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Medical Nursing > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What is the correct confirmation for the eye?

A

No sclera visible
No protrusion of globe
Correctly positioned on the head

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2
Q

What equipment will you need to preform and eye exam?

A 
Optalmoscope 
Tonometer 
Schirmer tear test 
Pen torch 
20D condensing lens 
Consumables-flurescein, tropicamide(dilated pupils)
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3
Q

What is a direct optalmoscope for and what light settings can you apply?

A

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

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4
Q

What specific opthalmologists equipment can you use?

A

Slit lamp biomicroscope
Advanced tonometers
Lens gonioscopy

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5
Q

What should you ask for in the history of an opthomology patient?

A 
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
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6
Q

What order should you carry out an opthalmological examinations?

A 
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
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7
Q

What is involved when completing a distance exam for opthomology?

A

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

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8
Q

List the clinical signs that will present within an opthomology case

A

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

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9
Q

What is involved when completing a neuro-opthalmicexamination?

A 
Menace response (blink response) 
Tracking response 
Visual placing 
Look for strabismus Anisocoria Nystagmus 
Eyelid ptosis(drooping)
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10
Q

How do you complete a schirmer eye test?

A

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

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11
Q

How do you take a corneoconjunctival culture?

A

Cytobrush sterile cotton bud before diagnostic drops culture and sensitivity

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12
Q

How do you test the tear quality?

A

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

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13
Q

How do you preform and Adenexa and anterior segment exam?

A

Use direct opthalmoscope
Close examination examines conjunctiva cornea and anterior segment
Retro illumination shows opacities

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14
Q

What is the jones test in ophthalmology?

A

Demonstrates the permeability of the mask-lacrimal duct system
Flurorescein applied in both eyes green then present at the nostrils 1 -5 minutes later

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15
Q

What equipment can be used to test intraocculare pressure?

A

Tonometer schiotz tonometer
Apply general anaesthetic
Or an measurement 10-20 mmHg

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16
Q

How can you dilate the pupil?

A

Administer one drop of tropicamide into each eye wait 20-30 minutes. If the eye is not dilated enough add another drop.

17
Q

How do you exam the posterior segment of the eye after dilation?

A

Monocular indirect ophthalmoscope

Direct ophthalmoscope using the lens

18
Q

List the three types of topical drugs and their properties

A

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

19
Q

List lubricants used for the eyes

A

Clinadry mild dryness
Clinitas soothe: moderate dryness
Hycare gel moderate to severe dryness

20
Q

Which product is a lubricant that combines sodium hyaluronate?

A

Optixcare

21
Q

List the topical antibiotics used for eyes and their order of intentions?

A 
First intention
Chloramphenicol 
Second intention 
Gentamycin 
Third intention 
Ofloxacin not good for cornea
22
Q

List the topical corticosteroids used for the eye

A

Prednisalone (predforte)

Maxitrol (dexmethasone)

23
Q

List the NSAIDs that can be used to treat eye infections

A

Ketorolac (acular)

Bromfenac (yellox)

24
Q

List the immunosuppressive drug used to treat KCS

A

Optimmune ciclospoin

25
Q

What would you use to treat a melting corneal ulcer?

A

Serum EDTA very frequent administration every hour

26
Q

How would you treat glaucoma?

A

Reduce the production and increase the drainage of the aqueous humour in the eye
Carbonic anhydrase inhibitors
Prostaglandin analogues

27
Q

Name the mydriatic agents used in opthomology and their function

A

Dilation of the pupil atropine days duration

Tropicamide duration 4-8 hours

28
Q

Discuss the tips fro applying eye drops and the nursing care required after eye surgery

A 
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
29
Q

What causes the red eye?

A

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)

30
Q

Clinical signs associated with position

of the globe in the orbit

A

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

31
Q

Clinical signs associated with the position of the eyelids?

A 
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..)
32
Q

Clinical signs associated with the condition of the eyelid?

A

Conjunctivitis: Inflammation (hyperaemia)

Conjunctival Oedema: Chemosis

33
Q

The blue eye clinical signs

A 
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
34
Q

The white eye

A

Scar to previous
ulcer, corneal
surgery
(conjunctival graft)

35
Q

The cloudy eye

A

White color: lipid keratopathy
“Archus liposis”
Lipid depositis associated with hyperlipidemia (triglycerides) and some
systemic conditions: i.e. hypothyroidism, pancreatitis, diabetes mellitus

36
Q

What is a corneal ulceration?

A 
Defect of the
epithelial layer with
most of the time
involvement of the
stroma (deeper layer)
37
Q

What is a cherry eye? How is it corrected and what is the postop care?

A 
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
38
Q

What is keratoconjunctiva sicca, what are the clinical signs and how is it treated?

A

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.

39
Q

What is the treatment for an infected ulcer or a deep ulcer?

A 
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)

Medical Nursing (22 decks)

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