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Year 4 small animal > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Signalment

A

Breed
Age - older dog, intraocular neoplasia, cat systemic hypertension
Gender (pyometra uveitis)

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2
Q

History for ophthalmic exam

A

Vaccination, worming, diet
Other pets
Travel
General health
Medications
Previous eye issues
Uni/bilateral
Duration/progression
Ocular pain, appearance change, vision changes

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3
Q

presenting ocular complaints

A

ocular pain - blepharospasm, increased tearing
change in appearance - redness, discharge, swelling
decreased vision - day vs night, changes in unfamiliar surroundings

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4
Q

things to examine - ophthalmic

A

behaviour - do they seem visual/painful etc
symmetry - colour, nostrils, swelling, palpebral fissure size, third eyelid position
external anatomy, palpation, under eyelids, anterior surface, retropulsion
schirmer tear test
ocular reflexes

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5
Q

ocular reflexes

A

menace - vision
palpebral (before menace to check blink)
dazzle
pupillary light - really bright light
vestibulo-ocular
corneal sensation (if suspect of blinking/trigeminal disorder)

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6
Q

anterior assessment

A

pen torch +/- magnification
examine outside to inside
eyelids/lashes/nasolacrimal puncta
third eyelid
conjunctiva, sclera, limbus
anterior chamber
iris and pupil

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7
Q

distant direct ophthalmoscopy

A

essential
0 dioptre at arms length
tapetal reflex to highlight visual axis
compare pupil sizes, opacities

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8
Q

close direct

A

0 dioptres 2-3cm from eye
dilate pupil with tropicamide
small highly magnified field of vision - hard to examine whole fundus
line up eye, light source and condensing lense, curved side towards you

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9
Q

fluorescein staining

A

orange dye - turns green in alkaline conditions
stroma turns it green
indicated in most opthalamic assessments but towards end of assessment
strips are preferable to drops
always flush afterwards
stain should appear at nose in 3-5 mins (jones test)

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10
Q

conjunctival swabs/scrapes

A

sterile swabs
if bacteria suspected - charcoal medium
ocular surface disease - chlamydophila felis, feline herpes virus PCR

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11
Q

tonometry

A

end of exam
essential for reduced vision
red/blue eyes or corneal oedema
measures IOP 10-25mmHh normal in dog/cat, 15-20mmHg normal in rabbit
raised - suspect glaucoma
lowered - suspect uveitis
difference >8mmHg abnormal

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12
Q

split lamp - specialist

A

judge depth and localise lesions

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13
Q

electroretinography - specialise

A

assessment of retinal function

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14
Q

gonioscopy - specialist

A

assessment of iridocorneal drainage angle

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15
Q

imaging - specialist

A

ultrasound, ct, mri

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16
Q

corneal pathology

A

oedema - breach/dysfunctional barrier
vascularisation - promotes healing but increases scarring
pigmentation - non-specific response to corneal insult

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17
Q

wound healing

A

corneal epithelium self renews - movement up/centrally
proliferation from basal epithelium at limbus

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18
Q

superficial, epithelial only ulcers

A

cover defects in hours-days with proliferation, migration and adhesion

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19
Q

stromal healing

A

healing starts after re-epithelialisation
fibroblasts migrate in and lay down new collagen
requires vascularisation and results in scar tissue/remodelling

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20
Q

common causes of corneal ulceration

A

trauma
tear film production - KCS
adnaxal conditions - eyelids/eyelashes
primary corneal disease (SCCEDs - spontaneous chronic corneal epithelial defect)
infection
neurological disease

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21
Q

types of ulcer

A

superficial
SCCED
stromal
desmetocoele
infected/melting
perforated

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22
Q

clinical signs of ulceration

A

pain
conjunctival hyperaemia
ocular discharge
corneal oedema
reflex uveitis

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23
Q

superficial ulcer

A

epithelial loss only
acute
painful
sharp distinct borders
minimal inflammatory response
+/- reflex uveitis

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24
Q

SCCED - spontaneous chronic corneal epithelial defect

A

non-healing, indolent ulcer
any breed but boxers and corgis are common
> 7 years old
epithelium loss only, usually unilateral
no stromal involvement
lip of loose epithelium - grows across but cannot adhere to stroma

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25
Q

stromal ulcer

A

epithelial and stromal loss
acute/chronic
fluorescein staining of walls and floor of ulcer
can be superficial or deep
anterior uveitis is common side effect
visible crater

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26
Q

desmetocoele

A

acute/chronic
complete stromal ulcer down to descemets membrane
walls of ulcer common bottom does not stain
revealed by flushing

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27
Q

melting corneal ulcers

A

keratomalacia
present with acute closed painful eye with ++ gloopy discharge
ill defined/ rounded/soft edges - look like melting away
anterior uveitis
can perforate within hours - ophthalmic emergency
pathogensis - enzymes digest stroma - caused by cornea itself or bacterial infection
steroids suppress and potentiate collagenase

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28
Q

treatment of simple superficial

A

chloramphenicol
nsaids
regular checks

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29
Q

SCCEDs treatment

A

debridement
keratotomy/keratectomy
chloramphenicol
nsaids
atropine
contact lens as bandage

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30
Q

keratotomy

A

grid - hash with needle, bevel up parallel to surface
diamond burr

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31
Q

complex corneal ulcer treatment

A

intensive treatment +/- infection
C+S - enrofloxacin
nsaids +/- opioids
atropine to effect
hospitalise/very close monitoring

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32
Q

melting treatment

A

apply serum 1-2 hourly for 24h then reduce
n-acetylcysteine (stromease) - new product

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33
Q

feline ulcers

A

infection/trauma/corneal sequestrum
non-healing - gentle cotton bud debridement, never grid on a cat

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34
Q

traumatic globe prolapse

A

pathophysiology - immediate oedema
traction on optic nerve can blind
desiccation of ocular surface - potential to ulcerate, dries quickly. rupture of ocular muscles
brachycephalic much more likely to occur but better prognosis, long nose, much less likely but bad prognosis, cats unlikely except RTA
replace or enucleate
treat immediately, dont refer. distressing, painful, prevent self trauma
GA for replacement
lateral canthotomy to make replacement easier
temporary tarsorrhaphy to prevent reprolapse and tamponade haematoma - needle cannot go full thickness as dont want sutures against eye
treat with antibiotics, antiinflammatories and buster collar
most eyes are blind

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35
Q

retrobulbar abscess

A

cs - acute onset, unilateral, exophthalmos, pain (worse on mouth opening) third eyelid protrusion/swelling, ocular discharge, pyrexia, lethargy
ultrasound for fluid filled cavity
treatment - drain abscess under GA, abscess via mouth and release pus, amoxy clav and nsaids
referral approrpiate

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36
Q

acute glaucoma

A

ocular pain (blepharospasm, increased lacrimation, photophobia), head shy, yelping, dull/quiet, vision loss, appearance change
emergency in purebreeds with hereditary, terrier breeds with acute lens luxation
diagnose with tonometry often >40mmHg can be 60-80mmHg
treatment - reduce IOP - prostaglandin analogue (latanoprost) is primary, carbonic anhydrase inhibitors (brinzolamide/dorzolamide). analgesia
seek referral advice/offer

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37
Q

anterior lens luxation

A

cs - acutely painful eye
glaucoma
focal corneal oedema
lens outline can be visible in anterior chamber
if terrier with acutely painful eye - assume luxation until proven otherwise
treatment - referral - couching, analgesia. ongoing management

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38
Q

chemical injury

A

acid/alkali - immediate loss of epithelium, alkali can be worse
acids - bleach, toilet cleaner, spirit base skin prep
alkali - caustic solution, lime burns, washing detergents
treatment - immediate irrigation - tap water and copious flushing
test pH

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39
Q

eye foreign body

A

urgent attention needed
most not true emergencies
refer with lots of pain relief

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40
Q

causes of sudden onset blindness

A

acute glaucoma
acute uveitis
intraocular haemorrhage
retinal detachment
optic neuritis
sudden acquired retinal degeneration
toxicity
intracranial lesion

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41
Q

vision diagnostics

A

menace
PLR
tracking
obstacle course
ophthalmoscopy

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42
Q

nuclear sclerosis

A

nucleus becomes denser and harder appearing with a grey-blue haze
minimal visual effects
no effects on ocular health
common with ageing

43
Q

cataracts

A

opacity of lens or capsule
very variable appearance
classification on onset, aetiology, extent, position
variable visual effects
can cause uveitis
may need surgery

44
Q

diabetic cataracts

A

increased glucose - hexokinase pathway overwhelmed producing cortisol leading to lens osmosis absorbing water causing them to swell and turn white
occurs in days - hours
50% blind within 6 months of diabetes, 75% in 1 year

45
Q

generalised progressive retinal atrophy

A

important cause of inherited blindness
bilateral symmetrical degeneration of neurosensory retina
no treatment
night vision goes first, secondary cataract and fundus changes common

46
Q

what are the causative agents of bacterial granulomatous dermatitis

A

mycobacterium tuberculosis complex
non-tuberculous mycobacteria
treatment - long term antibiotic treatment

47
Q

dermatophytosis

A

microsporum canis most common
multifocal circular patches of alopecia +/- hyperpigmentation and follicular casts
dx - woods lamp flouresence
trichography - arthrospores around hair shaft

48
Q

demodex

A

follicular long bodied mites
short bodied surface mites
inflammation = hair hair loss
clip hair
isoxazolines

49
Q

what should you always do with comedomes

A

squeeze and scrape

50
Q

most common cause of bacterial pyoderma

A

s, pseudintermedius

51
Q

what are hotspots

A

acute moist dermatitis (pyotraumatic dermatitis)
triggered by irritants
very rapid bacterial overgrowth

52
Q

treatment for surface pyoderma

A

topical treatment only - flamazine/isoderm

53
Q

treatment for superficial pyoderma

A

topical where possible
first tier antimicrobial where necessary

54
Q

urticaria/angiogenic oedema

A

degranulation of mast cells/basophils leading to painless pitting oedema
type 1/3 hypersensitivity
treatment - immunosuppressants

55
Q

what is panniculitis

A

inflammation of SC fat

56
Q

pruritis of pinnal margins

A

scabies
neotrombicular autumnalis

57
Q

pruritis of pinnal surface

A

atopic dermatitis
food allergy
pemphigus foliaceus
fleas
contact irritant dermatitis

58
Q

pruritis of pinnal body

A

aural haematoma

59
Q

things to consider in otitis externa

A

primary disease
secondary disease
predisposing factors
perpetuating factors

60
Q

primary causes of otitis

A

otodectes, demodex, scabies
foreign bodies (grass awns)
hypersensitivity
keratinisation disorders
glandular disorders

61
Q

clinical signs of otitis external

A

aural pruritis
exudate
malodour
head tily
deafnesss

62
Q

treatment of otitis media

A

myringotomy + flush till clean
aqueous antibiotics
pain relief

63
Q

indications for myringotomy

A

bulging TM with pain/neuro signs
tympanosclerosis
radiographic/MRI bulla changes
tissue/fluid behind tm
medically unresponsive

64
Q

myringotomy

A

clean and dry canal
incise tm with polypropylene catheter at caudal ventral aspect
swab for bacteriology
flush with saline until clean

65
Q

imaging for OM

A

radiography - insensitive
ct - quite good
mri - far better soft tissue images, ct often as useful and cheaper

66
Q

otitis interna

A

rare extension of OM
cs - head tilt, spontaneous/rotatroy nystagmus, asymmetric limb ataxia, falling, V+/anorexia
ddx - vestibular diseases
dx - cs, neuro exam, otic exam, mri/ct
specialist advice needed

67
Q

examination points

A

canal - wall (swelling ulceration, hyperplasia, hair, masses, redness), lumen (wax, pus, mites, fb, occlusion
drum - present/absent, colour changes, bulges?
discharge/cerumen
smell

68
Q

biofilm

A

extracellular matrix produced by bacteria
lead to lack of antibiotics/disinfectant penetration

69
Q

flushing solutions

A

saline
squalene (dissolution of wax)
chlorhexidine

70
Q

types of ear cleaner

A

cleanaural/epiotic - general purpose
otodine - purulent otitis
cerumaural/otoact - waxy ceruminous otitis
triz edta - base or pre flush
triz edta with n-actyl cycsteine - biofilm breakdown

71
Q

ear treatment for cocci bacterial +/- yeast overgrowth with minimal inflammation

A

treat inflammation alone with cleaner

72
Q

ear treatment for cocci bacterial +/- yeast overgrowth with consistent inflammation

A

narrow spectrum polypharmacy product

73
Q

ear treatment for rods +/- cocci and yeast with significant inflammation

A

polypharmacy product
systemic steroids
antibiotics with good action in pus

74
Q

ear treatment for chronic inflammatory rod based inflammation

A

polypharmacy/ homemade mixture
systemic steroids
GA flush

75
Q

care for drugs in the ear

A

none are licensed for the ear
all state not to use with ear drum perforation - must get owner consent and warn if drum cannot be visualised

76
Q

aural haematoma treatment

A

incision, drainage, suture (longitudinal with blood supply)
drip tubing to spread pressure
skin punches to tack onto cartilage
teat tubes/surgical drains possible
complications - cosmetics, recurrence, pinna necrosis

77
Q

indications for lateral wall resection

A

neoplasia of lateral wall of vertical external canal
management of otitis media (rare)

78
Q

total ear canal ablation and lateral bulla osteotomy indication

A

chronic/recurrent otitis externa with hyperplastic changes in luminal epithelium
failure of more conservative surgery
neoplasia of external canal
unmanageable otitis media

79
Q

ventral bulla osteotomy indications

A

certain brachycephalics (lateral impossible)
cases where teca not required
often used in cats as 2 bulla compartments

80
Q

cholesteatoma

A

Slowly enlarging, cystic lesions within the middle ear cavity
treatment - tecabo or vbo
guarded prognosis

81
Q

inflammatory polyps

A

emanate from tympanic bulla - nasopharyngeal/horizontal ear canal
lead to otitis media - obstruct nasopharynx
can present mouth breathing
can use spay hook to grasp after pulling soft palate forward

82
Q

medial canthal pocket syndrome

A

mucus accumulation at medaial cathas
keep clean
common in dolichocephalic

83
Q

differentials for discharging eyes

A

purulent - fb, infection, KCS
thick/tenacious - KCS
serous - ulcer, blocked nasolacrimal duct, tear overflow
haemorrhaegic - ocular trauma, coagulopathy

84
Q

entropion treatment

A

hotz-celsus elliptical removal
+/-wedge resection

85
Q

distichiasis

A

eyelashes emerging from meibomian glands in line with eyes

86
Q

ectopic cilia

A

emerge through conjunctiva at right angles to cornea and irritate

87
Q

KCS

A

keratoconjunctivitis sicca
immune mediated destruction of lacrimal tissue
common cause of conjunctivitis
cs - recurrent conjunctivitis, tacky mucoid-mucopurulent discharge, blepharospasm +/- ulceration
Dx - schirmer tear test <10mm/min tears, 10-15 borderline
Tx - lifelong treatment, tear substitutes/stimulants, broad spectrum antibiotics for secondary infection

88
Q

dacryocystitis -

A

tear duct infection - common in rabbits
often caused by over long molar roots pressing on nasolacrimal ducts

89
Q

conjunctival involvement of systemic disease

A

anaemia
jaundice
coagulopathy
neoplasia
auto-immune disease

90
Q

feline infectious conjunctivitis

A

chlamydophilia felis - treat with doxycycline
feline herpes virus - nursing, anti-virals
feline calicivirus
mycoplasma felis - chloramphenicol/tetracyclines
bordetella bronchiseptica - doxycycline

91
Q

cataract classification

A

dependent on age, aetiology, position
extent

92
Q

acute glaucoma signs

A

pain , belpharospasm, altered behaviour
red eye - engorged episcleral vessels, corneal vascularisation
corneal oedema
fixed dilated pupil
vision loss
IOP >40mmHg

93
Q

chronic glaucoma signs

A

globe engorgement
corneal changes
lens luxation
cataracts

94
Q

glaucoma treatment

A

urgent treatment
IOP hard to control
may require enucleation

95
Q

generalised progressive retinal atrophy

A

inherited retinal diseases
bilateral symmetrical degeneration of neurosensory retina
no treatment

96
Q

sudden acquired retinal degeneration

A

middle aged-older
acute vision loss
present with dilated pupils and absent PLRs
fundus normal in early stages
electroretinogram needed for diagnosis
no treatment

97
Q

uveitis

A

CS
Pain –blepharospasm, epiphora, photophobia
Red eye – conjunctival and episcleral hyperaemia
Miosis, swollen dull iris, rubeosis iridis
Inflammation in anterior chamber
- Aqueous flare, hypopyon, hyphaema, keratic precipitates
Corneal oedema
low intraocular pressure (may help diagnosis!)
secondary vision loss
treat - underlying cause, topical +/- systemic anti-inflammatories

98
Q

feline hypertensive chorioretinopathy

A

ocular changes in 50% of hypertensive cats - develop >160mmHg (may reflect late hypertension diagnosis)
treat - amlodipine, may need ACEi, address underlying cause

99
Q

feline eosinophilic keratitis

A

cottage cheese deposits on cornea
immune mediated
dx - cytology/appearance
tx - topical corticosteroid

100
Q

feline corneal sequestrum

A

amber corneal discolouration - dark brown plaque
cause unknown, chronic irritation can predispose
dx - characteristic appearance
tx - keratectomy +/- graft

101
Q

feline diffuse iris melanoma

A

hyperpigmented iris spots progressing to whole iris
histopathology for definitive
enucleation if highly suspicious

102
Q

horners syndrome

A

cs - miosis, third eyelid protrusion, ptosis, enopthalmos

103
Q

uveal neoplasias

A

fdim in cat, iris melanoma in dog most common

Year 4 small animal (18 decks)

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