w/c 5/5/14 Opthamology Flashcards
What is nuclear sclerosis?
Normal aging process affecting the refractive index of the lens. Gives the nucelus of the lens a hazy look
How to differentiate nuclear sclerosis and cataracts
Distant direct opthamoscopy. The tapetal reflex would not be observed with cataracts but would be with nuclear sclerosis
LOOK THROUGH OPTHALMASCOPY. DON’T CONFUSE WITH INDIRECT OPTHALMOSCOPY= FUNDUS IMAGE
Lymphoid follicles on the bulbar side of the third eyelid are indicitive of…
Young animals, allergies. Accompanied by hyperaemia. Can also occur on the palprebral side.
Conjuncitval pattern of BV’s =
Sequale=
Dictomatous branching. Dilation of vessels and seperation of endothelial cells leads to Hyperaemia and Edema (chemosis)
Define chemosis
Oedema of the conjunctiva
Conjunctival pattern of BV= dilation of vessels and seperation of endothelial cells leading to hyperaemia and chemosis.
Episcleral pattern is indicitive of
No dichotomous branching, larger, meander. Signal intraocular disease (uveitis or glycoma)
What % of tear film is provided by lacrimal gland?
30% therefore do not excise cherry eye! Reposition…
4 layers of cornea
Epithelium
Stroma
Descemet’s membrane
Endothelium
Cornea epithelium (hydro____, has or had not got BV?)
The cornea epithelium is hydrophobic and does not have blood vessels. it does have non-myelinated nerves
Cornea stroma (hydro___) stays _________
Cornea stroma is hydrophillic. It stays relatively dehydrated through the action of epithelium and endothelium which actively pumps fluid back into AC
Corneal stroma overhydration is known as
Corneal oedema
Name a specific disease for loss of the corneal epithelium
Corneal ulcer
Name a specific disease for damage to the endothelium
Glacoma, uveitis, lens luxation, primary endothelial degen.
Name a speicif disease for vasculaisation (leakage)
Any irritating problem of the cornea (KCS, LPI, ulcers etc)
What structures define the anterior chamber?
Corneal endothelium, anterior iris and lens, Iridocorneal angle
Purpose of the aqueous humour that fills the anterior chamber?
Establises IOP, feeds posterior cornea and anterior lens.
Route of aqueous humour
Comes from cillary body, into POSTERIOR chamber, goes through pupil into AC and exits through the iridocorneal angle/ uvea
Which two diseases affect the anterior chamber?
Uveitis (inflamm of uvea) and Glaucoma
How does Uveitis affect IOP ( through its affect of the aqueous humour)
Inflamm of the uvea (uveitis) decreases IOP because it increases uveoscleral outflow.
Chronic uveitis can lead to keratic precipitates blocking the flow of aqueous humour and therefore RAISED OCCULAR PRESSURE
Uveitis can lead to
- Miosis= iris spasm
- Endothelial cell seperation leading to leakage of blood components
- Posterior synechia
- Development of PIFMs
What are posterior synechia
Adhesions of iris to the anterior lens. Commonly causes by uveitis
What are PIFMs? Apperance of them
Preiridal fibrovascular membranes. Commonly caused by uveitis. Grow over iris and in pale iris visible as rubeosis iridis. May lead to bleeding in eye= hyphema or closure of the ICA = secondary glaucoma
An undilating pupil can be an indication chronic uveitis and is caused by the formation of
Posterior synechia (adhesions between iris to anterior lens)
Why do keratitic precipitates, hypopion and hyphema occur in uveitis?
Due to endothelial cell seperation leading to leakage of blood components
Define epiphora
Cause of epiphora
Excessive tearing. 1) Trigeminal (CN V) irritation or 2) drainage problems (prolpased gland, eye lid abnormality, blockage of nasolacrimal system)
If eyelid mass affects less than ___% wedge resection. if more then consider referral
<25% = wedge resection then figure of 8 knot.
Treatment of Spastic entropion
When eye is closed tightly (blepharospasm) can lead to spastic entropion. Apply 1 drop of proxymetacaine (topical anaesthetic) if entropion persistas needs surgical correction if disappears investigate source of opthalmic pain
Difference between Strabismus and Nystagmus
Strabismus: Deviation in the position of the globe (congenital, neurologic or extraocular muscle abnormality)
Which nerves supply the extraocular muscles (and subsequent damage produces specific strabismus)
Strabismus = deviation of the globe. Most muscles innervated by oculomotor (CN III)
Abducens: Lateral rectus (ALR)
Trochlear: Superior Oblique (TSO)
Nystagmus= involuntary oscillatory movement of the eyes
Which breed of cats are predisposed to congenital strabismus?
Siamese cats.
What is a coloboma?
Congenital absence of tissue within the eye or adnexa. Normally lahteral part of eyelid in cat.
Can have eyelid coloboma
Define ankyloblepharon
Aklyoblepharon is normally in kittens/puppies up to 10-14 days old.
Pathogeneisis and treatment of Opthalmia neonatorum
Development of a purulent conjunctivitis prior to eyelid opening. Swelling of the fused lids.
Eyelids need to be surgically opened early to avoid corneal damange. Broad spec topical antiobiotics.
Inflammation of the eyelids is known as
Blephritis
Define symblepharon
Seqalae to conjunctivitis which conjunctival adhesions form. Common result of feline herpes virus-1.
Which virus is associated with corneal oedema in dogs?
Canine adenovirus is associated with corneal oedema, (so is anterior uvetitis) forms immune-complexes on corneal epithelium preventing pumps removing fluid
Breed predisposition for plasmoma
Plasmoma - inherited in GERMAN SHEPHERD DOGS.
Thickened irregular boarder. IM disease therefore ciclosporin.
Related condition to Chronic superficial keratitis/ pannus. but PLASMOMA only AFFECTS THIRD EYELID
Aeitiology and treatment of Episcleritis
Episcleritis is an immune-mediated disease of the episclera. Responds to corticosteroids e.g. Azothiaprine.
Left eye is known as…
Oculus sinister (the left eye) OD= right eye OU = Both eyes.
Young golden retriever with bilateral, non painful exophalmos is likely to have
Extraocular polymyositis. Systemic corticosteriods +- Azothiaprine (immunosuppressive)
What is the probably cause of corneal oedema in a Daschund
Inherited endothelial dystrophy in boston terriers, chihauhuas, dauchunds, english springer spaniels
Aetiology of sequestrum
Major cause of black/brown corneal lesions in cats. Consists of necrotic corneal stroma and often surrounded by a ring of inflammatory cells. Can be unilat or bilat. Often associated with herpes
Sequestrum in cats often associated with what virus
Herpes virus.
Define Lagophtalmos
Inability to close the eye completely.
Where do the first lesions of CSK appear?
CSK is Chronic superficial keratitis and is an immune mediated disease aka ‘Pannas’ aka lymphocy..plsmocytic..
It first appears in the VENTROLATERAL quadrant
Exposure to ___ is known to be a predisposing factor for CSK /Pannus/LPI
UV light.
What does the third eyelid normally have a roughened appearance?
Due to the lymphoid tissue
What are Habbs Striae
Stretch marks ‘breaks in Descemet’s membrane
Aqueous flare is pathopneumonic for
Uveitis
Treatment for Glucoma
Glucoma (40-60 mmHg = clinc signs of bupthalmia
Miotics (constrict pupil) e.g. Pilocarpine
Mannitol
Beta-blockers
Carbonic anhydrase inhibitors
Normal Schirmer tear test for dogs
> 15mm/min
TSS-1 = NO ANAESTHIC (dogs have less corneal nerves)
TSS-2 = WITH ANAESTHETIC
When would you use blue light?
Blue light: Fluorescein Green light (aka red free): Differentiate blood from pigment
Type of image with indirect opthalmoscopy
Used for wide field of view of fundus
Inverted virtual Left to Right image.
Don’t confuse with DDO (used for tapetal reflex/ cataracts vs nuc sclerosis)
Where do you place STT strip?
Use STT-1 (no anaesthetic) LATERALLY (doesn’t interfer with third eyelid)
BEFORE USE LIGHT EXAMINATION
>15mm/min = good but if ulcer could be pain?
Persistant Papillary Membranes
Remnants of normal prenatal vascular network.
Not uncommon in dogs
Presence of pigmented strands from one side of iris to the other
ARISE FROM THE IRIS COLLARETE
Can cause CORNEAL and LENS opacity
Close direct ophthalmology
<2cm from patient!
Look for optic disk. Make big picture.
All vessels lead to optic disk. Divide into 1/4s
Jones test
Use Fluorescein staining but do not wash.
Check nasolacrimal duct patency.
Should flow in <4minutes
Examine with BLUE light