Ophtho Part 2 Flashcards
name the muscles of mastication
pterygoid
masseter
temporalis
what is exophthalmos?
Abnormal protrusion of normal sized globe from the orbit
what is a classic sign you see with exophthalmos?
Third eyelid protrusion
what are the two most common causes of exophthalmos
- orbital/retrobulbar neoplasia
- orbital cellulitis/abscess
Exophthalmos
Elevated third eyelid
NO pain on mouth opening
Globe deviation (dorsolateral strabismus)
what would you think?
retrobulbar neoplasia
Rapid onset, painful
Elevated 3rd eyelid
Conjunctivitis
Pain on opening mouth
what would you think?
orbital cellulitis/abscess
common sign of masticatory muscle myositis
inflam = exophthalmos
atrophy = enophthalmos
googly eyes
diagnostics for exophthalmos
look above or straight on
retropulse globe (limited retropulsion)
nictitans protrusion (present)
orbital neoplasia treatment
globe sparing (radiation, surgical explore, chemotherapy)
globe removal (enucleation or exenteration)
orbital cellulitis/abscess treatment
medical (NSAID, steroid, abx)
surgical exploration + drainage
what is an example of enophthalmos due to passive globe retraction
horner’s syndrome (sympathetic denervation)
symptoms of horner’s syndrome
ptosis
enophthalmos
miosis
third eyelid elevation
what do you call an enlarged globe
bupthalmos
what is the difference between bupthalmos and exophthalmos
bupthalmos has NO 3rd eyelid protrusion
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?
proptosis
brachycephalics
what is a common complication from surgery for proptosis
lateral strabismus
name the tear film layers in order from inner to outer
inner: mucin layer by conjunctiva
middle: aqueous layer by lacrimal and gland of third eyelid
outer: lipid layer by meibomian glands
normal Schirmer tear test in dog? cat? horse?
dog > 15mm/min
cat > 5 mm/min
equine > 10mm/min
what does the Schirmer tear test measure?
tear quantity
what is the most common form of KCS
quantitative - deficiency of aqueous layer
what is the most common cause of KCS? other causes?
immune-mediated
metabolic dz - Cushings or DM
drug induced - sulfa, NSAID, atropine
infectious - distemper or FHV1
treatment for KCS in dogs…
which lacrostimulants? include dosage
which abx?
which anti-inflam?
tear replacement?
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
what is the most common cause of feline conjunctivitis and feline keratitis
FHV-1
FHV-1
age group?
pathogenesis?
what triggers it?
unilateral or bilateral?
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
conjunctivitis + keratitis +/- URT signs in cat
what is your number one differential?
FHV-1
what is pathognomonic for FHV-1
dendritic ulcer
what test can you do for FHV1?
none - no definitive test
treatment for FHV-1
reduce stress
supportive care - erythromycin
L-lysine 500mg BID (adults), SID (kittens)
cidofovir 0.5% BID
famcliclovir 40mg/kg TID`
most common signs of chlamydia felis
chemosis
bilateral
no ulceration
treatment for chlamydia felis
topical ax
- tetracycline (oxytet) BID/TID
- macrolide (erythromycin) BID/TID
calicivirus clinical signs
conjunctival & oral ulceration (pathognomonic)
diffuse episcleral injection
not painful
no intraocular abnormalities
perilimbal corneal edema
what disease process?
diffuse episcleritis “red eye”
what are the 5 layers of the cornea in dogs/cats
tear film
epithelium
stroma
descemet’s membrane
endothelium
criteria of simple ulcers
- superficial
- not infected
- heals in 5-7 days
- no complicating factors
what is the goal of treating simple ulcers?
prevent infection NOT to accelerate healing
what is the treatment for a simple ulcer? include dosage
erythromycin/tobramycin TID (triple abx ideal)
oral NSAID
oral GABA
topical atropine
e-collar
when do you want to recheck a simple ulcer in normal dogs? brachycephalics?
5-7 days in normal dogs
2-3 days in brachycephalics
criteria of a complicated ulcer
deep loss of stroma
infected/melting
delayed wound healing
complicating factors
if there is <50% stromal loss/melting/infection how would you want to rule out infection?
cytology (rapid)
culture and Se (slower)
use microbrush or cytobrush
how to control secondary uveitis with a complicated ulcer?
topical atropine 1% q 8-24hrs
oral NSAIDs
4-5 A’s of complicated corneal ulcer therapy in dogs & cats
antibiotic topical?
anti-collagenase?
atropine
antibiotic oral?
anti-inflam oral?
ofloxacin, cephalexin
serum or EDTA
atropine
clavamox
NSAID
4-5 A’s of complicated corneal ulcer therapy in horses
antibiotic topical?
anti-collagenase?
atropine
antifungal?
anti-inflam oral?
ofloxacin, cephalexin
serum or EDTA
atropine
voriconazole
NSAID
what can you do as a treatment option for horses with a complicated ulcer to administer medications?
Subpalpebral lavage tube
if a dog has a non-healing superficial ulcer present for weeks-months that is not infected, what is it? treatment?
indolent corneal ulcer
grid keratotomy or diamond burr debridement
dendritic ulcers are pathognomonic of what
FHV-1
what does a blue corneal opacity indicate?
edema
focal corneal edema is due to what?
epithelial disease
generalized diffuse corneal edema is due to what?
endothelial disease
corneal edema treatment
hyperosmotics (5% saline)
what does a red corneal opacity indicate?
blood vessels = vascularization of the cornea
criteria of pannus and what is it?
immune mediated chronic superficial keratitis
- superficial vascularization
- corneal degeneration
- pigmentation
- fibrosis
treatment for pannus
dexamethasone or pred acetate
cyclosporine or tacrolimus
lifelong (not cured, just controlled)
decrease UV exposure
what common pigment disease do pugs get and what is the treatment?
pigmentary keratopathy
tacrolimus for life long
what is the anterior chamber
space between cornea and iris
what is the posterior chamber
space between iris and lens
what is aqueous flare
protein and cells in anterior chamber that scatters light
what other abnormal contents can be seen in the anterior chamber
keratic precipitates
neutrophils (hypopyon)
hyphema (blood)
fibrin
lipid
what is a specific clinical sign associated with uveitis
miosis
common INFECTIOUS causes of canine uveitis
bacterial (lepto, brucella, borrelia, septicemia)
fungal (blasto, coccidioides, crypto, histo)
rickettsial - ehrlichia, rickettsia
common NON- INFECTIOUS causes of canine uveitis
idiopathic (most common)
hyphema present in dogs, do what? cats, do what?
dogs - coag panel
cat - blood pressure
common INFECTIOUS causes of feline uveitis
4 F’s and T
FIP, FeLV, FIV
fungal (crypto, histo, blasto, coccidioides)
toxoplasma
bartonella
common NON- INFECTIOUS causes of feline uveitis
idiopathic (most common)
treatment of uveitis
prolonged, recurrence common
prednisolone acetate
uveitis vs anterior uveitis
uveitis - ciliary flush, corneal edema, episcleral injection, photophobia, epiphora
anterior uveitis - discharge, anterior flare, iris changes (hyperemia, hyperpigmentation, synechia)
what can causes fly biting behavior in the dog
iris cysts
iris cyst treatment
none unless vision changes or increased IOP
are intraocular neoplasia more aggressive in dogs or cats
cats
common intraocular tumor in cats
feline diffuse iris melanoma
