Ophtho Part 2

Question 1

name the muscles of mastication

Answer 1

pterygoid
masseter
temporalis

Question 2

what is exophthalmos?

Answer 2

Abnormal protrusion of normal sized globe from the orbit

Question 3

what is a classic sign you see with exophthalmos?

Answer 3

Third eyelid protrusion

Question 4

what are the two most common causes of exophthalmos

Answer 4

1. orbital/retrobulbar neoplasia
2. orbital cellulitis/abscess

Question 5

Exophthalmos
Elevated third eyelid
NO pain on mouth opening
Globe deviation (dorsolateral strabismus)

what would you think?

Answer 5

retrobulbar neoplasia

Question 6

Rapid onset, painful
Elevated 3rd eyelid
Conjunctivitis
Pain on opening mouth

what would you think?

Answer 6

orbital cellulitis/abscess

Question 7

common sign of masticatory muscle myositis

Answer 7

inflam = exophthalmos
atrophy = enophthalmos
googly eyes

Question 8

diagnostics for exophthalmos

Answer 8

look above or straight on
retropulse globe (limited retropulsion)
nictitans protrusion (present)

Question 9

orbital neoplasia treatment

Answer 9

globe sparing (radiation, surgical explore, chemotherapy)
globe removal (enucleation or exenteration)

Question 10

orbital cellulitis/abscess treatment

Answer 10

medical (NSAID, steroid, abx)
surgical exploration + drainage

Question 11

what is an example of enophthalmos due to passive globe retraction

Answer 11

horner’s syndrome (sympathetic denervation)

Question 12

symptoms of horner’s syndrome

Answer 12

ptosis
enophthalmos
miosis
third eyelid elevation

Question 13

what do you call an enlarged globe

Answer 13

bupthalmos

Question 14

what is the difference between bupthalmos and exophthalmos

Answer 14

bupthalmos has NO 3rd eyelid protrusion

Question 15

what do you call anterior displacement of the globe such that eyelids are caught behind the quarter of the globe? who are they common in?

Answer 15

proptosis

brachycephalics

Question 16

what is a common complication from surgery for proptosis

Answer 16

lateral strabismus

Question 17

name the tear film layers in order from inner to outer

Answer 17

inner: mucin layer by conjunctiva

middle: aqueous layer by lacrimal and gland of third eyelid

outer: lipid layer by meibomian glands

Question 18

normal Schirmer tear test in dog? cat? horse?

Answer 18

dog > 15mm/min
cat > 5 mm/min
equine > 10mm/min

Question 19

what does the Schirmer tear test measure?

Answer 19

tear quantity

Question 20

what is the most common form of KCS

Answer 20

quantitative - deficiency of aqueous layer

Question 21

what is the most common cause of KCS? other causes?

Answer 21

immune-mediated

metabolic dz - Cushings or DM
drug induced - sulfa, NSAID, atropine
infectious - distemper or FHV1

Question 22

treatment for KCS in dogs…
which lacrostimulants? include dosage
which abx?
which anti-inflam?
tear replacement?

Answer 22

topical cyclosporine 0.2% or topical tacolimus 0.01-0.02% TID
oral pilocarpine
abx if conjunctivitis or ulcer is present - tobramycin/terramycin or neopolybac
anti-inflam (use if keratitis, no ulcer): diclofenac or neopolydex
gel or ointment

Question 23

what is the most common cause of feline conjunctivitis and feline keratitis

Answer 23

FHV-1

Question 24

FHV-1
age group?
pathogenesis?
what triggers it?
unilateral or bilateral?

Answer 24

young cats
acute lysis, latent in trigeminal ganglion, active with stress (spontaneous, enviornmental, corticosteroids, co-infection) + epithelial tropism = surface dz
stress or chronic steroids
unilateral

Question 25

conjunctivitis + keratitis +/- URT signs in cat what is your number one differential?

Answer 25

FHV-1

Question 26

what is pathognomonic for FHV-1

Answer 26

dendritic ulcer

Question 27

what test can you do for FHV1?

Answer 27

none - no definitive test

Question 28

treatment for FHV-1

Answer 28

reduce stress supportive care - erythromycin L-lysine 500mg BID (adults), SID (kittens) cidofovir 0.5% BID famcliclovir 40mg/kg TID`

Question 29

most common signs of chlamydia felis

Answer 29

chemosis bilateral no ulceration

Question 30

treatment for chlamydia felis

Answer 30

topical ax - tetracycline (oxytet) BID/TID - macrolide (erythromycin) BID/TID

Question 31

calicivirus clinical signs

Answer 31

conjunctival & oral ulceration (pathognomonic)

Question 32

diffuse episcleral injection not painful no intraocular abnormalities perilimbal corneal edema what disease process?

Answer 32

diffuse episcleritis "red eye"

Question 33

what are the 5 layers of the cornea in dogs/cats

Answer 33

tear film epithelium stroma descemet's membrane endothelium

Question 34

criteria of simple ulcers

Answer 34

- superficial - not infected - heals in 5-7 days - no complicating factors

Question 35

what is the goal of treating simple ulcers?

Answer 35

prevent infection NOT to accelerate healing

Question 36

what is the treatment for a simple ulcer? include dosage

Answer 36

erythromycin/tobramycin TID (triple abx ideal) oral NSAID oral GABA topical atropine e-collar

Question 37

when do you want to recheck a simple ulcer in normal dogs? brachycephalics?

Answer 37

5-7 days in normal dogs 2-3 days in brachycephalics

Question 38

criteria of a complicated ulcer

Answer 38

deep loss of stroma infected/melting delayed wound healing complicating factors

Question 39

if there is <50% stromal loss/melting/infection how would you want to rule out infection?

Answer 39

cytology (rapid) culture and Se (slower) use microbrush or cytobrush

Question 40

how to control secondary uveitis with a complicated ulcer?

Answer 40

topical atropine 1% q 8-24hrs oral NSAIDs

Question 41

4-5 A’s of complicated corneal ulcer therapy in dogs & cats antibiotic topical? anti-collagenase? atropine antibiotic oral? anti-inflam oral?

Answer 41

ofloxacin, cephalexin serum or EDTA atropine clavamox NSAID

Question 42

4-5 A’s of complicated corneal ulcer therapy in horses antibiotic topical? anti-collagenase? atropine antifungal? anti-inflam oral?

Answer 42

ofloxacin, cephalexin serum or EDTA atropine voriconazole NSAID

Question 43

what can you do as a treatment option for horses with a complicated ulcer to administer medications?

Answer 43

Subpalpebral lavage tube

Question 44

if a dog has a non-healing superficial ulcer present for weeks-months that is not infected, what is it? treatment?

Answer 44

indolent corneal ulcer grid keratotomy or diamond burr debridement

Question 45

dendritic ulcers are pathognomonic of what

Answer 45

FHV-1

Question 46

what does a blue corneal opacity indicate?

Answer 46

edema

Question 47

focal corneal edema is due to what?

Answer 47

epithelial disease

Question 48

generalized diffuse corneal edema is due to what?

Answer 48

endothelial disease

Question 49

corneal edema treatment

Answer 49

hyperosmotics (5% saline)

Question 50

what does a red corneal opacity indicate?

Answer 50

blood vessels = vascularization of the cornea

Question 51

criteria of pannus and what is it?

Answer 51

immune mediated chronic superficial keratitis 1. superficial vascularization 2. corneal degeneration 3. pigmentation 4. fibrosis

Question 52

treatment for pannus

Answer 52

dexamethasone or pred acetate cyclosporine or tacrolimus lifelong (not cured, just controlled) decrease UV exposure

Question 53

what common pigment disease do pugs get and what is the treatment?

Answer 53

pigmentary keratopathy tacrolimus for life long

Question 54

what is the anterior chamber

Answer 54

space between cornea and iris

Question 55

what is the posterior chamber

Answer 55

space between iris and lens

Question 56

what is aqueous flare

Answer 56

protein and cells in anterior chamber that scatters light

Question 57

what other abnormal contents can be seen in the anterior chamber

Answer 57

keratic precipitates neutrophils (hypopyon) hyphema (blood) fibrin lipid

Question 58

what is a specific clinical sign associated with uveitis

Answer 58

miosis

Question 59

common INFECTIOUS causes of canine uveitis

Answer 59

bacterial (lepto, brucella, borrelia, septicemia) fungal (blasto, coccidioides, crypto, histo) rickettsial - ehrlichia, rickettsia

Question 60

common NON- INFECTIOUS causes of canine uveitis

Answer 60

idiopathic (most common)

Question 61

hyphema present in dogs, do what? cats, do what?

Answer 61

dogs - coag panel cat - blood pressure

Question 62

common INFECTIOUS causes of feline uveitis

Answer 62

4 F's and T FIP, FeLV, FIV fungal (crypto, histo, blasto, coccidioides) toxoplasma bartonella

Question 63

common NON- INFECTIOUS causes of feline uveitis

Answer 63

idiopathic (most common)

Question 64

treatment of uveitis

Answer 64

prolonged, recurrence common prednisolone acetate

Question 65

uveitis vs anterior uveitis

Answer 65

uveitis - ciliary flush, corneal edema, episcleral injection, photophobia, epiphora anterior uveitis - discharge, anterior flare, iris changes (hyperemia, hyperpigmentation, synechia)

Question 66

what can causes fly biting behavior in the dog

Answer 66

iris cysts

Question 67

iris cyst treatment

Answer 67

none unless vision changes or increased IOP

Question 68

are intraocular neoplasia more aggressive in dogs or cats

Answer 68

cats

Question 69

common intraocular tumor in cats

Answer 69

feline diffuse iris melanoma