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Veterinary Nursing > Surgical Conditions of the Eye > Flashcards

Surgical Conditions of the Eye Flashcards

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1
Q

What are some clinical signs of ocular pain?

A 
Squinting
Third eyelid protrusion
Redness
Increased blink rate, blepharospasm
Increased lacrimation and overflow
Photophobia
Rubbing
Miosis (contraction of pupil)
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2
Q

What is the purpose of topical lubricants?

A

Provide a protective layer
Moisturise dry eyes
Soothe
Lubricate

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3
Q

What is the purpose of topical mydriatics?

A

Pupil dilation
Muscle spasm release
Comfort

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4
Q

What is the purpose of topical antibiotics?

A

Treatment/prevention of bacterial infection

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5
Q

What is the purpose of topical NSAIDs?

A

Treat inflammation within anterior eye

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6
Q

What is the purpose of topical carbonic anhydrase inhibitors?

A 
Reduce IOP (glaucoma)
Decrease the production of aqueous humour
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7
Q

What is the purpose of topical prostaglandin analogues?

A 
Reduce IOP (glaucoma)
Increase the aqueous outflow
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8
Q

What abbreviations are used to describe which eye is affected?

A 
OS = Ocular Sinister (left eye)
OD = Ocular Dexter (right eye)
OU = Ocular Uterque (both eyes)
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9
Q

What pre-anaesthetic considerations should we have prior to ocular surgery?

A

Full physical examination
Pre-anaesthetic blood tests?
Eye drops prior to surgery?
IV catheter - increasing venous pressure will increase ocular pressure
Diabetic patients - insulin or no insulin?

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10
Q

When do we clip for ocular surgery?

A

Do clip for eyelid surgery

Do not for corneal/intraocular surgery

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11
Q

How do we make up povidone iodine solution for the globe and the eyelids?

A 
Globe = 1:50 with sterile saline
Eyelids = 1:10 with sterile saline
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12
Q

How do we prep for eyelid surgery?

A

Wear gloves
Apply copious amounts of lubricating gel to eye(s)
Use small, clean, sharp clippers
Clip area required as close to skin without causing irritation
Use gauze swabs and sterile saline to remove gel and hair from eye(s)
Prep globe first with 1:50 povidone iodine solution
Then prep eyelids with 1:10 povidone iodine solution
After 3 mins, flush globe with sterile saline to prevent corneal toxicity

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13
Q

How do we prep for corneal/intraocular surgery?

A

Wear gloves
Prep globe with 1:50 povidone iodine solution
After 3 minutes, flush globe with sterile saline to prevent corneal toxicity

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14
Q

How do we clean microsurgical instruments?

A

Immediately after procedure, remove any gross material with distilled water and soft nail brush/toothbrush
Check instruments for damage
Place in ultrasonic cleaner for 5-10 minutes using a neutral pH ultrasonic cleaning solution (ensure they are on a finger mat, not touching each other)
Allow instruments to air dry
Place in microsurgical tray in silicone finger matting (they should not touch one another)
TST strip, double-wrapped, sterilise by autoclave 134-137 degrees C
Allow kits to dry thoroughly before storing
Store flat

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15
Q

How do we care for ocular patients post-op?

A 
Remember - increased venous pressure = increased IOP
Harness walk, not collar and lead
No jugular samples
Buster/soft collar
Recognise and monitor pain
Admin pain relief/eye medication
Keep wound clean and patient calm
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16
Q

What ocular conditions are commonly seen in practice?

A 
Exophthalmos (abnormal protrusion of eyeball)
Globe proptosis
Entropion (eyelids inverted)
Keratoconjunctivitis sicca (KCS)
Conjunctivitis - inflammation (hyperaemia)
Corneal ulcers
Uveitis
Opacity of the lens (cataracts)
Retinal detachment
17
Q

What equipment do we need for an ophthalmic exam?

A 
Dark room
Pen torch
Direct ophthalmoscope
20D condensing lens
Tonometer
Consumables e.g. Fluorescein, Schirmer Tear Test strips etc.
18
Q

How do we restrain patients for ophthalmic examination?

A

Minimal is best
Calm and confident
Patient seated at edge of table (unless large)
Place one hand over back towards chest and one hand supporting under the chin

19
Q

How should we handle fractious patients when restraining for an ophthalmic exam?

A

Muzzle
Towel
+/- chemical restraint

20
Q

How should we handle blind/visually impaired patients?

A

Talk to them before you approach them
Go slow
Guide them carefully when walking

21
Q

How can we avoid increasing venous pressure to avoid increasing IOP?

A 
No neck leads - harness walk
Gentle handling
Keep barking/stress to a minimum
No jugular samples
No temperature checks
May need to sedate prior to placing IV catheter (saphenous preferred)
Ensure smooth recovery from anaesthesia
22
Q

What are the stages of the ophthalmic exam?

A 
History
Distant examination and close examination
Schirmer tear test (+ sample collection)
Neuro-ophthalmic examination
Close direct ophthalmoloscopy
Indirect ophthalmoscopy
23
Q

What history do we need to collect about ocular patients?

A 
Signalment
General history
Known illness/signs of other illness
Previous ocular conditions +/- treatment
Current ocular complaint +/- any treatment
Vision?
24
Q

How do we carry out a distant and close examination?

A

Animal attitude - body condition
Face - symmetry, ocular discharge
Eyelids - palpebral fissure, size, colour, swelling
Eyeballs - position, size, direction, movements, retropulsion
Observation of pupil - static (symmetry, size, shape) and dynamic (PLR)
Use of direct ophthalmoscope - retro-illumination

25
Q

What reflexes do we test in the neuro-ophthalmic exam?

A 
Pupillary light reflex (PLR)
Dazzle reflex
Menace response
Tracking response
Visual placing
Maze test (in bright and dim light)
26
Q

What are some common diagnostic tests?

A 
Schirmer tear test
Bacterial swab, cytology, culture and sensitivity
Fluorescein staining
IOP measurement
Gonioscopy
Ocular ultrasound
Electroretinogram (ERG)
CT and MRI
27
Q

Describe an intraocular pressure (IOP) measurement.

A

Schiotz tonometer, Tonopen, Tonovet

Use topical anaesthetic with Schiotz tonometer and Tonopen

28
Q

What is a normal intraocular pressure?

A

Normal IOP = 10-25mmHg

29
Q

What is the normal value for a Schirmer tear test?

A

Normal dog = 15-25mm over 1 minute

30
Q

Describe gonioscopy.

A

Indications = patients with risk of developing inherited glaucoma/patients with confirmed glaucoma (increased IOP)
Use a special lens to view the drainage angle
Local anaesthetic applied prior to performing

31
Q

Why do we use CT and MRI?

A

Investigating exophthalmos

Main differentials = retrobulbar abscess, retrobulbar neoplasia, foreign body

Veterinary Nursing (65 decks)

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