Ophtho - Exam

Question 1

Normal intraocular pressure in the dog and cat?

Answer 1

10-20 mmHg

Question 2

Most appropriate MDx…?

Answer 2

Episcleritis

Question 3

What are we looking at?

Answer 3

canine glaucoma
and lens subluxation

Question 4

A cat presents to you with apparent signs of a chronic URT infection and the eye looks like this. What is this called and what is the most likely diagnosis?

Answer 4

symblepharon;
pathopneumonic for FHV-1

Question 5

Mrs. Johnson just adopted a third cat. The new 5 month old kitten is getting to know the other cats, but seems to still be adjusting (she’s stressed). The kitten was brought in and presented with this eye. What do we call this? What are you suspecting?

Answer 5

Chemosis (conjunctival edema);
​Chlamydia

Question 6

Identify the pathology.

Answer 6

Feline Corneal (stromal) Sequestrum

Question 7

What are 4 brachycephalic risk factors for corneal ulcers?

Answer 7

1. Ocular prominence
2. Decreased corneal sensitivity (blink less, react less)
3. Adnexal abnormalities
4. Tear film abnormalities

Question 8

What type of ulcer is this?

Answer 8

Simple, uncomplicated, superficial

Question 9

What type of ulcer is this and how do you know?

Answer 9

Complicated, Superficial,
INDOLENT ulcer…

the fluorescein dye makes a unique halo
from staining beyond the epithelial margins

Question 10

Visual impairment,
Lens-Induced Uveitis,
(secondary) Glaucoma,
and Retinal detachment
are all sequelae of ….?

Answer 10

Cataracts

Question 11

What is the surgery indicated (only proven and effective therapy) for cataracts?

Answer 11

Phacoemulsification
(breaking up of lens cortex and nucleus with a tool that irrigates and aspirates,
then the lens is replaced)

Question 12

How do we differentiate buphthalmos from exophthalmos?

Answer 12

IOP
greater in buphthalmos

Corneal Diameter
will be larger in buphthalmos

Check for Lens Luxation
can happen secondary to buphthalmos
(normal in exophthalmos)

Question 13

What term indicates movement of the iris and is usually supportive of lens luxation?

Answer 13

iridodonesis

Question 14

Term for inflammation of the cornea;
usu. evident by presence/corneal ulceration, corneal infiltrate, or blood vessels

Answer 14

Keratitis

Question 15

Term for inflammation of the cornea
that is caused by lack of sensory innervation
(Ophthalmic br./ CN V)

Answer 15

neurotrophic keratitis

Question 16

How is retropulsion a useful test?

Answer 16

Good for assessing symmetry and detecting dz of the orbit or space-occupying dz behind the globe

Question 17

When you apply fluorescein day to ocular surface of a patient, and shortly thereafter it appears at the nares, this demonstrates nasolacrimal patency. What test is this?

Answer 17

Positive Jones test

Question 18

When you apply fluorescein dye to the ocular surface of a patient, and subsequent aqueous humor is observed leaking thru dense fluorescein stain, this confirms corneal perforation. What test is this?

Answer 18

Positive Seidel test

Question 19

What even is uveitis?

(beyond inflammation of the uvea…)

Answer 19

defined as a brkdwn of blood ocular barrier

Question 20

Vision loss that occurs from optic nerve damage as a result of high intraocular pressure is also known as?

Answer 20

Glaucoma

Question 21

What is blepharitis?

Answer 21

Inflammation of the eyelid

Question 22

Term for abnormal enlargement and position of the eyeball, only caused by glaucoma…

Answer 22

Buphthalmos

Question 23

When proteins are suspended in the anterior chamber that become evident when a narrow, bright, and focused light source is directed at the eye, what is going on?

Answer 23

• *Aqueous Flare**
• this is pathognomonic sign of uveitis*

Question 24

Orbital neoplasia*,
orbital cellulitis/abscess**,
zygomatic salivary gland mucocoele,
MMM,
extraocular myositis,
and retrobulbar hemorrhage

are all common causes of what?
(d/t orbital volume imbalance)

Answer 24

EXOPHTHALMOS!
* & ** = most common 2 conditions in k9

**=working dogs & stick chewers

Question 25

How do we treat exophthalmos d/t **orbital neoplasia**?

Answer 25

1. Globe sparing- most often palliative * radiation, Sx exploration, ChemoTx* 2. Globe removal: Enucleation or ​*Exenteration (Enucleation + removal of all orbital contents)*

Question 26

3 common mechanisms for **enophthalmos**

Answer 26

1. Orbital volume imbalances 2. Active globe retraction _[ocular pain]_ (***skeletal mm.**—\>retractor bulbi- **CN VI***) 3. Passive globe retraction (***Smooth mm./***periorbital cone—\>*Horner’s Syndrome)*

Question 27

Horner’s Syndrome is considered sympathetic denervation to the eye and what else?

Answer 27

also denervation to ocular adnexa! *\*third eyelid protrudes bc it’s passively elevating on its own\**

Question 28

T or F: Neither **microphthalmos** nor **phthisis bulbi** are usually painful.

Answer 28

Truth.

Question 29

Define **proptosis**

Answer 29

**anterior** displacement of the globe such that the eyelids are caught *behind* the equator of the globe *lids contract, constricts venous return—\>swelling \*usu involves **minimal trauma\****

Question 30

Brachycephalic dogs, \< 3 extraocular mm torn, and positive direct and consensual PLRs Are considered to indicate what type of prognosis in **proptosis**?

Answer 30

A GOOD ONE!! | (Better than that of cats & dolichocephalic k9s)

Question 31

With regard to **proptosis complications**, which extraocular m.is shortest and most easily torn, resulting in strabismus?

Answer 31

medial rectus | (CN III- also innervates D,V, and Ventral Oblique mm.)

Question 32

What do we call the conical bony structure that is part of the adnexa and contains the eyeball and _periorbital cone_?

Answer 32

bony orbit

Question 33

Term for eyelashes (cilia) which emerge from the Meibomian (tarsal) glands

Answer 33

Distichia

Question 34

Term for hairs growing from normal skin that reach the corneal and/or conjunctival surface. *Technically, entropion causes this.*

Question 35

Term for cilia that protrudes thru the palpebral conjunctiva. *typically cause severe intermittent pain and cause corneal ulceration*

Question 36

CN responsible for sensory protection of eyelid skin?

Answer 36

CN V: maxillary and ophthalmic brr.

Question 37

Dysfunction of which muscles will cause ptosis?

Answer 37

levator palpebrae superioris (_CN III: general somatic efferent)_ & Muller’s mm. (General visceral efferent) (*both open upper eyelid)*

Question 38

Which muscle closes the eyelids like a zipper and what CN is it innervated by?

Answer 38

``` orbicularis oculi CN VII (general somatic efferent) ``` **dysfunction —\> lagophthalmos**

Question 39

What’s the holding layer for surgical eyelid closure?

Answer 39

the fibrous and glandular layer of the eyelid (AKA THE TARSUS!)

Question 40

What category of entropion is related to ocular pain that stimulates active globe retraction?

Answer 40

Blepharospasm associated entropion

Question 41

What are some causes of blepharospasm associated entropion?

Answer 41

chronic ocular surface pain- from keratitis, conjunctivitis or both

Question 42

What’s the permanent correction for Entropion?

Answer 42

Modified Hotz-Celsus \*rolls out the eyelid\*

Question 43

4 common causes of Lagophthalmos

Answer 43

1. Breed variation 2. Exophthalmos 3. Buphthalmos 4. CN V or CN VII dysfunction

Question 44

CN ___ closes the eyelid whereas CN ___ opens it

Answer 44

VII; III

Question 45

Which CN provides sensory input to the eyelid and is easily detected by abnormal palpebral reflex?

Answer 45

CN V (Max & ophthalmic brr.)

Question 46

Eyelid abnormality via ptosis presenting with mydriasis is most likely indicative of what type of lesion?

Answer 46

CN III *\*less common than a sympathetic pathway lesion tho - feature of Horner’s Syndrome)*

Question 47

Most common etiology of Horner’s Syndrome?

Answer 47

idiopathic \*post-ganglionic; resolves in 6-8 wks\*

Question 48

What is the aggressive Tx for trichiasis?

Answer 48

facial fold resection or medial canthoplasty

Question 49

If distichia (ciliar that emerge from meibomian glands) is causing corneal/conjunctival dz, how would we treat?

Answer 49

cryotherapy (cryoepilation) *\***this is also how we treat ectopic cilia!\****

Question 50

T or F: ectopic cilia is hair/cilia protruding thru palpebral conjunctiva and is commonly seen in brachycephalic breeds

Answer 50

TRUE: commonly causes severe pain and corneal dz

Question 51

What are 3 common factors to consider in canine eyelid tumors?

Answer 51

1. Irritation 2. Size 3. Location

Question 52

Treatment options for k9 eyelid tumors

Answer 52

1. Debulk and cryotherapy 2. Complete excision \***always submit for histopath!\***

Question 53

4 key concepts in understanding closure of eyelid margin defects

Answer 53

1. Limited debridement ​2. Closure must be perfect (**figure 8 suture pattern** at margin) ​3. *_Avoid full thickness suture bites_* 4. Tarsus is holding layer

Question 54

If we don’t treat a prolapsed gland of TEL, what could happen

Answer 54

chronic conjunctivitis KCS

Question 55

2 common techniques for treating prolapsed TEL to replace the gland into its normal position

Answer 55

1. Morgan pocket technique 2. Orbital tacking