Exam 5

Conjunctival hyperemia
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Terms in this set (92)
Conjunctival hyperemia
Extensive branching
Extraocular disease
Image: Conjunctival hyperemia
Episcleral Injection
Radial pattern from limbus
Dark red
Intraocular disease
Image: Episcleral Injection
Subconjunctival hemorrhage
Difuse red
Trauma/bleeding disorder
Image: Subconjunctival hemorrhage
Serous
Viral (FHV 1) and Epiphora cause ____ ocular discharge
Mucoid
KCS (dry eye disease) cause ____ ocular discharge
Mucopurulent
Bacterial infection cause ____ ocular discharge
Image: Mucopurulent
Ophthalmia Neonatorum
Infection prior to lid separation in puppies(bacterial) and kittens (herpes or chlamydia)
TX: separate eyelids --> flush with saline and abx, treat 4-6x daily
Sequalae: Symblepharon , corneal perforation, corneal scar formation, blindness
Image: Ophthalmia Neonatorum
Symblepharon
eyelids are stuck together
False
T/F: Canine Conjunctivitis is very often infectious
True
T/F: If you suspect conjunctivitis, be sure it is Fluorescein negative before you RX Topical corticosteroids such as hydrocortisone
Treatment of Canine ConjunctivitisTX = treat underlying cause, broad spectrum topical abx QID, topical corticosteroids such as hydrocortisone if no response to treatment, re-eval dxFollicular ConjunctivitisTypically seen in young dogs Lymphoid follicles bulbar surface of the nictitans Etiology immune mediated, allergic, chronic irritation Treatment topical steroids +/ topical antihistamines (olopatadine)TrueT/F: Feline Conjunctivitis is very often infectiousTrueT/F: You should use topical steroids with canine conjunctivitis (if no ulcer), but you should not use topical steroids in feline conjunctivitisFeline Herpesvirus 1 (FHV1)Most common cause of feline conjunctivitisFeline Herpesvirus 1 (FHV1)very high seroprevalance in cats, very common to be carriers. Causes Corneal ulcers/keratitis, Latency occurs in trigeminal ganglion, and URI Kittens most susceptible Often recurrent, more of an issue in multi-cat envrionmentsFeline Herpesvirus 1 (FHV1)DX is mostly CS in cats. Could do PCR of conjunctival cytology, serology is insensitiveFeline Herpesvirus 1 (FHV1)TX: most recover on own in 2-3 weeks, should treat if Moderate to severe conjunctivitis or Corneal disease --> Topical and systemic antiviral medications, Oral lysine, Decrease stress (Ie less freq medications)Feline Herpesvirus 1 (FHV1)TX: Topical - Cidofovir BID, Idoxuridine QID+, Trifluridine QID+/irritating Systemic: Famciclovir and LysineFeline Herpesvirus 1 (FHV1)Sequalae is Recurrence, Corneal disease/ulceration /perforation, Chronic epiphora, SymblepharonTrueT/F: Valacyclovir should NOT be used in catsChalmydia felisA 10 month old cat presents like this. Owner says they first noticed it in one eye last week but today you note this bilateral. You send off a cytology and 2 weeks later (after you already started TX) you get the report there is Intracytoplasmic inclusion bodies --> ______ diagnosisChalmydia felisTX for at least a month/2 weeks beyond CS. oral meds (doxy if over 4 weeks, caution with stricture), azithro, or pradofloxacin and topical abx QIDMycoplasmaopportunistic in cats --> Conjunctival pseudomembranes TX = topical FQ/tetracyclines, or oral pradofloxacin for at least 2 weeksCalicivirusin cats, causes URI, Oral and nasal ulceration, Polyarthritis, Low pathogenicity for conjunctiva TX is supportive care/self limitingMast cell tumorafter taking FNA to this conjunctival mass, your diagnosis of ___ means we will have to take out the eye to get proper marginsPapillomasyoung dog disease, will regress on own risky to remove/biopsy, masses may burstHemangioma/Hemangiosarcomaconjunctival neoplasia that are raised and red --> usually good prognosis --> simple incision doneLymphosarcomaseen in dogs and cats, more common to be intraocular than conjunctiva should take biopsyMelanomacan cause secondary glaucoma, should biopsy and further work up for metastasisSquamous Cell Carcinomacan remove if small enough --> curative, do axillary treatmentHistoplasma capsulatumseen in KS (Geographic Infectious Conjunctival Lesions), intraocular disease normally --> looks like SCC --> need biopsyPannusseen primarily in german shepards --> asymmetrically bilateral (start laterally --> grow across), non-painfulPannusChronic superficial keratitis in GSD --> need life long treatment via topical steroids/cyclosporine --> taper for long termPigmentary Keratitisseen primarily in pugs --> nonpainful, blinding (starts medially)Pigmentary KeratitisTX = surgery --> Medial canthoplasty (if young or acute) medical --> topical cyclosporine NOT STEROIDS (dt breed predisposition)FalseT/F: If a pug has inflamed eye, topical steroids are a good way to bring down that inflammation ASAPFalseT/F: With GSD the pigment will go across the eye medially while pugs the pigment goes across the eye laterallyCorneal DystrophyInherited , bilateral, non-painful opacity due to lipid deposition (no treatment)Corneal Endothelial Dystrophyyoung Boston Terriers, Boxers, Dachshunds, Poodles, or Chihuahuas --> corneal edemaCorneal Endothelial DystrophyYou have a 10 month old boston terrier presenting with corneal edema. You RX NaCl ointment T-QID and check for ulcers. What are you treating?Corneal Endothelial Degenerationgeriatric dogs with corneal edema (bulla can form/spread over cornea) --> TX = NaCl ointment T-QID +/- abx for ulcersCorneal edemauveitis, gluacoma, corneal ulcers can cause ____, should check STT, dye, and pressureCorneal Foreign Bodyusually plant material, if superficial can irrigate out or if deep needs surgical removalCorneal UlcersCS = Blepharospasm/squinting, Rubbing, Epiphora, Elevated third eyelid, "Red eye", Reflex uveitis --> Miosis , aqueous flare, hypopyon, fibrin, photophobiaFalseT/F: the left is deep vessels (ciliary flush), the right is superficial vesselsTrueT/F: When treating corneal ulcers/assessing chronicity, it's important to keep in mind it takes 3-5 days for corneal vessels to start to grow, and thy grow about 1 mm a dayCorneal Ulcer (general)TrueT/F: you should think these ulcers are infected due to their depth, corneal malacia (pain change), cellular infiltrate, pain, purulent d/c, hypopyonPerforated corneal ulcerbulging perforated site --> sealed with fibrin, blood, and iris *restrain patient very gentlyCorneal Ulcer (general)Trauma, KCS, Eyelash disorders (ectopic cilia/rarely distichiasis), Eyelid disorders (entropion), Exposure (lubricate under general anesthesia!!!), Foreign body and Infections (herpesvirus and Moraxella Bovis) --> can cause _______EntropionLocation of the ulcer can give you a hint as to what the cause is --> dark blue is ________Ectopic ciliaLocation of the ulcer can give you a hint as to what the cause is --> purple is ________KCS, exposureLocation of the ulcer can give you a hint as to what the cause is --> green is ________Foreign body behind third eyelidLocation of the ulcer can give you a hint as to what the cause is --> pink is ________FalseT/F: If ulcer is greater than 25% depth or severe infection --> Surgical therapy recommended: ConjunctivalFalseT/F: First step in surgical therapy for ulcers is placing a third eyelid flapSuperficial non-infected Corneal UlcerTX includes Broad spectrum antibiotic (Neomycin/ bacitracin/ polymyxin B), Mydriatic therapy (atropine for reflex uveitis - if no decreased tear production or glaucoma), analgesia, e-collar (prevent self trauma-some cones suck) should heal in 5-7 daysTrueT/F: You should never ever use topical steroids/non-steroidal meds for corneal ulcers in general practiceFalseT/F: Recheck superficial non-infected Corneal Ulcers --> if not healed within 7 days, you should change the antibiotic classTrueT/F: eye drops can cause hypersalivation in cats (due to running down nasolacrimal duct) --> can look like rabiesInfected Corneal UlcersTX = abx drops based on C&S every few hours, Anticollagenase agents (Autologous/ homogolous /heterologous serum/plasma), topical atropine, oral abx, oral anti-inflams /analgesia, e-collar and restrict activity --> recheck in 1 dayIndolent Ulcer/SCCEDSpontaneous chronic corneal epithelial defect seen in boxers --> Fluorescein 'leaking'Indolent Ulcer/SCCEDTX is surgical removal of all loose epithelium (Usually need to go several millimeters past fluorescein positive area) or Grid / diamond burr keratotomy + topical abx/atropine, e collar +/- analgesicsFalseT/F: If a cats corneal ulcer is not healing, you should consider a grid keratotomyGlaucomaA diverse group of diseases united by a common theme in which IOP is too high for the optic nerve to function properly resulting in the loss of some or all visionFalseT/F: Intraocular Pressure is elevated in glaucoma due to overproduction (NOT decrease outflow)FalseT/F: Normal Intraocular Pressure is 10-15 mmHg, can be normal to have a 5-10 mmHg variation between left and right eyeGlaucomaRed eye (episcleral injection) Corneal edema (blue) Mydriasis Lens subluxation/luxation Painful!!! (blepharospasm) Buphthalmia Retinal and optic nerve changes Decreased visionTrueT/F: Sedatives, tranquilizers, and anesthetic drugs can lower IOP (ketamine may increase IOP)GonioscopyUse of a special lens to visualize the iridocorneal angleFalseT/F: Primary Glaucoma is often bilateral (50-75% of the time) at time of presentation or soon afterTrueT/F: With prophylactic therapy, median time to onset of glaucoma is 31 monthsGlaucomaAnterior lens luxation, Anterior uveitis, Neoplasia, and Hyphema causes secondary _____FalseT/F: This is chronic glaucoma, you know due to it's colorTrueT/F: This is chronic glaucoma, you know due to it's colorTrueT/F: Goal of Glaucoma treatment is to avoid progressive optic nerve and retinal damage with associated visual deficits (save, regain, and maintain vision)Acute GlaucomaTreating ______, you should treat aggressively if you want a chance of vision! should refer thisGlaucomaTopical prostaglandin analogues (Latanoprost & Travaprost), Topical carbonic anhydrase inhibitors (Dorzolamide & Brinzolamide), and beta blockers (Timolol & Betaxolol) are emergency treatments ofMannitol/GlycerinDehydrate vitreous --> risk renal disease, heart disease, or dehydration. Can treat acute glaucomaAcute GlaucomaMaintenance therapy = Latanoprost, Dorzolamide, Timolol on effected eye & Timolol on normal eye + Frequent IOP checks for monitoring of BOTH eyesChronic GlaucomaCauses Irreversibly blind (duration >72 hours), Buphthalmic in adults, absent dazzle reflex, and Absent consensual PLR to fellow eyeChronic GlaucomaEnucleation, Evisceration, and Chemical ablation is palliative treatment for:PGF2α derivatives (Latanaprost & Travoprost)Increase uveoscleral outflow use SID or BID --> species specific (Causes miosis but does not lower IOP in cats & Ineffective in horses)Carbonic anhydrase inhibitors (Dorzolamide & Brinzolamide)Decrease aqueous humor production use TID or QID. oral can have systemic AE, topically can be irritatingBeta blockers (Timolol & Betaxolol)Decrease aqueous humor production by inhibiting receptors on ciliary epithelium --> May also increase aqueous humor outflow & cause mild miosis AE = bradycardia, exacerbation of feline asthma, decreased tear productionPilocarpine (Cholinergic miotics)Direct-acting parasympathomimetic agent Increase aqueous humor outflow --> Usually not effective alone and not used in uveitis and anterior lens luxation *Do not recommend using topical --> irritatingDemecarium bromide (Cholinergic miotics)Direct-acting parasympathomimetic agent Increase aqueous humor outflow --> Usually not effective alone and not used in uveitis and anterior lens luxation *prophylactic therapy SID with steroidGonioimplantsTube in AC drains fluid to subconjunctival space --> Increase aqueous humor outflowGonioimplantsGlaucoma treatment: High failure rate due to fibrosisFalseT/F: You cannot perform both cyclophotocoagulation and gonioimplant at the same timeCyclophotocoagulation diode or YAG laserDestruction of ciliary body --> Surgical Therapy to Decrease Production of aqueous humor --> Transcleral or endolaser Can cause postoperative pressure spike, cataract formation, inflammation