Ophthalmology Flashcards
What is the correct confirmation for the eye?
No sclera visible
No protrusion of globe
Correctly positioned on the head
What equipment will you need to preform and eye exam?
Optalmoscope Tonometer Schirmer tear test Pen torch 20D condensing lens Consumables-flurescein, tropicamide(dilated pupils)
What is a direct optalmoscope for and what light settings can you apply?
Look at ocular structures in detail
Have multiple filters and light settings for observing different structures
White light retro illumination
Red light differentiates blood vessels and pigments
Blue colbalt filter for flurescein staining
What specific opthalmologists equipment can you use?
Slit lamp biomicroscope
Advanced tonometers
Lens gonioscopy
What should you ask for in the history of an opthomology patient?
How long has it been going on Has it gotten worse Is is worse st night or in Bright light Any concurrent diesease Any trauma is it in both eyes Breed, species Coat colour Vaccination status Any other animals in the house
What order should you carry out an opthalmological examinations?
History Distance exam Tear test conjunctival culture Acne a and anterior segment Intraoccular pressure measurements and pupil dilation Posterior segment exam Any additional techniques reauired
What is involved when completing a distance exam for opthomology?
Face from above and direct any protrusion, squinting, symmetry ocular discharge
Eyelids-palpebral fissure, size colour swelling
Eyeballs- position, size, direction movements
Observation pupil static and dynamic
Use of direct optalmoscope retro illumination
List the clinical signs that will present within an opthomology case
Discharge-euphiod muccoid mucopurulent haemorrhagic
Eyelids- palpebral fissure, colour swelling hair? Position of the eyelid margin
Gobble- abnormal position of visual axis (strabismus) abnormL position within the orbit Abnormal size
Retro illumination- abnormal reflection opacities
What is involved when completing a neuro-opthalmicexamination?
Menace response (blink response) Tracking response Visual placing Look for strabismus Anisocoria Nystagmus Eyelid ptosis(drooping)
How do you complete a schirmer eye test?
Place paper in the lower fornixeyelid ensuring it is inside the lid allow to stay there for one minute normal tear production is 15-25 MM
How do you take a corneoconjunctival culture?
Cytobrush sterile cotton bud before diagnostic drops culture and sensitivity
How do you test the tear quality?
Tear break up time use of flurorescein maintain lids open for and measure time takes for dark spots to appear after last blink normal duration is 20 seconds
How do you preform and Adenexa and anterior segment exam?
Use direct opthalmoscope
Close examination examines conjunctiva cornea and anterior segment
Retro illumination shows opacities
What is the jones test in ophthalmology?
Demonstrates the permeability of the mask-lacrimal duct system
Flurorescein applied in both eyes green then present at the nostrils 1 -5 minutes later
What equipment can be used to test intraocculare pressure?
Tonometer schiotz tonometer
Apply general anaesthetic
Or an measurement 10-20 mmHg
How can you dilate the pupil?
Administer one drop of tropicamide into each eye wait 20-30 minutes. If the eye is not dilated enough add another drop.
How do you exam the posterior segment of the eye after dilation?
Monocular indirect ophthalmoscope
Direct ophthalmoscope using the lens
List the three types of topical drugs and their properties
Ointment: can’t be used if corneal ulcer, increased duration, lubrication, hydration of the cornea,
Solution and suspension: quickly eliminated not convienient in large animals lea 5 min between applications
Always apply drops in the order of viscosity
List lubricants used for the eyes
Clinadry mild dryness
Clinitas soothe: moderate dryness
Hycare gel moderate to severe dryness
Which product is a lubricant that combines sodium hyaluronate?
Optixcare
List the topical antibiotics used for eyes and their order of intentions?
First intention Chloramphenicol Second intention Gentamycin Third intention Ofloxacin not good for cornea
List the topical corticosteroids used for the eye
Prednisalone (predforte)
Maxitrol (dexmethasone)
List the NSAIDs that can be used to treat eye infections
Ketorolac (acular)
Bromfenac (yellox)
List the immunosuppressive drug used to treat KCS
Optimmune ciclospoin
What would you use to treat a melting corneal ulcer?
Serum EDTA very frequent administration every hour
How would you treat glaucoma?
Reduce the production and increase the drainage of the aqueous humour in the eye
Carbonic anhydrase inhibitors
Prostaglandin analogues
Name the mydriatic agents used in opthomology and their function
Dilation of the pupil atropine days duration
Tropicamide duration 4-8 hours
Discuss the tips fro applying eye drops and the nursing care required after eye surgery
Appropriate handling • Support the jaw when examining from a distance • Do not put pressure around the neck otherwise increase IOP (! Possible globe rupture in case of deep ulcer) • Corneal ulcer, post-op ocular surgery: buster collar on AT ALL TIME Good positioning for eye drops administration • Don’t open the eyelids for too long! Spread the tears every 10-15 sec
What causes the red eye?
Inflammation (hyperaemia): e.g. conjunctivitis
(non urgent to urgent) , uveitis (urgent)
• Haemorrhages: trauma (non urgent to urgent),
coagulopathy (urgent)
• Vasodilation: e.g. conjunctival: Horner
syndrome (non urgent), retrobulbar abscess (can
be urgent)
• Neovascularisation: e.g. associated with
corneal ulcer (urgent)
Clinical signs associated with position
of the globe in the orbit
Exophthalmos Abnormal protrusion of the eye
Globe proptosis
Enophthalmos
Recession of the globe into the orbit. Sunken eyeball
i.e. Claude Bernard Horner syndrome
Strabismus
Deviation of the visual axis compared to normal gaze
Clinical signs associated with the position of the eyelids?
Blepharospasm Macropalpebral fissure Treatment: • Lubrication • Topical antibiotic • Surgical correction Oversized eyelids Ectropion Exposed conjunctiva Dryness, impaired eyelid function Entropion • Primary or secondary (trauma, eyelid surgery..)
Clinical signs associated with the condition of the eyelid?
Conjunctivitis: Inflammation (hyperaemia)
Conjunctival Oedema: Chemosis
The blue eye clinical signs
Due to lesion of the superficial layer of the cornea: epithelium or the most inner layer: endothelium Leads to water uptake in the cornea URGENT
The white eye
Scar to previous
ulcer, corneal
surgery
(conjunctival graft)
The cloudy eye
White color: lipid keratopathy
“Archus liposis”
Lipid depositis associated with hyperlipidemia (triglycerides) and some
systemic conditions: i.e. hypothyroidism, pancreatitis, diabetes mellitus
What is a corneal ulceration?
Defect of the epithelial layer with most of the time involvement of the stroma (deeper layer)
What is a cherry eye? How is it corrected and what is the postop care?
Prolapsed third eyelid Surgical correction Post-operative treatment • Buster collar • First line antibiotic 3 -4 times daily • Lubrication 3 times daily • Systemic anti-inflammatory drug
What is keratoconjunctiva sicca, what are the clinical signs and how is it treated?
Causes: Thought to be an immune-mediated condition.
• Other causes: e.g. iatrogenic: GA (temporary)
ocular pain
mucoid strings on the cornea,
mucoid discharge
dryness and inflammation of
the conjunctiva and cornea
decreased vision and
progressive corneal disease
Lubrication
• Immunomodulating agent: topical cyclosporine A
(0.2% - Optimune®) or tacrolimus. Usually given
twice a day.
Broad-spectrum topical antibiotic to prevent
secondary bacterial infection. Moderate to
severe meibomianitis: systemic broad-spectrum
antibiotic
• Topical or systemic anti-inflammatory
treatment might be indicated.
Surgical technique: Parotid duct
transposition. The parotid duct if
individualised and transposed to exit in the
lower fornix of the lower eyelid.
What is the treatment for an infected ulcer or a deep ulcer?
Medical therapy: • Antibiotherapy: topical: first to third line topical antibiotic (C/S): up to hourly • Serum: up to hourly • Lubrication, systemic NSAIDs, +/- atropine, Systemic large spectrum antibiotic (i.e. Cephalosporin) Hourly drops!! • Reconstructive corneal surgery Antiproteolytic drugs: EDTA, serum (hourly until proteolytic mechanism stopped), NAcetylcystein • +/- surgical treatment • Advanced treatment for refractory cases (i.e. cross linking)
