Practical opthalmology lecture

Question 1

Patients may present WITHOUT an ocular complaint but…

Answer 1

STILL need their eyes examined!
-new patient visits
-wellness exam
-pre-op exam
-health certificate exam
-non-ocular sick exam
OR
-with a primary ocular complaint

Question 2

Ocular discharge normal but excessive..

Answer 2

Epiphora

Noted brown staining near the corners of the eye

Question 3

How do you describe ocular discharge?

Answer 3

Abnormal color, consistency, translucency… unilateral or bilateral.

Question 4

ID red eye

Answer 4

Slide 6

Could be allergic, infectious, or secondary to an underlying disease process (glaucoma)

Question 5

ID conjunctivitis

Answer 5

Chemosis

Edema

Question 6

Blepharospasm..

Answer 6

?

Question 7

Photophobia..

Answer 7

?

Question 8

ID change in corneal pigmentation..

Answer 8

slide 9

Question 9

Change in pigmentation of the Iris..

Answer 9

Iris nevus (singular)
Iris nevi (plural)
Iris melanoma?
Slide 10

Question 10

Change in pigmentation of the sclera…

Answer 10

icterus

Question 11

Prominent nictitans..

Answer 11

slide 12

Question 12

Third eye lid mass…

Answer 12

Cherry eye!

Slide 13

Question 13

Entropion

Answer 13

Eyelids roll IN

*slide 14

Question 14

Ectopion

Answer 14

Eyelids roll OUT

*slide 15

Question 15

Abnormal eyelids

Answer 15

Agenesis (lid is absent)

*slide 16

Question 16

Change in the shape of the globe.

Answer 16

Buphthalmos

*slide 17

Question 17

Change in the size/shape of the pupils…

Answer 17

Anisocoria

*slide 18

Question 18

Proptosis

Answer 18

*slide 19

Question 19

Acute blindness

Answer 19

Slide 20

Question 20

When patients present for a primary ocular complaint.. what do we need to know?

Answer 20

Clients perspective.. what have they noticed? what is there concern?
Which eye? Both? 
How long?
Has the condition progressed?
Does the patient seem bothered?
Blepharospasm? pawing at the eye? Third eyelid prominent? Rubbing? Change in behavior or activity?
Known incident?
Underlying medical conditions?

Question 21

Hyperthyroidism (renal disease) can cause…

Answer 21

Hypertension > retinal detachment

Question 22

Nutritional issues affecting the eye?

Answer 22

Taurine deficiency
(cats and vegetarian diets)

Question 23

Facial symmetry and/or distortion?

Answer 23

Ears, eyes, lips, nose..

Question 24

Globe position..

Answer 24

Enphtalmos (eye sunken in)

Question 25

Exophtalmos..

Answer 25

Globe is pushed out. | Decreased retropulsion as from space occupying mass or carnassial tooth root abscess.

Question 26

Ptosis

Answer 26

Droopy lid

Question 27

ID..

Answer 27

strabismus

Question 28

Look for evidence of corneal trauma..

Answer 28

loss of translucency | loss of transparency

Question 29

Trichiasis

Answer 29

Hair in normal site but misdirected towards the cornea.. | slide 36

Question 30

Distichiasis

Answer 30

extra eyelashes along the eyelid margin where they should not grow *slide 37

Question 31

Ectopic cilia

Answer 31

Eyelash emerges from the underside of the lid | *slide 38

Question 32

Ocular exam.. | Retropulsation

Answer 32

retropulse both of the globes (press with thumbs)

Question 33

Menace response

Answer 33

Cranial nerves II and VII | *Wave hand in front of the eye, cover the other.

Question 34

Palpebral reflex

Answer 34

CN V and VII

Question 35

Pupillary light reflex

Answer 35

``` CN II and III Direct 100% pupillary constriction Consensual 50% pupillary constriction Pupillary constriction (parasympathetic pathway) ```

Question 36

Advantages of direct opthalmosopy..

Answer 36

Greater magnification (greater detail) Options (grid, slit, altering the dioptic power) The fundus image is real, upright and 14x magnified in emmetropia (in the canine)

Question 37

Disadvantages of ophthalmoscopy..

Answer 37

Small field of view Short working distance Lack of steroposis- monocular exam Difficult to see through cloudy media (limited light source) Difficult examining the peripheral fundus Greater distortion when the visual axis is not completely transparent Your face is very close to the patients muzzle!

Question 38

ID the parts of the ophthalmic scope..

Answer 38

slide 45

Question 39

Direct ophthalmoscopy.. | To examine the right eye..

Answer 39

Stand or sit at the patients right side... Hold the opthalmoscope with your right hand vertically infront of your right eye Keep your index finger on the edge of the lens dial. 0 to -1 diopters focus on the fundus for most examiners Keep both eyes open and look as though you are looking past the patient to block your own accomidation

Question 40

Slide 49

Answer 40

Opthalmalogy lecture

Question 41

Indirect ophthalmoscopy

Answer 41

Image is virtual and inverted. The magnification depends on the focal length of the lens. 20 D lens: 4-5x mag less field of view 30 D lens: 2-3x mag but greater field of view An important point to consider is that the axial magnification of the image varies with the species examined. For this reason a very mild elevation of the optic disc seen in a horse should be given much more significance than a disc of similar appearance in a dog as a horse optic nerve would be minifed a the lens strength. Consider 14 D lens for horse exam.

Question 42

Indirect ophthalmoscopy | Advantages

Answer 42

``` Larger field of view for fundic image Larger and safer working distance Stereopsis Ability to use both hands for patient examination Ability to see through cloudy media. ```

Question 43

Indirect ophthalmoscopy | Disadvantages

Answer 43

Larger learning curve | Less magnification of structures, less detail

Question 44

ID indirect opthalmascope..

Answer 44

slide 52

Question 45

ID optic nerve

Answer 45

slide 53

Question 46

Schirmer tear test

Answer 46

diagnose keratoconjuctivitis sicca (KCS, dry eye)

Question 47

Fluorescein stain

Answer 47

Diagnose corneal ulceration

Question 48

Tonometry

Answer 48

Diagnose glaucoma, high intraocular pressure | Uveitis = low intraocular pressure.