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ophthalmology Flashcards

1
Q

what is the normal pressure of the eye

A

15-25 mmHg

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2
Q

Schrimer time in normal dog test

A

1 minute

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3
Q

which species has multi eyelash

A

Dog

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4
Q

pic of flouroscein stain or other stain have to decide which is which

A

One with normal light and one green phosphorescation

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5
Q

electro microscope picture of iridocorneal angle

A

A = iris B = Cornea arrow = pectinate ligaments

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6
Q

Which is the most important examining technique?
A) Flourescein staining
B) Ophtalmoscope ect

A

both

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7
Q

Pic where the blood vessels are visible - which answer is NOT true (Can’t find this pic) (?)
A) Ciliary vessel are visible
B) Conjunctival vessels are visible
C) Conjunctival vessels are not visible

A 
Conjunctival vessels
– bright red
– branch-like and tortuous
– vessels in the fornix affected
– vessels are mobile with the conj.
– may be cleared by topical adrenaline
Ciliary vessels
– dark red
– brush-like, short and straight
– vessels at the limbus affected
– vessels are stationary
– topical adrenaline has no effect
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8
Q

Drawing of an eye, with numbers from 20 to -3, what is this and what ophthalmological equipment needs
to be adjusted according to this?

A

These are settings for direct ophthalmoscope

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9
Q

in what species is glaucoma freq inherited

A

dog

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10
Q

What does symblepharon mean (same question twice with different choices)?

A

Adhesion of conjunctiva on itself or on the cornea. Typically found in young cats with viral conjunctivitis (FHV)

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11
Q

What is unnecessary for an eye examination?

A

(dark room, to sit, etc.)
GENERAL PHYSICAL EXAMINATION (reduced) OPHTHALMIC EXAMINATION 1. Examination of the head, the
periocular area and eye globe in lightened room 2. Preliminary examinations in lightened room
•PLR (pupillary light reflexes)
•STT (Schirmer tear test)
•collection of specimens for laboratory ex.

Ophthalmology 2018/2019 Final Exam

3

•evaluation of vision
3. Detailed physical examination procedure of the
eye under magnification with focal light source in
a darkened room, from outside toward inside

(slit-lamp biomicroscope)
4. Additional diagnostic techniques
•vital staining
•tonometry
•tests of lacrimal patency
•ophthalmoscopy
•ultrasonography
•gonioscopy
•sciascopy, keratoscopy
•x-ray techniques, computertomography
•electroretinography
•laser tomography
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12
Q

in what species is cataract inheritable

A

dogs - DM , in horse and cat it usually develops due to uveitis

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13
Q

What doesn’t have a role in the amount of aqueous humour?

A

light reflection of the tapetum , and non tapetal fundus

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14
Q

what can be the reason for lens surgery

A

anterior lens luxation , cataract

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15
Q

cobalt blue light

A

provides suitable means of exciting the sodium flourscein dye ( orange dye ) for examination of the ocular surface integrity

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16
Q

What doesn’t cause glaucoma?

A

posterior lens luxation

Lens luxation to be cured with and without surgery
Anterior lens luxation->surgery

Posterior lens luxation->no surgery, observation, medical treatment
Lens subluxation->no surgery, observation, medical treatment

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17
Q

what do you not do before taking a sample for bacteriology

A

use local anaesthetic

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18
Q

txt of cataract

A

surgery is the only way

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19
Q

when can you see a crescent moon

A

at subluxation of lens

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20
Q

Plenty questions of ‘morgagnian’ cataract

A

Morgagnian (hyper-mature cataract undergoing substantial resorption where the cortex liquefies and the nuclear
drops (uncommon, Cocker / Bichon)
Most of the lens cortex reabsorbs, except for a few scattered remnants, the nucleus sinks to the bottom of the
capsule. Focal posterior synechiae can be found due to lens induced uveitis (LIU). Due to the resorption vision
may partially return. LIU must be treated aggressively!

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21
Q

Horners syndrome symptoms

A

(sympathetic denervation of the eye)
Third eyelid prolapse (due to exophthalmos and loss of sympathetic tone)
Myosis (due to lack of normal sympathetic tone in the iris dilator muscle)
Enophtalmos (due to lack of tone in the orbital muscle)
Narrowing of the palpebral fissure
Peripheral vasodilatation may occur causing increased facial warmth, best observed in the ipsilateral ear

Especially prevalent inn Golden retriever-idiopathic
Other causes: trauma, otitis, tumour

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22
Q

sub conjunctival inj of horse

A

local supf anasthesia , full anasthesia , max 3ml

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23
Q

What grows together when there is posterior synechia?

A

The iris adheres to lens (anterior: when iris adheres to cornea)

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24
Q

what are the consquences of chronic inflammation in horses e

A

Chronic uveitis:
Corneal endothelial degeneration/dystrophy
• corneal vascularization/precipitates
Lens luxation, subluxation
• vitreal opacities (hyalitis)
• focal chorioretinitis, retinal detachment

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25
Q

def of glaucoma

A

disturbance in the drainage of aqeous humour , can increase the IOP

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26
Q

how to examine the retina detachment in the most precise way

A

By monocular indirect ophthalmoscope-> greater field of view
(Direct ophthalmoscopes-this one is not so handy, because the magnification is increases, thus the field of view
decreases)

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27
Q

What is true for direct ophthalmoscope?

A

monocular , lens system with changable diopter

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28
Q

Something about recurrent uveitis of horses?

A

First uveitis (usually at age 4-8 y) is usually caused by an insult (trauma, infection, corneal disease) that results in
acute uveitis-> immune response: T-lymphocyte infiltration of the eye->persisting sensitised lymphocytes will
cause the hypersensitivity of uvea-> Equine Recurrent Uveitis (ERU). It will reoccur due to re-exposure to
antigen/self-protein, decreased down-regulation of T cells-persisting T-lymphocytes
80% is unilateral
Immune-mediated
Some breed predisposition (Appaloosa, draft horses)
Posterior

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29
Q

how descemetocele is stained by flourscene

A

Fluorescence adheres only to the walls of the ulcer, the central floor (Descemet
membrane) of the ulcer appears black.

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30
Q

What is phacoemulsification?

A

Phacoemulsification is a modern cataract surgery in which the eye’s internal lens is emulsified with an ultrasonic
handpiece and aspirated from the eye

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31
Q

jones test

A

Fluorescein stain appear at the nares after 1-10 minutes (?)

Fluorescein strains the exposed storm in bright green!

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32
Q

components of the uvea

A

iris, corpus , cilare and choroid

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33
Q

Purekinjes images

A

presence = opacity of the lens , purkjnes images are formed on the anteriors and posterior lens capsule and are bright , clear and regular , there is no opacity of the lens

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34
Q

connection of the retina

A

at 2 sites - behind the cillary body pars plana and near optic nerve head

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35
Q

what do cillary bodies do

A

produce aqeous fluid , pars plicata - cilary body processes aqeous humoue , cillary body - pars plicata and pars plana - joins the retina

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36
Q

normal pressure in the anterior chamber

A

15-25 mmHg signs of glaucoma IOP > 25 Hgmm , 12-22mmHg according to google

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37
Q

which nerve blocks do you use for the subpalbebral drainage

A

superorbital and frontal nerve block

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38
Q

why do you perform a subpalpebral drainage

A

continous eye drops in the horse

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39
Q

how long can drain last

A

3-4 weeks

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40
Q

nasolacrimal drainage

A

only when you cant use subpalpebral

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41
Q

why do you use a third eyelid flap

A

for protection and healing , only small animals - forbidden in deep corneal ulcers

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42
Q

How long can the the third eyelid flap stay on

A

2 weeks

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43
Q

Tarsorraphy

A

suturing eyelids together

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44
Q

what is lateral canthotomy

A

cutting the lateral canthus

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45
Q

when is lateral canthotomy used

A

porobtosis , ocular trauma and release of IOP , incr size of palpebral fissure

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46
Q

contraindication of lateral canthotomy

A

globe rupture

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47
Q

stay sutures of globe

A

into sclera , not penetrating - gives support for surgery at 3 and 9 oclock

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48
Q

Neuromuscular blocker used

A

Atracurium/pancuroonium 0.2mg/kg paralyse breath for 30 mins

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49
Q

Human opthalmological sutures

A

10/0 and 11/0 non absorable atraumatic nylon

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50
Q

vet opth sutures

A

6-8/0 monofilament, polyfilament ABS , atraumatic

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51
Q

cannula for injection of fluid

A

30G

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52
Q

Extraocular tampon

A

cotton

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53
Q

intraocular tampon

A

cellulose

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54
Q

Viscoelastic material

A

methylcellulose injected into the anterior chamber to replace the aqueous humour

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55
Q

what is the fundus

A

visible background of the eye seen through dilated pupil , clinical def : every structure wat can be seen on the ocular background . exam of the fundus : opthalmosope, darkened examination room - induced mydriasis ie dilation of the pupil

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56
Q

How to dilate the pupil

A

1 drop of tropicamide , wait for 20 minutes , its hould last 4-6 hours - its an effective mydriatic , and poor cyclopegic . used for mydriasis ( other parasympatholytics include atropine , homatropine , cyclopentolate

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57
Q

when do you not perform this examination? IOP

A

glaucoma or lens luxation

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58
Q

direct ophthalmoscope

A

lens and light together is the best - slit lampDirect ophtalmoscope: Monocular, lens system changeable with diopter. Animals -2D and -3D, changeable illumination light, high magnification (15x), small field of view and eye movement will be magnified. Erected picture.
Indirect: binocular,- stereopsis, changeable features of illumination and +20D convex lens. Small magnification (4-5x), large field of view and inverted picture .

59
Q

Diopter for the fundus

A

glaucoma or lens luxation

60
Q

role of the tapetum fundus

A 
reflective tissue ( no pigments ) , amplify light ( not in pig or human)
at the dorsal fundus bw the retina and the choroid is the tapetum --> it is a reflective layer ( pig and human dont have it )
61
Q

what is not true about the tapetum

A

located bw the choroid and retina ventrally on the globe - incorrect its located dorsally !!

62
Q

which species have tapetum fibrosum

A

herbivores , merck : tapetum lucidum to enhance vision in dim light ( tapetum cellulosum in carnivores and tapetum fibrosum in herbivore)

63
Q

Which species have tapetum cellulosum

A

carnivores

64
Q

who has stars of winslow in the fundus

A

horse ( horse has for sure , other species I couldnt find so i guess its just horse )

65
Q

What is progressive retinal atrophy syndrome (PRA)

A

pigmented change in the tapetal fundus with attenuation of vasculature and atrophy of the optic disc and vessels . prone in middle aged labrador. The retina absorbs less light and therefore there is more light being reflected .
Merck : a group of degenerative retinopathies consisting of inherited photoreceptor dysplasia and degenerations that have a similar clinical appearance

66
Q

What is seen in PRA

A

very reflective tapetum , atrophy of vessels and pale optic nerve head
Merck : opthalmoscopic lesions are a bilateral symmetric increase in reflectivity of the tapetal fundus , decreased pigmentation of the non tapetall fundus and attenuation and decrease in the number of retinal vessels , eventual atrophy of the optic papilla

67
Q

What is seen in the collie eye anomaly CEA / Retinal dysplasia (RD) ?

A

CEA : is a congenital recessively inherited ocular defect with variable expression in rough and smooth coated collies. it is also seen in shetland sheepdogs , border collies . The basic lesions is an area of choroidal or chorioretinal hypoplasia that an opthalmoscopy appears as focal , variable sized , pale area lateral to the optic desk . intraocular haemorrhage may occur . vision not effected unless retina is detached

Retinal dysplasia : a congenital , focal , geographic , or generalised maldevelopment of the retina that may arise from trauma , genetic defect or intrauterine damage such as viral infections. most forms of RD in dogs are inherited

68
Q

How is the CEA seen on an opthalmoscope

A

Folds seen are epsilon like stripes

69
Q

reasons for retinal haemorrhages

A

cat with hypertension, ethylene glycol toxicosis and erlichiosis

70
Q

retina detachment

A

separation of inner layer of retina from the choroid plexus - holes in the retina

71
Q

solution

A

pH 3.5-10.5 , should be sterile , pH and temp stabile ( determine the stability)

72
Q

Suspension

A

Drug is included in small particles , the tear dissolves the particles , it and has long contact time , absorption in form of solution : prolonged contact time

73
Q

Ointment

A

pH and temp is not important , oil or water base , disadvantage : inhibit corneal wound healing

74
Q

absorption after topical admin

A

mostly washed out , absorption by the conjunctival capillaries or penetration to the cornea - lipid best
Lipid soluble drugs : easy transcellular absorption
water soluble drugs : poor intercellular absorption

75
Q

subconjunctival injection

A

corticosteroids mostly , max 1 ml in the dorsal palpebra
- cornea conjunctiva barrier is bypassed . high drug concentration in the anterior segment . after topical anaethesia , fine needle , mild haemorrhage , mydriatics , abs and corticosteroids

76
Q

Retrobulbar injection

A

lower lateral quadrant into the retrobulbar space , anaesthetic for eye removal in cow , antibiotic in small animal
high drug conc in the orbit and the posterior segment ( sclera is not a severe barrie) . in small animals : gen anasthesia - antibiotics. in cow : local anasthesia for exstripration . IOP may increase after admin

77
Q

intraviteal injection

A

at the lateral canthus , quadrant , with 2-3 mm from limbus , the needle is inserted into the viterous ( aspiration then injection) gentamicin inj in glaucoma

penetration of the drugs into the virtous is poor due to the blow aqeous and the blood retina barrier. antibiotics , under gen anaesthesia

78
Q

systemic injection

A

only if inflammed . AB or hyperosmotics are the most common. iv im injection : ABs and anti inflammatory drugs . iv infusion : hyperosmotics
po : application AB anti inflamm , hyperosmotic by owner at home

79
Q

mydriasis

A

sympathetic innervation m dilator pupillae , glandula lacrimalis

80
Q

miosis

A

parasympathetic innervation , M sphincter pupilla . M cillaris and glandular lacrimalis

81
Q

what is not a topical txt

A

subconjunctival /instillation

82
Q

when doing bacterial sampling

A

take sample before anaesthesia

83
Q

what do you do immediately with horse with pink eye

A

fluorescin test

also at any suspect of corneal ulcers and injuries , in any case of painful eyes and before topical or subconjunctival steroid therapy is decided

84
Q

which is false for the third eyelid

A

well muscled in large and small animals , covered both sides by the conjunctiva , position supported by the globe

85
Q

mydriasis

A

pupil dilation

86
Q

what effect do parasympatholytics have on the eye

A

They inhibit the pupil sphincter m and cillary m . function . mydriasis with cycloplegia

87
Q

what are solutions

A

not easily infected - pH 3.5-10.5 pH and temp = determine the stability , should be sterile

88
Q

Fluorescein stain

A

hydrophilic and stains exposed stroma
water soluable , orange , used to assess the condition of the corneal epithelium , injury , painful eye , red eye or before topical or subconjunctival steroid therapy is decided

89
Q

The tear test

A

is done without anaesthesia ??
STT : schrimer tear test is a semi quantitive measurement of tear production . indication : dry eye inflammation (KCS) by orginal test strips for 1 min

90
Q

what do you not use for melting ulcers

A

supf keratectomy/ pedicle graft transplantation / free island transplantation

91
Q

what do you do with descemetocele ?

A

it requires surgical intervention - emergency intervention , elimination of the cause , medical th. is contraindicated , surgery !

92
Q

what is ankyloblepharon

A

inability to close the lids/lid margins partial or total closure

93
Q

How to treat blepharospasm in horse

A

frontal nerve block / auriculopalpebral nerve block / tropicamide solution

94
Q

what are the indications for vitrectomy in a horse

A

recurrent uveitis

95
Q

effectiveness of atropine to keep the pupil dilated gives us info about ?

A

The severity of uveitis

The longer and better the pupil stays dilated , the milder the uveitis

96
Q

when are glucocorticoids contraindicated

A

corneal ulcers , if fluorscein stains the cornea

97
Q

what is blepharitis

A

inflammation of the eyelids

98
Q

what are the glands of the eyelid

A

glands of zeis , glands of moll , meibomian or tarsal glands

99
Q

what is chemosis

A

edematic swelling of the conjunctiva

100
Q

what are the borders of the eye chamber

A

iris , pupil , cornea

101
Q

what is the dazzle relfex

A

subcortical reflex- reflex blink in response to bright light

102
Q

which animals have cilia on the lower eyelid

A

absence of lower cilia - cat , horse ,cow

multiple rows of upper cilliae : dog

103
Q

The shape of the pupil in herbivores

A

horizontal elliptical

in pig its the same , in dog its round and in cat its perpendicular rhomboid at middle wide position

104
Q

what is false about ointments

A

can be used intraocularly

105
Q

Johnes test

A

The appearance of something at the nostril

106
Q

most important drain/outflow in the horse

A

uveo scleral route irido corneal outflow conventional

107
Q

ectropion

A

eversion , turning of the eyelid , always the lower eyelid is affected. etiology : dev or structural , acquired or cicatrical , intermittent

108
Q

what is not a clinical sign of acute uveitis

A

mydriasis
some clinical findings of acute uveitis –> blepharospasms , conjunctival hyperemia , aqueous flare , mitosis and IOP decrease

109
Q

picture of schrimer test

A

semi quantitative measurement of tear production

110
Q

picture of chronic KCS and how to treat it

A

cyclosporin A

111
Q

Rose bengal

A

hydrophilic red stain . stains the degenerated , necrotic cells and the mucus in brillant red

112
Q

picture of bluish eye in horse and the questions was how to treat it

A

could be chronic uveitis , treat with topical steroids( if no ulcer) , NSAIDS topically or systemically , atropine

113
Q

picture - equine eye with green substance oozing from the eye

A

might have been a melting ulcer corneal ulcer

114
Q

picture of a free island conjunctival transplatation. question was which one is false

A

conjunctival graft translocation

115
Q

horse tarscorrhaphy

A

tarsorrhaphy is the joining of part or all of the upper and lower eyelids so as to partially or completely close the eye

116
Q

which one is false when examining the fundus

A

examiner needs to sit

117
Q

adjustments needed for direct and indirect ophthalmoscope

A

Direct : from -3 to +20 ( don’t know the options were )

118
Q

There is a strong connection bw posterior lens and the anterior surface of vitrous body( fossa hylaoidea) in animals

A

true ( not true in human)

119
Q

cataract surgery , which one has the posterior lens capsule intact

A

ECE - extracapsular lens extraction

120
Q

Is phaco ICE or ECE

A

ECE

121
Q

Picture of TSCP - what changes occur in the eye in case of tSCP

A

decreases the intra ocular pressure

TSCP - decreases the aqueous production , so therefore decreasing the intraocular pressure . ( TSCP is a laser txt for glaucoma )

122
Q

ERU in horses can lead to what ?

A

ERU - equine recurrent uveitis - results in influx of inflammatory cells into the eye and hypersensitivity of the uvea.

123
Q

entropion is never

A

intermittent

124
Q

when is it appropriate to take bacterial sample

A

before topical ansthesia

125
Q

picture of green dye at nares

A

jones test

126
Q

What do parasympatholytics do

A

They block function of m .sphincter pupillae and m .cillaris. mydriasis with cycloplegia

127
Q

Fluorescent dye

A

Hydrophilic , stains exposed stroma green

128
Q

what is in the picture

A

Direct ophthalmoscope

129
Q

perform schrimer test

A

fold the strip at the mark and place in the lower conjunctival sac ( lower eyelid) for 1 minute. ( normal in dog/cat ; more than 14 , normal in horse more than 16)

130
Q

picture of KCS and what is the txt

A

acute KCS - both medical and surgical methods used. Artificial tears , topical antibiotics , subconjunctival steroids , acetylcysteine and cyclosporine topically.
questions about what not to use - think hyaluronic acid was answer

131
Q

photo of a black eye - treatment ?

A

chemotherapy , radiotherapy , evisceration

132
Q

chemosis

A

swelling/ odema of the conjunctiva. sign of conjunctivitis

133
Q

cherry eye syndrome

A

a defect , laxity in the retinaculum that binds the gland and the nicitans to the periorbita - protrusion of third eyelid, replace prolapsed gland is the txt

134
Q

Entropion and Ectropion

A

entropion is the inward turning of the eyelid margin ( mainly the lower lid is affected )
Ectropion is the eversion , turning out of the eyelid ( always the lower lid affected)

135
Q

solutions

A

topical use
solution : pH 3.5-10.5 ( by buffers)
pH and temp — determine the stability
should be sterile

136
Q

suspension

A

topical use
drug is included in small particles. Tear dissolves the particles –> absorption in the form of solution , prolonged contact time

137
Q

Ointment

A

topical use

oil or water based , pH and temp is not as important in the stability . inhibit the corneal wound healing

138
Q

Trichiasis

A

Ciliae arising from normally located follicles , are pointed in abnormal direction ( often together with the skin )
( Distachiasis : additional cillae originating from abnormally located follicles (follicles that are in or near the tarsal gland)

(Ectopia cillae – additional cillae originating from abnormally located follicles ( follicle may be located anywhere eg . underneath the palpebral conjunctiva – cilia emerges through it )

139
Q

Extirpartion vs Evis ceration

A

Extirpation : complete excision or surgical destruction of a body part

Evisceration : The removal of the eyes contents , leaving the scleral shell and extraocular muscles intact

140
Q

Jones test

A

To see if the lacrimal duct is obstructed or not
– put flourscein in the conjunctiva and wait a few minutes
pos jones test –> dye is detected in the nostril of the same side of the eye in question –> lacrimal gland is working fine and is not obstructed
neg jones test –> dye is not detected in the nostril of the same side of the eye – a partial or complete obstruction or failure of the lacrimal gland

141
Q

abnormalities regarding the hair

A

The eyelids can have deformities which can cause hair to be in constant contact with the cornea , causing irritation and excessive lacrimation and may lead to corneal vascularisation and corneal ulceration
deformities : prominent nasal fold in brachycephalic breeds , disorders of the cille , Distichiasis , Trichiasis , ectopia cillae , entropion , ectropion , hordeolum , blepharitis , traumas

142
Q

Dazzle reflex

A

dazzle reflex is the type of reflex blink where the eyelids involuntarily blink in response to a sudden bright light

143
Q

properties of atropine

A

mydriatic , minimises adhesions , may not be able to break down synechiae in chronic cases , the effectiveness of atropine to keep the pupil dilated gives us info about how severe an uveitis case is – the longer the pupil is dilated , the milder the uveitis case
cycloplegic - relaxes the cillary muscles , relieve muscle pain in cillare muscle , stablises blood aqueous barrier

ophthalmology (1 decks)

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