammation of the cornea. Clinical signs include corneal neovascularization (Most common), corneal pigmentation, corneal fibrosis, corneal ulceration and white blood cell infiltration
130
Symblepharon
Permanent adhesion between the conjunctiva and the cornea
131
Ghost vessels
non-perfused corneal blood vessels. These blood vessel tracks provide evidence of previous keratitis
132
Chemosis
edema of the conjunctiva
133
What are the clinical signs of Allergic Conjunctivitis?
``` Blepharospasm Epiphora Mucoid discharge Hyperemia Lymphoid follicles ```
134
What is the treatment for Allergic Conjunctivitis?
Steroid: Neomycin-Polymixin - Dexamethasone NSAID: Diclofenac T-cell inhibitor: Cyclosporine
135
What is the function of tear film?
Nourish Cleanse Protect
136
What secretes the Oil/Lipid layer of the tear film?
Meibomian gland
137
What secretes the Aqueous layer of tear film?
Lacrimal and gland of the third eyelid
138
What secretes the Mucinous layer of the tear film?
Conjunctival goblet cells
139
What is the most common cause of Keratoconjunctivitis sicca?
Immune-mediated destruction
140
What are the causes of Keratoconjunctivitis sicca?
``` Immune mediated destruction Excision of the gland of the third eyelid Drugs Trauma Neurogenic Infectious ```
141
Xeromycteria
Dry nose
142
With what test do you diagnose Quantitative KCS?
Schirmer tear test
143
What is the most common cause of conjunctivitis in dogs?
Bacterial
144
What are the two categories of KCS?
Qualitative | Quantitative
145
What virus causes KCS?
Canine Distemper Virus
146
Qualitative KCS
Lipid or mucin deficiency
147
What are the clinical signs of Keratoconjunctivitis sicca?
``` Keratitis: Superficial corneal neovascularization Corneal fibrosis Superficial corneal pigmentation Corneal ulceration White blood cell infiltration Hyperemia ``` Conjunctivitis: Mucopurulent discharge
148
What is the treatment for Keratoconjunctivits sicca?
Topical cyclosporine
149
Cyclosporine
T-cell inhibitor Immunomodulator Suppresses further destruction of lacrimal tissue Directly stimulates tear production Anti-inflammatory effects: reduces vessels, clears fibrosis and clears pigment
150
What are the objectives of KCS treatment:
Replace the tears Stimulate more tears Anti-inflammatory therapy
151
What is the pathophysiology of Neurogenic KCS?
Loss of parasympathetic innervation to the lacrimal gland and ipsilateral nostril
152
What are the causes of Neurogenic KCS?
Trauma Severe otitis interna Neoplastic Idiopathic
153
What is the surgical therapy for KCS?
Parotid duct transposition
154
What are the most common causes of Feline conjunctivitis?
Feline Herpesvirus keratoconjunctivitis Chlamydial conjuncitivitis Mycoplasma conjunctivitis Calicivirus conjunctivitis
155
What is the most common cause of feline conjunctivitis and feline keratitis?
Feline herpesvirus keratoconjunctivitis
156
What are the 2 forms of Feline herpesvirus keratoconjunctivitis?
Primary | Recrudescence
157
Recrudescent disease
Latent FHV-1 virus becomes reactivated due to environmental stress
158
What are the Clinical signs of FHV-1?
``` Blepharospasm Epiphora mucoid discharge Hyperemia Conjunctival and corneal epithelial ulceration Symblepharon ```
159
Symblepharon
permanent adhesion between the conjunctiva and the cornea
160
What is the pathognomic lesion for FHV-1?
Dendritic corneal ulceration
161
If you observe a cat with conjunctivitis and evidence of present or historic keratitis what is the diagnosis?
FHV-1
162
What is the treatment for FHV-1?
Topical cidofovir Oral Famciclovir Supportive Care: Erythromycin
163
What is the second most common cause of conjunctivitis in FHV-1?
Chlamydial conjunctivitis
164
What are the clinical signs of Chlamydial conjunctivitis?
``` Blepharospasm epiphora mucoid or mucopurulent discharge hyperemia Chemosis ```
165
Chemosis
conjunctival edema
166
How do you diagnose Chlamydial conjunctivitis?
Cytology: Intracytoplasmic inclusion bodies
167
Facet
Loss of corneal stroma with intact overlying epithelium. This occurs because epithelialization progresses more rapidly than stromal healing
168
Cornea edema
The only "blue" opacity. Corneal edema often appears heterogenous or fluffy. There are only two common sources of corneal edema: Epithelial disruption or Endothelial disruption
169
Superficial corneal neovascularization
This vessel pattern occurs in response to superficial disease processes. These vessels are tree-like in their appearance, can often be seen crossing the limbus, and can coalesce to form raised granulation tissue
170
Deep corneal neovascularization
This vessel pattern occurs in response to deep disease processes. These vessels are usually straight, cannot be seen crossing the limbus and do not extend as far across the cornea as superficial vessels
171
Ciliary flush (Ciliary neovascularization)
360 degree deep corneal neovascularization that is pathognomonic for uveitis. Ciliary refers to the ciliary body, implying that these vessels arrive in the cornea from an intraocular or deep origin
172
White blood cell corneal infiltration
this falls within our "white" category of corneal opacity and is a sign of active inflammation (keratitis). White blood cell infiltration is often painful and signals infection. Presence typically signifies an ocular emergency. These infiltrates can have a yellow or green appearance and are most commonly observed in equine stromal abscesses and cases of corneal melting "keratomalacia".
173
Corneal fibrosis
AKA corneal scarring. This results from stromal collagen contracture and appears as a dull, wispy white. You might see ghost vessels present from past active keratitis. This is non-painful
174
Corneal dystrophy or degeneration
Dystrophy most often involves corneal lipid and appears glittery/shiny. Degeneration most often involves calcium and appears gritty or chalky
175
Feline corneal sequestrum
This condition results from chronic corneal irritation and/or ulceration
176
What is the most common cause of corneal ulceration in cats?
Feline herpesvirus
177
Keratic precipitates
These are cellular adhesions to the endothelium and are pathognomic for uveitis. They have a classic appearance that can be easily recognized. You will see tiny dots from the mid-portion of the cornea that becomes larger and denser in the ventral cornea
178
Limbus
junction between cornea and sclera
179
Blue corneal opacity
edema
180
What are the two possible causes of edema?
Epithelial barrier disruption | Endothelial barrier/pump disruption
181
What does the degree of edema depend on?
Geographic size of the ulcer Depth of the ulcer If reflex uveitis is present or not
182
What is caused by Endothelial barrier/pump generalized reduction in function?
Glaucoma | Uveitis
183
What is a Red Corneal opacity?
Corneal neovascularization
184
What are two important sources of corneal neovascularization?
Superficial neovascualrization | Deep neovascularization
185
What do you see with superficial neovascularization?
Granulation tissue | Ghost vessels
186
What causes superficial neovascularization?
Superficial stimuli such as KCS, eyelid conformation, hair abnormalities, or superficial corneal ulcers
187
How much growth of superficial neovascularization occurs per day?
1mm
188
How long does it take for the insult to start growing superficial neovascularization?
3 days
189
Ghost vessels
Non-perfused empty vessels
190
What occurs with deep stimuli from uveitis or deep corneal inflammation/ulceration ?
Deep neovascularization
191
White with yellow or green hue opacity
White blood cell infiltration
192
White with gray or wispy features
Fibrosis
193
Crystalline or chalky white
Mineral or lipid Dystrophy Degeneration
194
What does white blood cell infiltrate signal?
Corneal infection
195
Crystalline White opacity
Lipid degeneration
196
Chalky white opacity
Calcific degeneration
197
What is a common cause of corneal opacity in dogs?
Corneal dystrophy with lipid
198
Brown or Black corneal opacities
Pigment | Feline Corneal sequestrum
199
What can cause Chronic superficial corneal ulceration in feline?
Feline Herpes Virus
200
Tan or Greasy Punctate
Keratic Precipitates
201
What causes Keratic precipitates?
Cellular and fibrinous adhesions to the endothelial surface
202
What is the source of Keratic Precipitates?
Uveitis
203
Superficial corneal ulceration
loss of the corneal epithelium without any loss of corneal stroma
204
Simple or Uncomplicated Corneal Ulcer
A superficial corneal ulcer that heals according to the expected time frame of less than 7 days
205
Complex or complicated corneal ulcers
any ulcer that does not heal within the expected time frame
206
Indolent ulceration or spontaneous chronic corneal epithelial Defect or Boxer ulcer
a canine specific form of complex corneal ulceration in which the epithelium fails to adhere to the stroma
207
Reflex uveitis
The trigeminal nerve and certain cytokines cause direct stimulation of the ciliary body, inducing spasm, pain, and disruption of the blood ocular barrier
208
Descemetocele
A corneal ulcer that has reached the depth of Descemet's membrane. This has a classic staining pattern that you should be familiar with
209
Keratomalacia
Softening of the cornea due to collagenolysis from infection and the ocular inflammatory response
210
Collagenolysis
Enzymatic destruction of the corneal stroma that signals infection, Bacteria, most often Pseudomonas trigger collagenolysis. The body's ocular inflammatory response from white blood cells also cause similar destruction
211
Iris prolapse
one of the only rule outs for a brown, raised, corneal opacity. This iris will rush forward to plug a corneal perforation in certain circumstances
212
Sequestrum
A devitalized portion of feline corneal stroma that pigments amber to black. The cause for the pigment is unknown, though this condition often forms following chronic or recurrent corneal ulceration
213
Pannus or Chronic Superficial Keratitis
An autoimmune condition that is inherited in German Shepards and Greyhounds. This condition forms progressive pigment and granulation tissue across corneal and conjunctival epithelium. It is painless, though binding if left untreated. Ultraviolet light is thought to exacerbate this problem
214
Pigmentary Keratitis
Most commonly seen in a pug. This is a condition that involves superficial corneal pigment migration from the limbus. Its presence suggests that superficial inflammation is present
215
What is the most common cause of a Deep Stromal Corneal Ulcer?
Infection
216
What are brachycephalic risk factors for corneal ulcers?
Ocular prominence Decreased corneal sensitivity Adnexal abnormalities Tear film abnormalities
217
Why do you not use Steroids in ulcerative keratitis treatment?
Delayed healing | Enhanced corneal destruction
218
What are the superficial corneal ulceration categories?
Simple | Complicated
219
Simple Corneal Ulcer
A superficial corneal ulcer that heals in 7 days or less
220
Causes of Superficial corneal ulceration?
Irritants Infection Trauma
221
What is the treatment of simple/uncomplicated superficial corneal ulceration?
E-collar Broad spectrum topical antibiotics 3-4x/day Atropine
222
Complicated/Complex Superficial corneal ulcer
An ulcer that does not heal appropriately 1. Indolent ulcer 2. Persistent irritant 3. Infection
223
How do you treat Indolent ulceration?
Debridement
224
What are the three possible causes of Complex/complicated ulcer?
Feline herpesvirus Bacterial Fungal
225
What is the identifying feature of stromal ulceration?
Inappropriate level of reflex uveitis
226
Clinical signs of Stromal ulcer
Miosis Aqueous flare Diffuse corneal edema Hypopyon or hyphema
227
How do you diagnose Deep stromal corneal ulceration?
Fluorescein Topical anesthesia Cytology Aerobic culture
228
Treatment for deep stromal corneal ulceration
E-collar Antibacterial therapy Anti-collagenase therapy Reflex uveitis and pain management
229
What are the three indications for parenteral antibiotics?
1. the ulcer has become vascularized 2. The corneal is close to perforation 3. Iatrogenic vascularization
230
How do you treat the Reflex uveitis and pain management?
Atropine NSAIDs Tramadol
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Three guidelines for referral or surgical repair
1. The ulcer has 50% or greater stromal depth 2. The ulcer is failing aggressive medical therapy 3. Descemetocele or perforation
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Uvea
The uvea has three components, the iris, cilliary body and choroid. The uvea is synonymous with the vascular tunic layer of the globe
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Uveitis
Defined by a breakdown of the blood-ocular barrier
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Anterior Uveitis
Inflammation of the iris and ciliary body.
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Posterior uveitis
Inflammation fo the choroid or choroiditis. This is rarely observed independent of retinal inflammation and is thus the term "chorioretinitis"
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Panuveitis
Inflammation of the all components of the uvea, the iris, ciliary body, and choroid
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Endophthalmitis
Inflammation of all structures internal to the fibrous tunic of the eye
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Panophthalmitis
Inflammation of all structures of the globe, including the fibrous tunic
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Aqueous flare
a pathognomonic sign of anterior uveitis in which proteins and cells are suspended in the anterior chamber. This debris scatters light and can be visualized when a bright focused beam light is passed through it, like a headlights through fog. This optical phenomenon is known as the Tyndall effect. The presence of aqueous flare signals active inflammation
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Keratic precipitates
Another pathognomonic sign of uveitis which consists of cellular debris that adheres to the corneal endothelium as a result of constantly cycling convection currents within the eye.
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Ciliary flush
Pathognomonic for uveitis. This term refers to 360 degree deep corneal neovascularization. These vessels arise from the ciliary body and deep episcleral vessels
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Fibrin
Pathognomonic for uveitis. Fibrin develops within the eye like it would anywhere else in the body. Fibrin is very good at adhering delicate structures to one another within the eye and is often responsible for synechia
243
Hypopyon
Pathognomonic for uveitis, hypopyon refers to white blood cells that have settled out dependently in the anterior chamber
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Miosis
Constriction of the pupil. When you see inappropriate miosis, uveitis should be on your list
245
Dyscoria
An abnormally shaped iris. Most commonly observed with posterior synechia
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Synechia
Adhesion of the iris to the lens or to the cornea
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Iris bombe
360 degree posterior synechia. Aqueous humor becomes entrapped within the posterior chamber which causes the iris to bulge forward
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Hyphema
Blood that settles within the anterior chamber. Common with uveitis and indicative of a large breakdown in the blood ocular barrier. Note that hypertension and coagulopathies can also cause hyphema
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Hypotony
Decreased intraocular pressure. Hypotony is consistent with acute uveitis
250
Cycloplegia
paralysis of the ciliary body. Induced by atropine and useful at alleviating pain from uveitis
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What are the three components of the uvea?
Iris Ciliary body Choroid
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What is the purpose of the Blood ocular barrier?
Still allows for selective nutrition of avascular intraocular structures Prevents free passage of cells or proteins into the anterior chamber Allows clear media for vision
253
What are the two components of the Blood ocular barrier?
Blood aqueous barrier | Blood retinal barrier
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What makes up the Blood aqueous barrier?
Iris blood vessels | Ciliary body
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What makes up the Blood-retinal barrier?
Retinal blood vessels | Retinal pigmented epithelium
256
What is responsible for the inflammation in uveitis?
Prostaglandins
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What cause ocular pain?
Spasm of the ciliary body
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What are the clinical signs of ciliary body spasm?
``` Blepharospasm Epiphora Photophobia Hiding Aggressive behaviors ```
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What are the differentials for Miosis?
``` Bright light Horner's syndrome Brain trauma Drugs Uveitis ```
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Tyndall Effect
light scatter through a turbid environment
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What causes Dyscoria?
Posterior Synechia
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What tests should you perform with Hyphema present?
Blood pressure Platelet count Coagulation panel
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What are long term sequelae for chronic uveitis?
``` Cataract Secondary lens luxation Secondary glaucoma Retinal detachment Phthisis bulbi ```
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What is the most common cause of blindness from uveitis?
secondary glaucoma
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Exogenous causes of canine uveitis
Blunt or perforating trauma | corneal ulceration
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Endogenous causes of canine uveitis
``` Lens induced Infectious Neoplastic Metabolic Auto-immune ```
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What is the most common primary canine neoplasma of the eye?
Melanocytoma
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What are the clinical characteristics of Uveal cysts?
Spherical Transilluminate Benign Can be free floating
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What is the most common feline uveal tumor?
Feline diffuse Iris Melanoma
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What characteristics of the tumor aid in diagnosis of Feline diffuse Iris Melanoma?
Rapid progression Texture is velvety Dyscoria due to invasion of iris musculature Pigmented cells floating in the anterior chamber
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What is the metabolic cause of endogenous uveitis in cats?
Hypertension from renal disease or hyperthyroid
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Treatment for Uveitis
``` Topical steroids Topical NSAIDs Systemic steroids Systemic NSAIDs Topical atropine Systemic antimicrobials ```
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Nuclear sclerosis
The hardening of the lens that occurs naturally in animals | The hardening scatters light such that the lens appears cloudy
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Cataract
Any opacity of the lens or lens capsule that interferes with vision and fundus is not visible through cataract
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Parallax
Utilizing the appearance of one object relative to another to determine depth
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Lens Zonules
Small collagen fibrils arising from the ciliary body that attach to the equator of the lens securing the lens position within the eye
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Intumescent Cataract
Common cataract in diabetic patients in which the cataract progression is driven by osmotic effect as a result of entrapped sorbitol and fructose within the lens capsule
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Phacoemulsification
This is the modern technique for cataract surgery in which the lens is broke up using ultrasound energy and aspiration
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Aldose reductase
enzyme that converts glucose to sorbitol and fructose which become trapped within the lens capsule, causing an osmotic pulling effect/ The lens swells creating an intumescent cataract
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Lens luxation
complete detachment of the lens from the lens zonules. The lens typically shifts anteriorly or posteriorly following luxation
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Lens subluxation
partial detachment of the lens from the lens zonules. The lens typically shifts side to side with subluxation revealing an aphakic crescent
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Aphakic crescent
Phakic refers to lens. Aphakic is therefore without a lens. A lens subluxation displays a crescent shaped area in which the lens is visibly displaced
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Iridonesis
Movement of the iris that occurs secondary to lens instability
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Phacodonesis
Movement of the lens that occurs secondary to lens instability
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What is the appearance of Nuclear Sclerosis?
Bluish-gray pearly haze
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What is the treatment for Nuclear Sclerosis?
No treatment required
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What causes Cataracts?
``` Inherited Chronic uveitis Metabolic Trauma Nutritional Toxic Senile degeneration ```
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What is the most frequent cause of cataracts in Cats and horses?
Chronic uveitis
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What is the pathophysiology of Inflammatory Cataracts?
Mediators of inflammation diffusing into and altering lens structure or metabolism, changes in aqueous humor production and synechiae
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What is the most common cause of Metabolic Cataracts in dogs?
Diabetes Mellitus
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What is the pathophysiology of Diabetic cataracts?
Normal glucose metabolism is shunted to an alternate pathway due to high levels of Aldose Reductase
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What causes Progressive retinal atrophy?
degenerating photo receptors releasing toxic substances into the vitreous
293
What is the most common clinical signs of Progressive retinal atrophy?
Night Blindness
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What are the two types of Lens-Induced Uveitis?
Phacoclastic | Phacolytic
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Phacoclastic Lens Induced Uveitis
Severe form associated with traumatic tears of the the lens capsule
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Phacolytic Lens induced Uveitis
milder form of lens induced uveitis associated with leakage of lens proteins from a cataract that results from exposure of immunologically isolated lens protein to the immune system
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How do you treat Phacolytic Lens induced Uveitis?
Topical +/- systemic anti-inflammatory agents
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What is the medical treatment for Cataracts?
Topical corticosteroids and NSAIDs
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What is the surgical treatment for Cataracts?
Phacoemulsification
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What is the reason for Lens Luxation?
loss of zonular ligament support
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What is the primary etiology of Lens Luxation?
Inherited disorder common in canine terrier breeds | Abnormal degeneration of zonular ligaments
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What is the secondary etiology of Lens Luxation?
Chronic uveitis Trauma Chronic glaucoma
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What is the most common cause of Lens Luxation in cats?
Chronic Uveitis
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What are some easily identifiable clinical signs of Lens Luxation?
``` Aphakic crescent Iridodonesis Phacodeonesis Focal corneal edema Cataract ```
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How do you treat Anterior Lens Luxation?
Medically stabilize by decreasing IOP: Mannitol Carbonic Anhydrase Surgical: Intracapsular lens extraction
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What do you not use to treat Anterior Lens Luxation?
Miotics
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How doyou prevent Anterior Lens luxation from a Subluxation?
Miotically trap the lens with Latanoprost | Anti-inflammatory therapy (NeoPolyDex)
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Glaucoma
Vision loss that occurs due to elevated intraocular pressure and damage to the optic nerve and retina
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Carbonic Anhydrase
An enzyme found in the ciliary body that aids in the production of aqueous humor. Therapeutic strategies to inhibit this enzyme "carbonic anhydrase inhibitors" are used commonly when treating glaucome
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Optic Nerve cupping
The optic nerve is extremely sensitive to increased intraocular pressure. With glaucoma, the optic nerve will lose myelin and will be displaced posteriorly, displaying a cupped appearance
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Buphthalmos
Enlargement of the globe.
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What is the common cause of Buphthalmos?
Glaucoma
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Haab's striae
Fractures of Descemet's membrane that occur secondary to buphthalmos and stretching of the globe. They can be seen as subtle white streaks coursing across the cornea
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Goniodysgenesis
an abnormal iridocorneal angle conformation in which the angle is narrowed or closed. Sheets of abnormal tissue often coat the iridocorneal angle with goniodysgenesis
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Gonioscopy
The use of a goniolens, applied to the surface of the eye which allows light to bend into the iridocorneal angle and facilitates examination
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What are the two outflow options for Aqueous humor?
Iridocorneal angle | Uveoscleral
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What enzyme is part of the active secretion of Aqueous humor?
Carbonic Anhydrase
318
What are the common clinical signs of Glaucoma?
``` Episcleral injection Blepharospasm Corneal edema Mydriasis Impaired vision ```
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What are the chronic clinical signs of Glaucoma?
Optic disc cupping Retinal degeneration Blindness
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How do you decide on Prognosis for vision due to glaucoma?
Duration of signs (greater than 24 hours) | Buphthalmos is present
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If Bupthalmos is present what is the prognosis?
Blindness
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What treatments should you consider if glaucoma is chronic and no vision is present?
Enucleation Eviseration and prosthesis Ciliary Body ablation
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What is the normal Tonometric reading for the eye?
10-20 mmHg
324
If the pressure of the eye is greater than 25mmHg what is the diagnosis?
glaucoma
325
What are the three most common causes of Secondary glaucoma?
Uveitis Neoplasia Lens Luxation
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What is an important feature of primary glaucoma?
Bilateral
327
What are the two outcomes to consider with treatment of glaucoma?
Vision | Comfort
328
What is the Emergency therapy for Glaucoma?
Latanoprost
329
What is Latanoprost used for?
Increases uveoscleral outflow
330
What is a contraindication for Latanoprost?
Anterior Lens Luxation
331
What is the second most effective therapy for glaucoma?
Dorzolamide
332
What does Dorzolamide do?
Decrease aqueous production
333
What is considered emergency therapy for glaucoma when Dorzolamide and Latanoprost have failed?
Intravenous Mannitol
334
What is the function of a Gonioimplant?
Increase aqueous outflow
335
What is the function of a Ciliary body ablation?
Decrease aqueous production
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What is the function of Cyclodestruction?
Decrease the production of aqueous humor by destroying the ciliary body
337
What are the complications from Cyclodestruction?
Postoperative pressure spike Cataract formation inflammation
338
How long does it take for blindness to occur with glaucoma and no therapy?
6-12 months
339
How long does it take for blindness to occur with glaucoma and therapy?
3 years
340
What are the three options for end stage glaucoma treatment?
Enucleation Evisceration and prothesis Cilliary body ablation
341
What are the components of the fundus?
``` Sclera Choroid Tapetum RPE Neurosensory Retina ```
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RPE
Retinal Pigmented Epithelium
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Atapetal
some species/individuals lack a tapetum
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What causes Retinal Hemorrhage?
``` Anemia Systemic hypertension Hyperviscosity Diabetes mellitus Chorioretinits Coagulopathy Trauma Retinal detachment ```
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What does Pre-retinal hemorrhage resemble?
Keel boat
346
What does hemorrhage within nerve fiber layer resemble?
Flame-shaped
347
What does hemorrhage within the retina resemble?
Dot-blot
348
What does hemorrhage within the sub-retinal resemble?
Diffuse, irregular shape
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What causes Retinal detachment?
``` Vitreous disease Congenital malformations Lens luxations neoplasia Intraocular inflammation: Chorioretinitis Trauma Vascular disease: Hypertension ```
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What are the 2 types of retinal detachment?
Bullous | Rhegmatogenous
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What is the sign of retinal detachment on the ultrasound?
"Seagull sign"
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What is a common early sign of Feline hypertensive retinopathy?
Bullous Detachment
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How do you treat Bullous detachment?
Treat underlying disease | Anti-hypertensive therapy
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What is common with primary vitreous degeneration?
Rhegmatogenous Detachment
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What is the treatment for Partial Retinal detachment?
Retinopexy
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What is the treatment for Complete Retinal detachment?
Re-attachment surgery
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What are the vascular changes seen with retinal detachment?
``` Attenuation (thinning) Dilation Hemorrhage Exudation Increased tortuosity: Hypertension and Hyperviscosity ```
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What are the different Altered Tapetal Reflectivity?
Hyperreflective | Hyporeflective
359
What causes Hyperreflectivity of the Tapetum?
Retinal thinning
360
What causes Hyporeflectivity of the Tapetum?
Increased retinal thickness
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What is Patchy depigmentation?
Non-specific response to inflammation/ injury/ degeneration
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What are the clinical signs of Progressive Retinal Atrophy?
``` Narrowing and loss of retinal blood vessels Tapetal hyper-reflectivity Optic nerve atrophy Non-tapetal pigmentary changes Secondary cataract formation ```
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What are the characteristics of Retinal degeneration?
Bilateral and Symmetrical Sudden loss of vision Acute photo receptor death Dilated pupils
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SARDS
Sudden Acquired retinal Degeneration Syndrome
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How do you diagnose SARDS?
ERG
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Feline central Retinal Degeneration
elliptical area of dorsalateral degeneration caused by Taurine deficiency
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What can cause acute permanent loss of vision due to Retinal degeneration in cats?
Enrofloxacin
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How do you treat Chorioretinitis?
Anti-microbial | Systemic NSAIDs or corticosteroids

RUSVM Small Animal Medicine II 2017 (4 decks)

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