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Ophthalmology > Unit 1 - Conjunctiva and Cornea > Flashcards

Unit 1 - Conjunctiva and Cornea Flashcards

1
Q

What are the functions of the conjunctiva?

A

Lines the eyelids and sclera and allows movements

Source of tear film mucin

Conjunctival associated lymphoid tissue

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2
Q

Conjunctiva is clear, ____ tissue with thin branching _____.

A

mobile, vessels

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3
Q

What are the bacterial flora of the conjunctiva?

A

Gram + aerobes

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4
Q

When evaluating the conjunctiva, what should you be evaluating for?

A

Evaluate the bulbar and palpebral surfaces for injected vessels, bleeding, swelling, masses, foreign bodies, etc

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5
Q

When evaluating the sclera what should you be looking for?

A

Evaluate for episcleral vessel congestion, masses, etc

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6
Q

What are ways that the conjunctiva can respond to ocular or systemic disease?

A

Hyperemia, chemosis, color change, lymphoid follicles, ocular discharge

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7
Q

What color change can the conjunctiva go through in cases of ocular or systemic disease?

A

Extreme pallor, icterus, and/or subconjunctival hemorrhage

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8
Q

Serous ocular discharge = _________

Mucoid/mucopurulent ocular discharge = ________

Purulent ocular discharge = _________

A

epiphora

KCS

bacteria

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9
Q

What can cause ‘red eye’?

A

Conjunctival hyperemia or episcleral injection

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10
Q

Conjunctival hyperemia is due to (surface/deep) disease and episcleral injection is due to (surface/deep) disease.

A

surface, deep

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11
Q

T/F - Primary conjunctivitis is more common than secondary

A

False - it is very rare, secondary is the most common presentation

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12
Q

What can cause primary conjunctivitis?

A

Foreign bodies, infection, and/or allergies

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13
Q

What is the most important step to treating conjunctivitis?

A

ID and address the underlying cause

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14
Q

How is bacterial conjunctivitis treated?

A

Topical antibiotic QID - make sure to do a STT to check for KCS first

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15
Q

How is conjunctivitis due to allergies or conjunctival pocket syndrome treated?

A

Topical gel lube and saline eye rinsing

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16
Q

What is another term for neonatal conjunctivitis?

A

ophthalmia neonatorum

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17
Q

What is neonatal conjunctivitis?

A

Infection behind closed puppy/kitten eyelids (this is prior to normal lid opening)

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18
Q

How is neonatal conjunctivitis treated?

A

Separate eyelids, flush eyes, antibiotic ointment QID, +/- lube

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19
Q

Benign or malignant?

Conjunctival melanoma

Hemangioma

Mast Cell Tumor

Subconjunctival fat prolapse

A

Conjunctival melanoma - malignant (not at eyelid or limbus)

Hemangioma - benign

Mast cell tumor - benign

Subconjunctival fat prolapse - benign

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20
Q

How are conjunctival hemangiomas and mast cell tumors treated?

A

Excise and freeze the base

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21
Q

What miscellaneous ‘disease processes’ can happen to the conjunctiva?

A

Dermoid, inflammatory nodules, foreign bodies, and KCS

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22
Q

The cornea is a smooth, clear, and physically ______ window that has major ______ function.

A

tough, refractive

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23
Q

‘A _____ cornea is a happy cornea’

A

moist

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24
Q

What are the layers of the cornea?

A

Epithelium, stroma, Descemet’s membrane, and Endothelium

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25
Q

The corneal epithelium is _____philic and provides ______ function.

A

Lipophilic; barrier

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26
Q

The corneal stroma is ____philic, adheres _____, and is composed of collagen, keratocytes, and GAGs.

A

hydrophilic; fluorescein

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27
Q

Descemet’s membrane is _____philic.

A

lipophilic

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28
Q

What is the role of the corneal endothelium?

A

It maintains ‘dehydrated’ clear cornea

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29
Q

What are the many things that can cause an abnormal corneal appearance?

A

Superficial vs. deep vascularization (red)

Granulation (pink)

Leukocytes (white, cream, yellow)

Corneal scarring (white/gray +/- vesses or synechia)

Corneal edema (white or blue)

Pigment (brown)

Sequestrum (brown or black)

Foreign body (dark or any color)

Rough or dull surface defects

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30
Q

Superficial or deep neovascularization?

A

Superficial

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31
Q

Superficial or deep neovascularization?

A

Deep

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32
Q

What can cause corneal ulcers?

A

Injury, conformational issues, eyelash disorders, and acquired conditions

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33
Q

What injuries can cause corneal ulcers?

A

Trauma, foreign body, chemical or thermal insult

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34
Q

What conformational issues can cause corneal ulcers?

A

Entropion, macropalpebral fissure, lagophtalmos, nasal fold trichiasis

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35
Q

What eyelash disorders can cause corneal ulcers?

A

Ectopic cilia, distichia (rarely)

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36
Q

What acquired conditions can cause corneal ulcers?

A

Keratoconjunctivitis sicca, facial nerve paralysis, eyelid masses, eyelid injuries, indolent ulcer, exposure, anesthesia, herpesvirus, Moraxella bovis, and others

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37
Q

A.

A

Ectopic cilia

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38
Q

B.

A

Exposure, KCS, trauma, chemical, thermal, M. bovis, etc

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39
Q

C.

A

Nasal fold trichiasis

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40
Q

D.

A

Foreign body behind third eyelid

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41
Q

E.

A

Entropion

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42
Q

What clinical signs are associated with corneal ulcers?

A

Blepharospasm
Epiphora
Rubbing at eyes
Enophthalmos
Elevated third eyelid
‘Red eye’
Corneal edema, blood vessels (BV), infiltrates, melting
Corneal defect or surface irregularity
Reflex uveitis

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43
Q

What is associated with reflex uveitis?

A

Miosis, aqueous flare, hypopyon, fibrin, and photophobia

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44
Q

What is used to diagnose corneal ulcers?

A

History, complete ocular exam, fluorescein stain, +/- Rose bengal stain

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45
Q

If a corneal ulcer is present, how will fluorescein act when placed on the eye?

A

the stain will adhere to the exposed stroma

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46
Q

What does the Seidel test do?

A

It demonstrates corneal perforation or leakage

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47
Q

How does the Seidel test work?

A

Apply the stain (do not rinse) and then assess for aqueous leakage diluting stain as lighter green gravitational flow

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48
Q

Describe a superficial corneal ulcer.

A

Loss of corneal epithelium only

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49
Q

Describe a stromal corneal ulcer.

A

Some of the stroma is missing as well - superficial, midstromal, and deep stromal

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50
Q

What is a desmetocele?

A

Loss of epithelium and stroma to Descemet’s membrane

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51
Q

Superficial or deep?

A

Superficial

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52
Q

Superficial or deep?

A

Deep

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53
Q

Superficial or deep?

A

Deep - desmetocele

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54
Q

Superficial or deep?

A

Deep

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55
Q

Superficial or deep?

A

Superficial

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56
Q

Superficial or deep?

A

Superficial

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57
Q

Superficial or deep?

A

Deep

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58
Q

Superficial or deep?

A

Superficial

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59
Q

Superficial or deep?

A

Deep

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60
Q

Superficial or deep?

A

Superficial

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61
Q

Superficial or deep?

A

Deep

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62
Q

A superficial ulcer will have a _______ corneal curvature.

A

normal

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63
Q

A stromal corneal ulcer will look like what on examination?

A

Corneal flattening or some indentation

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64
Q

A desmetocele will look like what on examination?

A

severe indentation (and stain + edge)

65
Q

Simple or infected?

A

simple

66
Q

Simple or infected?

A

infected

67
Q

Simple or infected?

A

simple

68
Q

Simple or infected?

A

infected - melting cornea

69
Q

Simple or infected?

A

infected

70
Q

Simple or infected?

A

infected

71
Q

Simple or infected?

A

infected

72
Q

Simple or infected?

A

unsure

73
Q

Simple or infected?

A

infected - fungal

74
Q

What are some findings consistent with ruptured ulcers?

A

The perforation site may be bulging

It is sealed with fibrin, blood, and iris

Other possible findings - hyphema, shallow anterior chamber, low IOP +

Seidel test

75
Q

Treatment of corneal ulcers varies based on what?

A

Underlying cause, depth, chronicity, +/- infected, +/- melting

76
Q

Treatment for simple/uncomplicated ulcers aims to do what?

A

Prevent infection, reduce pain, and facilitate healing

77
Q

What is used to prevent infection in simple corneal ulcer management?

A

Prophylactic topical antibiotic - TID and QID

78
Q

What are some broad spectrum topical abx options for simple corneal ulcer management?

A

Neomycin/PolymyxinB/Bacitracin ointment, Neomycin/PolymyxinB/Gramicidin solution, Tobramycin solution, oxytetracycline ointment

79
Q

When is a topical ointment base abx for simple corneal ulcer management preferred?

A

For superficial ulcers (especially if due to KCS), conformational issues, or eyelash disorders

80
Q

When is a drop abx preferred for simple corneal ulcer management?

A

When the patient is incooperative

81
Q

What can be used to reduce pain in simple corneal ulcer management?

A

Topical atropine 1% solution or ointment - SID-BID or systemic NSAID or gabapentin

82
Q

What is used to facilitate healing in simple corneal ulcer management?

A

E-collar +/- ophthalmic lubricant

83
Q

When should simple corneal ulcers be rechecked?

A

in 3-5 days

84
Q

If a simple corneal ulcer does not heal within 7-10 days, what may that mean?

A

The underlying cause persists, the ulcer is infected, it is an indolent ulcer

Change the diagnosis not the antibiotic

85
Q

What diagnostic testing can be done for complicated corneal ulcers?

A

Culture and sensitivity and/or cytology

86
Q

What are the preferred abx for gram + infected complicated corneal ulcers?

A

Chloramphenicol or fortified 5% cefazolin

87
Q

What are the preferred abx for gram - infected complicated corneal uclers?

A

Aminoglycosides - Tobramycin

Fluoroquinolons - Ciprofloxacin (good gram + coverage also)

88
Q

How often should abx be given for infected complicated corneal ulcers?

A

Initially every 1-2 hours, then every 4 hours if not worsening

Minimum of 6x per day

89
Q

How are complicated corneal ulcers due to reflex uveitis treated?

A

Atropine drip SID-BID, oral NSAID +/- gabapentin

90
Q

What should be used to treat melting ulcers?

A

Anticollagenases

91
Q

What is the preferred anticollagenase for melting ulcers?

A

Serum/plasma given every 1-2 hours

Other options: EDTA, N-acetylcysteine, tetracycline abx

92
Q

What novel ulcer therapy option promotes healing of severe and melting ulcers, is helpful with complicated and neurotrophic ulcers, and is given TID?

A

Vetrix Eye Q Amniotic Eye Drop

93
Q

What systemic antibiotics can be given for complicated corneal uclers? What is the caveat to using systemic antibiotics?

A

Clavamox or Doxycycline

Only aids ulcer if vascular supply is present

94
Q

What is contradicted for treatment of corneal ulceration?

A

Topical steroids, topical nonsteroidals, or topical anesthetics (only okay for initial exam)

95
Q

When is surgical treatment of complicated corneal ulcers warranted?

A

If midstromal or deeper, worsening condition, or prolonged pain

96
Q

What are the surgical options for complicated corneal ulcers?

A

Corneal cross-linking, conjunctival graft, collagen graft, corneaconjunctival transposition, and corneal transplant

97
Q

What should be avoided surgically when treating corneal ulcers?

A

Third eyelid flap or temporary tarsorrhaphy

98
Q

What are the advantages to surgical treatment of corneal ulcers?

A

More thorough ulcer debridement

Immediate tectonic support

Possible blood supply

Faster healing

Less aggressive medical therapy needs

99
Q

What are the disadvantages to surgical treatment of corneal ulcers?

A

Requires general anesthesia

Potentially more scarring

Added expense

100
Q

What are some other names for indolent ulcers?

A

Refractory ulcer, Boxer ulcer, and SCCED

101
Q

What is an indolent ulcer?

A

Superficial ulcer with loose epithelial edges

102
Q

What is the signalment for indolent ulcers?

A

middle-aged to older dogs

103
Q

How is an indolent ulcer diagnosed?

A

Signalment, history of failed healing with appropriate therapy and no infection or other persisting cause, and the classical appearance

104
Q

What is the classical appearance of indolent ulcers?

A

Epithelial defect only, loose margins, and does not extend into the stroma

105
Q

How can an indolent ulcer be treated?

A

Thorough debridement with cotton-tipped applicators

Keratotomy

Superficial keratectomy (most effective)

106
Q

What are the general non-surgical management methods for indolent ulcers?

A

Standard ulcer medications (topical antibiotic, atropine, and pain control) and E-collar

107
Q

What are some additional optional therapies (non-surgical) to treat indolent ulcers?

A

Contact lens, tetracycline antibiotic, serum QID, 5% NaCl TID, and PSGAGs QID

108
Q

When should indolent ulcers be rechecked after treatment has been initiated?

A

10-14 days +/- repeat

109
Q

IF there is severe vascularization, what can be added to the treatment protocol for indolent ulcers?

A

Cyclosporine or tacrolimus BID

110
Q

Corneal foreign bodies are commonly what?

A

Plant material

111
Q

If a corneal foreign body is superficial, how should it be treated?

A

Apply a topical anesthetic and remove with hydropulsion or cotton swab

112
Q

If there is a deep or penetrating corneal foreign body, what should be done?

A

REFER

113
Q

After removal of a corneal foreign body, what should be done treatment-wise?

A

Treat as a corneal ulcer

Topical abx 4-6x/day

Topical atropine solution SID-BID

Systemic NSAID and/or gabapentin PO

E-collar

114
Q

What is chronic superficial keratitis also known as?

A

Pannus

115
Q

What is the signalment for chronic superficial keratitis?

A

German shepherd type breeds and Greyhounds

Young adult to middle-aged

116
Q

What is chronic superficial keratitis?

A

Progressive inflammatory disease of the cornea and conjunctiva

Usually bilateral +/- symmetrical, immune-mediated, and there is a UV light factor

117
Q

What clinical signs are associated with chronic superficial keratitis?

A

Corneal neovascularization, pigmentation, and scarring

Starts laterally and moves medially across the cornea

Can cause blindness +/- thickened and depigmented third eyelid

118
Q

What is atypical pannus (plasmoma)?

A

Chronic superficial keratitis with third eyelid involvement without corneal change

It is a lymphocytic-plasmacytic conjunctivitis

119
Q

What does plasmoma look like?

A

There is a depigmented margin of the third eyelid and a thickened, cobblestone surface

120
Q

How is chronic superficial keratitis diagnosed?

A

Signalment and appearance

No other cause of CS (rule out KCS)

Cytology

121
Q

How is chronic superficial keratitis treated?

A

Topical steroid QID x 2-4 weeks with tapering

Topical cyclosporine or tacrolimus BID (taper to SID)

Reduce UV exposure

Client education

+/- Lifelong therapy

122
Q

What topical steroid is recommended for chronic superficial keratitis management?

A

Prednisolone acetate or dexamethasone

123
Q

What is the physiologic cause of exposure keratitis?

A

A disorder of tear coverage or distribution

124
Q

What are the corneal manifestations of exposure keratitis?

A

Roughened corneal surface, corneal edema, vascularization, pigmentation, scarring, and corneal ulceration

125
Q

What are the many possible causes of exposure keratitis?

A

Exposure during anesthesia, eyelid deformaties, facial nerve paralysis, macropalpebral fissure, lagophthalmos, exophthalmos, buphthalmos, proptosis

126
Q

How is exposure keratitis diagnosed?

A

Complete ophthalmic examination - CN testing, baseline diagnostic tests, assess eyelid apposition and closure, corneal status, and globe retropulsion

127
Q

How is exposure keratitis managed?

A

Ocular lubrication, therapy based on causative agent, and prevention of further corneal changes and vision loss

128
Q

In what breed group is pigmentary keratitis common in?

A

brachycephalic dogs

129
Q

What is pigmentary keratitis a response to?

A

chronic irritation or inflammation

130
Q

What are possible underlying causes of pigmentary keratitis?

A

KCS, chronic superficial keratitis, chronic ulcerative disease, hairs rubbing cornea, and lagophthalmos

131
Q

How is pigmentary keratitis diagnosed?

A

Signalment and pattern and adnexal exam

132
Q

What medications can be used to treat pigmentary keratitis?

A

Lube and cyclosporine or 0.5% tacrolimus (preferred) BID

Topical steroids if BV present and NO ulcer risk

133
Q

What surgeries can be used to treat pigmentary keratiits?

A

Cryotherapy or strontium beta-irradiation to thin pigment

Keratectomy if blinded

134
Q

What is corneal dystrophy?

A

An inherited, nonpainful, bilateral central/paracentral opacification

135
Q

T/F - Corneal dystrophy is an age related change that affects vision

A

False - it is not age related and does not affect vision

136
Q

When maginifying the cornea of a patient with corneal dystrophy, what does it reveal?

A

Sparkling corneal opacities

137
Q

What is juvenile corneal dystrophy?

A

Congenital subepithelial faint opacities of the cornea that are hazy, grayish-white, mosaic and usually located in the interpalpebral fissure

138
Q

T/F - Juvenile corneal dystrophy is nonpainful and no treatment is needed.

A

True - it should resolve by ~10 weeks of age

139
Q

What is corneal degeneration?

A

Corneal opacities with other ocular/intraocular pathology

140
Q

___________ exacerbate deposition in patients with corneal degeneration.

A

Corticosteroids

141
Q

How can corneal degeneration result in a corneal ulcer?

A

The dense mineral plaques may slough resulting in a corneal ulcer

142
Q

How is corneal degeneration managed?

A

Address underlying issues, +/- topical EDTA 1-2% BID-QID to bind calcium, +/- keratectomy and corneal/conjunctival graft

143
Q

What are some other less common corneal opacifications?

*Not on test*

A

Perilimbal lipid deposits, superficial punctate keratopathy, lipid keratopathy, macular corneal dystrophy, florida spots, and infectious crystalline keratopathy

144
Q

How are perilimbal lipid deposits diagnosed?

*Not on test*

A

labwork with a thyroid panel

145
Q

In what breeds is superficial punctate keratopathy common in?

*Not on test*

A

Shelties and Daschunds

146
Q

Superficial punctate keratopathy is (painful/nonpainful) +/- fluorescein stain uptake.

*Not on test*

A

painful

147
Q

How is superficial punctate keratopathy treated?

*Not on test*

A

Topical cyclosporine BID long-term

148
Q

What causes lipid keratopathy?

*not on test*

A

Corticosteroid use

149
Q

In what breeds is macular corneal dystrophy common in?

*not on test*

A

Labradors

150
Q

Where (geographically) are Florida spots common in?

*not on test*

A

Tropical and subtropical areas

151
Q

How is infectious crystalline keratopathy treated?

*Not tested*

A

BV or surgery

152
Q

What is endothelial dystrophy?

A

Endothelial cell loss of the cornea

153
Q

What clinical signs are associated with endothelial dystrophy?

A

Corneal edema that starts laterally, progresses and intensifies, and is bilateral but commonly not symmetrical initially

It is not painful unless ulcers are present

154
Q

T/F: Endothelial dystrophy is acquired.

A

False - it is inherited most often in Boston terriers, dachshunds, and chihuahuas

155
Q

What is endothelial degeneration also known as?

A

Old dog disease

156
Q

What clinical signs are associated with endothelial degeneration?

A

corneal edema with possible bulla formation that can lead to recurrent ulcers and discomfort

157
Q

What is the preferred medication for endothelial dystrophy or degeneration management?

A

5% NaCl ointment TID + abx if ulcers are present

158
Q

What is the preferred surgical treatment for endothelial dystrophy or degeneration? Other options?

A

Preferred - thin conjunctival graft (Gunderson flap)

Other - thermokeratoplasty, corneal transplantation, Descemet’s stripping endothelial keratoplasty (best option for repaired vision, but is being investigated)

159
Q

What are some ‘other’ corneal pathologies that were not discussed?

A

Epithelial inclusion cyst, dermoid, leukoma, and nodular granulomatous episclerokeratitis

Ophthalmology (13 decks)

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