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Small animal med > Ophtho > Flashcards

Ophtho Flashcards

1
Q

4 components of 3rd eyelid

A
  • cartilage
  • lacrimal glands
  • lymphoid nodule
  • conjunctiva
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2
Q

Muscle closing eyelid

- CN innervation

A
  • obicularis m.

- CN 7

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3
Q

M. opening eyelid

- CN innervation

A
  • levator palpebral superioris

- CN 2

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4
Q

3 layers of tear film, their composition, made by what?

A
  • meibum: lipid from meibomia gland
  • aqueous: water from lacrimal gland
  • mucin: glycoprptein from conjunctival
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5
Q

3 layers of cornea

A
  • epi
  • stroma
  • endothelium –> incl descemet
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6
Q

Corneal epi

  • histo epi type
  • water affinity
  • function
A
  • non-keratinized strat epi
  • lpophilic
  • mech barrier
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7
Q

Corneal stromal

  • histo
  • water affinity
  • innervated by
A
  • collagen fiber
  • hydrophilic
  • CN5
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8
Q

3 parts parts of uvea

- function

A
  • iris: controls pupil opening
  • ciliary: aqueous humour prod
  • choroid: supplies nutrients to retina
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9
Q

3 chambers

A
  • anterior
  • prosterior
  • vitreal
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10
Q

Eye dev sequence roughly

A

Optic vesicle grows out –> optic cup –> hyaloid vascular system –> lens placode invagination –> optic fissure closes –> formation of vitreal and anterior chambers

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11
Q

What is persistent pupillary membrane formed from

A
  • reminent of part of iris and hyaloid vascular system that was suppose to degrate in embryogenesis
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12
Q

How does cataracts form from embryogenesis

A
  • as lens placode invaginates, forms nucleus of lense –> if issue, get cataracts
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13
Q

Microphthalmia

  • what
  • cause
  • tx
A
  • small ocular globe
  • congenital
  • if severe enucleate
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14
Q

Congenital strabismus cause

A

Muscle or innervation issue

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15
Q

Congenital exophthalmos

  • breed
  • cause
  • sequalae
  • tx
A
  • brachys
  • shallow orbit
  • can’t blink well
  • canthoplasty (ie lengthening of the palpebral fissure of the eyelids by cutting through the external canthus.)
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16
Q

Extraocular (eosinophilic) myositis

  • sign
  • dx
  • tx
A
  • bilat exophthalmos, painful mastication if eosinophilic, m. atrophy
  • m. biopsy
  • corticosteroid
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17
Q

Neoplasia in orbit

  • sign
  • malignancy
  • dx
  • tx
A
  • progressive exophthalmia, no pain opening mouth
  • often malignant
  • CT, MRI
  • sx, +/- radiation
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18
Q

Enophthalmia

  • what
  • 4 main types of cause
A
  • eye abn sunken into orbit

1) loss of orbital tissue: dehydration, cachexia, m loss, etc.
2) trauma: fracture
3) Horners
4) ocular pain: e.g. corneal ulcer, uveitis

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19
Q

3 eye removing sx and what happens in them

A

1) enucleation: remove eye globe
2) exenteration: remove globe and orbital content
3) evisceration: remove globe contents but leave sclera

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20
Q

2 approaches to enucleation

A

1) tran-conjunctival: lateral canthotomy –> dissect away conjunctiva –> cut from m. and optic n. –> take globe out –> remove 3rd eyelid –> close
2) trans-palpebral: suture eyelids closed –> dissect away globe –> cut m. and nerve –> close

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21
Q

Evisceration step

A
  • incise conjunctiva and sclera –> remove intraocular content –> replace with silicone prosthesis –> close
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22
Q

When do you do orbitotomy

A
  • to explore orbit

- referral proceedure

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23
Q

Define:

  • distichiasis
  • ectopic cilia
  • triachiasis
A
  • hair growing from meibomian gland touching cornea
  • hair growing from meibomian gland exits at palpebral conjunctiva and rubs against cornea
  • hair growing form normal position touching cornea
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24
Q

Entropion

  • what
  • sequelae
  • tx
A
  • eyelids roll in
  • hair rubs against cornea
  • tacking suture if temp, surgery
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25
Q

Ectropion

  • what
  • sequelae
  • tx
A
  • eyelids rolling outwards
  • conjunctivitis
  • sx
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26
Q

Blepharitis

  • what
  • causes
A
  • inflammation of eyelids

- chalazion, hordoleum, cellulitis, allergy, parasites, immune-med

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27
Q

What is cherry eye? What does it look like? tx?

A
  • prolapsed glands of 3rd eyelid
  • pink ovoid mass in corner of eye
  • sx
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28
Q

Everted cartilage of 3rd eye lid

  • cause
  • tx
A
  • genetic

- remove bent stem

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29
Q

Follicular conjuntivitis of 3rd eyelid

  • signs
  • tx
A
  • lympoid hyperplasia, conjuncitivitis, mucupurulent d/c

- debride follicles, abx and steroid drops

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30
Q

Keratoconjunctivitis sicca

  • what
  • pathophys
  • cause
  • dx
  • tx
A
  • dessication of cornea
  • lack of nutrients and moistured from lack of good tear film –> vessels gorw in –> melanocytes
  • immune-mediated, genetic, neurogenic, infectious, drug (e.g. opiod, TMS), gen anaesth
  • Schirmer tear test
  • tear stimulant (cyclosporin, tacrolimus, pilocarpine), tear supp, parotid duct transposition
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31
Q

Normal value for Schirmer tear test

A

15-25mm/min

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32
Q

Epiphora

  • what
  • cause
A
  • excessive tearing

- irritation, improper drainage from NL-duct system

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33
Q

2 ways NL system fails to cause epiphora

  • cause
  • dx
  • tx
A

1) imperforated puncta
- congenital
- sx
2) obstruction of duct
- infection, chronic swelling of medial lower canthus
- CT skull
- sx

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34
Q

Definition of chemosis

A

Pouching out of conjuncita from edema

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35
Q

Conjunctivitis

  • signs
  • causes
  • dx
  • tx
A
  • dilated blood vessels in conj., chemosis, ocular d/c
  • KCS, corneal ulcer, infection, intraocular dz
  • culture, biopsy –> often not done though?
  • broad spec abx
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36
Q

Conjunctival haemorrhage

  • what
  • cause
  • tx
A
  • blood btw conj and sclera
  • trauma, coagulopathy, high BP
  • tx underlying cause, support, resolves by self
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37
Q

Conjunctival dermoid

  • what
  • cause
  • tx
A
  • skin cells on conjunctiva, may grow hair
  • congenital
  • excision
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38
Q

Scleritis

  • what
  • cause
  • breed
  • tx
A
  • inflammation of sclera
  • immune-med, uveritis
  • corticosteroid, cyclosporine –> aim to aim
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39
Q

Most common mass on sclera

  • dx
  • tx
A
  • nodular granulomatous episcleritis
  • biopsy
  • tetracycline/niacinamide
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40
Q

Corneal ulcer (aka ulcerative keratitis)

  • what happens
  • cause
  • signs
A
  • no epi, stromal loss
  • trauma, infection, KCS
  • painful
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41
Q

3 types of corneal ulcers and what makes them that type

A

1) Simple
- superficial, only epi
- no infection, vascularization, or pigmentation

2) Complex
- depth beyond epi, infected, corneal edema, vascularization if chronic, +/- melting

3) Recurrent
- chronic, superficial (only epi), not infected, loose epi edges
- stromal hylaine membrane forms –> epi can’t anchor to heal

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42
Q

How does corneal epi heal?

What about cornea?

What if hit endothelium

A
  • Epi detach from anchor –> migrate and thing out over lesion –> proliferate
  • keratocyte proliferate –> become fibroblasts –> form collage bundles; can scar is collagen not organized
  • endothelial cells spread and enlarge
  • -> corneal edema if defect too large
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43
Q

Tx for the 3 diff types of ulcers

A
  • in gen: recheck in 24-48h to ensure protocol working
  • Topical steroids and NSAIDS contra-indicated!!!**

1) Simple: fix initial cuase, abx (-cidal) QID, +/- atropine for pain, E-collar,
- recheck 3-5d

2) Complex:
- debride, flush, topical abx, serum if melting, atropine, systemic NSAID,
- recheck 24h
- sx: keratectomy, conj graft, enucleation

3) Recurrent:
- corneal debridement, grid kertotomy
- abx, atropine, +/- analgesia, +/- systemic NSAD, +/- contact lens
- recheck 7d

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44
Q

Pigmentary keratitis

  • what
  • cause
  • dx
  • tx
A
  • melanocytes in epi
  • chronic irritation, KCS, pug predisposed
  • Shimir tear test, fluorescein stain
  • remove insult, lub, steroids, cyclosporine
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45
Q

Chronic superficial keratitis

  • breed
  • sign
  • cause
  • dx
  • tx
A 
- GSD, Grey hounds-
 neovascularization, pigmentation
- immune-mediated
- cytology (see plasma cells)
- steroid, cyclosporine, no cure
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46
Q

Ddx corneal dystrophy vs degeneration

A
  • dystrophy: inherited, bilat, pri dz, issue in central cornea, no vasc or blindness
  • degeneration: acquire, unilat, secondary dx, can occur anywhere on cornea, yes vasc, +.- ulcer
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47
Q

Endothelial dystrophy

  • pathophys
  • tx
A
  • abn endothelial cells –> corneal edema –> form bubbles = epi bullae formation –> chornic ulcer
  • hypertonic saline, thermkeratoplasty, conj graft, corneal transplant
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48
Q

What could a corneal mass be

- tx

A
  • congenital
  • hair
  • pigment
  • hemangioma
  • keratectomy –> corneal ulcer –> heal
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49
Q

What makes aqueous humor? Where does it drain?

A
  • ciliary body

- iridocorneal angle

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50
Q

Glaucoma

  • what
  • pathophys
A
  • incr intraocular pressure

- imparied drainage –> incr pressure –> ischemia and hypoxia –> cell death incl of n.

51
Q

Causes of glaucoma

- which breed predisposed to each type

A
  • congenital –> any
  • primary: irido-corneal angle close/narrow, goniodysgenesis (angle abn) –> Cocker, Boston, Basset
  • secondary to other dx (e.g. lens lux, uveitis, formation of membranes over angle, neoplasia)
52
Q

What are 2 diseases of irido-corneal membrane

A
  • pre-iridofibrovascular membrane –> from retinal detachement –> incr VEGF –> membrane formation
  • corneal endothelial overgrowth
  • membranes are granulation that migrated to angle?
53
Q

Clinical signs of acute glaucome and chronic glaucoma

A
  • acute: red eye, conjunctivits, corneal edema, dilated fixed pupil
  • chronic: buphthalmia, exposure keratitis, corneal striae, fixed dilated pupil, retinal atrophy, blind eye
54
Q

What is corneal striae

A
  • white lines from desment’s membrane breaking
55
Q

Dx for glaucoma

A
  • PLR to check for blindness
  • flourescein stain
  • IOP
56
Q

Medical tx for glaucoma

  • drug options
  • primary
  • w/ uveitis
A
  • osmotic diuretics, carbonic anhydrase inhibitor, prostaglandin analouge, B-antagonist
  • post. ana + CAI + B-blocker
    • mannitol if corneal edema
  • CAI + B-blocker + corticosteroids
57
Q

Lens luxation

  • breed
  • 2 positions
  • tx
A
  • terrier
    1) anterior lens lux: sx extraction, enucleation if blind
    2) prosterior: topical prostalglandin, topical corticosteroid
58
Q

What is aqueocentesis

A
  • pulling aq humor out via needle

- contraversial tx for glaucoma

59
Q

What can be given in concern of reperfusion injury in glaucoma tx

A

Calcium channel blocker

60
Q

What are some contra-indications to glaucoma tx drugs

A
  • osmotic diuretic: diabetes, cardio, renal
  • B-blocker: cardio, asthma
  • prostaglandin: uveitis (as is an inflammatory molecule), lens lux if anterior,
61
Q

Sx tx for glaucoma

A
  • enucleation
  • evisceration
  • chemical ablation w/ gentamicin
  • laser photocoagulation of ciliary body
  • anterior chamber shunt
62
Q

Prognosis for glaucoma

A
  • congenital can only extend eye life

- good secondary if cause early

63
Q

Uveal cyst

  • 2 location
  • what
  • breed
A
  • posterior iris, ciliary body
  • fluid trapped btw 2 layers of iris
  • golden
64
Q

Persistent pupillary membrane

  • what
  • can go btw iris and?
A
  • iris tissue that whould have disintegrated in embryo dev

- iris, cornea, lens

65
Q

Iris coloboma

  • what
  • cause
  • tx
A
  • hole in iris
  • congenital
  • no tx
66
Q

Iris atrophy

  • what
  • breed
A
  • dev or degenerative (old age) hole in iris

- small breed

67
Q

Uveitis

  • what
  • pathophys
  • signs
A
  • inflammation of uvea
  • inflamm compromises retinal-blood barrier –> more inflamm
  • pain, red eye, miosis, corneal edema, aq flare
68
Q

Aqueous flare

  • what is it
  • what can fill it
  • causes
  • dx
  • tx
  • sequelae
A
  • lit beam scattered from stuff in in aq humor
  • WBC (hyphema), RBC (hypopion), keratitic precipitate
  • infection, immune-mediated, breed predisposition, neoplasia, idiopathic
  • low IOP, BW, xray, US
  • anti-inflammatory (cort., NSAID), atropine
  • cataracts, synechiae, glaucoma, lens lux, retinal detachment
69
Q

Phacolytic vs phaclastic

A
  • phacolytic: lens protein leak out of lens into ant chamber

- phacoclastic: lens rupture

70
Q

3 Common neoplasia of uvea

  • malignancy
  • where on uvea
  • tx
A

1) melanocytoma
- benign
- iris and ciliary body
- laser, enucleation
2) Adenoma
- resect, laser, enucleate
3) lymphosarcoma
- malignant (2nd)
- chemo

71
Q

What lens shape and zonule positions for near vs distant vision

A
  • near: sphere, relaxed z

- far: ovoid, tense

72
Q

Where does lens get it’s nutrients

A

Aqueous humor

73
Q

What is microphakia? Cause?

A

Small lens

Congenital

74
Q

5 Stages of cataracts and descriptions

A

1) incipient/punctate
- small focal areas where fibres misaligned
- +ve tapetal reflect.

2) Immature/incomplete
- cataract more generalied
- protein leaking –> will induce inflamm
- +ve tapetal

3) mature/ complete/ generalized
- generalized cataract
- leak protein
- no tapetal reflect.

4) hypermature
- generalized
- lost vol from protein leak
- may see white dots on lens
- no tapetal reflect.

5) morgagnian
- resportion of lens
- +/-tapetal reflect

75
Q

What is cataracts

A

Opacity of lens

76
Q

4 components of lens

A
  • capsule
  • cortex
  • nucleus
  • equator
  • incipient cataract can be any of these places
77
Q

Causes of cataracts

A
  • congenital
  • genetic: lab, golden
  • nutrition: low arginine
  • diabetes
  • trauma
  • uveitis
78
Q

Med tx of cataracts

A
  • managelens-induced uveitis: cort or NSAID
79
Q

Things to do pre-op cataract sx?

Sx procedures

Post off care?

A
  • stabilize patient and eye
  • ERG: check vision working
  • US eye: ensure no other issues
  • Phacoemulsification, (ie break up lens and suck up), IOL
  • monitor IOP
  • wean off drugs
80
Q

Nuclear sclerosis

  • what
  • cause
A
  • nucleus of len gets condensed

- normal aging

81
Q

Lens lux causes

A
  • primary: congenital, genetic (terriers)

- secondary: uveitis, trauma, chronic glaucoma

82
Q

3 positions of lens lux and sequlae

A
  • sublux
  • prosterior –> cataracts from lack of nutrients
  • anterior –> glaucoma –> thus emergency!
83
Q

Lens lux tx options

A
  • sx extract
  • trans-corneal reduction if anterior
  • prostalglandin for miosis
  • enucleation
  • fix underlying issue too (e.g. uveitis, glaucoma, etc.)
84
Q

Eyelid agenesis in cats

  • cause
  • tx
A
  • congenital, genetic

- sx: rotational flap, cryotherapy

85
Q

Ophthalmia neonatorum

  • what
  • tx
A
  • inflammatory dz of eyelids in which neonate’s eyelids bulge before even opening, often has mucopurulent dc
  • irrigate conjunctiva, topical abx, lube
86
Q

Parasites causing blepharitis

- tx

A
  • demodex
  • Ntoedres
  • ivermectin, lime sulfur
87
Q

lipogranulomarous conjunctivitis

  • what
  • cause
  • dx
  • tx
A
  • white mass on conjuctiva from impacted mebomian glands
  • actinic radiation, ointment
  • biopsy
  • excision
88
Q

Feline herpes virus

  • signs
  • dx
  • tx
  • sequelae
A
  • dendritic ulcers which can merge to geographic ulcers, occasionally stromal keratitis
  • cytology, IFA, PCR
  • topical abx, antiviral (famciclovir, syst, trifluridine topical), lysine, lube
  • symblepharon = adhesion and scarring btw conjunctiva and cornea/3rd eyelid
89
Q

Tx for Chlamydophila cause of conjuncitivitis

Tx for mycoplasma cause

A
  • topical and systemic tetracycline

- topical tetracycline

90
Q

Corneal sequestrum

  • pathophys
  • tx
A
  • corneal ulcer –> dev black scab when healing –> may slough off
  • topical abx, sx
91
Q

Eosinophilic keratitis (cats)

  • what
  • cause
  • dx
  • tx
A
  • eosino infiltrate in cornea
  • herpes virus?
  • cytology: see eosinophil
  • control herpesvirus
92
Q

Bullous keratopathy

  • pathophys
  • tx
A
  • “focal ball” of corneal edema

- hypertonic saline, conjunctival graft, 3rd eyelid

93
Q

Common causes of cataracts in cats

A
  • congenital

- chronic uveitis

94
Q

Nutritional retinal degeneration (cats)

  • cause
  • signs
  • tx
A
  • taurine def
  • granular tapetum, hyper-reflective lesion on tapetum, loss of retinal vasculature
  • taurine supp
95
Q

hypertensive retinopathy

  • what happens
  • tx
A
  • retinal detachment from high systemic BP

- amlodipine

96
Q

Baytril toxicity in cats

  • dose
  • signs
  • tx
A
  • > 5mg/kg/d
  • acute blindness, retinal atrophy
  • stop baytril
97
Q

Common neoplasias in eye of cats

A
  • SCC
  • Iris melanoma
  • traumatic intraocular mass
98
Q

Normal variations of fundu

A
  • pigment islands in tapetum
  • abscence of tapetum
  • parital or sub
  • albunotic fundus
  • hyper-reflective area around optic nerve head
  • blue tapetum in puppies
99
Q

3 common congenital issues with retina in collies

A
  • choroidal hypoplasia
  • optic n. coloboma
  • retinal detachment
100
Q

Retinal dysplasia

  • pathophys
  • cause
  • tx
A
  • malformation of retinal layers –> folds or rosettes
  • inherited, toxic, infection
  • none
101
Q

Progressive retinal degeneration/atrophy

  • signs
  • dx
A
  • progressive loss of vision, starting with night

- fundic exam (tapetal hyperfrlec, decr arteries), ERD, genetic test

102
Q

Sudden acquired retinal degen syndrome

  • sign
  • dx
  • tx
A
  • acute hx of blindness
  • PLR normal, fundus normal, ERG
  • none
103
Q

Retinal detachment

  • what
  • cause
  • sign
  • dx
  • tx
A
  • photoreceptor detachses from retinal pig epi
  • exudate (e.g. infect, BP), tear, traction bands from fibrous tissue
  • blindness, dilated pupil
  • BW, look for underlying dz
  • tx underlying cause, sx
104
Q

2 things toxic to retina, how, and tx

A
  • ivermectin: retinal edema, fluids

- Baytril (cat): retinal degen, stop baytril

105
Q

Optic n. coloboma

  • what
  • cause
  • sequlae
A
  • hole in optic n.
  • congenital
  • retinal detachment, blindness
106
Q

Optic n. neuritis

  • cause
  • sign
  • dx
  • tx
A
  • inflamm., (G)ME
  • blind (no PLR nor menance)
  • MRI. CSF
  • systemic anti-inflamm.
107
Q

3 main components that need to be functional for vision

A

1) ocular globe (esp transparency of cornea, lens, chamber; retina)
2) optic n.
3) brain

108
Q

What is used mostly in night vs day vision? What’s the fancy word for night and day vision?

A
  • night = scotopic –> cones

- day = photopic –> cones

109
Q

what is hyperopia vs myopia

A
  • hyper = far sighted

- myopia = near

110
Q

Patient prep for ophtho sx

A
  • clip
  • scrub
  • povidone-iodine solution
  • avoid -OH and H2O2 and chlorohex
111
Q

Position for eyelid vs orbital sx

A
  • eyelid: sternal

- orbital: lateral

112
Q

Post-op things we want after eye sx

A
  • slow wake-up

- analgesia (opioid, NSAID), E-collar, harness walk

113
Q

Orbital abscess

  • common hx
  • signs
  • dx
  • tx
A
  • dentistry recently
  • exophthalmia, prolapsed 3rd eyelid, retrophulsion of globe, painful opening mouth
  • PLR, flouro stain, oral exam, eye US
  • abx, NSAID, sx drain?
114
Q

Proptosis

  • what
  • dx
  • tx
  • recheck
  • prognosis
A
  • eye out of socket
  • check PLR and fluoro stain
  • tarsrrhaphy (suture eyelids closed), abx
  • 1-2d
  • good with +ve direct PLR, worse with everything else
115
Q

orbital FB

  • dx
  • tx
A
  • ocular US, CT

- incise around FB to take out as whole, topical and systemic abx, systemic NSAID

116
Q

Lid laceration dx and tx

A
  • check cornea okay with fluoro stain

- prep area (povidine-iodine), suture close, abx, systemic NSAID

117
Q

Corneal FB

A
  • incise around FB to take out as whole, topical abx, systemic NSAID
118
Q

Corneal ulcer - ensure to check what in eye exam?

A

under 3rd eye lid

119
Q

Corneal laceration

  • dx
  • tx
A
  • Seidel’s test

- small defect can suture, large likely enucleate

120
Q

Chemical keratitis

  • sign
  • tx
  • check
A
  • corneal ulcer, miosis, pain
  • flush!, tx ulcer/uveitis
  • 3d
121
Q

Hyphema

  • what
  • dx
  • tx
A
  • blood in anterior chamber
  • PLR, IOP, fluoro, ocular US
  • tx underlying cause, corticosteroid
122
Q

Lens lux prognosis better with?

A

normal IOP

123
Q

Glaucoma an emergency?

A

YES

124
Q

Causes of acute blindness and their dx

A
  • glaucoma: IOP
  • retinal detachment: IOP
  • sudden acquired retinal degen
  • retinal toxicity: ivermectin, baytril
  • optic neuritis
  • cortical blindness (ie from brain cortex): other neuro signs

Small animal med (5 decks)

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