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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
Q

Boney orbit

A

a part of the adnexa, the conical boney structure that contains the eyeball and periorbital cone

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26
Q

Periorbital cone

A

Supportive cone like structure that contains the eyeball, extraocular muscles, fat, vessels, nerves, and fascia that reside within the orbit

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27
Q

Orbital Ligament

A

ligamentous structure that forms the lateral boundary of the boney orbit in cats and dogs

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28
Q

Exopthalmus

A

Abnormal protrusion of the eye from the orbit. The position is abnormal. The globe size is normal

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29
Q

Buphthalmos

A

“cow eye” but refers to the abnormal enlargement of the eyeball

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30
Q

What causes Buphthalmos?

A

glaucoma

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31
Q

Enophthalmos

A

Abnormal recession of the eye within the orbit

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32
Q

Strabismus

A

deviation of one or both eyes, so that both eyes are not directed at the same object

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33
Q

Horner’s Syndrome

A

sympathetic denervation to the eye and ocular adnexa.

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34
Q

What are the clinical signs of Horner’s Syndrome?

A

Enophthalmos
Ptosis
Miosis
Protrusion of the third eyelid

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35
Q

Microphthalmos

A

a congenitally small and malformed globe

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36
Q

Phthisis bulbi

A

an acquired shrunken globe, most often from severe or chronic inflammation

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37
Q

Proptosis

A

Anterior displacement of the globe such that the eyelids are caught behind the equator of the globe

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38
Q

What can induce orbital or periorbital disease?

A

Dental disease especially from the carnassial tooth

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39
Q

What can cause displacement of the globe?

A

Inflammation of the Zygomatic salivary gland

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40
Q

What can cause temporary or permanent blindness in cats?

A

The use of Mouth Gags

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41
Q

What is different about orbital anatomy of the dog and cat?

A

Open orbit with an orbital ligament

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42
Q

What is different about orbital anatomy in ruminants and horses?

A

Closed orbit

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43
Q

What are the clinical signs associated with Exophthalmos?

A 
Third eyelid protrusion
Facial swelling
Soft palate bulging
Pain opening mouth 
Fever
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44
Q

What is the most common cause of exophthalmos?

A

Orbital volume imbalance

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45
Q

What is a non-painful cause of Exophthalmos?

A

Orbital neoplasia

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46
Q

What causes acute onset painful Exophthalmos in working dogs and stick chewers?

A

Orbital Cellulitis

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47
Q

What can causes Lateral deviation in orbital disease?

A

Tumor involving the third eyelid

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48
Q

Strabismus

A

deviation of one or both eyes, so that both eyes are not directed at the same object

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49
Q

What are the treatments for Orbital Neoplasia?

A

Globe sparing:
Radiation
Surgical exploration
Chemotherapy

Globe removal:
Enucleation
Exenteration

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50
Q

Exenteration

A

removal of the eye and all orbital contents

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51
Q

What are the treatment approaches for Orbital cellulitis?

A

NSAIDs
Antibiotics
Surgical exploration and/or drainage

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52
Q

What are the common clinical signs of Enophthalmos?

A

Facial muscular loss (unilateral or bilateral)
Third eyelid protrusion
Entropion

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53
Q

What are the three common mechanisms of Enophthalmos?

A

Orbital volume imbalances
Active globe retraction
Passive glove retraction

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54
Q

What are the common causes of Enophthalmos?

A 
Dehydration
Emaciation or cachexia
Myopathies
Space occupying lesions anterior to the globe 
Ocular pain 
Horner's Syndrome
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55
Q

What are the congenital Strabismus?

A

Divergent strabismus in brachycephalic dogs
Convergent strabismus in Siamese Cats
Ventrolateral divergent strabismus in Hydrocephalus

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56
Q

What are the acquired causes of Strabismus?

A

Mechanical or nervous dysfunction of any rectus muscle

Imbalance of orbital volume

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57
Q

What are the two considerations in the prognosis of Proptosis?

A

Vision?

Globe retention?

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58
Q

Tarsus

A

The fibrocartilagenous layer of the eyelid that contains the meibomonian glands. This is the holding layer for surgical eyelid closure

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59
Q

Meibomian glands

A

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

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60
Q

Lateral canthus

A

the lateral, or temporal convergence of the upper and lower eyelids

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61
Q

Medial canthus

A

the medial, or nasal convergence of the upper and lower eyelids

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62
Q

Palpebral fissure

A

the area outlined by the upper and lower eyelid margins

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63
Q

Ptosis

A

drooping of the eyelids (most often evident by upper eyelid drooping) cause by sympathetic denervation to the eyelid.

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64
Q

Lagophthalmos

A

incomplete eyelid closure/coverage of the eyeball

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65
Q

Eyelid margin

A

identified by the”grey line” of Meibomian gland orifices. This is an important landmark to identify when closing the eyelid surgically

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66
Q

Entropian

A

rolling in the eyelid margin such that hairs are touching the ocular surface

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67
Q

Ectropion

A

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

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68
Q

Blepharospasm

A

Spasm of the orbicularis oculi muscle resulting in eyelid closure.
AKA squinting

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69
Q

Tarsorrhaphy

A

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)

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70
Q

Trichiasis

A

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.

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71
Q

Distichia

A

cilia (eyelashes) which emerge from Meibomian (tarsal) glands.

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72
Q

Ectopic cilia

A

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

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73
Q

What muscle closes the eyelids like a zipper?

A

Orbicularis oculi

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74
Q

What Cranial nerve innervates the Orbicularis oculi?

A

CN VII

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75
Q

What is caused by dysfunction of the CN VII?

A

Lagophthalmos

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76
Q

What muscle is innervated by the CNIII to open the upper eyelid?

A

Levator palpebrae superioris

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77
Q

What nerve innervates the Levator palpebrae superioris?

A

CN III

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78
Q

What is caused by dysfunction of the CNIII?

A

ptosis

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79
Q

What muscle opens the upper eyelid due to the sympathetic nervous system?

A

Muller’s muscle

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80
Q

What is caused by dysfunction of the Muller’s muscle?

A

ptosis

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81
Q

What layer supports the Meibomian glands?

A

tarsus layer

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82
Q

Anatomic entropion

A

the eyelids are not appropriately conformed to the eye and its presence is unrelated to ocular pain

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83
Q

Blepharospasm associated entropian

A

ocular pain stimulates active glove retraction and an altered eyelid to eye relatioship

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84
Q

What are the hereditary causes of Anatomic entropion?

A

Abnormal canthus in brachycephalic dogs
Abnormal palpebral fissure in Hounds and giant breeds
Excessive facial folds in Shar Pei

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85
Q

What are the acquired causes of Anatomic entropion?

A

Enophthalmos

Blepharospasm that alters anatomy

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86
Q

What should you consider with Anatomic Entropion caused by Blepharospasm?

A

Chronic corneal ulceration
Dry eye
Conjunctivitis

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87
Q

How do you differentiate anatomic and blepharospasm entropion?

A

Take away the ocular pain that induces blepharospasm

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88
Q

What is a common cause of Entropion in foals?

A

Septic dehydration

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89
Q

What is a temporary treatment for Entropion?

A

Viscous lubrication
Eyelid tacking
Partial temporary tarsorrhapy

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90
Q

What is a permanent treatment for Entropion?

A

Modified Hotz-Celsus - rolls out the eyelid

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91
Q

What is a common cause of Ectropion?

A

Iatrogenic: aggressive entropion correction
Hereditary: Hounds and giant breeds

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92
Q

What are 4 common causes of Lagophthalmos?

A

Breed variation
Exophthalmos
Buphthalmos
CN V or CN VII dysfunction

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93
Q

What is caused by secondary eye exposure from Lagophthalmos?

A

Keratoconjunctivitis

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94
Q

How do you treat Lagophthalmos temporarily?

A

Lubrication or temporary tarsorrhaphy

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95
Q

How do you treat Lagophthalmos permanently?

A

permanent partial tarsorrhaphy or canthoplasty

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96
Q

What nerve innervates the eyelid for sensory?

A

CN V (maxillary or ophthalmic branches

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97
Q

What nerves innervate the 3 muscles of the eyelid?

A 
CN III (Open)
CN VII (close)
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98
Q

What causes an abnormal palpebral reflex?

A

CN V

CN VII

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99
Q

What are the clinical signs of Horner’s Syndrome?

A

Miosis
Enophthalmos
Protrusion of the third eyelid
Ptosis

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100
Q

What causes the clinical signs of Horner’s Syndrome?

A

Disruption of innervation to the Muller’s Muscle, Iris dilator, or Periorbital cone

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101
Q

What are the common causes of Horner’s Syndrome?

A

Otitis
Nasopharyngeal polyps
Iatrogenic: venipuncture or feeding
Idiopathic

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102
Q

How do you diagnose Horner’s Syndrome?

A

Dilute phenylephrine (0.1%). 1 drop to both eyes

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103
Q

What three conditions cause irritation to the cornea or conjunctiva?

A

Trichiasis
Distichiasis
Ectopic Cilia

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104
Q

What breeds are commonly affected by Trichiasis?

A

Brachycephalic

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105
Q

What is the treatment for Trichiasis?

A

Lubrication

Facial fold resection

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106
Q

In what breeds would you find Distichia?

A

Cockers
Poodles
Sheepdogs

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107
Q

What is the treatment for Distichia?

A

Cryotherapy and plucking of the hairs

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108
Q

What breed is Ectopic cilia common in?

A

Brachycephalic breeds

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109
Q

How do you treat Ectopic cilia?

A

Cryotherapy with hairs sharply excised

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110
Q

What type of tumor is Canine eyelid tumors?

A

benign

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111
Q

What type of tumor is feline eyelid tumors?

A

malignant

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112
Q

What is the most common eyelid tumor in dogs?

A

Meibomian gland adenoma

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113
Q

What are the surgical considerations for removing Canine eyelid tumors?

A

Irritation to the ocular surface?
Size
Location

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114
Q

How do you treat Canine eyelid tumors?

A

Debulk and cryotherapy

Complete excision

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115
Q

What are the 4 key concepts to closure of eyelid margin defects?

A
  1. Limited debridement
    2/ Closure must be perfect
  2. Avoid full thickness suture bites
  3. The tarsus is holding layer
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116
Q

What is important about the figure 8 suture pattern used to correct eyelid margin defects?

A

Knot and suture are directed away from the cornea

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117
Q

What is the purpose of the third eyelid cartilage?

A

Gives the third eyelid shape and structure
Performs a squeegee like function
Supports the gland of the third eyelid

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118
Q

What is caused by Prolapse of the third eyelid?

A

Chronic conjunctivitis

Keratoconjunctivitis sicca

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119
Q

What is the treatment for prolapse of the third eyelid?

A

Morgan pocket technique

Orbital tacking

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120
Q

Conjunctival fornix

A

The area where palpebral conjunctiva meets bulbar conjunctiva

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121
Q

Palpebral and Bulbar conjunctiva

A

Conjunctiva that lines the inner surface of the eyelid and the anterior aspect of the globe respectively

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122
Q

Epiphora

A

Abnormal overproduction of tears. This is common response to ocular irritation

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123
Q

Conjunctival lymphoid follicles

A

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

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124
Q

Goblet cells

A

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

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125
Q

Mucoid discharge

A

a very common clinical sign with conjunctivitis

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126
Q

Mucopurulent discharge

A

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

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127
Q

Conjunctival hyperemia

A

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.

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128
Q

Episcleral injection

A

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

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129
Q

Keratitis

A

Inflammation of the cornea. Clinical signs include corneal neovascularization (Most common), corneal pigmentation, corneal fibrosis, corneal ulceration and white blood cell infiltration

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130
Q

Symblepharon

A

Permanent adhesion between the conjunctiva and the cornea

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131
Q

Ghost vessels

A

non-perfused corneal blood vessels. These blood vessel tracks provide evidence of previous keratitis

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132
Q

Chemosis

A

edema of the conjunctiva

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133
Q

What are the clinical signs of Allergic Conjunctivitis?

A 
Blepharospasm
Epiphora
Mucoid discharge
Hyperemia
Lymphoid follicles
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134
Q

What is the treatment for Allergic Conjunctivitis?

A

Steroid: Neomycin-Polymixin - Dexamethasone
NSAID: Diclofenac
T-cell inhibitor: Cyclosporine

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135
Q

What is the function of tear film?

A

Nourish
Cleanse
Protect

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136
Q

What secretes the Oil/Lipid layer of the tear film?

A

Meibomian gland

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137
Q

What secretes the Aqueous layer of tear film?

A

Lacrimal and gland of the third eyelid

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138
Q

What secretes the Mucinous layer of the tear film?

A

Conjunctival goblet cells

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139
Q

What is the most common cause of Keratoconjunctivitis sicca?

A

Immune-mediated destruction

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140
Q

What are the causes of Keratoconjunctivitis sicca?

A 
Immune mediated destruction 
Excision of the gland of the third eyelid
Drugs
Trauma
Neurogenic 
Infectious
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141
Q

Xeromycteria

A

Dry nose

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142
Q

With what test do you diagnose Quantitative KCS?

A

Schirmer tear test

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143
Q

What is the most common cause of conjunctivitis in dogs?

A

Bacterial

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144
Q

What are the two categories of KCS?

A

Qualitative

Quantitative

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145
Q

What virus causes KCS?

A

Canine Distemper Virus

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146
Q

Qualitative KCS

A

Lipid or mucin deficiency

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147
Q

What are the clinical signs of Keratoconjunctivitis sicca?

A 
Keratitis: 
Superficial corneal neovascularization 
Corneal fibrosis 
Superficial corneal pigmentation 
Corneal ulceration 
White blood cell infiltration 
Hyperemia

Conjunctivitis:
Mucopurulent discharge

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148
Q

What is the treatment for Keratoconjunctivits sicca?

A

Topical cyclosporine

149
Q

Cyclosporine

A

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
Q

What are the objectives of KCS treatment:

A

Replace the tears
Stimulate more tears
Anti-inflammatory therapy

151
Q

What is the pathophysiology of Neurogenic KCS?

A

Loss of parasympathetic innervation to the lacrimal gland and ipsilateral nostril

152
Q

What are the causes of Neurogenic KCS?

A

Trauma
Severe otitis interna
Neoplastic
Idiopathic

153
Q

What is the surgical therapy for KCS?

A

Parotid duct transposition

154
Q

What are the most common causes of Feline conjunctivitis?

A

Feline Herpesvirus keratoconjunctivitis
Chlamydial conjuncitivitis
Mycoplasma conjunctivitis
Calicivirus conjunctivitis

155
Q

What is the most common cause of feline conjunctivitis and feline keratitis?

A

Feline herpesvirus keratoconjunctivitis

156
Q

What are the 2 forms of Feline herpesvirus keratoconjunctivitis?

A

Primary

Recrudescence

157
Q

Recrudescent disease

A

Latent FHV-1 virus becomes reactivated due to environmental stress

158
Q

What are the Clinical signs of FHV-1?

A 
Blepharospasm
Epiphora
mucoid discharge
Hyperemia 
Conjunctival and corneal epithelial ulceration 
Symblepharon
159
Q

Symblepharon

A

permanent adhesion between the conjunctiva and the cornea

160
Q

What is the pathognomic lesion for FHV-1?

A

Dendritic corneal ulceration

161
Q

If you observe a cat with conjunctivitis and evidence of present or historic keratitis what is the diagnosis?

162
Q

What is the treatment for FHV-1?

A

Topical cidofovir
Oral Famciclovir
Supportive Care: Erythromycin

163
Q

What is the second most common cause of conjunctivitis in FHV-1?

A

Chlamydial conjunctivitis

164
Q

What are the clinical signs of Chlamydial conjunctivitis?

A 
Blepharospasm
epiphora
mucoid or mucopurulent discharge 
hyperemia
Chemosis
165
Q

Chemosis

A

conjunctival edema

166
Q

How do you diagnose Chlamydial conjunctivitis?

A

Cytology: Intracytoplasmic inclusion bodies

167
Q

Facet

A

Loss of corneal stroma with intact overlying epithelium. This occurs because epithelialization progresses more rapidly than stromal healing

168
Q

Cornea edema

A

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
Q

Superficial corneal neovascularization

A

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
Q

Deep corneal neovascularization

A

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
Q

Ciliary flush (Ciliary neovascularization)

A

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
Q

White blood cell corneal infiltration

A

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
Q

Corneal fibrosis

A

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
Q

Corneal dystrophy or degeneration

A

Dystrophy most often involves corneal lipid and appears glittery/shiny. Degeneration most often involves calcium and appears gritty or chalky

175
Q

Feline corneal sequestrum

A

This condition results from chronic corneal irritation and/or ulceration

176
Q

What is the most common cause of corneal ulceration in cats?

A

Feline herpesvirus

177
Q

Keratic precipitates

A

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
Q

Limbus

A

junction between cornea and sclera

179
Q

Blue corneal opacity

180
Q

What are the two possible causes of edema?

A

Epithelial barrier disruption

Endothelial barrier/pump disruption

181
Q

What does the degree of edema depend on?

A

Geographic size of the ulcer
Depth of the ulcer
If reflex uveitis is present or not

182
Q

What is caused by Endothelial barrier/pump generalized reduction in function?

A

Glaucoma

Uveitis

183
Q

What is a Red Corneal opacity?

A

Corneal neovascularization

184
Q

What are two important sources of corneal neovascularization?

A

Superficial neovascualrization

Deep neovascularization

185
Q

What do you see with superficial neovascularization?

A

Granulation tissue

Ghost vessels

186
Q

What causes superficial neovascularization?

A

Superficial stimuli such as KCS, eyelid conformation, hair abnormalities, or superficial corneal ulcers

187
Q

How much growth of superficial neovascularization occurs per day?

188
Q

How long does it take for the insult to start growing superficial neovascularization?

189
Q

Ghost vessels

A

Non-perfused empty vessels

190
Q

What occurs with deep stimuli from uveitis or deep corneal inflammation/ulceration ?

A

Deep neovascularization

191
Q

White with yellow or green hue opacity

A

White blood cell infiltration

192
Q

White with gray or wispy features

193
Q

Crystalline or chalky white

A

Mineral or lipid
Dystrophy
Degeneration

194
Q

What does white blood cell infiltrate signal?

A

Corneal infection

195
Q

Crystalline White opacity

A

Lipid degeneration

196
Q

Chalky white opacity

A

Calcific degeneration

197
Q

What is a common cause of corneal opacity in dogs?

A

Corneal dystrophy with lipid

198
Q

Brown or Black corneal opacities

A

Pigment

Feline Corneal sequestrum

199
Q

What can cause Chronic superficial corneal ulceration in feline?

A

Feline Herpes Virus

200
Q

Tan or Greasy Punctate

A

Keratic Precipitates

201
Q

What causes Keratic precipitates?

A

Cellular and fibrinous adhesions to the endothelial surface

202
Q

What is the source of Keratic Precipitates?

203
Q

Superficial corneal ulceration

A

loss of the corneal epithelium without any loss of corneal stroma

204
Q

Simple or Uncomplicated Corneal Ulcer

A

A superficial corneal ulcer that heals according to the expected time frame of less than 7 days

205
Q

Complex or complicated corneal ulcers

A

any ulcer that does not heal within the expected time frame

206
Q

Indolent ulceration or spontaneous chronic corneal epithelial Defect or Boxer ulcer

A

a canine specific form of complex corneal ulceration in which the epithelium fails to adhere to the stroma

207
Q

Reflex uveitis

A

The trigeminal nerve and certain cytokines cause direct stimulation of the ciliary body, inducing spasm, pain, and disruption of the blood ocular barrier

208
Q

Descemetocele

A

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
Q

Keratomalacia

A

Softening of the cornea due to collagenolysis from infection and the ocular inflammatory response

210
Q

Collagenolysis

A

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
Q

Iris prolapse

A

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
Q

Sequestrum

A

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
Q

Pannus or Chronic Superficial Keratitis

A

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
Q

Pigmentary Keratitis

A

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
Q

What is the most common cause of a Deep Stromal Corneal Ulcer?

216
Q

What are brachycephalic risk factors for corneal ulcers?

A

Ocular prominence
Decreased corneal sensitivity
Adnexal abnormalities
Tear film abnormalities

217
Q

Why do you not use Steroids in ulcerative keratitis treatment?

A

Delayed healing

Enhanced corneal destruction

218
Q

What are the superficial corneal ulceration categories?

A

Simple

Complicated

219
Q

Simple Corneal Ulcer

A

A superficial corneal ulcer that heals in 7 days or less

220
Q

Causes of Superficial corneal ulceration?

A

Irritants
Infection
Trauma

221
Q

What is the treatment of simple/uncomplicated superficial corneal ulceration?

A

E-collar
Broad spectrum topical antibiotics 3-4x/day
Atropine

222
Q

Complicated/Complex Superficial corneal ulcer

A

An ulcer that does not heal appropriately

  1. Indolent ulcer
  2. Persistent irritant
  3. Infection
223
Q

How do you treat Indolent ulceration?

A

Debridement

224
Q

What are the three possible causes of Complex/complicated ulcer?

A

Feline herpesvirus
Bacterial
Fungal

225
Q

What is the identifying feature of stromal ulceration?

A

Inappropriate level of reflex uveitis

226
Q

Clinical signs of Stromal ulcer

A

Miosis
Aqueous flare
Diffuse corneal edema
Hypopyon or hyphema

227
Q

How do you diagnose Deep stromal corneal ulceration?

A

Fluorescein
Topical anesthesia
Cytology
Aerobic culture

228
Q

Treatment for deep stromal corneal ulceration

A

E-collar
Antibacterial therapy
Anti-collagenase therapy
Reflex uveitis and pain management

229
Q

What are the three indications for parenteral antibiotics?

A
  1. the ulcer has become vascularized
  2. The corneal is close to perforation
  3. Iatrogenic vascularization
230
Q

How do you treat the Reflex uveitis and pain management?

A

Atropine
NSAIDs
Tramadol

231
Q

Three guidelines for referral or surgical repair

A
  1. The ulcer has 50% or greater stromal depth
  2. The ulcer is failing aggressive medical therapy
  3. Descemetocele or perforation
232
Q

Uvea

A

The uvea has three components, the iris, cilliary body and choroid. The uvea is synonymous with the vascular tunic layer of the globe

233
Q

Uveitis

A

Defined by a breakdown of the blood-ocular barrier

234
Q

Anterior Uveitis

A

Inflammation of the iris and ciliary body.

235
Q

Posterior uveitis

A

Inflammation fo the choroid or choroiditis. This is rarely observed independent of retinal inflammation and is thus the term “chorioretinitis”

236
Q

Panuveitis

A

Inflammation of the all components of the uvea, the iris, ciliary body, and choroid

237
Q

Endophthalmitis

A

Inflammation of all structures internal to the fibrous tunic of the eye

238
Q

Panophthalmitis

A

Inflammation of all structures of the globe, including the fibrous tunic

239
Q

Aqueous flare

A

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

240
Q

Keratic precipitates

A

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.

241
Q

Ciliary flush

A

Pathognomonic for uveitis. This term refers to 360 degree deep corneal neovascularization. These vessels arise from the ciliary body and deep episcleral vessels

242
Q

Fibrin

A

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
Q

Hypopyon

A

Pathognomonic for uveitis, hypopyon refers to white blood cells that have settled out dependently in the anterior chamber

244
Q

Miosis

A

Constriction of the pupil. When you see inappropriate miosis, uveitis should be on your list

245
Q

Dyscoria

A

An abnormally shaped iris. Most commonly observed with posterior synechia

246
Q

Synechia

A

Adhesion of the iris to the lens or to the cornea

247
Q

Iris bombe

A

360 degree posterior synechia. Aqueous humor becomes entrapped within the posterior chamber which causes the iris to bulge forward

248
Q

Hyphema

A

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

249
Q

Hypotony

A

Decreased intraocular pressure. Hypotony is consistent with acute uveitis

250
Q

Cycloplegia

A

paralysis of the ciliary body. Induced by atropine and useful at alleviating pain from uveitis

251
Q

What are the three components of the uvea?

A

Iris
Ciliary body
Choroid

252
Q

What is the purpose of the Blood ocular barrier?

A

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
Q

What are the two components of the Blood ocular barrier?

A

Blood aqueous barrier

Blood retinal barrier

254
Q

What makes up the Blood aqueous barrier?

A

Iris blood vessels

Ciliary body

255
Q

What makes up the Blood-retinal barrier?

A

Retinal blood vessels

Retinal pigmented epithelium

256
Q

What is responsible for the inflammation in uveitis?

A

Prostaglandins

257
Q

What cause ocular pain?

A

Spasm of the ciliary body

258
Q

What are the clinical signs of ciliary body spasm?

A 
Blepharospasm
Epiphora
Photophobia
Hiding
Aggressive behaviors
259
Q

What are the differentials for Miosis?

A 
Bright light 
Horner's syndrome
Brain trauma
Drugs
Uveitis
260
Q

Tyndall Effect

A

light scatter through a turbid environment

261
Q

What causes Dyscoria?

A

Posterior Synechia

262
Q

What tests should you perform with Hyphema present?

A

Blood pressure
Platelet count
Coagulation panel

263
Q

What are long term sequelae for chronic uveitis?

A 
Cataract
Secondary lens luxation
Secondary glaucoma
Retinal detachment 
Phthisis bulbi
264
Q

What is the most common cause of blindness from uveitis?

A

secondary glaucoma

265
Q

Exogenous causes of canine uveitis

A

Blunt or perforating trauma

corneal ulceration

266
Q

Endogenous causes of canine uveitis

A 
Lens induced
Infectious
Neoplastic 
Metabolic 
Auto-immune
267
Q

What is the most common primary canine neoplasma of the eye?

A

Melanocytoma

268
Q

What are the clinical characteristics of Uveal cysts?

A

Spherical
Transilluminate
Benign
Can be free floating

269
Q

What is the most common feline uveal tumor?

A

Feline diffuse Iris Melanoma

270
Q

What characteristics of the tumor aid in diagnosis of Feline diffuse Iris Melanoma?

A

Rapid progression
Texture is velvety
Dyscoria due to invasion of iris musculature
Pigmented cells floating in the anterior chamber

271
Q

What is the metabolic cause of endogenous uveitis in cats?

A

Hypertension from renal disease or hyperthyroid

272
Q

Treatment for Uveitis

A 
Topical steroids
Topical NSAIDs
Systemic steroids
Systemic NSAIDs
Topical atropine
Systemic antimicrobials
273
Q

Nuclear sclerosis

A

The hardening of the lens that occurs naturally in animals

The hardening scatters light such that the lens appears cloudy

274
Q

Cataract

A

Any opacity of the lens or lens capsule that interferes with vision and fundus is not visible through cataract

275
Q

Parallax

A

Utilizing the appearance of one object relative to another to determine depth

276
Q

Lens Zonules

A

Small collagen fibrils arising from the ciliary body that attach to the equator of the lens securing the lens position within the eye

277
Q

Intumescent Cataract

A

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

278
Q

Phacoemulsification

A

This is the modern technique for cataract surgery in which the lens is broke up using ultrasound energy and aspiration

279
Q

Aldose reductase

A

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

280
Q

Lens luxation

A

complete detachment of the lens from the lens zonules. The lens typically shifts anteriorly or posteriorly following luxation

281
Q

Lens subluxation

A

partial detachment of the lens from the lens zonules. The lens typically shifts side to side with subluxation revealing an aphakic crescent

282
Q

Aphakic crescent

A

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

283
Q

Iridonesis

A

Movement of the iris that occurs secondary to lens instability

284
Q

Phacodonesis

A

Movement of the lens that occurs secondary to lens instability

285
Q

What is the appearance of Nuclear Sclerosis?

A

Bluish-gray pearly haze

286
Q

What is the treatment for Nuclear Sclerosis?

A

No treatment required

287
Q

What causes Cataracts?

A 
Inherited 
Chronic uveitis
Metabolic
Trauma
Nutritional 
Toxic
Senile degeneration
288
Q

What is the most frequent cause of cataracts in Cats and horses?

A

Chronic uveitis

289
Q

What is the pathophysiology of Inflammatory Cataracts?

A

Mediators of inflammation diffusing into and altering lens structure or metabolism, changes in aqueous humor production and synechiae

290
Q

What is the most common cause of Metabolic Cataracts in dogs?

A

Diabetes Mellitus

291
Q

What is the pathophysiology of Diabetic cataracts?

A

Normal glucose metabolism is shunted to an alternate pathway due to high levels of Aldose Reductase

292
Q

What causes Progressive retinal atrophy?

A

degenerating photo receptors releasing toxic substances into the vitreous

293
Q

What is the most common clinical signs of Progressive retinal atrophy?

A

Night Blindness

294
Q

What are the two types of Lens-Induced Uveitis?

A

Phacoclastic

Phacolytic

295
Q

Phacoclastic Lens Induced Uveitis

A

Severe form associated with traumatic tears of the the lens capsule

296
Q

Phacolytic Lens induced Uveitis

A

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

297
Q

How do you treat Phacolytic Lens induced Uveitis?

A

Topical +/- systemic anti-inflammatory agents

298
Q

What is the medical treatment for Cataracts?

A

Topical corticosteroids and NSAIDs

299
Q

What is the surgical treatment for Cataracts?

A

Phacoemulsification

300
Q

What is the reason for Lens Luxation?

A

loss of zonular ligament support

301
Q

What is the primary etiology of Lens Luxation?

A

Inherited disorder common in canine terrier breeds

Abnormal degeneration of zonular ligaments

302
Q

What is the secondary etiology of Lens Luxation?

A

Chronic uveitis
Trauma
Chronic glaucoma

303
Q

What is the most common cause of Lens Luxation in cats?

A

Chronic Uveitis

304
Q

What are some easily identifiable clinical signs of Lens Luxation?

A 
Aphakic crescent
Iridodonesis
Phacodeonesis
Focal corneal edema
Cataract
305
Q

How do you treat Anterior Lens Luxation?

A

Medically stabilize by decreasing IOP: Mannitol
Carbonic Anhydrase
Surgical: Intracapsular lens extraction

306
Q

What do you not use to treat Anterior Lens Luxation?

307
Q

How doyou prevent Anterior Lens luxation from a Subluxation?

A

Miotically trap the lens with Latanoprost

Anti-inflammatory therapy (NeoPolyDex)

308
Q

Glaucoma

A

Vision loss that occurs due to elevated intraocular pressure and damage to the optic nerve and retina

309
Q

Carbonic Anhydrase

A

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

310
Q

Optic Nerve cupping

A

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

311
Q

Buphthalmos

A

Enlargement of the globe.

312
Q

What is the common cause of Buphthalmos?

313
Q

Haab’s striae

A

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

314
Q

Goniodysgenesis

A

an abnormal iridocorneal angle conformation in which the angle is narrowed or closed. Sheets of abnormal tissue often coat the iridocorneal angle with goniodysgenesis

315
Q

Gonioscopy

A

The use of a goniolens, applied to the surface of the eye which allows light to bend into the iridocorneal angle and facilitates examination

316
Q

What are the two outflow options for Aqueous humor?

A

Iridocorneal angle

Uveoscleral

317
Q

What enzyme is part of the active secretion of Aqueous humor?

A

Carbonic Anhydrase

318
Q

What are the common clinical signs of Glaucoma?

A 
Episcleral injection 
Blepharospasm
Corneal edema
Mydriasis
Impaired vision
319
Q

What are the chronic clinical signs of Glaucoma?

A

Optic disc cupping
Retinal degeneration
Blindness

320
Q

How do you decide on Prognosis for vision due to glaucoma?

A

Duration of signs (greater than 24 hours)

Buphthalmos is present

321
Q

If Bupthalmos is present what is the prognosis?

322
Q

What treatments should you consider if glaucoma is chronic and no vision is present?

A

Enucleation
Eviseration and prosthesis
Ciliary Body ablation

323
Q

What is the normal Tonometric reading for the eye?

A

10-20 mmHg

324
Q

If the pressure of the eye is greater than 25mmHg what is the diagnosis?

325
Q

What are the three most common causes of Secondary glaucoma?

A

Uveitis
Neoplasia
Lens Luxation

326
Q

What is an important feature of primary glaucoma?

327
Q

What are the two outcomes to consider with treatment of glaucoma?

A

Vision

Comfort

328
Q

What is the Emergency therapy for Glaucoma?

A

Latanoprost

329
Q

What is Latanoprost used for?

A

Increases uveoscleral outflow

330
Q

What is a contraindication for Latanoprost?

A

Anterior Lens Luxation

331
Q

What is the second most effective therapy for glaucoma?

A

Dorzolamide

332
Q

What does Dorzolamide do?

A

Decrease aqueous production

333
Q

What is considered emergency therapy for glaucoma when Dorzolamide and Latanoprost have failed?

A

Intravenous Mannitol

334
Q

What is the function of a Gonioimplant?

A

Increase aqueous outflow

335
Q

What is the function of a Ciliary body ablation?

A

Decrease aqueous production

336
Q

What is the function of Cyclodestruction?

A

Decrease the production of aqueous humor by destroying the ciliary body

337
Q

What are the complications from Cyclodestruction?

A

Postoperative pressure spike
Cataract formation
inflammation

338
Q

How long does it take for blindness to occur with glaucoma and no therapy?

A

6-12 months

339
Q

How long does it take for blindness to occur with glaucoma and therapy?

340
Q

What are the three options for end stage glaucoma treatment?

A

Enucleation
Evisceration and prothesis
Cilliary body ablation

341
Q

What are the components of the fundus?

A 
Sclera
Choroid
Tapetum
RPE
Neurosensory
Retina
342
Q

RPE

A

Retinal Pigmented Epithelium

343
Q

Atapetal

A

some species/individuals lack a tapetum

344
Q

What causes Retinal Hemorrhage?

A 
Anemia
Systemic hypertension
Hyperviscosity 
Diabetes mellitus
Chorioretinits
Coagulopathy
Trauma
Retinal detachment
345
Q

What does Pre-retinal hemorrhage resemble?

346
Q

What does hemorrhage within nerve fiber layer resemble?

A

Flame-shaped

347
Q

What does hemorrhage within the retina resemble?

348
Q

What does hemorrhage within the sub-retinal resemble?

A

Diffuse, irregular shape

349
Q

What causes Retinal detachment?

A 
Vitreous disease
Congenital malformations
Lens luxations
neoplasia
Intraocular inflammation: Chorioretinitis
Trauma
Vascular disease: Hypertension
350
Q

What are the 2 types of retinal detachment?

A

Bullous

Rhegmatogenous

351
Q

What is the sign of retinal detachment on the ultrasound?

A

“Seagull sign”

352
Q

What is a common early sign of Feline hypertensive retinopathy?

A

Bullous Detachment

353
Q

How do you treat Bullous detachment?

A

Treat underlying disease

Anti-hypertensive therapy

354
Q

What is common with primary vitreous degeneration?

A

Rhegmatogenous Detachment

355
Q

What is the treatment for Partial Retinal detachment?

A

Retinopexy

356
Q

What is the treatment for Complete Retinal detachment?

A

Re-attachment surgery

357
Q

What are the vascular changes seen with retinal detachment?

A 
Attenuation (thinning)
Dilation
Hemorrhage
Exudation 
Increased tortuosity: Hypertension and Hyperviscosity
358
Q

What are the different Altered Tapetal Reflectivity?

A

Hyperreflective

Hyporeflective

359
Q

What causes Hyperreflectivity of the Tapetum?

A

Retinal thinning

360
Q

What causes Hyporeflectivity of the Tapetum?

A

Increased retinal thickness

361
Q

What is Patchy depigmentation?

A

Non-specific response to inflammation/ injury/ degeneration

362
Q

What are the clinical signs of Progressive Retinal Atrophy?

A 
Narrowing and loss of retinal blood vessels
Tapetal hyper-reflectivity
Optic nerve atrophy
Non-tapetal pigmentary changes
Secondary cataract formation
363
Q

What are the characteristics of Retinal degeneration?

A

Bilateral and Symmetrical
Sudden loss of vision
Acute photo receptor death
Dilated pupils

364
Q

SARDS

A

Sudden Acquired retinal Degeneration Syndrome

365
Q

How do you diagnose SARDS?

366
Q

Feline central Retinal Degeneration

A

elliptical area of dorsalateral degeneration caused by Taurine deficiency

367
Q

What can cause acute permanent loss of vision due to Retinal degeneration in cats?

A

Enrofloxacin

368
Q

How do you treat Chorioretinitis?

A

Anti-microbial

Systemic NSAIDs or corticosteroids

RUSVM Small Animal Medicine II 2017 (4 decks)

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