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RUSVM SAM II > SAM II Exam II Material - Ophthalmology > Flashcards

SAM II Exam II Material - Ophthalmology Flashcards

1
Q

Primary lens luxations are due to:

A

Inherited dysplasia or degeneration of zonules​

  • ​DNA testing can be done for clear, carrier, and genetically affected
  • Predisposed: Terrier breeds, poodles, Shar Peis, others
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2
Q

Which of the following treatments would be least indicated in the treatment of a deep corneal ulcer?

  • Autologous serum administration on the eye
  • Conjunctival graft
  • Gentamycin ophthalmic drops
  • Grid keratotomy
A

Grid keratotomy​

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3
Q

This is the most common cause of glaucoma in cats:

A

uveitis

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4
Q

What is the most common eyelid tumor that we see in the cat?

A

Squamous cell carcinoma​

MALIGNANT!!

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5
Q

Holes or defects in uveal tissue (iris or choroid):

A

colobomas

  • Holes or defects in uveal tissue: iris or choroid
  • Typical at 6 o’clock
  • Choroidal colobomas can result in poor retinal development = impaired vision
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6
Q

Which of the following are congenital diseases of the eyelids?

  • Dermoids
  • Entropion
  • Eyelid agenesis
A

Dermoids and Eyelid agenesis

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7
Q

When a dog can’t close its eyes completely (and sleeps with its eyes open), this is termed:

A

lagophthalmos

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8
Q

A cat presented with conjunctivitis (owner called it a ‘red eye’). Fluorescein stain showed a small corneal ulcer. Tear production was also lower than expected for a cat. What is the most likely cause of these signs?

A

herpes virus

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9
Q

Intumescent cataracts are associated with what systemic metabolic disease?

A

Diabetes mellitus

  • Hyperglycemia causes high glucose in the lens → Hexokinase becomes saturates so alternate sorbitol pathway is used → Sorbitol and fructose accumulate in the lens → Sorbitol cannot escape from the lens, resulting in hypertonicity → causes water uptake, swelling, and rupture of lens fibers → uveitis*
  • (Note: cats do not have the alternative sorbitol pathway)*
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10
Q

What IOP is indicative of glaucoma?

A

> 25 mmHg

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11
Q

This is a purulent bacterial infection of the meibomian gland (internal site) or skin gland of the lid (gland of Moll or Zeis/external site):

A

hordeolum or stye

  • Clinical signs: red raised area on lid margin; epiphora; blepharospasm, blepharedema
  • Painful and comes to a head on outside of lid
  • Often seen in young dogs but also cats
  • May be multiple
  • Treatment: local warm packs, topical & systemic anti-inflammatories & antibiotics
  • May need culture and sensitivity if chronic recurrent infection
  • Rarely need surgical correction
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12
Q

A cat presents with this fleshy growth with superficial vascularization on the lateral conjunctiva. You perform a cytology and note infiltrates of eosinophils, plasma cells and lymphocytes. What is your diagnosis?

A

Feline Eosinophilic Keratoconjunctivitis​

  • May be associated with FHV‐1 immune stimulation or reaction​
  • Treatment: topical glucocorticoids only if no corneal ulcer (may need to use cyclosporine)​
    • ​Could activate herpes infection!
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13
Q

What are the 5 basic layers of the cornea?

A
  • Tear film
  • Epithelium
  • Stroma
  • Descemet’s membrane
  • Posterior epithelium

_T_hat _E_ye’s _S_o _D_amn _P_imp

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14
Q

Glaucoma can be caused by any of the following except:

  • Intraocular neoplasia
  • Lens luxation
  • Uveitis
  • Abnormal iridocorneal angle
  • Optic nerve atrophy
A

Optic nerve atrophy​

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15
Q

What is the term used to describe ingrowth or introversion of the eyelashes resulting in normal hairs contacting the cornea?

A

trichiasis

  • Normal hairs contacting cornea
    • Eyelids/lashes, nasal fold fur
  • Common in long-haired dogs & brachycephalics
  • Often subclinical
    • Epiphora
    • Corneal pigmentation and ulcerations
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16
Q

What treatment for indolent ulcers has the highest rate of success?

A

superficial keratectomy

  • Best chance of success (99-100%), but most invasive
  • Remove epithelial layer & parts of stroma allowing for reformation of normal epithelial complexes
  • Success proves the poor healing is related to abnormal BM & lack of stroma adhesion
  • Not recommended as first line due to need for general anesthesia and cost
  • Not recommended in cats: may predispose to formation of a corneal sequestrum.
  • Referral procedure usually
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17
Q

T/F: The majority of diabetic dogs develop cataracts within 1 year of diagnosis despite adequate glycemic control

A

True

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18
Q

inflammation of the lacrimal sac is termed:

A

dacryocystitis

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19
Q

Identify this progressive, bilateral, inflammatory, non‐ulcerative potentially blinding corneal abnormality:

A

chronic superficial keratitis​

(aka Pannus or Uberreiter’s syndrome)

  • Immune-mediated theory: Reaction to corneal antigens; exacerbated by exposure to UV light & possibly associated with high altitudes.
  • German shepherds:
    • Young, 1–5 yrs, usually severely progressive & extensive
    • Older dogs, 4 ‐6 yrs slowly progressive & extensive
  • Greyhounds: 2‐3 yrs with relatively mild lesions
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20
Q

An overflow of tears on the cheek is termed:

A

epiphora

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21
Q

T/F: Lagopathalmos refers to the inability to open the eyelids completely

A

False

Lagopathalmos refers to the inability to close the eyelids completely

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22
Q

T/F: Cyclosporine A is a drug of choice for treatment of KCS and Pannus

A

True

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23
Q

Which one of the following findings is NOT found with acute glaucoma?

  • Cloudy cornea
  • Blindness
  • Buphthalmia
  • Red eye
  • Painful eye
A

Buphthalmia​

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24
Q
  • What kind of ulcer is this?
  • What part of the cornea is affected?
  • How is it treated?
  • How long will it take to heal?
  • When will you do a recheck fluorescein stain?
A
  • Superficial corneal ulcer
    • Superficial epithelial layer is affected
    • Treated with topical antibiotics (BNP if it’s a dog)
    • May take ~1 week to heal
    • Recheck in 1-4 days
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25
Q

What is the most common cause of cataracts in dogs?

A

developmental

  • Hereditary
  • Many breeds
  • 1‐7 years old
  • Often bilateral; can be asymmetrical
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26
Q

In general, what are the three main tests that should be performed on all eyes and in a specific order?

A
  1. Schirmer Tear Test (STT)
  2. Fluorescein stain (FS)
  3. Tonometry
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27
Q

This dog presents with “big eye” on the left and decreased vision for 2 weeks. He now has ocular cloudiness bilaterally and has also stopped eating. On physical examination, you note exophthalmos on the left, anterior uveitis bilaterally, and peripheral lymphadenopathy. Temperature = 39.5˚C

What diagnostic test could be done next to help with your diagnosis?

A

Lymph node aspiration or biopsy

  • What are some differential diagnoses for lymphadenopathy?
    • Lymphoma
    • Tick-borne disease
    • Fungal disease
    • Protozoal disease
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28
Q

EXTREME exophthalmos is termed:

A

proptosis

forward displacement of the globe with simultaneous entrapment of the eyelids behind the equator

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29
Q

T/F: Corticosteroids are the drug of choice for treating corneal ulcers

A

FALSE

IF EVER ASKED ABOUT STEROIDS AND ULCERS, IN GENERAL THE ANSWER IS AVOID.

The only real exception to this is to treat Superficial Punctate Keratitis

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30
Q

What is normal IOP in the dog?

A

10-25mmHg

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31
Q

What is your diagnosis?

A

essential iris atrophy

  • (aka stromal iris atrophy)
  • Holes are present in the iris so that you can see tapetal reflex through the defects
  • PLR is reduced, but does not affect vision
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32
Q

A 7-year-old obese dog presents with acute onset blindness, mydriasis, slow or no PLRs, positive but slow dazzle response. You don’t note any abnormalities on fundic examination. How do you definitively diagnose this condition?

A

ERG

The description is of SARDS (Sudden Acquired Retinal Degeneration Syndrome)

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33
Q

What are the indications for surgical intervention with regard to deep corneal ulcers?

A
  1. Deep ulcer (melting, perforating, or descemetocele) that may rupture
  2. Greater than 50% of the corneal thickness
  3. If refractory to medical therapy
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34
Q

You surgically repaired a ‘Cherry eye’ using one of the techniques recommended in class. Which of the following should you tell the owner?

  • Artificial tears will be needed for rest of the patient’s life
  • Epiphora could occur as result of the prolapse
  • The other gland could prolapse
  • Topical cyclosporine will help prevent future prolapses
A

The other gland could prolapse​

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35
Q

Which of the following is one advantage to direct ophthalmoscopy?

  • A better view of the anterior chamber
  • A more magnified image
  • A wider field of vision
  • Less interference by choroid
A

A more magnified image

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36
Q

What is hallmark sign of uveitis?

A

aqueous flare

During slit lamp examination of the eye, an abnormal appearance of the beam of light as it travels through the anterior chamber. The flare is caused by light reflecting off proteins in the aqueous humor. It is found in patients with inflammation in the anterior chamber.​

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37
Q

__________ is a firm, usually nonpainful swelling of the meibomian gland caused by the accumulation of secretions that results in chronic inflammation and a granulomatous reaction

A

chalazion

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38
Q

The treatment of choice for adult dogs with entropion is:

A

Hotz-Celsus technique​

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39
Q

Inward rolling of the eyelids is termed:

A

entropion

  • Inherited or Breed-related:
    • Medial: brachycephalics usually
    • Dorsolateral/ventrolateral: giant breeds
    • Circumferential: Shar Peis & Chow Chows
    • Puppies may “grow out of it”
  • Acquired: more common in cats
    • Spastic: Chronic blepharospasm
    • Non-spastic: Post-trauma or surgery
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40
Q

To treat eyelid lacerations, you should first clean the area. You should avoid chlorhexidine, but you can use betadine. What should you do with betadine before using is on an eyelid laceration?

A

dilute the shit out of it!

Can use VERY VERY dilute betadine on corneal surface (1:50 dilution)

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41
Q

What is the treatment for the corneal abnormality shown?

A

benign neglect (active monitoring)

The image shows Florida Keratopathy (aka Florida spots, Florida keratitis, Caribbean keratopathy)

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42
Q

In the case of posterior synechia, the __________ sticks to the __________

A

In the case of posterior synechia, the iris sticks to the lens

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43
Q

What layer of the tear film is closest to the cornea?

A

mucous layer (goblet cells)

  • Three tear film layers:
    • Inner mucin layer
    • Middle aqueous layer
    • Outer lipid layer
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44
Q

Define enucleation:

A

removal of the globe of the eye

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45
Q

Identify the type of ulcerative keratitis:

A

superficial punctate keratitis

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46
Q

T/F: IV mannitol is indicated in a case of acute primary glaucoma

A

True

IV mannitol osmotically draws water from eye; dehydrates vitreous

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47
Q

Which of the following clinical signs is not typically associated with keratoconjunctivitis sicca (KCS)?

  • Conjunctivitis
  • Corneal ulcer
  • Hyphema
  • Mucopurulent discharge
A

Hyphema​

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48
Q

What drugs are well-known to cause keratoconjunctivitis sicca (KCS)?

A

Sulfa drugs and Etogesic (NSAID)

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49
Q

Identify the corneal abnormality:

A

corneal foreign body

  • Penetrating FB will need to be removed; some might be flushed out with saline
  • May need surgery for ruptured cornea
  • Remove any prolapsed iris that is devitalized; will likely have uveitis too with prolapsed iris
  • Use conjunctival flap if > 2/3 cornea involved
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50
Q

Identify this corneal abnormality:

A

persistent pupillary membrane

  • Usually of minimal significance
  • See focally pigmented endothelial opacity & a uveal strand that extends from the iris collarette (not from iris margin)
  • Common for the strand to be resorbed leaving just a patch on the back of the cornea
  • Naturally regress from pupillary membrane during the first 6 to 8 weeks of life
  • All breeds, but especially Basenji and Pembroke Welsh Corgi
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51
Q

You suspect herpesvirus in a cat with conjunctivitis. What is the best modality to confirm your diagnosis?

A

PCR

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52
Q

Ignore the fact that this picture is of a human. What congenital uveal disease is present?

A

persistent pupillary membranes​

  • Failure of complete regression of embryonic pupillary membrane
  • Normally regress by 6-8 weeks
  • No treatment
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53
Q

What surgical procedure is shown here?

A

conjunctival graft (pedicle graft)

used in the treatment of deep ulcers

  • Conjunctival graft advantages
    • Mechanical support for weak area
    • Continuous supply of serum, anticollagenases, GFs
    • Immediate source of actively replicating fibroblasts for collagen regeneration in the stroma
    • Route for systemic antibiotics to be delivered to ulcer
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54
Q

__________ is the most common cause of conjunctivitis in cats and kittens

A

herpesvirus

  • Feline Herpesviral Conjunctivitis​
  • 3 different age presentations
    • Neonatal Ophthalmia 􏰚
      • Ankyloblepharon 􏰚
      • Symblepharon
    • 8-12 wks
      • 􏰚Upper respiratory and ocular signs
    • 􏰚Mature
      • 􏰚Recrudescence
      • 􏰚Harbored in CN V ganglion
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55
Q

What drug is most commonly used to stimulate tear production in a KCS case?

A

Topical Cyclosporine A

If that is not working, Topical Tacrolimus is the 2nd choice

  • Cyclosporine A: T cell inhibitor
    • Directly lacrimogenic
    • Inhibits pigmentation & vascularization
    • 􏰚Q 12 hr topically; Up to 8 wks to max effect
  • Tacrolimus: topical 􏰚
    • Refractory cases
    • 􏰚Up to 30% better response
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56
Q

What is most likely the cause of superficial punctate keratopathy?

A

tear film deficiency (mucin deficiency most likely)

  • May also be an autoimmune disease
  • Superficial keratitis from mild insults or after anesthesia can look similar but not the same disease
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57
Q

Was this image taken using a direct or indirect ophthalmoscopic technique?

A

indirect

  • Inverted, reversed image
  • Larger field of view
  • Can see periphery
  • Distant from patient
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58
Q

T/F: Eyelid tumors are often benign in cats

A

False

  • Eyelid tumors are infrequent and often malignant in cats
  • Squamous cell carcinoma most common in cat & is malignant
  • Others: basal cell carcinoma, mast cell tumor, apocrine hidrocystomas in Persians and Himalayans
  • Treatment: Surgery, chemo, RT, Cryo, grafts
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59
Q

Abnormal growth of the cilia from the Meibomian gland openings is termed:

A

distichiasis

  • Aberrant cilia erupt from Meibomian gland openings
  • Common in dogs, uncommon in cats, rare in horses
  • Upper or lower lid
  • May be incidental findings
    • Keratitis, epiphora, ulcers, etc.
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60
Q

What cranial nerves are tested with the menace response?

A

CN II (optic) and CN VII (facial)

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61
Q

__________ is the 2nd most common cause of conjunctivitis in cats and kittens

A

Chlamydophila felis

  • Obligate intracellular bacterium
  • Conjunctivitis most common clinical sign in cats
  • Chemosis
  • Respiratory & GI: mild or absent
  • Diagnosis
    • Conj. Smear cytology: intracellular inclusion bodies ; can submit for fluorescent Ab test
    • 􏰚Conj. Swab: PCR for organism
  • Treatment
    • Supportive care
    • Topical tetracyclines, chloramphenicol (Risk for humans)
    • Systemic doxycycline if severe
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62
Q

Pannus may be bilateral, but lesions are not symmetrical in development. It starts at the ________ as red vascularized area on conjunctiva before speading centrally

A

Pannus may be bilateral, but lesions are not symmetrical in development. It starts at the temporal limbus as red vascularized area on conjunctiva becoming “fleshy” before speading centrally

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63
Q

Is buphthalmia seen in acute or chronic glaucoma cases?

A

chronic

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64
Q

T/F: Blue irises are a form of iris hypoplasia

A

True

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65
Q

Enlarged globe caused by ↑ IOP is termed:

A

buphthalmos

↑ IOP, often blind with mydriasis, often painful, often firm but should retropulse​

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66
Q

All of the following clinical signs may be seen with uveitis. Which one(s) is/are specific for uveitis?

  • Blepharospasm
  • Episcleral injection
  • Corneal edema
  • Deep perilimbal vascularization
  • Aqueous flare
  • Miosis
  • Iritis
  • Hypopyon or hyphema
A
  • Aqueous flare
  • Miosis
  • Hypopyon or hyphema
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67
Q

Name two contraindications for using Tropicamide:

A

glaucoma and some lens luxations

  • 0.5-1% Tropicamide (Mydriacyl®)
    • Rapidly dilates pupil
      • Within 15-30 min; can repeat if not dilated in 10 min.
    • Short duration 6-8 hours
    • Well tolerated
      • Salivation in cats
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68
Q

What are the three main acquired diseases of the lens?

A
  1. Nuclear or lenticular sclerosis
  2. Cataracts: focal or diffuse opacity of lens or lens capsule
  3. Luxations: displacement of lens from its normal fossa
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69
Q

T/F: Cherry eye is treated by removing the gland of the nictitans

A

NO!

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70
Q

About ___% of acquired KCS cases are immune-mediated

A

About 80% of acquired KCS cases are immune-mediated

  • Lymphoplasmacytic inflammation of lacrimal (and nictitans) glands​
  • Progressive until complete gland destruction
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71
Q

You diagnosed an acute superficial corneal ulcer in a dog. Which of the following would be incorrect information to give to the owner?

  • An E collar needs to be kept on the dog until the ulcer heals
  • Most of these cases resolve in 2-6 days
  • Topical antibiotics are indicated because infection is often present
  • You will need to put medications into the eye every hour for the first 24 hours
A

You will need to put medications into the eye every hour for the first 24 hours

(this is part of the treatment plan for deep ulcers)

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72
Q

What part of the eye produces aqueous humor?

A

ciliary body

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73
Q

In the case of anterior synechia, the ________ sticks to the ________

A

In the case of anterior synechia, the iris sticks to the cornea

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74
Q

__________ syndrome refers to the chronic conjunctivitis occurring in dogs with deep orbits, enophthalmia, narrow skulls, slight entropion, and inadequate tear drainage

A

Medial Canthal Pocket Syndrome

75
Q

What two types of tonometry require local anesthetic (proparacaine)?

A

Schiotz and Applanation

76
Q

A 2-year-old poodle presents with night blindness. This is an early sign of:

A

Progressive retinal atrophy (PRA)

77
Q

T/F: Melanoma is often benign in the canine eyelid

A

True

78
Q

Diagnosis in a cat?

A

Feline Diffuse Iris Melanoma

  • Starts as multiple patches
  • Becomes confluent
  • Late metastasis possible
79
Q

What recently developed drug is known as the ‘cure for KCS’?

A

Doesnotexisticol®

THERE IS NO CURE FOR KCS

  • But we have treatment goals:
    • Stimulate tear production
    • Control 2° inflammation or infection
    • Maintain lubrication
    • Treat ulcer if present; prevent future ulcers
    • Educate owner: treatment is FOREVER & FOREVER
80
Q

Inflammation of choroid and retina is termed:

A

chorioretinitis

inflammation of choroid and retina usually due to infectious agent​

81
Q

Which one of the following findings is not found with acute glaucoma?

  • Cloudy cornea
  • Blindness
  • Buphthalmia
  • Red eye
  • Painful eye
A

Buphthalmia​

82
Q

What are the two main rule-outs for this condition?

A

intraocular neoplasia and chronic glaucoma

83
Q

T/F: Anterior uveitis affects the iris and ciliary body, whereas posterior uveitis affects the choroid

A

True

84
Q

T/F: Topical steroids may be indicated in cases of superficial punctate keratitis

A

TRUE

This is an exception to avoiding topical steroids with corneal ulcers! If you’re asked about steroids and ulcers, the general answer is to AVOID.

85
Q

What tear film layer is responsible for stabilizing the tear film?

A

outer lipid layer (meibomian gland)

  • Three tear film layers:
    • Inner mucin layer
    • Middle aqueous layer
    • Outer lipid layer
86
Q

This layer of the cornea is hydrophobic:

A

epithelial layer

  • Hydrophobic: no fluorescein dye uptake if normal (no ulcer).
    • If break (ulcer) in it, see [+] fluorescein dye because it is absorbed by next layer (stroma). Will look ‘smooth,’ not like a crater.
87
Q

What are the medical and surgical treatments for bullous keratopathy?

A
  • Medical:
    • Topical 5% NaCl ointment: minimize edema and bullae formation (need to apply 4x/day)
  • Surgical:
    • Thermokeratoplasty
      • Make multiple small superficial stromal burns with special equipment (referral procedure)
      • Forms scar which helps to get rid of excess water
88
Q

Removal of the globe and orbital contents is termed:

A

exenteration

89
Q

The third eyelid contains the gland of ________, which makes up 40% of tears

A

The third eyelid contains the gland of nictitans, which makes up 40% of tears

Removing this may cause KCS

90
Q

This corneal abnormality may be due to a post-vaccine reaction to MLV canine adenovirus-1:

A

infectious canine hepatitis (blue eye)

91
Q

T/F: Glaucoma in cats is typically primary

A

False

Feline glaucoma is usually secondary to chronic uveitis, aqueous misdirection syndrome (shallow anterior chamber), lens luxation, intraocular neoplasia

92
Q

Identify the type of ulcerative keratitis:

A

Acute Superficial Corneal Ulceration (erosion)

  • This is an uncomplicated ulcer that involves variable degrees of loss of the corneal epithelium and basement membrane
    • Does not extend into stroma
  • Note ‘smooth’ appearance; not a crater!
93
Q

removal of the globe contents while leaving the sclera & extraocular muscles intact is termed:

A

evisceration

94
Q

For most proptosed eyes, what treatment will most likely be needed?

  • Same treatment as for glaucoma
  • Exenteration
  • Enucleation
  • Temporary tarsorrhaphy
A

Temporary tarsorrhaphy

(lateral canthotomy may also be needed)

95
Q

In a patient with unilateral acute primary glaucoma, what should the contralateral eye be treated with?

A

Timolol, dorzolamide, or demecarium bromide

prophylactically treat the contralateral eye with Timolol, dorzolamide, or demecarium bromide forever

96
Q

This image shows an ulcer that extends to what layer of the cornea?

A

Descemet’s membrane (DM)

For a corneal ulcer that extends to DM, only the sides of the crater will stain with fluorescein. This ulcer is termed a Descemetocele

97
Q

Which of the following is NOT USED to treat glaucoma?

  • Atropine
  • Oral carbonic anhydrase inhibitor
  • Topical miotic
  • Mannitol
  • Topical carbonic anhydrase inhibitor
A

Atropine​

98
Q

This layer of the cornea is important in normal corneal epithelial cell turnover and wound healing, as it contains proteinases, natural proteinase inhibitors, growth factors and cytokines:

A

tear film

Outermost aspect of the cornea

99
Q

Eversion of the lower eyelid; exposing conjunctival surface is termed:

A

ectropion

  • Eversion of the lower lid; exposes conjunctival surface
  • Common in dogs; rare in cats
  • Causes
    • Conformational; Loose facial skin: Bloodhounds, St Bernards
    • Paralytic: facial paralysis
    • Acquired: scar after eyelid injury or overcorrection of entropion
  • Signs: subclinical or conjunctivitis, epiphora
100
Q

What is the only indication for removal of the gland of the nictitans?

A

third eyelid neoplasia

  • Uncommon; usually older pets
  • Usually malignant SCC, HSA, LSA, melanoma
  • Can look like cherry eye!
  • Biopsy!
  • Surgical removal of entire TEL, including gland, if neoplastic
    • Only indication for gland removal!
101
Q

Describe the medical treatment for ectropion

A

n/a

  • Surgery is the only treatment for ectropion (aside from medical treatment for secondary infection that may be associated with the condition)*
  • Full-thickness V plasty is the surgery*
102
Q

T/F: Cataracts are very common to see associated with diabetes mellitus in dogs and cats

A

False

DM uncommonly results in cataracts in cats

103
Q

T/F: Corneal surgery in cats predisposes them to corneal sequestrum

A

True

That’s true.

104
Q

Which is FALSE regarding acquired eyelid disorders?

  • Blepharitis & blepharedema usually is associated with underlying skin dz
  • Eyelid lacerations although dramatic, are not emergencies
  • When correcting eyelid lacerations, it is important that apposition of eyelid margins must be exact
A

Eyelid lacerations although dramatic, are not emergencies​

105
Q

Identify this brown-black focal region of necrotic cornea in this cat:

A

Feline Sequestrum

(corneal necrosis, corneal nigrum, keratitis nigrum)​

  • Unknown etiology but often hx of previous corneal irritation /ulceration or FHV-1
  • Increased incidence in Persian, Siamese, Burmese and Himalayan
  • Treatment: remove the source of irritation/inflammation or treat for FHV1
    • Conservative treatment usually adequate because in most cases the focal necrotic plaque will detach and slough in several weeks
    • Surgical therapy if no change in 2 to 4 weeks
106
Q

A 2 year old German shepherd has had an eye discharge for several months. Schirmer tear test results were: OS: 5 mm/min, OD: 2 mm/min. The fluorescein stain was positive for a superficial corneal ulcer. Based on these results, which of the following drugs would not be used?

  • Artificial tears
  • Cyclosporine A
  • Tacrolimus
  • Topical corticosteroid
A

Topical corticosteroid​

107
Q

What term is used to describe abnormal iridocorneal angle due to developmental changes in pectinate ligaments (seen in narrow or closed angle glaucoma)?

A

goniodysgenesis

108
Q

Gentamicin is often used (vitreal injection) for pharmacologic ablation of the ciliary body. Why should this be avoided in cats?

A

gentamicin has been reported to cause sarcomas in cats

109
Q

Which of the following is the most common cause of glaucoma in cats?

  • Intraocular neoplasia
  • Lens luxation
  • Uveitis
  • Abnormal iridocorneal angle
  • Optic nerve atrophy
A

Uveitis

110
Q

With regard to cataracts, what stage of development is best described below:

Affects 15-99% of the lens; vision is affected if the cataracts are bilateral

A

Immature

111
Q

When the eyelids are fused to each other, this is termed:

A

ankyloblepharon

112
Q

What are the two main causes of buphthalmos?

A

glaucoma and intraocular neoplasia

113
Q

Which type of conjunctivitis is more common in the cat:

primary or secondary

A

primary

Primary conjunctivitis: common in cat; usually associated with feline herpesvirus or Chlamydophila, calici virus, or mycoplasma

114
Q

What is your most likely diagnosis?

A

uveal cysts

115
Q

This portion of the uvea controls the amount of light entering eye; focuses light on retina:

A

Iris

116
Q

A cat presents with conjunctivitis and mild respiratory signs. You identify the organism responsible via PCR and decide to treat with topical tetracycline.

What organism was likely identified on PCR?

A

Chlamydophila felis

Chlamydophila felis is the 2nd most common cause of conjunctivitis in the cat

117
Q

Which type of conjunctivitis is more common in the dog:

primary or secondary

A

secondary

Secondary conjunctivitis: common in dog; associated with with systemic (viral, parasitic, bacterial, allergic, immune mediated, etc) & ocular diseases

118
Q

If a dog presents with acute primary glaucoma, still has his vision, and signs have been present for less than three days, what are your two avenues of treatment?

A

decrease aqueous production, increase outflow

  • Decrease aqueous production - do not give IV fluids
    • Hyperosmotic agent: IV mannitol osmotically draws water from eye; dehydrates vitreous
    • Carbonic anhydrase inhibitor
      • Oral: Methazolamide (Neptazane, Glauctabs), acetazolamide (Diamox), dichlophenamide
      • Topical: Dorzolamide or brinzolamide
  • Increase outflow
    • F2 α prostaglandin analogue: Ex: Travoprost. Causes miosis & increase in outflow
    • Β-adrenergic blocker: Ex: Timolol, Betaxolol. ↓ aqueous production & ↑ ou􏰘tflow
    • Parasympathomimetics: Ex: pilocarpine, demecarium bromide. Both induce miosis
119
Q

With regard to cataracts, what stage of development is best described below:

Affects 100% of the lens; can’t see the fundus; totally opaque lens; vision loss if bilateral

A

Mature

120
Q

With regard to the healing process of a superficial stromal ulcer, at about 30 minutes to 5 hours, __________ infiltrate the defect. After ~12 hours, the keratocytes transform into __________. Collagenases help epithelial cells migrate in. These epithelial cells fill the defect and fibroblasts lay down __________ to restore the stromal defect.

A

With regard to the healing process of a superficial stromal ulcer, at about 30 minutes to 5 hours, leukocytes infiltrate the defect. After ~12 hours, the keratocytes transform into fibroblasts. Collagenases help epithelial cells migrate in. These epithelial cells fill the defect and fibroblasts lay down collagen to restore the stromal defect.

121
Q

Owner says dog had an eye problem and vet had to do surgery. What disease was most likely present to result in this?

  • Descemetocele
  • “Boxer” ulcer
  • Superficial non-healing ulcer
  • Pannus
  • Melting ulcer
A

Descemetocele and/or Melting ulcer

122
Q

Systemic Famciclovir may be used in cats with herpesvirus conjunctivitis. What is the main drawback of this drug in cats?

A

may be hepatotoxic

Famciclovir is an antiviral drug that is active against herpesvirus

123
Q

Lens proteins are called ________

A

crystallins

The lens capsule forms before immune system so embryo fails to learn that lens protein is ‘self.’ If there is lens damage and subsequent release of proteins in aqueous, there will be severe inflammation because they are not recognized as ‘self’

124
Q

Why do we not use intraocular prosthesis or intravitreal gentamicin injections in cats?

A

increases risk of sarcoma development​

125
Q

With what dog breed is pannus most associated?

A

German Shepherds

  • Young, 1–5 yrs, usually severely progressive & extensive
  • Older dogs, 4 ‐6 yrs slowly progressive & extensive

(Also seen in greyhounds)

126
Q

If there’s no response after debridement of an indolent ulcer, what is your next step in treatment?

A

grid keratotomy

  • Create scaffold for epithelium to attach
  • May have to repeat 2‐3 x
  • Punctate: less scarring but less likely to heal & more risks
127
Q

What is hypopyon?

A

pus in the anterior chamber of the eye​​

128
Q

large palpebral fissure is termed:

A

euryblepharon​

129
Q

Primary glaucoma can be broken down into two types. What are the two types and which one is more commonly seen?

A
  1. Narrow or closed angle (more common)
  2. Open angle (less common)
130
Q

When is tonometry performed during diagnostic testing?

  • After dilating the pupil
  • After examination of the retina
  • After fluorescein staining
  • Before performing Schirmer’s tear test
A

After fluorescein staining

131
Q

What are the two most commonly seen systemic metabolic diseases that cause cataracts?

A

Diabetes mellitus and Cushing’s disease

132
Q

The most common intraocular tumor is:

A

melanoma

  • Most common intraocular tumor
    • Usually benign in dogs but locally destructive
    • Cats: diffuse pigment changes
  • Refer for evaluation, monitoring, laser?
  • Enucleation when indicated
133
Q

A 5 year old dog has mucopurulent ocular discharge OU Schirmer Tear Test values: <5 o.u. Which of the following is the least likely etiology of the findings?

  • CN 7 damage
  • Sulfa drug use
  • Corneal ulcer
  • Destruction of the lacrimal gland
  • Etogesic drug use
A

Corneal ulcer​

134
Q

This test can distinguish retinal blindness from optic nerve or intracranial blindness:

A

ERG

135
Q

Identify the type of ulcerative keratitis:

A

Non‐healing superficial ulcer (chronic ulcer)

also called chronic corneal epithelial defect, indolent ulcer, Boxer ulcer, etc.​

136
Q

Name the cells found in the conjunctiva that secrete inner mucin layer of tear film:

A

goblet cells

137
Q

When aberrant cilia from tarsal gland grows through palpebral conjunctiva, this is termed:

A

ectopic cilia

  • Aberrant cilia from tarsal gland grows through palpebral conjunctiva
  • 4-12 mo. old dogs most common
  • Acute onset blepharospasm.
  • Non-healing or recurrent corneal ulcer
    • Dorsal elliptical ulcer
    • Often microscopic
138
Q

2 year old dog. How is this treated?

  • Topical antibiotics
  • Replace gland via surgery
  • Remove scrolled cartilage via surgery
  • Topical antibiotics and Cyclosporin A
A

Replace gland via surgery​

The picture is showing ‘cherry eye.’

139
Q

This corneal abnormality is characterized by vesicles in stroma:

A

Bullous Keratopathy​

  • Characterized by vesicles in stroma
  • Due to chronic endothelial disease
  • Stromal bullae may rupture & cause erosions
    • Does not always cause ulcer
  • Bullae may coalesce to form large bullae
  • Surrounding stroma and epithelium may be edematous and vascularized due to bulla or underlying disorder
140
Q

With regard to cataracts, what stage of development is best described below:

Affects <15% of the lens; No change in vision

A

Incipient

141
Q

Diagnosis?

A

cherry eye.

142
Q

T/F: In the case of deep ulcers, part of the treatment plan involves administering antibiotics every 1 to 2 hours for the first 24 hours

A

True

143
Q

This dog was hit by a car. What is this?

  • Exophthalmos
  • Panophthalmos
  • Proptosis
  • Buphthalmos
A

Proptosis​

144
Q

Note the scalloped margin of the pupil in this image. What is your most likely diagnosis?

A

senile iris atrophy

  • Senile iris atrophy – scalloped margin
    • PLR reduced
    • Dilated pupil; +/- abnormal shape
  • PLR is reduced, but does not affect vision​
145
Q

Which of the following is true in treatment for KCS?

  • The drug of choice is topical cyclosporin 0.2%
  • The drug of choice for neurogenic cases is pilocarpine
  • Glucocorticosteroids for treatment of chronic KCS
  • All of the above
  • A and B
A

All of the above​

146
Q

Which of the following ulcers would you use grid keratotomy to treat?

  • Deep corneal ulcer
  • Superficial corneal ulcer
  • Non-healing superficial ulcer
  • Descemetocele
  • Melting corneal ulcer
A

Non-healing superficial ulcer

(aka indolent ulcer, “boxer ulcer”)

147
Q

What is the most common metastatic tumor seen in the eye?

A

lymphoma

148
Q

What is a normal Schirmer Tear Test result in a dog?

A

> 15 mm/min

low values are significant

149
Q

What diagnostic tool is most useful for confirming glaucoma?

A

tonometer

  • Measures intraocular pressure (IOP)
    • Indentation tonometry
    • Applanation tonometry
    • Rebound tonometry
  • Normal IOP <25mmHg
  • Glaucoma >25mmHg
150
Q

What would you do first?

  • IOP
  • Fluorescein stain
  • Refer
  • Schirmer tear test
A

Schirmer tear test​

151
Q

For lens luxations, subluxations, and some cataracts, the treatment of choice is:

A

lens removal

  • Phacoemulsification for cataract removal & ruptured lens
    • 95% success rate with experience! preferred
    • Small corneal incision; small opening in lens capsule; lens emulsified by ultrasonic handpiece; then aspirated.
    • Artificial lens implanted into capsule
    • Removes entire lens
  • Intracapsular lens extraction for luxated lens
    • 70% success rate
    • Large corneal incision
    • Artificial lens implant may be sutured into place
152
Q

Identify the type of ulcerative keratitis:

A

Bullous keratopathy

Does not always ulcerate​

153
Q

Which two parts of the eye are avascular?

A

cornea and lens

This is important when thinking about corneal ulcer healing.

  • Vessels invade in response to injury on day 3-6 and supply nutrients and growth factors
  • Source of vessels:
    • Superficial: from conjunctiva; tree branching appearance; cross the limbus
    • Deep: from sclera; shorter & straighter vessels; may appear as deep red halo near limbus
154
Q

What are the two most common tear film abnormalities and the most important sequela of each?

A
  • Impaired production (results in keratoconjunctivitis sicca - KCS)
  • Impaired drainage (results in epiphora)
155
Q

Inflammation of the tissues of the eye is termed:

A

orbital cellulitis

  • May progress to retrobulbar abscess or orbital infection
  • Causes
    • Puncture : unilateral more often (like prior example)
    • Foreign body: more unilateral. Enter via eyelids, mouth or conj. sac
    • Infectious: bacterial, fungal, parasitic or extension from adjacent salivary infection, sinus, tooth root
    • 􏰖Idiopathic inflammation: unilateral or bilateral
  • Treatment
    • Topical & systemic antibiotics (Broad Spectrum pending culture)
    • Systemic anti-inflammatories (Steroids preferred)
    • Supportive care
156
Q

A 10-year-old mixed breed dog presents to your clinic with opacity of the lens. He appears to still have his vision and on direct ophthalmoscopy, you can clearly see the fundus.

What is your diagnosis?

A

lenticular sclerosis

  • Normal aging of lens
  • Starts about 7 yrs of age (dog) - later in cats
  • Changes refractive index = bluish‐grey appearance when light hits eye at angle.
  • Does not affect vision
  • Can see fundus
157
Q

A break in Descemet’s membrane is termed:

A

Haab’s striae

158
Q

Note the wrinkled appearance to the anterior lens capsule from lens protein liquefaction.

At what stage of development is this cataract?

A

Hypermature

159
Q

Was this image taken using a direct or indirect ophthalmoscopic technique?

A

direct

  • ​**Upright image
  • Small field of view
  • Can’t see periphery
  • Closer to patient
160
Q

T/F: Atropine is indicated in cases of acute primary glaucoma

A

False!

Atropine is contraindicated. In cases of acute primary glaucoma, you want the eye miotic, NOT mydriatic

161
Q

Prolapsed gland of the nictitans is termed:

A

cherry eye

  • Common in dogs: often < 2 yrs
    • English bulldogs, Cocker spaniels, Beagles
  • Rare in cats: Burmese
  • Acute appearance of red mass at medial canthus
  • Secondary inflammation variable: conjunctivitis, epiphora
  • Rule out neoplasia or other diseases in older pets: FNA or biopsy
162
Q

What would a normal Schirmer tear test result be in dogs?

A

≥15 mm/min

  • Dogs
    • 􏰚 ≥15 mm/min – WNL
    • 􏰚 11-14 mm/min – early
    • 􏰚 6-10 mm/min – moderate 􏰚
    • <5 mm/min - severe
  • Cats
    • ≈10 mm/min – WNL
    • > 5 mm/min may be normal
163
Q

What breeds are predisposed to proptosis?

A

brachycephalic breeds

they have a more shallow orbit

164
Q

Identify the corneal abnormality:

A

melting corneal ulcer with hypopyon ventrally

Melting ulcer

  • Exogenous proteases released by bacteria cause collagenolysis of stroma
  • Serious condition
  • Usually Gram [-] bacteria, but also can be sterile or due to other bacteria
  • Usually causes or can result in a deep ulcer
165
Q

T/F: Immunosuppressive agents are indicated in the treatment of chronic superficial keratitis (pannus)

A

True

Topical immunosuppression:

  • Ophthalmic 0.1% dexamethasone or 1% prednisolone acetate
  • Cyclosporine 0.2% ointment or 1-2% solution
  • Pimecrolimus or tacrolimus
  • Combination of above
  • Doggle sunglasses
166
Q

Normal sized globe that protrudes anteriorly is termed:

A

exophthalmos

167
Q

What is the most common eyelid tumor that we see in the dog?

A

Meibomian gland adenoma​

Meibomian gland adenoma (sebaceous adenoma or cystadenoma) is usually benign. Can be associated with chalazion due to obstructed gland​

168
Q

A dog presents with this type of ulcerative keratitis. As part of your treatment protocol, you prescribe topical antibiotics.

Which antibiotics would you use?

A

triple antibiotic (BNP) or chloramphenicol or gentamicin

In cats, avoid using BNP (causes anaphylaxis). Instead you can use terramycin, erythromycin, tobramycin, chloramphenicol, or gentamicin.

169
Q

This layer of the cornea makes up 90% of the corneal thickness and is hydrophilic:

A

stroma

  • Layers of collagen fibers, GAGs, some mesenchymal cells
  • Hydrophilic: will take up fluorescein dye: will look like crater.
  • Slow turnover: 2 years
  • Endothelial cells remove water from this layer. Amount of water in stroma is tightly regulated to maintain corneal clarity
170
Q

Identify the type of ulcerative keratitis:

A

Deep corneal ulcer​

See crater‐like lesion of variable depth in cornea. Includes descemetocele & melting ulcer​

171
Q

Identify the corneal abnormality. Multifocal punctuate circular grey fluffy cotton‐like opacities in corneal stroma:

A

Florida Keratopathy: Florida spots, Florida keratitis, Caribbean keratopathy

  • Unknown etiology
  • Multifocal punctuate circular grey fluffy cotton‐like opacities in corneal stroma
    • Inflammatory component
    • Generally not painful
  • Typically asymptomatic
    • Some have a transient conjunctivitis at first
  • Treatment: benign neglect
    • No response to glucocorticoids, antibiotics or antifungals
172
Q

If a dog presents with an acute superficial corneal ulceration as well as miosis and uveitis, what should you make sure to use as part of your treatment plan?

A

mydriatic

Atropine to counteract painful ciliary muscle spasm, to prevent synechia (adhesion of iris to cornea or lens) & to ↓ uveal area available to incite inflammation.​​

173
Q

Name three fundic signs of retinal disease:

A

hyperreflectivity, hyporeflectivity, and vessel changes

  • Hyperreflectivity: shiny bright tapetum due to thinning of retinal layers allowing more light to be reflected back from tapetum
    • Inflammation, degeneration, toxins, ischemia
  • Hyporeflectivity: dull, fuzzy because of fluid or cell infiltrate between retina & tapetum
    • Hypertension, inflammation, infection, neoplasia
  • Vessel changes
    • Decreased size (attenuation) seen with degeneration, anemia, hypovolemia
    • Large size seen with inflammation, hyperviscosity, hypertension, polycythemia
    • Bleeding: trauma, coagulopathy, hypertension, neoplasia, microaneurysms
174
Q

Inflammation of the lacrimal gland is termed:

A

dacryoadenitis

175
Q

Identify the type of ulcerative keratitis:

A

Corneal laceration​

If deep, can exude aqueous humor; iris can prolapse. Small lacerations may heal quickly​

176
Q

This acquired vitreal disease results when Ca2+ and phospholipids condense within the vitreal gel. It is seen in older pets:

A

Asteroid Hyalosis

177
Q

What is hyphema?

A

blood in the anterior chamber of the eye​

178
Q

Identify the type of ulcerative keratitis:

A

Acute superficial corneal ulcer

(aka corneal erosion). Epithelial layer involved

179
Q

For which condition below would you use autologous serum in the treatment?

  • Indolent corneal ulcer
  • Melting corneal ulcer
  • Non-ulcerative keratitis
  • Superficial corneal ulcer
A

Melting corneal ulcer​

180
Q

Golden retreiver presents with waxing/waning “surprised” expression over the past 2 weeks; non-painful when the mouth is opened. Orbital tissues are not hyperemic and the dog’s behavior is normal. What is your primary differential?

A

extraocular polymyositis

  • Etiology is known; more than likely immune-mediated
  • Treat with corticosteroids
    • ​May relapse
  • Good prognosis
181
Q

When treating a corneal ulcer with ________, the resultant mydriasis will prevent ________ from occurring.

  • Antibiotics, a descemetocele
  • Tropicamide, glaucoma
  • Atropine, synechiae
  • Steroids, melting ulcer
A

When treating a corneal ulcer with Atropine, the resultant mydriasis will prevent synechiae from occurring.

182
Q

What is a senile cataract?

A

The most advanced form of nuclear sclerosis

  • Fundus view is obscured
  • Impaired vision
  • Dogs >14 years old
    • Cats older
183
Q

Adhesion of the conjunctiva to itself or the cornea is termed:

A

symblepharon

Treatment: eliminate infection; trim tissue; often repeat trimming

184
Q

Presence of haired skin on the surface of the eye is termed:

A

dermoid

RUSVM SAM II (8 decks)

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