Veterinary Ophthalmology Study Notes

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Questions and Answers

What is the prognosis for complicated KCS in cases with severe ulceration?

  • Conjunctival grafting may be needed. (correct)
  • Early diagnosis is unnecessary.
  • The eye will return to normal function.
  • Vision will be completely restored.

Which clinical sign was noted in the left eye of the dachshund patient?

  • Healthy corneal appearance
  • Absence of discharge
  • Normal tear production
  • Severe superficial corneal vascularization (correct)

What was the Schirmer tear test reading in the left eye of the patient?

  • 3 mm/min (correct)
  • 14 mm/min
  • 8 mm/min
  • 11 mm/min

What treatment had the patient been receiving prior to the increased discharge in the left eye?

<p>Twice daily ciclosporin and carbomer gel (A)</p> Signup and view all the answers

After 2 weeks of increased discharge, what changed in the treatment frequency of carbomer gel by the owner?

<p>Increased to four times daily (B)</p> Signup and view all the answers

What complication can occur despite a successful parotid duct transposition?

<p>Blepharitis from mineral deposition (C)</p> Signup and view all the answers

In the context of the dachshund's medical history, what additional condition was the patient diagnosed with?

<p>Hypothyroidism (A)</p> Signup and view all the answers

What was observed in the cornea staining with fluorescein?

<p>Absence of ulceration (A)</p> Signup and view all the answers

What is the purpose of the book as stated in the content?

<p>To help practitioners keep up to date and develop confidence in ophthalmologic cases. (B)</p> Signup and view all the answers

Which chapter is focused on blepharitis?

<p>Chapter 4 (C)</p> Signup and view all the answers

Which of the following conditions is addressed in Chapter 10?

<p>Acute conjunctivitis in dogs (D)</p> Signup and view all the answers

What is the main theme of Part 4 of the book?

<p>Issues related to the cornea (C)</p> Signup and view all the answers

Which condition is outlined in Chapter 40?

<p>Diabetic cataract in a dog (D)</p> Signup and view all the answers

Which chapter introduces canine uveitis?

<p>Chapter 32 (B)</p> Signup and view all the answers

What is the focus of Chapter 56?

<p>Episcleritis (D)</p> Signup and view all the answers

What is the topic of Chapter 18?

<p>Chronic purulent conjunctivitis (D)</p> Signup and view all the answers

Which chapter deals with ocular emergencies?

<p>Appendix 3 (C)</p> Signup and view all the answers

What condition is described in Chapter 22?

<p>Deep corneal ulcer (C)</p> Signup and view all the answers

What type of procedure can be performed if the nasolacrimal punctae are present but misplaced?

<p>Microsurgical repositioning (B)</p> Signup and view all the answers

What is a complication associated with the surgical removal of the caruncle?

<p>Damage to the nasolacrimal punctae (B)</p> Signup and view all the answers

What shape is typically required for the piece of skin removed during a Hotz-Celsus procedure?

<p>Triangular (D)</p> Signup and view all the answers

What suture material is commonly used during the Hotz-Celsus procedure?

<p>6/0 polyglactin 910 (B)</p> Signup and view all the answers

What is an alternative to surgical excision for treating caruncular trichiasis?

<p>Cryosurgery (B)</p> Signup and view all the answers

What postoperative care is recommended after cryosurgery of the caruncle?

<p>Topical antibiotic/steroid ointment (D)</p> Signup and view all the answers

Which of the following factors makes surgical intervention more complicated at the medial canthus?

<p>Tight medial canthal ligament (B)</p> Signup and view all the answers

Why is good magnification important during caruncle surgery?

<p>To avoid damaging the canaliculi (B)</p> Signup and view all the answers

What is the main factor that contributes to corneal transparency?

<p>Lattice organization of cellular structures (A)</p> Signup and view all the answers

What result can occur if the endothelial pumps in the cornea fail?

<p>Corneal oedema (C)</p> Signup and view all the answers

Which of the following is not a common cause of corneal ulceration?

<p>Corneal endothelial dystrophy (A)</p> Signup and view all the answers

How do superficial corneal defects typically heal?

<p>By migration and mitosis of epithelial cells (B)</p> Signup and view all the answers

Which eyelid abnormality can contribute to corneal ulceration?

<p>Blepharitis (A)</p> Signup and view all the answers

What type of irritant is associated with corneal ulceration?

<p>Shampoo (D)</p> Signup and view all the answers

In which of the following scenarios would you expect corneal oedema?

<p>Corneal endothelial pump failure (B)</p> Signup and view all the answers

Which of the following is a potential cause of corneal ulceration due to trauma?

<p>Cat scratch (C)</p> Signup and view all the answers

What is the recommended initial treatment for secondary bacterial infections?

<p>Topical and systemic antibiotics (B)</p> Signup and view all the answers

Why is culture and sensitivity testing important in treating bacterial infections?

<p>To identify the specific bacteria and appropriate antibiotics (B)</p> Signup and view all the answers

What common mistake leads to the recurrence of problems after treatment?

<p>Not treating systemically and using a too short course (B)</p> Signup and view all the answers

What should be done if a conjunctival foreign body is identified?

<p>Immediately flush the nasolacrimal duct (A)</p> Signup and view all the answers

What is recommended if medical management does not yield positive results?

<p>Referral to a veterinary ophthalmologist for surgical intervention (D)</p> Signup and view all the answers

What duration should topical and systemic treatments continue after successful flushing?

<p>3–4 weeks (B)</p> Signup and view all the answers

What could indicate a need for a short course of topical corticosteroid drops?

<p>Marked conjunctival inflammation at the medial canthus (D)</p> Signup and view all the answers

What should be done if the nasolacrimal duct is patent during surgical intervention?

<p>Immediately suture a catheter in place (C)</p> Signup and view all the answers

What is the primary method by which the endothelium heals in dogs and cats?

<p>Hypertrophy and sliding (A)</p> Signup and view all the answers

What color change is associated with neovascularization in the cornea?

<p>Red (A)</p> Signup and view all the answers

Which breed is mentioned as being commonly affected by recurrent epithelial erosions?

<p>Corgi (A)</p> Signup and view all the answers

What is a common consequence of damaged endothelium in dogs and cats?

<p>Corneal oedema (B)</p> Signup and view all the answers

Which of the following is NOT a cause of white corneal lesions?

<p>Neovascularization (C)</p> Signup and view all the answers

What is the typical presentation of a dog with recurrent epithelial erosions?

<p>Mild conjunctival hyperaemia and increased lacrimation (D)</p> Signup and view all the answers

Which color change in the cornea indicates mild corneal oedema?

<p>Blue-grey (C)</p> Signup and view all the answers

Which of the following is a common sign observed with recurrent epithelial erosion in affected animals?

<p>Blepharospasm in the affected eye (D)</p> Signup and view all the answers

Flashcards

Ophthalmic Examination

A comprehensive assessment of the eye and its structures.

When is an ophthalmic exam performed?

A procedure performed on all animals presenting with eye problems.

Why is an ophthalmic exam important?

Used to ensure accurate diagnosis and appropriate treatment.

What does the ophthalmic exam include?

External examination of the eye and its surroundings.

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What are the key structures examined?

Evaluation of the eyelids, conjunctiva, cornea, iris, lens, and vitreous humor.

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What is included in the functional assessment?

Assessing the eye's movements, pupils, and reflexes.

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What is used to examine deeper structures?

Special tools and techniques are used to visualize internal structures.

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What is documented after the exam?

A detailed record of all findings and observations.

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How is examination information used?

The information helps the veterinarian make a diagnosis and create a treatment plan.

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What is the main goal of the ophthalmic exam?

Helping to identify and treat eye diseases in animals.

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What is Keratoconjunctivitis Sicca (KCS)?

A condition where the eye does not produce enough tears, leading to dry and irritated eyes. It can progress to severe ulceration and even vision loss.

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What is the Prognosis for Complicated KCS?

The outlook for severe cases of KCS is guarded, as it can cause significant damage to the eye, even after treatment.

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Describe the Treatment for Severe KCS Ulceration.

Severe ulceration of the cornea in KCS, requiring surgical interventions like conjunctiva grafting and parotid duct transposition, which aim to restore tear production.

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What are the Long-Term Complications of KCS?

Chronic pigmentation in KCS that can impair vision, even after treatments like parotid duct transposition, which can lead to mineral deposition-related irritation and blepharitis.

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What is Essential for Managing KCS?

Regular monitoring and good compliance with treatment are crucial to prevent complications and manage KCS effectively.

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Describe the Discharge Seen in KCS.

A common symptom of KCS that appears as thick, sticky mucus in the eye, adhering to the cornea.

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What is the Schirmer Tear Test?

A diagnostic test used to measure tear production, where a strip of filter paper is placed near the eye to absorb tears, with normal values ranging between 8 and 14 mm.

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What is Hypothyroidism?

A condition that affects tear production and can contribute to KCS.

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Medial Entropion

A condition where the eyelashes turn inwards and rub against the cornea.

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Caruncular Trichiasis

When hairs grow from the caruncle, a fleshy bump at the inner corner of the eye, and rub against the cornea.

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Modified Hotz-Celsus Procedure

A surgical procedure used to correct medial entropion and caruncular trichiasis that involves removing a small triangular piece of skin from the eyelid.

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Nasolacrimal Punctae

A small opening in the eyelid that allows tears to drain into the nasolacrimal duct.

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Cryosurgery

A surgical procedure that uses extremely cold temperatures to destroy tissue. It can be helpful for caruncular trichiasis.

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Canaliculi and Catheterization

The canaliculi are delicate and can be easily injured during surgery. Catheterization helps protect them.

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Importance of Nasolacrimal Punctae

During surgery, it's crucial to ensure that the nasolacrimal punctae are not damaged, as this can lead to tear drainage problems.

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Caruncle Removal and Potential Complications

When removing the caruncle, it's essential to avoid injuring the nasolacrimal punctae and canaliculi, as this can lead to tear drainage issues.

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Dacryocystitis

Inflammation of the lacrimal sac, often caused by blockage of the nasolacrimal duct.

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Nasolacrimal duct flushing

A procedure that involves flushing fluid through the nasolacrimal duct to clear blockages.

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Medical management of dacryocystitis

A medical approach to treat dacryocystitis using antibiotics and other medications.

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Surgical intervention for dacryocystitis

A surgical intervention, usually performed by a veterinary ophthalmologist, to address persistent dacryocystitis.

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Nasolacrimal duct catheterization

A tube placed in the nasolacrimal duct and secured with stitches to keep the passage open.

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Secondary bacterial infection

A bacterial infection that occurs alongside another primary infection.

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Broad spectrum antibiotics

Antibiotics that target a wide range of bacteria.

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Culture and sensitivity testing

Tests performed to identify the specific types of bacteria causing an infection and their sensitivity to different antibiotics.

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What is the cornea and its main function?

The cornea is the outermost, transparent layer of the eye, responsible for bending light rays that enter the eye. It has a greater refractive power than the lens due to the change in medium from air to aqueous humor.

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How does the cornea maintain its transparency?

Factors contributing to corneal transparency include the lack of blood vessels, pigment, and the organized arrangement of cellular structures and small collagen fibrils.

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What is the role of the corneal endothelium in maintaining transparency?

The corneal endothelium contains pumps that remove excess fluid, keeping the cornea relatively dehydrated and contributing to its transparency.

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Define a corneal ulcer.

A corneal ulcer is a sore or wound on the surface of the cornea, which can be caused by various factors like eyelid abnormalities, irritants, trauma, or infections.

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How can eyelid abnormalities lead to corneal ulceration?

Corneal ulceration can arise from eyelid abnormalities such as entropion (eyelids turning inwards) or blepharitis (inflammation of the eyelids), causing irritation on the corneal surface.

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Describe the healing process of superficial corneal defects.

Superficial corneal defects involving only the epithelium often heal through epithelial sliding and mitosis, where cells move and divide to fill the gap.

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What are some examples of irritants that can lead to corneal ulceration?

Various external factors like shampoo, smoke, acids, alkalis, and UV light can irritate the cornea and cause ulceration.

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How can trauma contribute to corneal ulceration?

Corneal ulceration can result from trauma, such as scratches, road traffic accidents, or foreign objects entering the eye.

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Corneal endothelium

The inner most layer of the cornea, responsible for maintaining corneal clarity by actively pumping fluid out.

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Hypertrophy

The process where cells grow larger instead of dividing by mitosis (cell division).

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Sliding

The process where cells slide over each other to compensate for lost cells.

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Corneal edema

Fluid buildup within the cornea, often caused by endothelial damage.

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Neovascularization

New blood vessel growth within the tissue.

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Conjunctival hyperemia

The most common sign of recurring epithelial erosion in dogs and cats.

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Corgis

A breed commonly affected by recurring epithelial erosion, along with boxers.

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Burmese

A breed of cat commonly affected by recurring epithelial erosion, along with Persians.

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Study Notes

Ophthalmology Study Notes

  • Ophthalmic Examination Importance: A full ophthalmic examination is crucial for all animals exhibiting eye complaints.

  • Keratoconjunctivitis Sicca (KCS) Prognosis: Prognosis for complicated KCS is guarded. Severe cases may require conjunctival grafting and parotid duct transposition, yet the eye won't return to normal. Enucleation may be necessary. Vision can be impaired by chronic pigmentation, with potential complications like blepharitis post-surgery due to mineral build up. Early diagnosis and owner/patient compliance are vital for preventing these complications.

  • Case Example 16.1 (KCS): A 13-year-old male neutered miniature long-haired dachshund presented with a 3-year history of bilateral KCS. The dog was initially well-controlled with medication. However, a worsening discharge and an inability to open the left eye led to presentation. The left eye showed a sticky mucopurulent discharge adhering to the cornea, severe superficial corneal vascularization, and pigment deposition. Schirmer tear test was 3 mm in the affected eye and 11 mm in the unaffected eye. Menace responses and pupillary reflexes were normal and intraocular examination showed no major abnormalities. Eye discharge swab and fluorescein staining revealed no ulceration.

  • Nasolacrimal Punctae Issues: Nasolacrimal punctae present but misplaced, can be surgically repositioned by a qualified colleague if required. Medial entropion and caruncular trichiasis can be addressed in general practice.

  • Medial Entropion Procedures: Surgical procedures for medial entropion, while possible in general practice, are more difficult than lateral procedures due to a tight medial canthal ligament. A modified Hotz-Celsus procedure might be used, with a triangular rather than elliptical skin removal. Thin, soft sutures (6/0 polyglactin 910) are preferred, ensuring nasolacrimal puncta and canaliculi are undamaged (catheterization with colored nylon helps with visualization). Careless surgery can cause damage to the canaliculi. Cryosurgery is another treatment option.

  • Secondary Bacterial Infections: Often involve mixed bacteria; culture and sensitivity testing is recommended.

  • Nasolacrimal Duct Obstructions: The lacrimal sac and nasolacrimal duct are small. Temporary obstructions are easier to manage, and early nasolacrimal duct flushing plays a role, especially with conjunctival foreign bodies.

  • Medical Treatment Options: Initial treatment uses broad-spectrum topical chloramphenicol and systemic cefalexin until culture and sensitivity results obtained. Repeated nasolacrimal flushing is key. Treatment continues for 3–4 weeks even if clinical signs resolve earlier, with systemic treatment being essential to prevent recurrences. Sometimes owners need 6 weeks of oral antibiotics. Topical corticosteroids can be helpful if the medial canthus is inflamed.

  • Surgical Treatment Options: Referral to ophthalmologist is advisable if medical management is not successful due to the potential needing of a surgeon. If the nasolacrimal duct is patent, catheter placement for 3-4 weeks might be considered, alongside medication.

  • Corneal Function: Corneal transparency is essential. Transparency is maintained via the lack of blood vessels, pigment, organized cellular structure and small collagen fibrils. The endothelium removes excess fluid for corneal hydration and clarity. Endothelial pump failure may cause corneal edema and colour changes.

  • Corneal Ulceration: Multifaceted causes are possible including eyelid abnormalities (agenesis, entropion, blepharitis), eyelash/hair abnormalities, irritants (shampoo, smoke, chemicals), tear film problems (KCS), trauma (cat scratches, accidents), and infection (bacterial, viral). Dystrophy can also cause ulceration.

  • Corneal Healing: Superficial defects heal by epithelial migration and mitosis. Endothelial healing involves limited mitosis with hypertrophy and sliding. Endothelial damage can lead to corneal edema which may be permanent.

  • Corneal Colour Changes: Corneal reactions to insults present with color changes, including red (neovascularization, hemorrhage, symblepharon), white (edema, lipid, calcium), blue-grey (mild edema), and pigmented (melanin, sequestrum).

  • Recurrent Epithelial Erosion: Often presents with minor conjunctival hyperemia, increased tearing, and slight blepharospasm in the affected eye. Boxers, Corgis, are commonly affected, along with some Burmese and Persian cats. Typically only one eye is affected, but both can be involved. Discomfort varies.

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