optho 2

Question 1

epiphora

Answer 1

tear staining from increased production or decreased outflow (obstruction of nasolacrimal system)

Question 2

obstruction of NL system

Answer 2

imperforate puncta
atresia of canaliculus or nasolacrimal duct
tx- remove tissue +steroids to prevent closure

Question 3

dacryocystitis

Answer 3

inflammation of nasolacrimal duct -> obstruction

tx- NL flush, topical steroid/abx

Question 4

canine conjunctivitis causes

Answer 4

allergic- tx underlying atopy, steroids and anti histamine + pataday solution q12-24

Question 5

feline conjunctivitis causes

Answer 5

herpes, chlamydophila, mycoplasma
tx- self limiting for herpes, regress in 2-6 wks for chlamydia (can use doxy 5-10mg/kg q12 4wks)

dx- PCR, empirical

Question 6

feline herpesvirus infection, C/S

Answer 6

direct transfer-> epithelium of URT-> cytopathic effects-. secondary infection

C/S- sneezing/ocular dc for 10-14 in younger cats, older get conjunctivitis only

Question 7

Answer 7

dendritic ulcer- feline herpesvirus keratitis

tx- antivirals? can use famcyclovir systemic, cidofovir q12 topical (not practical)
oral lysine 250-500mg (effective?)
topical abx

Question 8

neonatal ophthalmia

Answer 8

primary FHV infection with bacterial infection before eyes are open-> swollen eye lids, dc
tx- open eyes and use topical abx

Question 9

Answer 9

corneal sequestrum- necrotic cornea
occur following ulceration or irritation

tx- if comfortable let it slough naturally (months to years)
painful- keratectomy w conjunctival graft or corneoconjunctival transposition, corneal transplant

Question 10

Answer 10

eosinophilic keratitis- young adult DSH
dx- cytology of scrapings
tx- dexamethasone or pred QID, cyclosporine, tacrolimus

Question 11

Answer 11

corneal degeneration- prior ulcers/age
can predispose to ulcers

tx- remove mineral
keratectomy and corneoconjunctival transposition, corneal burr

EDTA (needs burr)
eye lube (no steroids)

Question 12

Answer 12

corneal dystrophy
bilateral inherited (sheepdog, beagle, husky)
abnormal metabolism, non painful
no tx

Question 13

Answer 13

endothelial dystrophy
slow progressive corneal edema with age (chihuahua, bostons, dachshunds)
bullae can form-> rupture, ulceration

Question 14

endothelial dystrophy tx

Answer 14

tx- hypertonic saline
thermokeratoplasty (cautery)-> only with ulcers

keratectomy w conjunctival graft to slow progression

corneal transplant

Question 15

endothelial degeneration

Answer 15

same C/S as endothelial dystrophy
damage to endothelial cells (uveitis, glaucoma, trauma, inflammation)
tx- treat underlying issue

Question 16

Answer 16

bullous keratopathy
acute in cats, unknown cause (uveitis, topical steroids)
tx- stop steroids, 3rd eyelid flap for 2 weeks
topical abx

Question 17

Answer 17

macropalpebral fissure syndrome- laterally displaced globes, lagopthlamia

non specific change-> vessels, pigment, scarring starting medially

tx- medial canthoplasty
cyclosporine to produce more tears

Question 18

Answer 18

immune keratitis (pannus)
non painful immune, starts in temporal limbus
GSD, greyhounds, UV radiation, elevation

Question 19

pannus tx

Answer 19

lifelong
topical dexmethasone, cyclosporine, tacrolimus
subconjunctival triamcinolone

Question 20

corneal ulceration

Answer 20

missing epithelial barrier

Question 21

ulcer managment

Answer 21

1. determine cause
2. medical tx
3. protect cornea

Question 22

ulcer causes, dx

Answer 22

trauma, trichiasis, distichiasis, ectopic cilia, infection, entropion, FB, KCS, endothelial dystrophy

dx- fluorescein

Question 23

ulcer types

Answer 23

superficial- refractory
stromal
descemetocele
melting ulcer
corneal perforation

Question 24

superficial

Answer 24

loss of epithelium
C/S- quinting, epiphora, dc, elevated 3rd eyelid , painful

simple tx- topical abx, should heal in 4-7d

Question 25

Answer 25

refractory ulcer- loos epithelium around edge chronic non healing 7-14d tx- broad abx wks to months debridement w topical anesthetic grid keratotomy- superficial incisions diamond burr debridement if unsuccessful-> superficial keratectomy (GA)

Question 26

stromal ulcer/descemetocele

Answer 26

invades stroma (bacterial infection) tx (shallow)- abx deep- conjunctival graft, corneoconjunctival transposition

Question 27

stromal ulcer healing

Answer 27

1. blood vessels move in 2. encircle ulcer 3. fill defect

Question 28

Answer 28

melting ulcer- excess enzymes cause softening dx- cytology w topical anesthesia tx- agressive medical, abx (ciprofloxacin, moxiflox), autogenous serum, doxy 10mg/kg q24 10d sx- conjunctival graft (stop melting first

Question 29

Answer 29

corneal perforation- red tissue is fibrin plug sx emergency- conjunctival graft, corneoconjunctival transposition

Question 30

Answer 30

dermoid-lateral limbus or lower lat eyelid' tx- keratectomy

Question 31

Answer 31

persistent pupillary membrane- mesodermal tissue should atrophy by 6wks normally no tx required

Question 32

anterior uveitis signs

Answer 32

aqueous flare low IOP miosis (constricted) corneal edema (endothelium malnourished when aqueous humor production decreases) episcleral injection, iris hyperemia- inflammation

Question 33

Answer 33

keratic precipitates- anterior uveitis

Question 34

Answer 34

posterior synechiae

Question 35

anterior uveitis feline causes

Answer 35

immune mediated most common neoplasia, systemis (lymphoma), lens induced infectious

Question 36

anterior uveitis canine causes

Answer 36

infectious, immune mediated, idiopathic, neoplastic (see slides)

Question 37

Answer 37

iris bombé- anterior uveitis-> fibrin-> iris sticks to lens all the way around stops aqueous humor flow iris moves forward and attaches to cornea-> glaucoma poor prognosis