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BVM3 NOSS > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Jones Test

A
  • Evaluation of Nasolacrimal Fluorescein
  • Fluorescein has been used in the diagnosis of corneal ulcers, obstruction of the nasolacrimal duct (Jones test)
  • A Jones II dye test is used to determine the presence or absence of anatomical obstruction of the nasolacrimal outflow system.
  • A positive result indicates no anatomical or functional blockage to tear flow.
  • A negative result indicates a lacrimal drainage system problem (ie, anatomical or functional blockage)
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2
Q

What is the name of this test? What is the result in this cat?

A

-ve in right nostril (blockage of some type)

+ve in left (no blockage)

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3
Q

What is the cause of epiphora?

A
  • Trichiasis
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4
Q

Trichiasis

A

ingrowth or introversion of the eyelashes

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5
Q

Epiphora

A
  • excessive watering of the eye
  • occular discharge
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6
Q

What do these prefixes pertain to?

  • blephar-
  • dacryo-
  • kerat-
  • cyclo-
  • phac-
  • hyalo-
A
  • eyelid
  • nasolacrimal system
  • cornea
  • ciliary body
  • lens
  • vitreous humor
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7
Q

What causes increased tearing?

(epiphora)

A

Trigeminal (CN V) nerve irritation e.g. corneal ulcer, FB

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8
Q

Conjunctiva

A
  • the mucous membrane that covers the front of the eye and lines the inside of the eyelids
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9
Q

What can cause drainage problems? (3)

A
  • prolapse of the gland of the nictitans membrane
  • eyelid abnormality - entropion/ectropion
  • blockage of the nasolacrimal system
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10
Q

Entropion

A

a condition in which the eyelid is rolled inward against the eyeball, typically caused by muscle spasm or by inflammation or scarring of the conjunctiva (as in diseases such as trachoma), and resulting in irritation of the eye by the lashes (trichiasis)

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11
Q

Trachoma

A
  • Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness
  • Trachoma is a bacterial infection of the eye that can lead to blindness if not treated. This preventable disease is linked to poor hygiene and is often associated with poverty. Lack of facial cleanliness is a key factor related to the spread of the infection
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12
Q

Ectropion

A
  • Ectropion is where the lower eyelid droops away from the eye and turns outwards. It’s not usually serious, but can be uncomfortable. Ectropion mainly affects the lower eyelid and can occur in one or both eyes
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13
Q

What are the 3 components of tears?

A
  • lipid
  • aqueous
  • mucin
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14
Q

Microphthalmia

A
  • Microphthalmia is an eye abnormality that arises before birth.
  • In this condition, one or both eyeballs are abnormally small. In some affected individuals, the eyeball may appear to be completely missing; however, even in these cases some remaining eye tissue is generally present.
  • Such severe microphthalmia should be distinguished from another condition called anophthalmia, in which no eyeball forms at all. However, the terms anophthalmia and severe microphthalmia are often used interchangeably
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15
Q

Buphthalmia

A
  • enlarged globe of the eye
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16
Q

Phthisis bulbi

A

Phthisis bulbi is a shrunken, non-functional eye. It may result from severe eye disease, inflammation or injury, or it may represent a complication of eye surgery. Treatment options include insertion of a prosthesis, which may be preceded by enucleation of the eye

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17
Q

Enophthalmia

A

enophthalmia describes eyes that are abnormally sunken into their sockets

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18
Q

Anisocoria

A
  • Anisocoria is a condition characterized by an unequal size of the eyes’ pupils.
  • usually not a big health problem
  • can cause visual effects of an abnormal eye shape
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19
Q

Differentials and “Red Herrings” of the

Small Eye

(affecting the globe)

A
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20
Q

Differentials and “Red Herrings” of the

LARGE EYE

(affecting the globe)

A
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21
Q

Exophthalmia

A
  • Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit.
  • Exophthalmos can be either bilateral (as is often seen in Graves’ disease) or unilateral (as is often seen in an orbital tumor)
  • can be a red herring to a large globe presentation (buphthalmia)
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22
Q

Globe size?

A
  • globe size is the same!
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23
Q

globe size?

A

globe size is the same!

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24
Q
A
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25
Q
A
26
Q

Dyscoria

A

An abnormality in the shape of the pupil of the eye

27
Q
A
28
Q
A
29
Q

arrows?

A
30
Q

synechia

A

synechia is an eye condition where the iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e.posterior synechia).

Synechiae can be caused by ocular trauma, iritis or iridocyclitis and may lead to certain types of glaucoma.

31
Q
A
32
Q

“Scleral Show”

A
  • “Scleral show” is an anatomical condition in which the sclera area is visibly exaggerated due to constitutional, evolutive, or endocrine etiology
33
Q
A
34
Q

Dazzle Reflex

A

Dazzle reflex is a type of reflex blink where the eyelids involuntarily blink in response to a sudden bright light (glare). Neurological pathways for the dazzle reflex involve subcortical pathways, such as the supraoptic nucleus and superior colliculus.

35
Q

Corneal Sequestrum

A

A corneal sequestrum is a part of the cornea which has died off and which is then rejected by the remaining healthy cornea. Most sequestra (as more than one sequestrum is known) affect the centre of the cornea. Corneal sequestra are usually pigmented in different shades of brown and may vary in appearance from subtle bronze staining to very obvious dark plaques. In some patients, blood vessels grow into the cornea in response to the sequestrum and a reddish rim may surround the pigmented plaque. In many affected patients, their tears will also be darkly pigmented and brown to black discharge may crust on the eyelids

36
Q

Is a corneal sequestrum a problem for affected cats?

A
  • Overall, the answer to this question is yes. In their very early stages, corneal sequestra will not cause pain or visual impairment but with time corneal ulceration (wounding) develops, and patients will show intermittent signs of eye pain such as blinking, squinting, weeping and light-shyness. Occasionally patients will show signs of a sequestrum only after several episodes of apparently spontaneous corneal ulceration.
  • Corneal sequestra can become infected, and this may lead to loss of the eye in the absence of rapid treatment.
37
Q

What causes a corneal sequestrum?

A

Chronic injury has been identified as a possible cause of sequestrum formation and especially abnormalities of the eyelids such as inward turning of the eyelids and eyelashes. However, even today, it is not known why the majority of patients develop corneal sequestra. Many theories have been investigated and herpesvirus (one of the cat flu viruses) has been identified as a possible cause in crossbred (domestic short haired) cats. However, most corneal sequestra are seen in purebred cats such as Persians and British Short Hair cats. It is possible that the special shape of the faces of these patients is associated with the problem. They generally have big bulging eyes which often have a poor blinking response. Herpesvirus does not generally appear to be related to sequestrum developments in purebred cats. Abnormalities of the tear film such as a poor quality or quantity of tears are also considered to be involved in some cases.

38
Q

Treatment Options available for Corneal Sequestrum

(3)

A

There are three major treatment options available:

  • Conservative treatment with antibiotic and lubricating ointments to reduce irritation and prevent infection until the eye has shed the sequestrum by itself.
  • Surgical excision of the sequestrum and placement of a soft contact bandage lens.
  • Surgical excision of the sequestrum followed by a grafting procedure to provide support for the affected area of cornea and to reduce the risk of the sequestrum coming back.
39
Q

Ectopic Cilia

A
  • Ectopic cilia are one or several hairs that grow abnormally through the conjunctiva and come into contact with the surface of the eye (cornea).
  • These abnormal hairs most commonly occur on the upper middle eyelid.
  • come from underneath the upper eyelid through the conjunctival surface at about the 12 o clock position
40
Q
A
  • figure of 8
  • want eyelid margin to be perfectly aligned
  • cornea is like the windshield of your car and the eyelids being the wipers
  • any abnormality along the cornea will cause smearing and issues
41
Q
A

Hypopyon

  • is a medical condition involving inflammatory cells in the anterior chamber of the eye. It is a leukocytic exudate, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera
  • “white wine” - WBC’s, fibrin and debris in the anterior chamber and it settles like a snowglobe at the bottom –> Gives semicircular shape
42
Q
A
  • can see blood inside the eye - hyphema
  • conjunctiva isnt very hyperaemic –> can see white there
  • Dx: Corneal Perforation
  • anterior chamber is collapsed in this dog - defect that had actually ruptured
  • lots of wet discharge on the face as well
43
Q
A

Indirect Opthalmoscopy

using a lens

  • get an image that is upside down and back to front
  • if it was just the light and no lens in front of the eye: distant direct
44
Q
A

Hyperaemia conjunctiva/episcleral congestion

45
Q
A

Anisocoria

-unequal sized pupils

46
Q
A

Follicular Conjunctivitis

all signalment!

  • dog
  • less than 18 mo of age
  • eye is being exposed to different allergens (grass pollens, trees)
  • the ocular surface immune system is then being challenged and lymphoid follicles go into overdrive –> follicular conjunctivitis
  • Tx: usually ask owners to lubricate the eye and ride it out bc we want the eye to be exposed to the seasons and develop immunity
  • If it is causing a lot of itchiness and discharge–> may use topical steroid for a bit to alleviate the inflammation
  • Can look like a cherry eye –> but you would be able to note a cherry eye without manipulation of the 3rd eyelid
47
Q

Presentation of typical dyscoria (abnormally shaped pupil)

A
  • Posterior Synechia
  • Dx: Peristent pupillary membrane
  • The difference being that a PPM always originates from the center of the iris (iris collarette) and not the leading edge (as seen in this photo)
    *
48
Q

Synechiae

A

A synechia is an eye condition where the iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e.posterior synechia). Synechiae can be caused by ocular trauma, iritis or iridocyclitis and may lead to certain types of glaucoma

49
Q

Persistent Pupillary Membrane

A
  • Persistent pupillary membrane (PPM) is a condition of the eye involving remnants of a fetal membrane that persist as strands of tissue crossing the pupil.
  • The pupillary membrane in mammals exists in the fetus as a source of blood supply for the lens. It normally atrophies from the time of birth to the age of four to eight weeks.
  • PPM occurs when this atrophy is incomplete
  • May stick to the lens, iris or the cornea
50
Q
A
  • Schirmer Tear Test
  • would want to know with the case of this red eye
  • Schirmer’s test uses paper strips inserted into the eye for several minutes to measure the production of tears
  • Most sources state that the reference range of Schirmer tear test (STT) values is 15 to 20 mm/min in most species. But when considering the STT results, you must consider several factors.
  • First, older dogs frequently have STT values lower than 15 mm/min but have no clinical signs of keratoconjunctivitis sicca (KCS)
51
Q

ERG

A
  • Electroretinography
  • measures the electrical responses of various cell types in the retina, including the photoreceptors, inner retinal cells, and the ganglion cells
  • ex: some cockers can have progressive retinal atrophy
52
Q
A

Bilateral Mydriasis

  • dilation of the pupil of the eye
53
Q
A

retinal atrophy

  • Progressive retinal atrophy (PRA) is a group of genetic diseases seen in certain breeds of dogs and, more rarely, cats. Similar to retinitis pigmentosa in humans, it is characterized by the bilateral degeneration of the retina, causing progressive vision loss culminating in blindness
  • Dx: complete retinal detachment - as you cannot see any of the blood vessels and with this those retinal BV’s would fall down BUT the tapetum lucidum would be much more shiney as there is nothing between you and the tapetum anymore - would have much brighter hyper-reflectivity
54
Q

Tapetum Lucidum

A
  • The tapetum lucidum is a biologic reflector system that is a common feature in the eyes of vertebrates. It normally functions to provide the light-sensitive retinal cells with a second opportunity for photon-photoreceptor stimulation, thereby enhancing visual sensitivity at low light levels
55
Q

Retinal Detachment

A

Retinal detachment is a disorder in which the retina separates from the innermost lining of the eyeball. This can be caused by a variety of genetic and non-genetic factors, and in some cases is a result of a more serious underlying medical condition.

56
Q
A
  • Always unless contraindicated
  • contraindication: ruptured eye, very deep ulcer (worry about rupturing eye by doing the test)
57
Q
A
  • can see there is some corneal oedema, conjunctival hyperaemia, neovascularization
  • Would be best to do:
  1. Assessment for Aqueous Flare
  2. Fluorescein Staining** - most important here as we are worried about corneal disease when looking at the overall picture
  3. Intraocular Pressure Measurement

*

58
Q

Neovascularization

A

Neovascularization is the natural formation of new blood vessels (neo- + vascular + -ization), usually in the form of functional microvascular networks, capable of perfusion by red blood cells, that form to serve as collateral circulation in response to local poor perfusion or ischemia

59
Q

this is seen by doing retroilumination by distant direct

A

Phacoemulsification (cataract Sx)

Phacoemulsification is a modern cataract surgery in which the eye’s internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber

  • had no tapetal reflection and cataract seen in this image
  • with nuclear sclerosis you would still have tapetal reflection when doing distant direct
  • here we just got a white pupil
60
Q

Nuclear Sclerosis

A
  • Lenticular sclerosis or nuclear sclerosis is the medical term for a bluish transparent haze that develops in the lens of the eye in middle-aged to senior dogs.
  • Vision does not appear to be significantly affected in dogsdiagnosed with lenticular sclerosis.
  • This condition is not the same as cataracts
61
Q
A
  • Ectopic Cilia
  • bulldog –> doesnt tend to have long hair touching the eye like other breeds
62
Q
A
  • abnormal optic nerve head
  • tapetal - hyporeflectivity
  • this is actually a retinal detachment and there was fluid underneath the retina

BVM3 NOSS (5 decks)

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