Ophthalmology cases Flashcards
8yo cocker spaniel started having thick discharge OU 2 month ago
owner cleaning
menace and PLR are intact OU
blepharospsm
moderate to marked mucopurulent dischage OU
IOP 12mmHg OD 14mmHg OS
STT: 5mm in 1 min OD, 7mm in 1 min OS
Fluorescein stain: Negative
What is the diagnosis
Keratoconjunctivitis succa (KCS)
How do you treat KCS
1) Cyclosporine OU BID
2) NeoPolyDex can help improve keratitis if no ulcerations are present
3) Over the counter lubricating gel based drops PRN until STT improved
4) Clean with eye wash, dilute baby shampoo works really well for dry mucous
5) Ecollar
6) Recheck in 4-6 weeks to monitor STT
If you see mucoid discharge, what must you do *
must perform STT
What is a normal schirmir tear test
15mm in 60 seconds
can stop whenever it gets to 15mm
What are the three methods of IOP measurements
1) Schiotz: Indentation - requires a patient patient
2) Tonopen: Applanation- Requires Proparocaine
3) Tonovet: Rebound- No proparocaine
What is a normal IOP
8mmHg - 25mmHg
no more than 3-5mmHg discrepancy between the eyes
IOP is increased in ________ but decreased in
Increased: glaucoma
Decreased: uveitis and old age
4yo Persian
-Sneezes constantly
-OU has been swollen with discharge off and on
-Recently owner was out of town and staying with friend with kids
-Contact with stray cat
-Menace and PLR intact OU
-Moderate blepharospasm
-Conjunctival hyperemia
-Mild chemosis OD
-Moderate fidduse corneal vascularization OD
ST: 10mmOD, 5mm in 1min OS
IOP: 20mmHg OD, 18mmHg OS
Fluorescein stain: Negative
What is diagnosis? How do you treat?
Diagnosis FHV-1
Treatment:
1) Antivirals
-Famciclovir (45-90mg/kg PO BID-TID)
-Cidofovir 0.5% BID (drops)
2) Erythromycin TID if ulcerated
3) Over the counter lubricating drops 2-4x daily
4) Oral pain med if needed (eg Gabapentin)
5) E-collar
6) L-lysine - must be 500mg PO BID
might help do nothing or make things worse
*Recheck in 2-3 weeks (or call owner)
What antiviral can you give for FHV-1 flareups?
What if the owner cannot pill the cat
1) Famciclovir 45-90 mg/kg PO BID-TID
2) Cidofovir 0.5% BID (compounded drops) if the owner cannot pill the cat
FHV-1 can cause ulceration. What should you give if you see ulceration
Erythromycin TID if ulcerated
(multiple right answers) NeoPolyBac is acceptable if checked in clinic for polymixin reaction
2yo mare
-Started squinting and tearing OD 14 days ago
-rDVM started NeoPolyBac OD TID, Atropine 1% OD TID and Banamine once daily: these treatments havent helped
-Pupil is dilated OD and not response to light
-Menace is intact
-OS constricts when illuminating OD (consensual PLR
-Large feather shaped superficial corneal ulceration with 30% of cornea involved
-No far
STT: >35mm/min OD, 25mmmin OS
IOP: 18mmHg OD, 20mmHg OS
Fluorescein stain:
+ OD, - OS
What is diagnosis?
How do you treat?
Superficial Corneal Ulceration secondary to foreign body
1) Remove foreign body
2) Topical Antibiotic QID
NeoPolyBac (could do culture)
3) Over the counter lubricating drops an help with comfort
4) Oral anti-inflammatory for reflex iveitis (Banamine for equine and their steroid or NSAID for small animal
5) Ecollar
6) Recheck in 1 week
What drug can cause a patient to have menace but not response to light (dilated)
Atropine
What are the qualities of a simple ulcer
1) Superficial
2) Not infected
3) Heals in 5-7 days
13yo FS Shih Tzu
-Started quinting and developed discharge OD 2 weeks ago
-Owner started NeoPolyDex from another pet that worked for something similar so has been treating with this TID
-Over the weekend the eye became very cloudy
-Melting corneal ulcer (80% cornea, 30% stroma loss)
-Diffuse corneal edema, dense corneal vessel, WBC infiltrate in the cornea
-Intraocular structures cannot be evaluated due to the corneal opacity
STT: >30mm/min OD, 4mm/min OS
IOP: 4mmHg OD, 15mmHg OS
Fluorescein + OD, - OS
What is the diagnosis?
What do you do?
Melting Corneal Ulcer and reflex uveitis
1) Perform Cytology +/- culture
2) Ofloxacin q2hr
3) Anticollagenase (serum or Acetlycysteine) q 2hr
4) Systemic Anti-inflammatory: Prednisolone PO (NSAID if steroids are contraindicated
5) Pain control: atropine 1% topical, Gabapentin
+/- Doxycycline (antibiotic and anti-collagenase
6) E collar
Recheck in 24-48 hours
Discuss surgical options: Conjunctival graft
What can you do if you have >50% stromal loss or rapidly melting cornea
Conjunctival graft
6yo MN Schnauzer
Diagnosed w diabetes 8 mo ago
-monday eyes became cloudy and now he is completely blind
PLR and Dazzle: intac
Menace: negative
Intumescent cataract
Moderate conjuctival hyperemia and episcleral congestion
2+ flare
10mm/min OD, 8mm/min OS
IOP: soft OD, 6mmHg OS
negative OU fluorescein stain
Diabetic cataracts with lens induced uveitis and KCS
1) Topical Anti-inflammatory
-Diclofenac or Ketorolac (NSAID)
-If moderate to marked: Prednisolone acetate
2) Oral Anti-inflammatory: if moderate to marked oral NSAID (Not Galliprant)
3) Pain control: give a dose of atropine (very expensive
4) Cyclosporine 1% OU BID for KCS
Schedule appt with ophthalmologist ASAP
Why do you not want to prescribe Atropine for dry eye
because it decreases tear production
T/F: proparacaine is epithelial toxic
True
Why do you need to refer diabetics to an ophthalmologist at the time of diagnosis
80% will develop cataract within a year
Ruptured lens capsule due to intumescent diabetic catatacts will lead to
severe phacoclastic uveitis, glaucoma and the need for enucleation
8yo Basset HOund
-lethargy morning
-stumbling and bumping into things on the right side. That eye is very cloudy, red and is rolling back in her head
-Absent PLR OD
-Absent Menace OD
-Right pupil is midpoint to slightly dilated
-Elevated 3rd eyelid
-Moderate diffuse corneal edema
-Marked conjunctival hyperemia
-Episcleral congestion
STT: 22mm/min OD, 20mm/min
IOP: 64mmHG OD, 12mmHG OS
Fluorescein stain: Negative OU
Primary Glaucoma
Treatment in clinic
1) Administer Latanoprost q5-15min for 1 hour and recheck IOP
2) Administer Mannitol 1g/kg IV over 30 min if this does not work
check for dehydration, renal disease, heart disease before mannitol
Discharge
Right eye
1) Cosopt (Dorzolamide and Timolol) TID
2) Latanoprost BID
3) Topicoal and/or systemic steroid to help with underlying inflammation
Left eye:
1) Cosopt BID- without treatment on average the other eye will spike in 4-6 months
Can start latanoprost now or wait for IOP to be in high teens
recheck in one week
Why do dogs with diabetes have dry eye
Peripheral neuropathy - unable to feel the corneal surface and reduced tear production
What anti-inflammatory is contradindicated in diabetic patients
steroids - need to go with NSAIDs for treatment of diabetic cataracts
What oral NSAID does not help ocular patients
Galliprant
What should you do in emergencies if Latanoprost does not decrease IOP
Administer Mannitol 1g/kg IV over 30 min if this does not work
check for dehydration, renal disease, heart disease before mannitol
After glaucoma in one eye develops, what should you do for the other eye
Unaffected eye
1) Cosopt BID- without treatment on average the other eye will spike in 4-6 months
Can start latanoprost now or wait for IOP to be in high teens
What change will you expect to see after administering Latanoprost
Miotic pupil
3yo MN Lab
hunting with extensive travel to surrounding states
has had ticks in the past
has been squinting with red and slightly cloudy eyes OU for a few days
-Mild miosis OU, but PLR and menace intact OU
moderate episcleral congestion
3+ flare OD, 1+ flare OS
Rubeosis irides OU
STT: 28mm/min OD, 25mm/min OS
IO: 7mmHg OD, 10mmHG OS
Negative stain OU
What is the diagnosis? How do you fix it?
Dx: Anterior Uveitis
Do additional diagnostics
-CBC/Chem/UA
-4DX / Accuplex
-Fungal testing if in endemic areas
-Systemic staging: thoracic rads, abdominal US, LN aspirates
Treatment plan:
1) Prednisone PO BID on a tapering dose
2) Prednisolone acetate 1% QID
3) Atropine 1% if miotic and painful.
if mild uveitis give one dose
Recheck in 1 week
What are the causes of uveitis in dogs
-Idiopathic
-Trauma
-Immune mediated (lens induced)
-Reflex
-Infectious : rickettsial- anterior, fungal - posterior
-Neoplasia (primary ocular vs metastatic - lymphoma in particular
What are the causes of uveitis in cats
-FeLV
-FIV
-FIP (dry)
-Fungal
-Toxoplasma
-Bartonella
-Immune mediated
-Neoplasia
What are the causes of uveitis in horses
-Equine Recurrent Uveitis
-Borrelia
-Sepsis
-HIK
-Neoplasia
a condition characterized by the abnormal growth of new blood vessels (neovascularization) on the surface of the iris, the colored part of the eye
Rubeosis irides
What additional diagnostics should you do for hypertensive retinal detachment
Blood pressure
CBC/Chem/ UA, T4
Renal disease, hyperthyroid, cardiac disease are possible causes of hypertension in cats
How do you treat hypertensive retinal detachment
Amlodipine (Telmisartan*)
Analapril
prognosis is good if minimal hemorrhage and caught within one week
recheck BP in 1 week
Recheck BW in 1 month
can unmask renal disease
jagged or serrated junction where the photosensitive part of the retina transitions to the non-visual, non-sensory parts covering the inner surface of the ciliary body and iris.
The ora ciliaris retinae,
What diagnostic test would you recommend to confirm cause for retinal detachment
Blood pressure
What is the prognosis for patient’s systemic health with meibomian gland adenoma
good
A dog presents with a history of mucoid discharge. Which diagnostic test must be performed first?
Schirmer tear test
Which is considered a NORMAL Schirmer Tear Test result?
> 15mm/min
You confirm a diagnosis of Keratoconjunctivitis Sicca. What drug should this patient be started on?
Cyclosporine
Which is not a common cause for the development of cataracts.
Inherited
Cushing’s disease
Old Age
Inherited/Genetic
Cushing’s Disease
What treatment should a patient be on when they have a mature cataract
Ketorolac (NSAID)
White Blood Cells in the anterior chamber
Hypopyon
Red Blood Cells in the anterior chamber
hyphema
Excessive tearing
epiphora
Enlarged globe
Buphthalmos
Globe that is pushed forward but is still behind the eyelids
exophthalmos
Inability to completely blink
Lagophthalmos
Shrunken/Dead eye
Phthisis bulbi
Drooping eyelid
ptosis
What oral medication should be used to treat the ulcers seen with FHV-1
Famciclovir
