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Ophthalmology > The 3rd Eyelid > Flashcards

The 3rd Eyelid Flashcards

1
Q

The third eyelid is also called the ____ ____.

A

Nictitans membrane

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2
Q

What are the 3 functions of the third eyelid?

A
  1. Production of aqueous tear film
  2. Distribution of precorneal tear film
  3. Protection of the ocular surface
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3
Q

In which species is the 3rd eyelid actively controlled?

A

Birds

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4
Q

What is the lay term for a prolapse of the 3rd eyelid?

A

Cherry eye

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5
Q

In what age group of animals will you most likely see prolapsed 3rd eyelid, or cherry eye?

A

Young ( < 1 year of age)

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6
Q

Which dog breeds are predisposed to cherry eye?

A
  1. English bulldogs
  2. Cocker spaniels
  3. Beagles
  4. Brachycephalic breeds
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7
Q

Which cat breeds are predisposed to cherry eye?

A

Burmese

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8
Q

Everted cartilage of the 3rd eyelid is most common in which type of dog breeds?

A

Giant breeds

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9
Q

What are 2 treatment methods for everted cartilage of the 3rd eyelid?

A
  1. Thermal cautery

2. Surgical resection

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10
Q

What type of treatment is NEVER to be implemented in the treatment of a prolapsed gland of the 3rd eyelid?

A

Surgical excision

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11
Q

With which conditions would you expect ELEVATION of the 3rd eyelid?

A
  1. Ocular pain
  2. Globe displacement (exophthalmos, enophthalmos)
  3. Neurologic (Horner’s syndrome)
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12
Q

What are the 3 most common tumors of the 3rd eyelid?

A
  1. SCC
  2. Adenocarcinoma
  3. Hemangioma
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13
Q

What is the treatment of choice for neoplasia of the 3rd eyelid?

A

Surgical resection of the 3rd eyelid

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14
Q

For which condition is it acceptable to remove the ENTIRE 3rd eyelid?

A

Only for cancerous processes such as adenocarcinoma of the 3rd eyelid

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15
Q

How thick is the tear film?

A

7-10 um

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16
Q

What are the 5 roles of the tear film?

A
  1. Lubrication
  2. Nutrition (oxygen, glucose)
  3. Remove debris
  4. Refract light
  5. Anti-microbial
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17
Q

What is the outermost layer of the tear film?

A

Lipid

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18
Q

What is the middle layer of the tear film?

A

Aqueous

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19
Q

What is the innermost layer of the tear film?

A

Mucin

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20
Q

What produces the lipid layer of the tear film?

A

Meibomian glands

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21
Q

What produces the aqueous layer of the tear film?

A

Lacrimal gland and the gland of the 3rd eyelid

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22
Q

What produces the mucin layer of the tear film?

A

Conjunctival goblet cells

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23
Q

What is the function of the lipid layer of the tear film?

A

Prevents evaporation

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24
Q

What is the function of the aqueous layer of the tear film?

A

Lubrication and nutrition

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25
Q

What is the function of the mucin layer of the tear film?

A

Anchors tears to the eye

26
Q

What produces 2/3 of the aqueous layer of the tear film?

What produces 1/3 of the aqueous layer of the tear film?

A

2/3 = lacrimal gland

1/3 = gland of the 3rd eyelid

27
Q

Which type of tear film deficiency is most common, quantitative or qualitative?

A

Quantitative

28
Q

Which component(s) of the tear film is/are decreased in quantitative tear film deficiency?

A

Aqueous

29
Q

Which component(s) of the tear film is/are decreased in qualitative tear film deficiency?

A

Lipid and mucin

30
Q

What is an example of a quantitative tear film deficiency?

A

KCS

31
Q

True or False: BOTH quantitative and qualitative tear film deficiencies result in desiccation and inflammation of the ocular surface.

A

TRUE

32
Q

What are 2 examples of a qualitative tear film deficiency?

A
  1. Blepharitis

2. Conjunctivits

33
Q

Which component of artificial tears serves as a “lipid” component?

A

Mineral oil

34
Q

Which component of artificial tears serves as a “mucin” component?

A

Hyaluronic acid

35
Q

In KCS, which component of the tear film is decreased?

A

Aqueous

36
Q

What breeds may have a predisposition to KCS?

A
  1. King charles spaniel
  2. English bulldog
  3. Pug
  4. Lhasa apso
  5. Shih tzu
  6. West highland terrier
  7. Boston terrier
37
Q

What are the 3 components to KCS?

A
  1. Keratitis
  2. Conjunctivitis
  3. Sicca
38
Q

What are the clinical signs of the keratitis component?

A
  1. Neovascularization
  2. Pigmentation
  3. Ulceration
  4. Scarring
39
Q

What are the clinical signs of the conjunctivitis component?

A
  1. Conjunctival hyperemia
  2. Chemosis
  3. Secondary bacterial infection
40
Q

What are the clinical signs of the sicca component?

A
  1. Mucoid to purulent discharge

2. Dull, lusterless corneal surface

41
Q

What test can be used to diagnose KCS?

A

Schirmer tear test

42
Q

What is “normal” for a schirmer tear test?

A

15-25 mm/min

43
Q

What is “marginal” for a schirmer tear test?

A

10-15 mm/min

44
Q

What is “low” for a schirmer tear test?

A

< 10 mm/min

45
Q

What is a suspected KCS?

A

10-15 mm/min on STT

46
Q

What is diagnostic for KCS?

A

< 10 mm/min on STT

47
Q

What are the causes of KCS?

A
  1. Immune-mediated adenitis
  2. Neurogenic
  3. Metabolic
  4. Drug-induced
  5. Other (trauma, infectious, iatrogenic, developmental, debilitation/dehydration, neoplasia)
48
Q

What is the MOST COMMON cause of KCS?

A

Immune-mediated adenitis

49
Q

What is the treatment for immune-mediated adenitis caused KCS?

A

Immunomodulation

50
Q

Which drugs would you choose for KCS if the cause were immune-mediated?

A
  1. Cyclosporine A

2. Tacrolimus

51
Q

What is the MOA of the immuno-modulating drugs?

A

Inhibit T cell activation via IL-2

52
Q

Which drug would you choose for KCS if the cause were neurogenic?

A

Pilocarpine

53
Q

For how long should you treat before you recognize that tear values are not increasing and “give up”?

A

> 4 weeks

54
Q

If the KCS doe not respond to initial treatment, what are your 3 next options?

A
  1. Review the cause of the KCS
  2. Increase frequency and concentration of drug
  3. Discuss surgical options
55
Q

What are the 2 general causes for excessive ocular discharge?

A
  1. Over production

2. Inadequate drainage

56
Q

What are the causes for over production?

A
  1. Irritation from a tumor
  2. Irritation from corneal ulcer
  3. Abnormal eyelashes
  4. Entropion
  5. Glaucoma, uveitis
57
Q

Which breeds are most predisposed to a functional obstruction?

A

Brachycephalics

58
Q

With a functional obstruction, what would your Jones test result be?

A

Negative

59
Q

With a functional obstruction, what would your nasolacrimal flush test result be?

A

Positive

60
Q

What are the treatment options for a functional obstruction?

A

Surgery (medial canthoplasty or entropion correction)

61
Q

What ligament completes the orbit in the dog and cat?

A

Orbital ligament

Ophthalmology (8 decks)

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