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Small animal medicine II > Ophthomology > Flashcards

Ophthomology Flashcards

1
Q

What are the five required tools for ophthomology?

A

Good light source, schirmer tear test, fluorescein, tonometry, ophthalmoscope

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2
Q

What do you need to know about your patient before even seeing it?

A

Signalment, history,

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3
Q

What cranial nerves might be affected with Cavernous Sinus syndrome?

A

CN III, IV, V, VI

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4
Q

Which species, cat or dog, has a shorter orbital ligament?

A

Cat, so it has more protection from the skull

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5
Q

What type of dogs are most susceptible to ocular disease via damage to the orbital ligament, and why?

A

Brachiocephalic dogs. The orbital ligament is much shallower

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6
Q

What are some signs you will see with exophthalmos?

A

3rd eyelid protrusion, facial swelling, soft palate bulging, pain when opening mouth, fever

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7
Q

What are two most common causes of exophthalmos?

A

orbital neoplasia, orbital cellulitis/abscess

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8
Q

T/F: orbital neoplasia is often benign

A

False, malignant, slowly progressive, non-painful

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9
Q

T/F: orbital abscesses are often painful

A

True. acute onset

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10
Q

What are the two approaches to treat orbital neoplasia?

A

Globe sparing (radiation, exploration, chemo)

Globe removal (enucleation, exenteration)

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11
Q

What are the two approaches to treat orbital abscesses?

A

NSAIDs + antibiotics

Surgical intervention

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12
Q

What are some clinical signs seen with enophthalmos?

A

facial muscular loss, third eyelid protrusion, entropion (eyelid facing inward)

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13
Q

What are the three common mechanisms of enophthalmos?

A

Orbital volume imbalances (dehydration, emaciation, disease)

Active globe retraction (muscle retraction)

Passive globe retraction (horner’s syndrome, damage to sympathetic nerves)

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14
Q

What is phthisis bulbi?

A

an acquired shrunken globe, from severe or chronic inflammation

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15
Q

What is strabismus?

A

deviation of one or both eyes where both eyes are not directing the same object

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16
Q

How can strabismus be acquired?

A

dysfunction of any rectus muscle of the eye. CN III (DVM), CN IV, CN VI

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17
Q

What is proptosis?

A

Protrusion of the eye, where the eyelids are cause behind the equator of the globe.

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18
Q

What is a commonly better prognosis for proptosis?

A

brachycephalic dogs, a few torn extraocular muscles torn, positive PLRs

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19
Q

What is a commonly poor prognosis for proptosis?

A

Cats, dolichocephalic dogs, >3 extraocular muscles torn, hyphema, orbital fracture, ruptured eye

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20
Q

T/F: Dogs with proptosis have a low chance of regaining their sight.

A

True. 75-80% will be blinded in that eye

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21
Q

How would you treat proptosis?

A

Temporary tarsorrhaphy (suturing eyelids closed)

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22
Q

T/F: Proptosis can lead to strabismus.

A

True. medial rectus is the shortest muscle and is easily torn.

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23
Q

What’s another word for Meibomian glands?

A

Tarsal glands

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24
Q

What are the four layers of the eyelid?

A

Skin, Muscle, Tarsus, Conjunctiva

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25
Q

What are the three muscles that are relevant for eyelid movement?

A

Orbicularis oculi (closes like zipper)

Levator palpebrae superioris, Muller’s muscle (opens eyelid)

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26
Q

What is ptosis?

A

drooping of the eyelid

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27
Q

What is lagophthalmos?

A

Incomplete eyelid closure and globe coverage

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28
Q

What is the function of the tarsus of the eye?

A

It is the fibrous and glandular layer of the eyelid. Supports the Meibomian glands.

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29
Q

What do surgeons use the tarsus for?

A

It is the holding layer for eyelid closure

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30
Q

T/F: The bulbar conjunctiva is usually slightly more hyperemic than the palpebral conjunctiva.

A

False. Palpebral is more hyperemic than the bulbar.

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31
Q

What are the two types of entropion?

A

Anatomic, were eyelids are conformed to the eye.

Blepharospasm associated, where pain leads to retraction of the eyelid.

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32
Q

You see a 5 month old puppy with anatomic entropion. What are some options of treatment?

A

Temporary correction via sutures. Leave alone and it may fix itself in a few months

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33
Q

What can acquired anatomic entropion lead to?

A

Enophthalmos, and blepharospasm (vicious cycle)

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34
Q

How can you differentiate between anatomic and blepharospasm entropion?

A

Local anesthetic in eye (proparacaine) will relieve the pain-induced blepharospasm

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35
Q

What are some temporary corrections for entropion?

A

Viscous lubrication, eyelid tacking, partial temporary tarsorrhaphy

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36
Q

What is the permanent correction for entropion?

A

Modified Hotz-Celsus

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37
Q

What are the common causes of ectropion?

A

iatrogenic (too much entropion correction)

hereditary

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38
Q

T/F: ectropion requires a lot more treatment than entropion

A

False.

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39
Q

What is the surgical procedure used for ectropion?

A

Lateral eyelid wedge excision

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40
Q

What are the 4 common causes of lagophthalmos?

A
  1. ) Breed
  2. ) Exophthalmos
  3. ) Buphthalmos
  4. ) CN V/CN VII dysfunction
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41
Q

What are the ocular signs seen with sympathetic denervation?

A

(Horner’s syndrome)

Miosis, enophthalmos, protrusion of the 3rd eyelid, ptosis

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42
Q

How does Horner’s syndrome cause ptosis and miosis?

A

Lack of tone in the Muller’s upper eyelid muscle and pupillary dilator muscle respectively.

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43
Q

Most commonly, how do you approach treatment for Horner’s?

A

You don’t. It’s typically idiopathic and resolves itself

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44
Q

Does Horner’s usually affect post- or pre-ganglionic nerves?

A

Post-ganglionic.

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45
Q

How do you diagnose Horner’s?

A

Phenylephrine 1% into the eye.
Normal - 60 minutes to dilation
Post-ganglionic - 20 minutes
Pre-ganglionic - 40 minutes

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46
Q

What are the three abnormal hair conditions that have clinical significance?

A
  1. ) Trichiasis
  2. ) Disctichiasis
  3. ) Ectopic Cilia
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47
Q

What is trichiasis?

A

Normal hairs reach into the eye and cause irritation to the surface

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48
Q

What is a surgical treatment used on brachycephalic breeds with trichiasis?

A

Medial canthoplasty

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49
Q

What is distichia?

A

Cilia emerge from the Meibomian glands

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50
Q

When would you want to treat for distichia?

A

If it is causing corneal/conjunctival disease

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51
Q

What are the treatment options for distichia?

A

Cryotherapy. Pluck the hair, then freeze

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52
Q

What is something to be cautious about with cryotherapy?

A

Eyelis depigmentation and necrosis

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53
Q

Which of the eye hair abnormalities leads to severe pain and corneal disease, that also waxes and wanes through the hair life cycle?

A

Ectopic cilia.

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54
Q

How would you treat ectopic cilia?

A

Cryotherapy

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55
Q

T/F: Canine eyelid tumors are typically more malignant than feline eyelid tumors.

A

False.

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56
Q

What is the most common eyelid tumor in dogs?

A

Meibomian gland adenoma/melanocytoma

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57
Q

What is the most common eyelid tumor in cats?

A

SCC

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58
Q

What are the three questions to ask yourself when dealing with canine eyelid tumors?

A

Is it causing irritation? How big is it? Where is it?

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59
Q

How would you treat a canine eyelid tumor? (two methods)

A

Debulk and cryotherapy

Complete excision

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60
Q

What are four key concepts of closing the eyelid during surgery?

A
  1. Limit the debridement
  2. closure must be a perfect figure 8 suture pattern
  3. avoid full thickness bites
  4. tarsus is the holding layer
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61
Q

What is blepharitis?

A

Inflammation of the eyelids

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62
Q

What is a chalazion?

A

A type of blepharitis due to enlargement of the meibomian gland from a blockage of the duct

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63
Q

How do you treat a chalazion?

A

Warm compress, surgical draining via incision, topical antibiotics

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64
Q

What is a hordeolum? Meibomianitis?

A

Bacterial infection of a meibomian gland. Meibomianitis involves multiple glands.

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65
Q

How would you treat a bacterial blepharitis case?

A

Systemic antibiotics, topical antibiotics/steroid, warm compress

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66
Q

How do you diagnose immune-mediated blepharitis?

A

Biopsy and cytology

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67
Q

T/F: Cherry eye is not commonly an emergency nor painful.

A

True

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68
Q

What does the third eyelid cartilage do?

A

Gives structure and shape, and supports the third eyelid gland.

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69
Q

What is another way of saying ‘prolapsed gland of the 3rd eyelid’?

A

Cherry eye.

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70
Q

When is the only indication to completely remove the third eyelid gland?

A

Neoplasia.

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71
Q

What are the two treatments for cherry eye?

A

Morgan pocket technique, orbital tacking.

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72
Q

What is one important thing to think about when suturing up a cherry eye with the morgan pocket technique?

A

Do not fully close the incision. The gland still needs to drain its secretions, or a cyst may form

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73
Q

How can you treat eversion/scrolling of the third eyelid?

A

Excise the deformed cartilage, thermal cautery to kink/contract the cartilage.

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74
Q

What are some normal ocular conjunctival variations between each patient?

A

Encircling of the third eyelid (more some than others

Prominent episcleral vessels

Pigment

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75
Q

Where are the lymphoid follicles of the eye typically located?

A

On the bulbar surface of the third eyelid.

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76
Q

Where are the episceral vessels in relation to the conjunctival vessels?

A

They are deeper into the eye, also larger

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77
Q

What does conjunctival hyperemia suggest about the eye?

A

There is some superficial irritation (conjunctivitis, corneal ulcers, KCS)

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78
Q

What does episcleral injection suggest about the eye?

A

Deeper inflammation and congestion than conjuncival hyperemia.

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79
Q

T/F: You do not often see both hyperemia and episcleral injection at the same time

A

False. Commonly present together

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80
Q

What is the most common cause of conjunctivitis?

A

Keratoconjunctivitis sicca

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81
Q

What are some clinical signs of a patient with allergic conjunctivitis?

A

Blepharospasm, epiphora, mucoid discharge, hyperemia, lymphoid follicles

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82
Q

T/F: Allergic and viral conjunctivitia have the same clinical signs

A

True

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83
Q

How do you treat primary conjunctivitis?

A

Treat underlying cause, topical anti-inflammatory (NSAID, steroid), Optimmune (cyclosporine)

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84
Q

What are the most common causes of feline conjunctivitis?

A

Herpes, eosinophilic keratoconjunctivitis, chlamydia, mycoplasma, calicivirus

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85
Q

How many cats (percentage) are exposed to FHV-1?

A

100%

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86
Q

How many cats (percentage) are persistently infected by FHV-1?

A

80%

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87
Q

What are the two forms of herpes in cats?

A

Primary disease, then recrudescence (break out).

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88
Q

T/F: It is easy to diagnose and treat FHV-1

A

False! It’s hard!

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89
Q

What do you see with kittens that are infected with FHV-1?

A

Upper respiratory tract infection, blepharospasm, epiphora, and mucoid discharge

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90
Q

What cranial nerve is affected by FHV-1?

A

Cranial nerve V - trigeminal

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91
Q

How can latent FHV-1 be reactivated?

A

environmental stress

corticosteroids

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92
Q

What are some specific clinical signs for FHV-1?

A

Hyperemia and symblepharon (permanent adhesion between conjunctiva and cornea)

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93
Q

What corneal lesion is pathopneumonic for FHV-1?

A

Dendritic corneal ulceration (can see with fluorescein stain)

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94
Q

What disease should you consider when you see a cat with conjunctivitis and presence/history of keratitis?

A

FHV-1

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95
Q

How do you treat ocular FHV-1?

A

Antivirals - topical cidofovir, oral famciclovir

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96
Q

What do you see with feline eosinophilic keratoconjunctivitis?

A

Raised yellow/white plaques on the corneal/conjunctival areas

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97
Q

How do you diagnose feline eosinophilic keratoconjunctivitis?

A

Cytology. Just ONE eosinophils is diagnostic

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98
Q

How do you treat feline eosinophilic keratoconjunctivitis?

A

Immunomodulation (cyclosporine), anti-inflammatory, antiviral

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99
Q

What do you typically see with chlamydial conjunctivitis?

A

Chemosis!

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100
Q

T/F: Chlamydia does not commonly cause ulceration on the eye

A

True

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101
Q

How do you diagnose chlamydial/mycoplasma conjunctivitis?

A

PCR, cytology, rule outs of others

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102
Q

How do you treat chlamydial/mycoplasma conjunctivitis?

A

intracellular antibiotics (tetracycline, macrolides)

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103
Q

What is pathopneumonic for calicivirus conjunctivitis?

A

Oral ulcerations

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104
Q

Because definitive diagnosis is difficult, how would you treat feline conjunctivitis?

A

Give antibiotics first, then if it does not work, lean towards potential herpes virus -> antiviral

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105
Q

What are the three layers of the lacrimal system?

A

Lipid, aqueous, mucinous

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106
Q

What is the function of the lacrimal system?

A

Nourish, cleanse, protection of the ocular surface

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107
Q

Define quantitative keratoconjunctivitis.

A

Superficial corneal and conjunctival inflammation with low measurement of tear production (via Schirmer tear test)

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108
Q

What is the most common cause of quantitative KCS?

A

Immune-mediated destruction of the lacrimal tissue.

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109
Q

If the patient has quantitative KCS and a dry nose, what would your diagnosis be?

A

Parasympathetic nerve lesion of CN VII

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110
Q

What types of breeds are at most risk of KCS?

A

small, toy breeds

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111
Q

What are the clinical signs of KCS?

A

mucoid and mucopurulent discharge (from overproduction mucous from goblet cells with absence of aqueous layer), keratitis (superficial corneal vessels)

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112
Q

How do you treat KCS?

A

Cyclosporine (immunomodulator)

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113
Q

What do can you use to treat KCS if cyclosporine does not work?

A

Tacrolimus

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114
Q

What are the four objectives of KCS treatment?

A

Replace the tears
Stimulate more tears
Anti-inflammatory
Anti-biotics

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115
Q

What is the pathophysiology of neurogenic KCS?

A

Loss of parasympathetic innervation to the lacrimal gland and ipsilateral nostril (dry nose)

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116
Q

How would you treat neurogenic KCS?

A

pilocarpine (stimulates PNS)

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117
Q

What is the pathophysiology of canine distemper KCS?

A

viral destruction of the lacrimal glandular epithelium. Severe!

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118
Q

How would you surgically treat KCS?

A

Parotid duct transposition, use of saliva to replace tears. Test saliva pH

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119
Q

What produces the lipids of the outermost layer of the lacrimal system?

A

Meibomian glands

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120
Q

Define qualitative KCS.

A

superficial KCS with normal Schirmer Tear test results

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121
Q

What is the innermost layer of the lacrimal system?

A

Mucin layer.

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122
Q

What test can you use to test for mucin deficiency?

A

Tear Film Breakup Time (TFBUT). See how long it takes for fluorescein stain to break up on ocular surface. (Normal = 20 seconds)

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123
Q

What do you see you corneal fibrosis, and what causes it?

A

A whitish hazy appearance on the cornea, caused by qualitative KCS.

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124
Q

How do you treat qualitative KCS?

A

Replace the tears with (artificial tears), reduce inflammation (cyclosporine)

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125
Q

What are two things that lead to epiphora?

A

Poor drainage, blockage

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126
Q

What is the Jones test?

A

Tests presence of the nasolacrimal duct system

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127
Q

What is imperforate puntum?

A

When the punctal opening of the nasolacrimal duct is closed. Need surgical opening

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128
Q

What is a nasolacrimal disease and how can you treat it?

A

Dacryocystitis, treat with dacryocystotomy

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129
Q

What are the five most common categories of ulcerative keratitis?

A

Superficial uncomplicated ulcers, canine indolent ulceration, deep corneal ulcers, descemetoceles, perforations

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130
Q

What is the limbus?

A

Junction between cornea and sclera

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131
Q

What are the four primary layers of the cornea?

A

(superficial to deep)

Epithelium, stroma, descement’s membrane, endothelium

132
Q

How does the cornea stay clear?

A

Avascular, non-myelinated nerves, dehydrated, ordered cell arrangement

133
Q

How doest the cornea stay dehydrated?

A

Epithelium has a barrier to its tear film, endothelium has an active pump to get solutes out (water follows)

134
Q

What are the steps to epithelialization?

A
  1. ) Superficial ulcer
  2. ) Hemidesmosomes degrade from under epithelial layer
  3. ) Epithelial layer is able to slide
  4. ) Rapid cell division at limbus
  5. ) Epithelium slides to over ulcer
  6. ) Epithelium is fixed and hemidesmosomes form again
135
Q

What are the steps to stromal healing?

A
  1. ) Stromal cells (keratocytes) transform into contractile cells
  2. ) Cell fill up the defect
  3. ) Ulcer epithelializes and heals
  4. ) Stromal on the bottom heal, but cause disorganization and a scar
136
Q

What is a facet?

A

When the epithelium heals over the remodeled stroma before it becomes level with the epithelial layer. Forms a dip/pool

137
Q

T/F: Facets are painful

A

False

138
Q

How do descemetoceles heal?

A
  1. ) Vascular ingrowth is first required. (LONG TIME)
  2. ) Scar will form
    3) Epithelialization
139
Q

What is another term for descemetocele facet?

A

Epithelialized descemetocele

140
Q

What does a blue corneal opacity represent?

A

Edema

141
Q

What are the two possible causes of edema?

A

Epithelial barrier disruption, endothelial barrier/pump disruption

142
Q

How does the disruption of the epithelial barrier cause edema?

A

The tear film is able to enter the stroma due to the inability of the lack of the physical epithelial barrier

143
Q

How could the cornea have generalized edema?

A
  1. ) Large geographic epithelial/stromal defect
  2. ) significant depth in damage of cornea
  3. ) reflux uveitis
144
Q

How could the disruption of the endothelial barrier lead to edema?

A

Focal loss of the sodium pump, generalized reduction in number and function

145
Q

What is the term given to older patients with generalized edema?

A

Senile endothelial degeneration

146
Q

What two things can cause the generalized reduction in function of the endothelial barrier of the cornea?

A

Glaucoma, uveitis

hyperemia

147
Q

What are the two sources for corneal neovascularization?

A

Superficial - granulation tissue and ghost vessels

Deep - ciliary flush

148
Q

T/F: You can count the length of superficial vascularized vessels on the cornea to estimate how long they have been present.

A

True.

149
Q

T/F: Superficial neovascularization does not cross the limbus.

A

False. It does

150
Q

When would you see granulation tissue on the cornea?

A

When there is a chronic stimulant, typically with non-healing ulcers

151
Q

What would the superficial vessels look like with granulation tissue?

A

Dense, raised collection of superficial vessels

152
Q

What do you ghost vessels represent?

A

Empty, retracted blood vessels from a healed lesion.. Happens when the stimulus or irritant has been removed

153
Q

What do white corneal opacities represent?

A
  1. ) White blood cell infiltration
  2. ) corneal fibrosis
  3. ) minerals/lipids
154
Q

What does a white blood cell infiltrate on the cornea mean?

A

Corneal infection with aggressive treatment required!

155
Q

T/F: Corneal scars are painful.

A

False.

156
Q

What causes corneal minerals/lipids in the cornea?

A

Corneal dystrophy - lipids

Corneal degeneration - lipid or minerals

157
Q

What do brown or black corneal opacities represent?

A

Epi/endothelial Pigment (melanin) or corneal sequestrum (cats)

158
Q

What causes tan or greasy punctates in the cornea?

A

Keratic precipitates = cellular and fibrinous adhesions to the endothelium

159
Q

What are the four brachycephlic risk factors for corneal ulcers?

A
  1. ) ocular prominence
  2. ) decreased corneal sensitivity
  3. ) adnexal abnormalities
  4. ) tear film abnormalities
160
Q

What e-collars should you use with all ocular procedures?

A

Firm collars that extend beyond the nose

161
Q

T/F: It is not safe to use topical steroids with corneal ulcers.

A

True

162
Q

What affect do steroids have on ulcerative keratitis?

A

Delayed healing and enhanced corneal destruction

163
Q

What are some causes of corneal ulceration?

A

Irritants, infection, trauma

164
Q

What are the two categories of superficial corneal ulceration?

A

Uncomplicated/simple and complicated/complex

165
Q

How long does it take for simple/uncomplicated superficial corneal ulcerations to heal?

A

7 days or less

166
Q

T/F: Focal corneal edema may be present with simple/uncomplicated superficial corneal ulceration

A

True.

167
Q

How do you treat simple/uncomplicated superficial ulcers?

A

E-collar*, broad spectrum antibiotics, atropine to keep the eyes dilated, recheck

168
Q

What are some reasons as to why an ulcer will not heal appropriately?

A
  1. ) There is an indolent ulcer
  2. ) The underlying cause is not identified/treated
  3. ) Infection
169
Q

What is another term for indolent ulceration?

A

Spontaneous chronic corneal epithelial defect (SCCED)

170
Q

What breed most commonly has indolent ulcers?

A

Boxers

171
Q

What makes the indolent ulcer so difficult to heal?

A

The epithelium does not adhere to the stroma

172
Q

What are the ways to treat an indolent ulcer?

A

Debride the area around the ulcer to encourage epithelialization.

Anterior stromal puncture (ASP)
Diamond burr debridement (DBD)

173
Q

T/F: If the indolent ulcer is infected, it is not safe to perform an ASP or DBD.

A

True

174
Q

What is the consequnce of performing ASP or DBD on cats with corneal ulceration?

A

Corneal sequestrum formations

175
Q

Define collagenolysis and keratomalacia.

A

Enzymatic destruction of the corneal collagen leading to the softening and melting of the corneal stroma

176
Q

What are the three most common bacteria responsible for deep stromal corneal ulceration?

A

Staph, Strep, Pseudomonas

177
Q

What are the different variations of stromal ulceration?

A

Superficial stromal, mid stromal, deep stromal, descemetocele, perforation

178
Q

How can you identify a stromal ulcer?

A

episcleral injection, defect in stroma, diffuse corneal edema, aqueous flare

179
Q

What is the seidel test?

A

Tests perforation of the cornea by applying fluorescein and observing if it enters through any hole

180
Q

What percentage of stromal loss is required before you recommend surgery for a corneal ulcer?

A

> 50%

181
Q

What are the surgeries that can be performed for corneal ulceration?

A

Conjunctival pedicle flap

360 degree conjunctival graft

182
Q

How do you medically treat a deep corneal ulcer?

A

FREQUENT Antibiotics (q 1-2 hrs), anticollagenase therapy, pain management (NSAID)

183
Q

What are the three indications for parenteral (oral/IV) antibiotics?

A

Vascularized ulcer, perforated ulcer, iatrogenic vascularization

184
Q

What are the two forms of nonulcerative keratitis?

A

Pannus, pigmentary keratitis

185
Q

What is Pannus? Explain.

A

Chronic Superficial keratitis.

Immune-mediated reaction to the epithelial surface.

186
Q

T/F: Pannus is painful.

A

False

187
Q

How do you treat Pannus?

A

Topical anti-inflammatory therapy (steroids, cyclosporine)

UV-light protection

188
Q

What breeds are commonly seen with pigmentary keratitis?

A

Brachycephalic - pugs

189
Q

How do you treat pigmentary keratitis?

A

Topical anti-inflammatory is mild.

Severe: medial canthoplasty

190
Q

What muscles of the uvea are parasympathetic?

A

Iris sphincter muscles

191
Q

What muscles of the uvea are sympathetic?

A

Iris dilator muscles

192
Q

What are the function and components of blood-aqueous barrier?

A

Iris blood vessels and ciliary body prevent passage of proteins into the anterior chamber. Allows for clear media in the eye for vision

193
Q

What are the functions of the uvea?

A

To produce aqueous solution for nutrient and waste, main a good blood-aqueous barrier, light regulation

194
Q

Define dyscoria, anisocoria, anterior synechia, posterior synechia, peripheral anterior synechia, iris bombe

A

D - Abnormally shapred pupil
A - unequally sized pupils
AS - adhesion of iris to cornea
PS - adhesion of iris to lens
PAS - adhesion of iris to iridocorneal angle
IB - bulging of iris from poor passage aqueous from PS

195
Q

What are persistent pupillary membranes?

A

Incomplete absorption of embryonic vascular tissue and mesenchymal strands

196
Q

T/F:(Persistent pupillary membranes) PPMs are usually uncommon, cause disease, and are always bilateral.

A

False. Common, incidental, and uni/bilateral

197
Q

What are some specific lesions seen with Uveitis?

A

Miosis, aqueous flare, hyphema, hypopyon, keratic precipitates, thickened iris, hyperemic iris, decreased IOP

198
Q

What causes miosis in uveitis?

A

Prostaglandins cause pain and ciliary spasms, leads to iris sphincter contraction

199
Q

What does aqueous flare lead to?

A

Increased turbidity of aqueous humor from inflammation and breakdown of barrier, leading to proteins and cells in the anterior chamber

200
Q

What is considered normal intraocular pressure?

A

10-20 mm Hg

201
Q

What are the effects of decreased IOP?

A

decreased AH production, increased uveoscleral outflow

202
Q

What are some chronic signs of uveitis?

A

Dyscoria, Posterior synechia, Peripheral anterior synechia, iris hyperpigmentation

203
Q

What are the consequences of long term chronic uveitis (sequelae)?

A

Cataracts, lens luxation, glaucoma, retinal detachment, phthisis bulbi

204
Q

What are the two differentials of uveitis and how do you treat them?

A

Exogenous (treat primary issue and uveitis) and endogenous (hard to diagnose)

205
Q

What are some tests you want to run for a dog with uveitis?

A

Thorough travel history, PE, CBC, Chem panel, urinalysis, thoracic radiographs, tick titers, fungal titers

206
Q

If hyphema is present, what additional test would you want to run?

A

Coagulation panel

207
Q

What are some test you want to run for a cat with uveitis?

A

Thorough travel history, PE, CBC, Chem panel, urinalysis, thoracic radiographs, FIV/FeLV, toxo titer, fungal titer

208
Q

What are the two most common fungal infections in cats with uveitis?

A

Cryptococcus, histoplasmos

209
Q

What medication is required in ALL uveitis treatment, regardless of infection/non-infection?

A

Anti-inflammatory therapy

210
Q

T/F: Topical steroids and topical NSAIDs are allowed simultaneously

A

True

211
Q

Can you use topical corticosteroids for uveitis treatment?

A

No, does not penetrate the corneal wall.

212
Q

What should you rule out before giving systemic corticosteroids to treat uveitis?

A

Infection

213
Q

What medication is used as a mydriatic?

A

Atropine 1%

214
Q

T/F: Intraocular bacterial infections typically have a good prognosis

A

False

215
Q

How do differentiate between a uveal cyst and a tumor?

A

Translumination. If light flashes in the mass, is most likely a fluid filled cyst

216
Q

T/F: Most intraocular tumors in dogs are malignant.

A

False. Benign

217
Q

T/F: Most intraocular tumors in cats are malignant.

A

True

218
Q

What is the second most common uveal tumor in dogs?

A

Ciliary body adenoma/adenocarcinoma.

219
Q

What is the most common uveal tumor in cats?

A

Feline diffuse iris melanoma

220
Q

What are the two things to do with cats and potential uveal tumors?

A

Monitor!

Enucleation

221
Q

T/F: Any color, shape, or size change in the uvea can be serious for the cat.

A

True

222
Q

What is the most common secondary uveal tumor in both cats and dogs?

A

Lymphosarcoma

223
Q

What is the basic function of the lens?

A

To focus light onto the retina to produce a sharp image

224
Q

Define nuclear sclerosis.

A

When new lens cells and fibers are produced and the nucleus becomes compressed with age. Loss in ability to contract and relax shape

225
Q

What does an eye with nuclear sclerosis look like?

A

Bluish-gray, pearly haze

226
Q

T/F: Nuclear sclerosis patients have a loss of vision.

A

False

227
Q

Define a cataract.

A

Any opacity of the lens of capsule.

228
Q

T/F: Cataracts can cause a loss of vision.

A

True

229
Q

How would you classify cataracts?

A

Age of onset, location within the lens, state of maturation, cause

230
Q

Where would the nuclear vs the equatorial cataract be located?

A

Nuclear is in the center of the lens, equatorial is on the equator

231
Q

What two methods do you use to examine cataracts?

A

Oblique - judges the position of opacities

Parallax - decides depth of opacities

232
Q

Case: You see an opacity in the lens move on the opposite direction of the animal’s direction of sight. Where is the opacity?

A

Posterior part of the lens.

233
Q

What are the four stages of cataracts?

A

Incipient, incomplete (immature), complete (mature), resorbing (hypermature)

234
Q

How large is an incipient cataract?

A
235
Q

T/F: You cannot see the tapetal reflection with incipient cataracts and vision is typically affected

A

False. You can see it and they can see!

236
Q

T/F: You cannot see the tapetal reflection and vision is typically affected with incomplete cataracts

A

False!

237
Q

How much of the lens is affected in a complete cataract?

A

100%

238
Q

T/F: In a complete cataract, the tapetal reflection is not visible and the animal is blind.

A

True

239
Q

What happens to the lens with resorbing cataracts?

A

It liquefies, and shrinks

240
Q

What other disease of the eye do you commonly see with resorbing cataracts?

A

Uveitis

241
Q

What happens to the lens in an intumescent cataract?

A

It swells up and gets larger

242
Q

What endocrine condition commonly has association with intumescent cataracts?

A

Diabetes! (metabolic cataracts)

243
Q

What is the most common cause of cataracts in dogs?

A

Inherited.

244
Q

What is the most common cause of cataracts in cats?

A

Chronic uveitis

245
Q

What breed of dogs commonly have inherited cataracts?

A

Boston Terriers

246
Q

What is the pathophysiology of chronic uveitis in cats/horses?

A

Inflammatory mediators diffuse into the lens and alter its structure/metabolism, leading to aqueous humor production

247
Q

What is the pathophysiology of metabolic cataracts?

A

Sorbitol accumulation in the lens, draws water from aqueous humor and changes in the lens

248
Q

What enzyme is upregulated in diabetes that leads to the increase in sorbitol?

A

Aldose reductase

249
Q

What early signs may you see in the lens of a diabetic cataract?

A

Clefting of the Y-suture

250
Q

How do endogenous toxic cataracts cause disease?

A

Degenerating photoreceptors release toxic substances into the vitreous humor.

251
Q

T/F: Senile cataracts impair vision

A

False.

252
Q

How do you treat cataracts?

A

Medication - anti-inflammatories

Surgery - phacoemulsification

253
Q

What is the only proven and effective cataract treatment?

A

Phacoemulsification - high frequency vibration emulsifies the cataract and is then removed via aspiration

254
Q

What is pseudophakia and aphakia?

A

Presence (and absence) of an artifical intraocular lens after surgery

255
Q

What are some factors to consider before doing cataract surgery?

A

Extent of visual defects, overall health of animal and eye, client commitment, animal temperament

256
Q

When is the best time to refer an animal for cataract surgery?

A

ASAP!

257
Q

What is a phacoclastic lens-induced uveitis (LIU)?

A

severe form of LIU associated with traumatic tears of the lens capsule

258
Q

What is the phacolytic lens-induced uveitis (LIU?)

A

mild form of LIU associated with leakage of lens proteins

259
Q

What should you expect with a red eye with a cataract?

A

Phacolytic lens-induced uveitis

260
Q

What dog breed is most predisposed to lens luxation?

A

canine terrier breed due to their abnormal zonular ligament degeneration

261
Q

What is the most common cause of lens luxation in cats?

A

Chronic uveitis

262
Q

What are some early signs of lens luxation?

A

Iridodonesis/Phacodonesis (shaking of iris/lens)

263
Q

How does glaucoma and buphthalmos cause lens subluxation?

A

The pressure in the eye stretches the lens zonules and tear them

264
Q

T/F: Anterior lens luxation is an emergency

A

True.

265
Q

What should you do to the eye of a dog with anterior lens luxation before sending it to the referral ophthomologist?

A

Mannitol, carbonic anhydrase inhibitors, NO miotics/mydriatics

266
Q

How do you treat an anterior lens luxation?

A

Intracapsular lens extraction

267
Q

How do you medically treat an anterior lens luxation, if surgrey is not possible?

A

Dilate the pupil, let the lens fall to the back of the eye, then dilate the pupil to trap it back in.

268
Q

How does glaucoma cause disease?

A

Increased intraocular pressure leads to damaging of the optic nerve and retina, and loss of vision

269
Q

T/F: Glaucoma is almost always due to impaired inflow.

A

False. Outflow

270
Q

What are some common clinical signs associated with glaucoma?

A 
Red eye - episcleral injection
Pain - blepharospasm
Cloudy - corneal edema
Mydriasis
Impaired vision
271
Q

What are some clinical signs associated with chronic glaucoma?

A

retinal degeneration, blindness, buphthalmos, lens change, phthisis bulbi

272
Q

Define phthisis bulbi.

A

End stage disease of the eye. Shrunken

273
Q

How would you differentiate between buphthalmia and exophthalmia?

A

Check the IOP. Exophthalmia would be typically normal. Also check corneal diameter and for lens luxation

274
Q

At what IOP reading should you start being suspicious of glaucoma?

A

> 20 mm Hg

275
Q

What IOP reading is sufficient evidence for glaucoma diagnosis?

A

> 25 mm Hg, with clinical signs

276
Q

What tonometry instrument measures indentation of the eye?

A

Schiotz tonometry

277
Q

What tonometry instrument measures applanation of the eye?

A

TonoPen

278
Q

What instrument measures rebound tonometry?

A

TonoVet

279
Q

What is the benefit of using a TonoVet?

A

No topical anesthetic needed! even for cats!

280
Q

Of the four readings, which is the correct IOP? 20 mmHg, 15 mmHg, 16 mmHg, 25 mmHg

A

15 mmHg (lowest is the best answer)

281
Q

What is the most common primary cause of glaucoma?

A

Primary Angle Closure Glaucoma (goniodysgenesis)

282
Q

What is the most common secondary cause of glaucoma?

A

Uveitis (do full work up)

283
Q

What happens with goniodysgenesis that causes glaucoma?

A

decrease aqueous outflow from arrest iridocorneal angle

284
Q

T/F: Animals with unilateral goniodysgenesis usually also develop glaucoma in the other eye as well.

A

True

285
Q

What is the #1 treatment for primary open angle glaucoma/goniodysgenesis?

A

Latanoprost (prostagladin derivative). Increases uveoscleral outflow

286
Q

When would you not want to use latanoprost to treat glaucoma?

A

If the glaucoma is secondary to uveitis. Use only for primary glaucoma!

287
Q

What treatment do you use if latanoprost does not work?

A

Mannitol 20% with methazolamide, carbonic anhydrase inhibitors, pilocarpine (miotic)

288
Q

What are the two glaucoma drugs to have above all others?

A

Latanoprost (all primary)

Dorzolamide (all secondary, all cats)

289
Q

What is the best long term therapy for cats?

A

Surgery, gonioimplant (increases outflow), ciliary body ablation (decrease production)

290
Q

How effective is prophylactic therapy to prevent glaucoma in the fellow eye?

A

Very good, extends from 8 to 33 months before the other eye gets glaucoma

291
Q

What medications are used for prophylactic therapy in glaucoma?

A

Betaxolol 0.5%

Demarcarium bromide 0.125%

292
Q

How would you treat glaucoma secondary to uveitis?

A

Aggressive therapy for uveitis, dorzolamide!

293
Q

T/F: Feline glaucoma is often subtle and difficult to notice

A

True

294
Q

How do you treat feline glaucoma?

A

Dorzolamide

295
Q

What is aqueous misdirection syndrome and how do you treat it?

A

The aqueous humor is misdirected so that the lens/iris are shifted forward. Treat with dorzolamide, eventually enucleate

296
Q

T/F: The sclera has both pigmented and non-pigmented areas to allow the tapetum to reflect.

A

False. The retinal epithelium does this, but may be entirely unpigmented.

297
Q

T/F: Cats have myelinated optic nerve heads

A

False. Only dogs do.

298
Q

What is a holangiotic retinal vascular pattern?

A

Blood vessels are distributed all throughout the retina

299
Q

Merangiotic retinal pattern. Define it.

A

Localized vasculature in the retina. Rabbits

300
Q

Paurangiotic retinal pattern. Define.

A

Poorly vascularized retina. Horses

301
Q

Anangiotic retinal pattern. Define.

A

No blood in retina area. Hawks.

302
Q

List some species that are atapetal.

A

Chincilla, blue-eyed dogs, pigs, humans, alpacas

303
Q

What are the types of retinal hemorrhages that can be observed?

A

Pre-retinal, within nerve fiber layer, within the retina, sub-retinal

304
Q

List some causes of retinal detachment

A

Retinal degeneration, vitreous disease, lens luxation, neoplasia, trauma

305
Q

What are the types of retinal detachments?

A

focal, multifocal, complete, exudative, traction, rhegmatogenous

306
Q

What is a common early sign of feline hypertensive retinopathy?

A

Exudative detachment

307
Q

How do you treat exudative retinal detachment and feline hypertensive retinopathy?

A

antihypertensive therapy. the retina will then attach back on its own

308
Q

How do you treat a partial rhegmatogenous retinal detachment?

A

Retinopexy

309
Q

How do you treat a complete rhegmatogenous retinal detachment?

A

Re-attachment surgery

310
Q

What can cause increased reflectivity of the tapetum lucidum?

A

Retinal degeneration/scarring, detachment

311
Q

What can cause decreased reflectivity of the tapetum lucidum?

A

increased retinal thickness from folding, edema, effusion, infiltrates

312
Q

What is progressive retinal atrophy? (PRA)

A

photoreceptor degeneration and gradual loss of vision

313
Q

How do you treat PRA?

A

You can’t.

314
Q

What is a major finding in the fundus exam of a patient with PRA?

A

Narrowing and loss of retinal blood vessels, slow PLRs

315
Q

What is sudden acquired retinal degeneration syndrome (SARDS)?

A

Sudden loss of vision from acute photoreceptor death

316
Q

How would a fundus exam look on an patient with SARDS?

A

Normal.

317
Q

What are the common conditions of animals with SARDS?

A

Older and fatter

318
Q

What is feline central retinal degeneration?

A

Degeneration confined to elliptical area dorsolateral to optic nerve head.

319
Q

What drug may cause retinal degeneration in cats?

A

Enrofloxacin.

320
Q

What would you see in the fundus exam in a patient with active chorioretinitis?

A

Gray-white areas of edema or cellular infiltrate

321
Q

What type of lesions are categorized in chorioretinitis?

A

Active and inactive lesions

322
Q

What kind of lesions do you see with inactive chorioretinitis?

A

Scarring and flatness of the chorioretina

323
Q

How do you treat chorioretinitis?

A

Anti-microbials, anti-inflammatory

324
Q

What do you see in a patient with optic neuritis?

A

Hyperemia, peripapillary edema, associated retinal detachment and hemorrhage

PLR abnormalities

325
Q

What is the main goal as a clinician when dealing with a blind animal?

A

Finding if its a result of an ophthomological or neurological disease.

326
Q

What is the difference between peripheral and central blindness?

A

The visual pathway is shared with PLR in peripheral but not central blindness.

Small animal medicine II (8 decks)

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