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CVNT2 > Surgical Conditions of the Eye > Flashcards

Surgical Conditions of the Eye Flashcards

1
Q

which part of the eye has the photoreceptor cells?

A

retina

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2
Q

what are the corners of the eye called?

A

medial and lateral canthus

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3
Q

what is the junction between the sclera and the cornea?

A

limbus

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4
Q

what is the choroid?

A

vascular layer which supplies nutrients to the eye

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5
Q

what is the sclera?

A

protective covering which circles most of the entire eyeball

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6
Q

what is the cornea?

A

the transparent part of the eye that covers the iris and the pupil and allows light to enter the inside

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7
Q

what is the iris?

A

coloured part of the eye, controls pupil size

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8
Q

which part of the eye changes the shape of the lens?

A

ciliary muscle within the ciliary body

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9
Q

what does the lens do?

A

focuses light onto the retina

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10
Q

what is the pupil?

A

hole made by the iris, permits light onto the retina

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11
Q

what is the “normal” shape of a dogs eye?

A

almond shaped

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12
Q

how much sclera should you be able to see in a dog?

A

small amount medially and laterally

abnormal to see any ventrally or dorsally

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13
Q

what equipment is required for an ophthlamic exam?

A

dark room

pen torch/flashlight

direct ophthalmoscope

20D condensing lens

tonometer

consumables (fluorescein, schirmer test strips)

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14
Q

what is considered appropriate restraint for ophthalmic examination?

A

minimal is best, calm and confident

patient seated at edge of table

place one hand over back towards chest and one hand supporting under the chin

may need muzzle/towel/chemical restraint for fractious patients

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15
Q

what considerations should be made when restraining a blind/potentially blind dog?

A

talk to them before you approach
go slow
guide them carefully when walking

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15
Q

what considerations should be made when restraining a blind/potentially blind dog?

A

talk to them before you approach
go slow
guide them carefully when walking

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16
Q

what considerations should be made if a patient has a painful/fragile eye or increased IOP?

A

no neck leads, gentle handling

keep stress/barking to a minimum

no jugular samples or temperature checks

may need to sedate prior to placing IV catheter

ensure smooth recovery from anaesthesia

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17
Q

what are the 7 main steps of an ophthalmic exam?

A
  1. history
  2. distant and close examination
  3. schirmer tear test
  4. sample collection if required
  5. neuro-ophthalmic examination
  6. close direct opthalmoscopy
  7. indirect ophthalmoscopy
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18
Q

how should history be taken during an ophthalmic exam?

A

start broad then narrow down to presenting ophthalmic complaint

signalment, general history
known illness/signs of other illness
previous ocular conditions/any treatment
current ocular complaint/any treatment

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19
Q

what is assessed during the distant and close examination?

A

animals attitude, body condition

face - symmetry, ocular discharge

eyelids - palpebral fissure, size, colour, swelling

eyeballs - positions, size, direction, movements, retropulsion

observation of pupils - static and dynamic

use of direct ophthalmoscope (retro-illumination)

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20
Q

which tests are involved in the neuro-ophthalmic examination?

A 
pupillary light reflex (bilateral constriction) 
dazzle reflex 
menace response 
tracking response 
visual placing 
maze test
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21
Q

what is close direct ophthalmoscopy?

A

looking at the detail of the ocular structures

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22
Q

what is indirect ophthalmoscopy?

A

use of a 20D condensing lens to see structures at the back of the eye

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23
Q

what is the schirmer tear test?

A

placement of test strips in the lower eyelid to assess tear production
normal dog = 15-25mm over 1 minute

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24
Q

what other common diagnostic tests might be part of the ophthalmic examination?

A

bacterial swab for cytology/culture and sensitivity

fluorescein staining

IOP measurement

gionoscopy

ocular ultrasound
electroretinogram
CT/MRI

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25
Q

how is IOP measured?

A

with a schiotz tonometer/tonopen/tonovet

topical anaesthetic required for tonometer/tonopen

26
Q

what is normal IOP?

A

10-25 mmHg

27
Q

what is high pressure in the eye called?

A

glaucoma

28
Q

why might there be low pressure in the eye?

A

uveitis (intraocular inflammation)

29
Q

what is gonioscopy?

A

evaluation of the internal drainage system of the eye - use of a special lens and LA

30
Q

what are the indications for a gonioscopy?

A

patients with confirmed glaucoma/a risk of developing inherited glaucoma

31
Q

what does an electroretinogram do?

A

test the function of the retina (non-invasive)

32
Q

why might a CT/MRI of the eye be perfomed?

A

investigation of exophthalmos

main differentials are retrobulbar abscess/neoplasia or foreign body

33
Q

what is the term for left eye?

A

ocular sinister (OS)

34
Q

what is the term for right eye?

A

ocular dexter (OD)

35
Q

what is the term for both eyes?

A

ocular uterque (OU)

36
Q

what are the steps for administering drops to a patients eye?

A
  1. Ensure that you have the correct medication for the correct eye
  2. Clean any discharge
  3. Hold the bottle/tube between your thumb and first two fingers of your dominant hand
  4. With your other hand, support the chin and lift it upwards slightly, holding the muzzle gently if required
  5. Come from behind the head towards the eye
  6. Using your finger, gently lift the upper eyelid and squeeze the bottle to apply one drop of the medication
  7. Rest the hand that is holding the medication on your patient’s head (this will decrease the risk of accidental injury to the eye from the nozzle)
  8. If tolerated, remain in that position for a few seconds, lifting the chin slightly allowing the drop to stay within the eye and disperse
37
Q

what are the signs of ocular pain?

A

increased blink rate/blepharospasm
increased lacrimation and overflow

redness 
photophobia 
rubbing 
miosis 
third eyelid protrusion
38
Q

what are the commonly used topical drugs in ophthalmology?

A 
lubricants 
mydriatics 
topical antibiotics 
topical NSAIDs 
carbonic anhydrase inhibitors 
prostaglandin analogues
39
Q

what do mydriatics do?

A

pupil dilation, muscle spasm release (uveitis), comfort

40
Q

what do topical NSAIDs do?

A

treat inflammation within the eye

41
Q

what do carbonic anhydrase inhibitors do?

A

reduce IOP

decrease production of aqueous humour

42
Q

what do prostaglandin analogues do?

A

increase aqueous outflow (used in glaucoma treatment)

43
Q

what should be considered on the pre-anaesthetic checklist?

A

physical examination

pre-anaesthetic blood tests

eye drops prior to surgery - most patients

IV catheter - hindlimb preferable (OIP considerations)

diabetics - insulin vs no insulin

44
Q

which types of eye surgery do we clip for?

A

clip for eyelid surgery, not for corneal/intraocular

45
Q

what is used for ocular preparation pre-surgery? what strength?

A

povidone iodine solution

1: 50 iodine/sterile saline for globe
1: 10 for eyelids

46
Q

list the steps involved in surgical preparation for eyelid surgery.

A

1 .Wear gloves.

  1. Apply copious amounts of lubricating gel to the eye(s) e.g. Lubrithal, Viscotears.
  2. Use small, clean sharp clippers
  3. Clip area required as close to the skin without causing irritation
  4. Use gauze swabs and sterile saline to remove the gel and hair from the eye(s)
  5. Prep the globe first with 1:50 povidone iodine solution
  6. Then prep the eyelids (adnexa) with 1:10 povidone iodine solution
  7. After 3 minutes, flush the globe with sterile saline to prevent corneal toxicity
47
Q

list the steps involved in prep for corneal/intraocular surgery/

A
  1. wear gloves
  2. prep globe with 1:50 povidone iodine solution
  3. after 3 minutes, flush the glove with sterile saline to prevent corneal toxicity
48
Q

what is involved in setting up theatre for ocular surgery?

A

damp dust all surfaces, mop floor

arterial line set up, ventilator may be required if using neuromuscular blockers

prepare kit and consumables

referral setting: operating microscope, phacoemulsification machine

49
Q

how do you clean microsurgical instruments?

A

remove any gross material with distilled water and soft nail/toothbrush

check instruments for damage

place in ultrasonic cleaner for 5-10 mins using a neutral pH cleaning solution

allow to air dry

place in microsurgical tray - in matting - should not touch one another

TST strip, double wrapped, sterilise by autoclave and allow to dry thoroughly

store flat

50
Q

what temperature should the autoclave be for cleaning microsurgical instruments?

A

134-137°C

51
Q

why are neuromuscular blocking agents used during ocular surgery?

A

keeps patient still

prevents normal rotation of eye during anaesthesia

52
Q

what are the post-op care considerations for ocular surgery?

A 
harness, no collar/lead walk 
no jugular samples 
buster/soft collar 
recognise and monitor pain 
administer pain relief and eye medication 
keep wounds clean 
keep patient calm
53
Q

what is exophthalmos?

A

abnormal protrusion of the eyeball

e.g. due to orbital foreign body, tumour, abscess

54
Q

what is globe proptosis?

A

eyelids trapped behind globe - emergency, can quickly develop into corneal ulcer

55
Q

what is entropion?

A

inverted eyelids

can be primary or secondary (e.g. due to trauma or eyelid surgery)

56
Q

what is keratoconjunctivitis sicca (KCS)?

A

lack of tears due to immune-mediated
destruction of the gland which produces tears

assessed via tear test

57
Q

how is keratoconjunctivitis sicca treated?

A

topical medication - Optimmune and lubricants (life-long)

58
Q

what is conjunctivitis?

A

inflammation of the conjunctiva

many causes

59
Q

how are corneal ulcers visualised?

A

with fluorescein staining

60
Q

what is uveitis?

A

inflammation within the eye - very painful

61
Q

what is a cataract?

A

opacity of the lens

62
Q

what is a common cause of retinal detachment in cats?

A

systemic hypertension (secondary to chronic renal failure)

CVNT2 (47 decks)

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