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VET 433a - Small Animal Stream 1 > Ophtho > Flashcards

Ophtho Flashcards

Exam 2

1
Q

4 primary layers of the Adnexa

A

skin
orbicularis oculi m.
meibomian glands
palpebral conjunctiva

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2
Q

Orbicularis oculi muscle (purpose/ uses)

A

closed eyelids
responsible for blepharospasm
invervated by CN VII
surgical holding layer

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3
Q

Meibomian glands (purpose/ uses)

A

lipid layer tear film
distichiasis, ectopic cilia
duct is surgical landmark

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4
Q

palpebral conjunctiva (purpose/ uses)

A

goblet cells produce mucous for tear film

source of tissue for surgery

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5
Q

Superior palpebral levator muscle

A

open upper eyelid

innervated by CN III

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6
Q

Müller’s muscle

A

smooth muscle
sympathetic innervation
maintains palpebral fissure opening

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7
Q

Functions of the Adnexa

A
  • general eye protection
  • spread tear film and prevent evaporation
  • produce portions of tear film
  • contains portions of tear drainage system
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8
Q

What is blepharospasm

A

involuntary tight closure of the eyelid

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9
Q

General signs of disease of the Adnexa

A

redness
swelling
blepharospasm

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10
Q

Entropion

A
  • rolling in of eyelid margin
  • can be congenital, spastic, or cicatricial (from scar tissue)
  • dogs most common (also sheep and pot-bellied pigs)
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11
Q

Entropion (clinical signs)

A
  • larger dogs, lateral aspect lower lid
  • belpharospasm
  • epiphora (wetness along lower, lateral eyelid margin
  • corneal vessels, melanosis, esp ventrolaterally
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12
Q

Entropion (Causes)

A
  • inherited
  • spastic
  • Cictricial
  • Fat deposition (pigs)
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13
Q

Entropion (Diagnosis)

A
  • signalment

- clinical signs

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14
Q

Entropion (treatment)

A
  • Adolescents (lubrication, tacking)

Adults (surgical repair via Hotz-Celsus or “smile”)

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15
Q

Chronic epiphora syndrome

A
  • underlying problem medial entropion, lower lid
  • > malposition lacrimal punctum
  • > “crimping” canaliculus
  • > Trichiasis
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16
Q

Chronic epiphora syndrome (Signs)

A
  • chronic tear staining from medial canthus

- secondary moist dermatitis (brachycephalics)

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17
Q

Chronic epiphora syndrome (Cause)

A
  • Entropion medial aspect lower lid

- breed related (chich, poodles)

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18
Q

Chronic epiphora syndrome (treatment)

A
  • benign neglect

- Hotz-Celsus or “smile” surgery

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19
Q

Ectropion

A
  • majority dogs, breed related ( cockers , bloodhounds, giant breeds)
  • age-related
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20
Q

Ectropion

A
  • loss of contact lower eyelid with eye
  • leads to secondary corneal problems
  • > blepharospasm
  • > epiphora
  • > corneal vessels
  • > corneal melanosis
  • > corneal ulceration
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21
Q

Ectropion (Causes)

A
  • inherited

- age related

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22
Q

Ectropion (treatment)

A
  • often not necessary
  • lubricating ointments
  • antibiotics or steroid ointments
  • wedge resection
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23
Q

Meibomian Adenoma (Signs)

A
  • papilloma-like projection from margin
  • swelling affected gland
  • upper lid more common
  • variable size
  • blepharospasm if ulcer
  • met very rare
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24
Q

Meibomian Adenoma (Cause, Diagnosis)

A

Cause: Age-related
Diagnosis: Signalment, Signs, Biopsy

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25
Q

Meibomian Adenoma (treatment)

A
  • curettage and cryotherapy

- wedge resection

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26
Q

Most common Adnexa Neoplasias (canine)

A
  • meibomian adenoma
  • papilloma
  • melanoma
  • 2ary lymphoma
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27
Q

Most common Adnexa Neoplasias (feline)

A
  • squamous cell carcinoma
  • fibrosarcoma
  • mast cell tumor
  • basal cell carcinoma
  • 2ary lymphoma
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28
Q

Feline squamous cell carcinoma (Signs)

A
  • ulcerative lesions
  • lower lid
  • white or light pigmentation
  • met late
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29
Q

Feline squamous cell carcinoma (Cause)

A
  • lack of eyelid pigmentation

- UV exposure

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30
Q

Feline squamous cell carcinoma (treatment)

A
  • radiotherapy =)
  • surgical excision
  • cryotherapy
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31
Q

Distichiasis

A
  • meibomian glands modified hair follicles
  • undifferentiated gland produces cilia
  • cilia emerges form meibomian gland duct
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32
Q

Distichiasis (signs)

A
  • difficult to see without magnification
  • fine hairs emerging from eyelid margin
  • usually does not cause disease
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33
Q

Distichiasis (cause)

A
  • inherited

- developmental

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34
Q

Distichiasis (treatment)

A
  • manual epilation initially to confirm dx

- cryotherapy

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35
Q

Ectopic cilia

A
  • similar to distichiasis, cilium from meibomian glands

- cilium protrudes through palpebral conjunctiva

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36
Q

Ectopic cilia (signs)

A
  • 8-12 months of age
  • marked blepharospasm, epiphora
  • vertically linear superficial corneal ulcer
  • raised papilla, 12 o’clock position on upper lid
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37
Q

Ectopic Cilia (cause)

A
  • inherited

- developmental

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38
Q

Ectopic Cilia (Treatment)

A
  • excision

- cryotherapy

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39
Q

Trichiasis

A
  • hair from normal site in contact with ocular surface

- most frequent in dogs (bracycephalics + long facial hair breeds)

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40
Q

Trichiasis (signs)

A
  • periocular hair touching ocular surface
  • medial canthus, nasal folds
  • usually do not cause irritation
  • often “wick” tears onto face
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41
Q

Trichiasis (Cause, Diagnosis)

A

Cause: breed related, conformational
Diagnosis: signalment, clinical signs

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42
Q

Trichiasis (treatment)

A
  • usually not indicated
  • cryotherapy
  • lid surgery
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43
Q

Traumatic Injuries (treatment)

A
  • minimal debridement
  • 2 layer closure for lacerations (orbicularis oculi muscle is holding; skin needs careful alignment of margins)
  • reconstruction of inferior NL system
  • systemic, topical antibiotics
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44
Q

Bacterial blepharitis

A
  • overgrowth surface bacterial flora
  • ascends into eyelid via meibomian ducts
  • Staph and Strep spp.
  • Staph toxins exacerbate
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45
Q

Bacterial blepharitis (signs)

A
  • severe eyelid swelling
  • blepharospasm
  • excoriation
  • alopecia
  • mucopurulent discharge
  • granuloma formation
  • bilateral and recurrent (Dogs)
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46
Q

Bacterial Blepharitis (Cause and Dx)

A

Cause: infection from ascending bacteria, fight wounds
Dx: clinical signs, biopsy, culture and sensitivity

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47
Q

Bacterial Blepharitis (treatment)

A
  • topical antibiotic/ steroid (Neomycin and Polymyxin + dexamethasone)
  • oral antibiotics (cephalexin)
  • oral prednisone
  • warm compress
  • autogenous vaccines
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48
Q

Chalazion

A
  • obstructed meibomian duct
  • accumulation secretion
  • rupture of gland
  • granulomatous reaction
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49
Q

Chalazion (signs)

A
  • nodular swelling within lid
  • no inflammation
  • no pain
  • yellow/ white appearance through palpebral conjunctiva
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50
Q

Chalazion (Cause)

A
  • obstruction of meibomian gland duct

- age-related

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51
Q

Chalazion (treatment)

A
  • curettage of gland

- topical antibiotic/ steroid

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52
Q

Eyelid Agenesis (signs)

A
  • absence lateral 1/2 to 2/3 upper eyelid
  • trichiasis
  • always bilateral, but not symmetric
  • may have exposure keratitis
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53
Q

Eyelid Agenesis (Cause)

A
  • heritable or developmental
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54
Q

Eyelid Agenesis (treatment)

A
  • topical ointments
  • cryotherapy
  • blepharoplastic procedures
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55
Q

Neonatal ophthalmia

A
  • ankyloblepharon normal for cats and dogs 10-14 days
  • infection under eyelids before opening
  • Staph, strep, herpesvirus
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56
Q

Neonatal ophthalmia (signs)

A
  • inflamed, distended eyelids
  • purlent discharge
  • conjunctival hyperemia, chemosis
  • +/- corneal ulceration
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57
Q

Neonatal Ophthalmia (treatment)

A
  • open lids (digital manipulation, blunt probe)
  • flush dilute betadine solution
  • topical antibiotics
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58
Q

4 Primary layers of the cornea

A
  • epithelium
  • stroma
  • Descemet’s membrane
  • endothelium
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59
Q

Corneal epithelium

A
  • 5-10 cells thick
  • constant turnover
  • hydrophobic
  • mechanical barrier
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60
Q

Corneal Stroma

A
  • 90% thickness
  • hydrophilic
  • location of clinical signs
  • sensory innervation from CN V
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61
Q

Corneal Descemet’s membrane

A
  • basement membrane endothelium
  • elastic, last barrier to perforation
  • hydrophobic
62
Q

Corneal endothelium

A
  • Na/K pump removes fluid
63
Q

5 factors that affect corneal transparency

A
  1. avascular
  2. relatively dehydrated
  3. orderly arrangement stromal fibrils
  4. lack of pigment
  5. non-keratinized epithelium
64
Q

Corneal source of nutrition

A
  • tear film for anterior

- aqueous fluid for posterior

65
Q

Corneal functions

A
  • transmission of light
  • refraction of light
  • fibrous layer for protection
66
Q

Corneal ulcers (normal healing)

A
  • sliding (migration)
  • formation of new basement membrane
  • dividing (mitosis)
67
Q

Uncomplicated corneal ulcer (signs)

A
  • epithelium only, no stromal loss
  • heals in ~7 days
  • no change in stromal character
  • no extensive vascularization
  • miosis due to reflex uveitis
68
Q

Uncomplicated corneal ulcer (management)

A
  • topical steroid contraindicated
  • topic broad spectrum abx
  • topical atropine, q24hr
69
Q

Complicated corneal ulcer (signs)

A
  • increasing depth, non-specific
  • stromal infiltrate, specific
  • change in stromal character (melting)
  • corneal vascularization, non-specific
  • hasn’t healed in 7-10 days, non-specific
  • loose peripheral epithelium, specific
70
Q

Complicated corneal ulcer (common causes)

A
  • infection
  • foreign bodies
  • exposure
  • entropion
  • ectopic cilia
71
Q

Signs of infected ulcer (complicated)

A
  • all signs of complication possible

- stromal infiltrate, melting specific

72
Q

Diagnosis of infected ulcer

A
  • cytology

- culture and sensitivity

73
Q

Treatment of infected ulcer

A
  • referral
  • vigorous abx (q2hr)
  • topical serum
  • E-collar
  • warm compress
74
Q

Signs of exposure ulcer (complicated)

A
  • most frequent w/ brachycephalics
  • centrally loacated
  • round, firm edges
75
Q

Treatment of exposure ulcer

A
  • frequent abx ointment
  • +/- topical atropine
  • consider tarsorrhaphy
76
Q

Signs of ersistent ulcer syndrome or SCCED

A
  • middle-aged or older
  • superficial
  • redundant epithelium around periphery
77
Q

Treatment of persistent ulcer syndrome

A
  • corneal debridement
  • grid keratotomy or diamond burr (dogs only)
  • meidcal tx as uncomlicated
78
Q

Chronic superficial keratitis

A
  • immune-mediated
  • breed related (GSD)
  • environmental (UV light)
  • referred to as ‘pannus’
79
Q

Chronic superficial keratitis (signs)

A
  • Acute/ Active (fibrovascular invasion, ventrolateral thickening, 3rd eyelid thickening)
  • Chronic (corneal melanosis, blindness)
80
Q

Chronic superficial keratitis (cause)

A
  • genetics/ UV lights –> stromal protein alteration –> loss of immunotolerance –> inflammatory response
81
Q

Chronic superficial keratitis (treatment)

A
  • topical steroids
  • topical cyclosporine
  • maybe seasonal, often lifelong)
82
Q

Exposure Keratitis

A
  • usually dogs
  • incomplete blinking
  • eyelids ‘gap’ open while sleeping
  • senile change
  • cats w/ eeylid agenesis
    secondary to eyelid injury
83
Q

Exposure Keratitis (signs)

A
  • corneal vessels, melanosis medially

- may lead to ulcers

84
Q

Exposure Keratitis (Cause)

A
  • conformation
  • developmental
  • Age related
  • Eyelid inuury
85
Q

Exposure Keratitis (treatment)

A
  • if ulcer –> refer
  • surgery for agenesis or lid problem
  • abx/ steroid ointment QID until keratitis controlled, then reduce
  • topical lube long term
86
Q

Corneal Degeneration (Signs)

A
  • crystalline to chalky deposits composed of lipids of Ca salts
  • superficial w/in cornea
  • older patients
87
Q

Corneal Degeneration (Cause)

A
  • aberrant healing response

- 2ary to trauma, irritation, inflammation

88
Q

Corneal Degeneration (Treatment)

A
  • topical abx treatment

- chemical keratectomy

89
Q

Corneal Dystrophy (Signs)

A
  • crystalline ‘ground glass’ deposits
  • under corneal epithelium
  • bilateral, not symmetric
  • no pain, inflammation, vision change
  • early age onset (1-2 years)
90
Q

Corneal Dystrophy (cause)

A
  • heritable
91
Q

Corneal Dystrophy (treatment)

A
  • not indicated
92
Q

Feline Herpesvirus (Signs)

A
  • blepharospasm, epiphora
  • conjunctival hyperemia
  • chemosis
  • corneal vessels
  • linear (dendritic) ulcers [pathopneumonic]
  • focal, pinpoint cellular infiltrate
93
Q

Feline Herpesvirus (Treatment)

A
  • suppression of signs, not cure
  • topical antivirals (cidofovir)
  • oral antivirals (famciclovir)
  • topical steroids contraindicated
94
Q

Corneal Sequestrum (unique to what species)

A
  • cats
95
Q

Corneal Sequestrum (signs)

A
  • dark brown plaque, represents necrotic stroma
  • not melanin
  • painful, can lead to rupture
96
Q

Corneal Sequestrum (cause)

A
  • herpesvirus

- chronic exposure

97
Q

Corneal Sequestrum (treatment)

A
  • slough

- keratectomy

98
Q

Eosinophilic Keratitis (signs)

A
  • cats and some horses
  • fibrovascular infiltrate
  • ‘caseous’ islands
99
Q

Eosinophilic Keratitis (Cause)

A
  • herpesvirus
100
Q

Eosinophilic Keratitis (treatment)

A
  • topical steroids
  • topical antivirals
  • megesterol acetate
101
Q

Corneal Neoplasia - Canine

A

Primary - Limbal melanoma, hemangiosarcoma/carcinoma

Secondary - Lymphoma

102
Q

Corneal Neoplasia - Feline

A

Primary - Limbal melanoma/ melanocytoma

[ Lymphoma and SCC very rare]

103
Q

Limbal Melanoma (signs)

A
  • dark mass, centered on limbus
  • extends both ways
  • unilateral
104
Q

Corneal Dermoid (treatment)

A
  • keratectomy

- reconstruct lateral canthus

105
Q

Corneal Dermoid (what is it)

A
  • normal tissue in abnormal location
106
Q

Parts of the tear film

A
  • Lipid Layer (meibomian)
  • Aqueous Layer (lacrimal and 3rd eyelid gland)
  • Mucous Layer (goblet cells)
107
Q

Lacrimal Drainage Apparatus

A
  • lacrimal puncta
  • canaliculi
  • nasolacrimal duct
  • nasal punctum
108
Q

Functions of the lacrimal system

A
  • provides nutrition to occular surface
  • removes metabolites, waste, debris
  • provide lubrication to occular surface
109
Q

A patient has presents with mucoid ocular discharge, what is the first thing you will do before any other diagnostics?

A
  • Shirmer Tear Test
110
Q

Lacrimal System Diagnostics

A
  • Shirmer Tear Test
  • Fluorescine Dye Passage
  • Nasolacrimal (NL) flush
111
Q

Two causes of discharge

A
  • overproduction

- lack of drainage

112
Q

Keratoconjunctivitis sicca (signs)

A
  • mucoid discharge
  • blepharospasm
  • conjunctival hyperemia
  • 360 corneal vessels
  • corneal melansosis
113
Q

Keratoconjunctivitis sicca (causes)

A
  • immune-mediate (most common)
  • drugs (TMS, atropine, anesthesia)
  • ioatrogenic (removal of 3rd eyelid)
  • trauma to lacrimal nerve
114
Q

Keratoconjunctivitis sicca (Diagnosis)

A
  • signs + STT
115
Q

Keratonconjunctivitis sicca (treatment)

A
  • topical cyclosporine

- topical antibiotic/ steroid

116
Q

Developmental Drainage Obstruction (signs)

A
  • dogs have epiphora from birth
  • fluorescine dye passage poor or negative
  • NL flush nothing from inferior punctum
  • horses have chronic purulent discharge
117
Q

Developmental Drainage Obstruction (treatment)

A
  • in dogs – incise conjunctiva over imperforate punctum
  • topical abx/ steroid combination
  • in horses, cannulate
118
Q

Foreign Body Obstruction (signs)

A
  • blepharospasm
  • mucupurulent discharge
  • medial canthal swelling
  • (-) fluorescin dye passage
119
Q

Foreign Body Obstruction (Treatment)

A
  • vigorous flushing +/- anesthesia
  • dislodge/ retrieve fb
  • cannulate NL system
  • Abx/ steroids
120
Q

Inflammatory Obstruction (Causes)

A
  • descending infection w/ stagnant tear drainage
121
Q

Inflammatory Obstruction (signs)

A
  • mucopurulent discharge
  • no medial canthal swelling
  • (-) fluorescin dye passage
  • NL flush easy, mucoid plug
122
Q

Inflammatory Obstruction (Treatment)

A
  • NL flush (+/- betadine)

- abx/ steroid

123
Q

Functions of the anterior uvea

A
  • regulate light entry
  • accomodation
  • produce aqueous
124
Q

Anterior Uveitis (active - signs)

A
  • Aqueous flare
  • miosis
  • hypopyon or hyphema
  • keratic precipitates
  • iris bombé
  • corneal edema
  • episcleral injection
  • corneal vessels
  • dec IOP initially
125
Q

Anterior Uveitis (inactive- signs)

A
  • corneal scarring
  • posterior synechia
  • iridial scarring
  • cataracts
  • glaucoma, buphthalmos
126
Q

Anterior Uveitis (pathogenesis)

A
  • damage to anterior uvea –> release mediators inflammation –> increase vascular permeability -> breakdown BAB –> leakage of protein, fibrin, cells into aqueous
127
Q

Anteriur Uveitis (treatment)

A
  • topical steroid, NSAIDS, atropine
128
Q

Anterior Uveal Neoplasia (top 3)

A

1* - melanoma, ciliary body adenoma/ carcinoma

2* - Lymphoma

129
Q

Treatment of Anterior Uveal Neoplasia

A
  • enucleation
130
Q

Uveal cysts (signs)

A
  • 3 locations (posterior surface or iris/cb, pupillary margin, free floating in AC)
  • +/- transillumination
131
Q

Uveal Cysts (cause)

A
  • idiopathic

- 2* to inflammation

132
Q

Uveal cysts (treatment)

A
  • not necessary
133
Q

Iris Atrophy (signs)

A
  • scalloping at pupil margin
  • moth eaten appearance to iris stroma
  • slow PLRs
  • anisocoria
  • dyscoria
134
Q

Iris Atrophy (treatment)

A
  • not indicated
135
Q

Persistent pupillary membrane (signs)

A
  • originate @ collarette region of iris (iris-iris, iris-ant lens, iris-post. cornea)
136
Q

Persistent pupillary membrane (cause)

A
  • heritable in certain breeds

- developmental defect

137
Q

Persistent pupillary membrane (treatment)

A
  • usually not indicated

- iris > lens cataract surgery

138
Q

Glaucoma (progression)

A
  • peracute onset pressure spike
  • initially unilateral
  • fellow eye affected 6-12 months
139
Q

Glaucoma (primary mechanism)

A
  • decreased outflow of aqueous humor
140
Q

Glaucoma (signs - chronic)

A
  • buphthalmos
  • corneal striae, fibrosis
  • lens (sub)luxation
  • mydriasis
  • ‘cupped’ optic disk
  • tapetal hyper-reflectivity
  • retinal vascular attenuation
141
Q

Glaucoma (cause)

A
  • iridocorneal angle increasingly compromised first few yers of life
  • drainage angle collapsed
  • IOP spikes
142
Q

Causes of 2* Glaucoma

A
  • Anterior Uveitis (#1 cause)
  • lens luxation/ subluxation
  • intraocular neoplasia
143
Q

Glaucoma (treatment)

A
  • Mannitol (acute decrease in IOP by pulling fluid out of vitreous humor)
  • Methazolamide (oral carbonic anhydrase inhibitor – not really used)
  • Topical Meds [Xalatan (topical prostaglandin -> miosis), Dorzolamide (CA inhibitor will dec production), Timadol Maleate (B-blocker)]
144
Q

3 structural elements of the lens

A
  • lens capsule (barrier function)
  • lens epithelium (multiple through life)
  • lens fiber cells (transparent d/t orderly arrangement)
145
Q

Reasons for lens transparency

A
  • absence of blood vessels
  • lack of pigmentation
  • orderly arrangements of lens fiber cells
146
Q

Cataracts (4 classifications)

A
  1. incipient - focal, no intereference w/ vision
  2. incomplete - diffuse, + tapetal reflection
  3. complete - vision loss
  4. resorbing - crystalline, wrinkled ALC, deep AC, some degree of lens-induced uveitis
147
Q

Cataracts (causes)

A
  • disruption in lens-cell fibers
  • -> inherited
  • -> diabetes mellitus
  • -> anterior uveitis (most common in cats/horses)
  • -> senility (usually do not progress to vision impairment)
  • -> trauma
148
Q

Cataracts (treatment)

A
  • surgery
149
Q

Lens Sub-Luxation (signs)

A
  • shalow or uneqal ant. chambers
  • anisocoria
  • aphakic crescent
  • vitreous strands through pupil
  • iridodonesis
  • glaucoma
150
Q

Anterior Uveitis (causes)

A
  • infectious
  • immune-mediated
  • neoplastic
  • metabolic (systemic hypertension)
  • traumatic (blunt or perforating)
  • idiotpathic (#1 cause)

VET 433a - Small Animal Stream 1 (10 decks)

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