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Ophthalmology > The Opaque eye > Flashcards

The Opaque eye Flashcards

1
Q

main 2 areas affected causing ocular opacities

A

cornea then lens

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2
Q

Wound healing - The epithelium - Basal cells

A

Transient amplifying cells, capable of mitosis
At the limbus, stem cells are there
Limbal stem cells provide for other basal cells

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3
Q

Wound healing - The epithelium - wing cells

A

non-mitotic

2-4 layers

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4
Q

Wound healing - The epithelium - squamous non-keratinized epithelium

A

slough off with blinking

replaced with cells below

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5
Q

Wound healing - The epithelium - basal lamina

A

needed for permanent adhesions to form

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6
Q

Wound healing - The epithelium - sliding movement

A

abrasion - doesn’t reach basal lamina if stroma not exposed

happens quickly

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7
Q

Wound healing - The epithelium - vertical movement

A

from down, up
1st epithelial then basal cells
1 week cycle

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8
Q

Wound healing - The epithelium - centripetal movement

A

from limbus to centre
affects all layers
in spiral shape

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9
Q

centripetal movement - clinical significance

A

pigment from irritation/corneal scar can migrate over the pupil

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10
Q

Wound healing - The epithelium - healing by sliding

A

1-2mm per day

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11
Q

Wound healing - The epithelium - healing by sliding - depends on…

A

corneal health
existence of limbal basal stem cells
existence of a basal lamina onto which epithelium can adhere

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12
Q

Wound healing - The epithelium - superficial pigment deposition

A

irritants activate melanocytes

pigment deposited in new migrating epithelial cells + superficial stroma

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13
Q

Wound healing - The epithelium - vascularization

A

infl is a stimulus
vessels can coalesce + form granulation tissue
atrophy over time once stimulus has gone
can be superficial or deep

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14
Q

Wound healing - The epithelium - vascularization - what purpose does it serve

A

stabilizing serum
nutrients, growth factors + infl cells
structural suppost

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15
Q

Wound healing - The epithelium -  vascularization - indicator of?

A

chronicity

lag time of 2-4 days to bud, then 1mm/2 days

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16
Q

Wound healing - the stroma - composition - collagen lamellae

A

collagen 1 fibrils
travel from limbus to limbus
relative state of dehydration

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17
Q

Wound healing - the stroma - keratocytes

A

low in number

lamellar creation + myofibroblasts

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18
Q

Wound healing - the stroma - chemicals produced on injury

A

IL-1, EDGF, TNFa, EGF, TGF-beta, collagenases, metaloproteases

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19
Q

Wound healing - the stroma - where are the chemicals produced

A 
Lacrimal glands	
Epithelial cells	
Stromal keratocytes	
Corneal nerves	
Leukocytes that are attracted to the wound
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20
Q

Wound healing - the stroma - cellular attraction

A

monocytes + neutrophils to “clean up”

keratocytes - collagen + GAG production

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21
Q

Wound healing - the stroma - re-establishing corneal curvature

A

part of remodelling
takes time
done by epithelial hyperplasia
can for facets (flat parts)

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22
Q

Wound healing - the endothelium - intercellular Na+K+ATPase pumps

A

in between endothelial cells

put fluid back into the AC

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23
Q

Wound healing - the endothelium - Polimegathism + pleo/polimorphism

A

cells are diffent sizes, shapes (not all hexagonal) and overlap so that they’re not all 1 layer

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24
Q

Wound healing - the endothelium

A

v.sensitive cells with poor ability to regenerate

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25
how does the tissue know its ulcerated
cell to cell communication
26
causes of decr corneal sensation
desensitization | "brachycephalic factor" - exposed cornea
27
stromal collagenolysis ("melting") - causes
unstable repair of stroma excess infl - continued irritation secondary infection
28
areas that often cause problems during healing
tear film (qual/quantitative) 3rd/eyelids repair process make sure the cause of the ulcer is correctly identified
29
general treatment guidelines
``` Protection from self-harm Antibiotic cover for prevention Atropine for comfort Ciclosporin doesn't interfere with stromal/epithelial healing Steroids “a big no-no” healing aided by vascular growth ```
30
why use atropine
dilation of the pupil (mydriasis) relaxes the CB (cycloplegia) can dry out the eye though
31
why not to use steroids
enhance collagenolysis | slow healing
32
tarsorrhaphy
horizontal mattress suture with stents though eyelids | for corneal protection
33
antibiotics used in the eye
fusidic acid chloramphenicol aminoglycosides fluoroquinolones
34
melting - treatment
serum eyedrops - antiproteases | freq application + monitoring
35
corneal collagenolysis
corneal melting | v.rapidly (hours) to days
36
corneal collagenolysis can lead to
local destruction widespread corneal destruction perforation
37
descemetocele before perforation - appearance
partial bending of descemets membrane no fluorescein uptake but wall of oedematous stroma around it does clear centre
38
keratoconjunctivitis sicca (KCS) - causes
evaporative drug related anaesthetics + sedatives primary immune mediated
39
primary KCS - speed of progression
slowly progressive
40
primary KCS - effects on the eye
mucus accumulation + hyperaemia +/- vascularization + pigmentation ulcerative keratitis ulcers
41
primary KCS - trend A
either 0-2 or 6-8 y/o | ulcerative keratitis 50/72% - rapidly perforate
42
primary KCS - trend B
5 y/o | ulcerative keratitis 4/22% - mostly superficial
43
primary KCS - causes of central or paracentral ulcers
``` poor balance of destr/construction irritant still present (dryness) change in bacterial flora incr thick mucoid discharge infl cells in the surface ```
44
primary KCS - treatment for central ulcers
``` Corneolimboconjunctival transposition (CLCT) uses clear peripheral cornea ```
45
primary KCS - treatment of peripheral ulcers
conjunctival pedicle graft slightly faster doesn't clear much over time but is less important peripherally
46
primary KCS - medical treatment
topical ciclosporin preservative free viscous tears topical antibiotics serum eyedrops
47
primary KCS - medical treatment - why use ciclosporin
doesn't interfere with corneal healing
48
feline corneal sequestrum
spontaneous | uni or bilateral
49
feline corneal sequestrum - appearance + localization
tan/black discolouration of superficial stroma | usually in central/paracentral cornea
50
feline corneal sequestrum - progress over variable period of time causes which prolems
Darker plaque Neovascularization Ulceration around plaque Mild to very painful
51
Feline Corneal Sequestrum - Etiology - Idiopathic
Associated with corneal trauma Medial lower eyelid entropion Superficial grid scraping (“grid keratotomy”)
52
Feline Corneal Sequestrum - Treatment - Surgical
Superficial keratectomy +/- bandage lens +/- tarsorrhaphy | Superficial keratectomy and Grafting
53
Feline Corneal Sequestrum - Treatment - Postsurgical supportive medical therapy
Topical antibiotic until re-eithelialization | Preservative-free viscous tear preparation
54
Spontaneous chronic corneal epithelial defects (SCCEDDs) - appearance of eye
``` Loose epithelial edges Under-running of fluorescein dye – pulsed saline test ± corneal edema ± ocular pain ± vascularization ```
55
Spontaneous chronic corneal epithelial defects - treatment
Debridement (Db) Grid Keratotomy (not in cats)/Superficial Scrape (GK/SS) Keratectomy (K) mechanical debridement
56
SCCEDs - Medical therapy
Topical antibiotic: Chloramphenicol 3x day Consider serum eye drops 3-4 x day Protective collar on at all times Re-evaluation every 2 weeks
57
FHV-1
Virus lives in trigeminal ganglion and corneal tissue Usually infected in kittenhood (cat flu) Associated with symblepharon in kittens Corneal ulcerative disease can be severe Recrudescent disease seen during periods of stress
58
FHV-1 - treating with L-Lysine
Interferes with viral replication | Reduced viral shedding
59
FHV-1 - treating with IFN
decr cytopathic effects | may have no effect
60
FHV-1 - treating with Idoxuridine & TFT (triflurothymidine)
``` Thymidine-mimicking pyrimidine analogues Use 4x-6x day Specificity for FHV1 in vitro Tolerance? No trials TFT - ok? Idox – reportedly bad ```
61
FHV-1 - treating with Cidofovir
Cytosine-mimicking pyrimidine analogue Bid possible Reduce severity c-signs/shedding
62
FHV-1 - treating with Pen- Gan- and A- ciclovir
Adenosine/guanosisne-mimicking purine analogue Toxic orally – liver, kidney, BM Topically, none have been trialled
63
FHV-1 - treating with Famcyclovir is safe orally
``` Penciclovir is its active metabolite Same family as Pen- Gan- and A- ciclovir Do not reach the target But work clinically May be used long term ```
64
Feline Acute Bullous Keratopathy
Unknown etiology Actue development of corneal edema needs rapid referral
65
Facial Nerve Paralysis - etiologies
``` Viral (flu- Calici and FHV-1) Otitis media (tympanic bulla) Ear canal avulsion (trauma) Severe otitis externa Ear canal neoplasia TECA with LBO Idiopathic (some might be immune-mediated) Part of a polyneuropathy ```
66
Facial Nerve Paralysis - effects
Loss of blink - usually temporary | Interpalpebral fissure ulceration
67
Facial Nerve Paralysis - treatment
tarsorrhaphy for 1 to 2 months (horizontal mattress suture) Protective collar Topical antibiotic (Fucithalmic bid-tid) Preservative-free, viscous tear (Celluvisc 1%, bid-tid )

Ophthalmology (7 decks)

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