VMED 7502: Ophthalmic Exam Insights
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Questions and Answers

What is the primary cause of keratoconjunctivitis sicca (KCS) in dogs?

  • Age-related dry eye
  • Bacterial infection
  • Immune-mediated lacrimal gland adenitis (correct)
  • Allergic reaction
  • Which clinical sign is NOT typically associated with keratoconjunctivitis sicca (KCS)?

  • Mucopurulent discharge
  • Dull appearance of the cornea
  • Severe redness of the sclera (correct)
  • Blepharospasm
  • What diagnostic test is used to measure tear production in suspected cases of KCS?

  • Conjunctival scraping
  • Fluorescein stain
  • Tear break-up time test
  • Schirmer tear test (correct)
  • Which treatment is primarily aimed at stimulating tear production in immune-mediated KCS?

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

    What is the expected effect of long-term use of cyclosporine in KCS patients?

    <p>Break-up of corneal pigment (B)</p> Signup and view all the answers

    Which part of the nasolacrimal drainage system is responsible for initiating drainage from the eye?

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

    What is the purpose of using fluorescein dye in assessing nasolacrimal drainage?

    <p>To evaluate drainage patency (B)</p> Signup and view all the answers

    What potential benefit does pilocarpine have in the treatment of KCS?

    <p>Increases tear volume (A)</p> Signup and view all the answers

    What is the main anatomical structure responsible for the production of aqueous humor?

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

    Which pathway does aqueous humor follow through the eye before exiting?

    <p>Pupil -&gt; iridocorneal angle (A)</p> Signup and view all the answers

    What is the normal range for intraocular pressure (IOP) in mmHg?

    <p>10-20 mmHg (C)</p> Signup and view all the answers

    Which breed is most commonly associated with primary glaucoma?

    <p>American Cocker Spaniel (D)</p> Signup and view all the answers

    What is a common clinical sign of glaucoma in dogs?

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

    Which condition is characterized by impaired outflow leading to increased IOP in dogs?

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

    What anatomical change is typically seen in closed-angle glaucoma?

    <p>Narrowing of the iridocorneal angle (A)</p> Signup and view all the answers

    What is the effect of increased intraocular pressure on the optic nerve?

    <p>Causes optic nerve damage (C)</p> Signup and view all the answers

    Which of the following is a recognized cause of secondary glaucoma?

    <p>Anterior lens luxation (C)</p> Signup and view all the answers

    What is the main goal in managing primary glaucoma?

    <p>To preserve vision and comfort for as long as possible (B)</p> Signup and view all the answers

    What common treatment is used for uveitis that may also be applied in cases of hyphema?

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

    In chronic uveitis, which complication can occur that leads to pupillary block?

    <p>360-degree posterior synechia (B)</p> Signup and view all the answers

    What is a necessary action when managing secondary glaucoma regarding its underlying cause?

    <p>Address the underlying cause directly (D)</p> Signup and view all the answers

    What is the characteristic feature of distichiasis?

    <p>Hair growing from the meibomian gland openings (D)</p> Signup and view all the answers

    Which condition involves hair growing from the palpebral conjunctiva?

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

    What is the primary clinical sign of entropion?

    <p>Eyelid rolling inward (A)</p> Signup and view all the answers

    What procedure is indicated for temporary correction of entropion in puppies?

    <p>Temporary tacking sutures (C)</p> Signup and view all the answers

    What common eyelid tumor is associated with the meibomian gland?

    <p>Meibomian gland adenoma (A)</p> Signup and view all the answers

    Which statement about ectropion is accurate?

    <p>Some breeds may have normal conformation without issues. (C)</p> Signup and view all the answers

    Which condition involves inflammation of the eyelids?

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

    What is the function of the nictitating membrane?

    <p>To move debris from the corneal surface (D)</p> Signup and view all the answers

    What is the primary goal of treatment in cases of chronic glaucoma where the affected eye is permanently blind?

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

    Which hyperosmotic agent administers intravenously and lowers intraocular pressure within 30-60 minutes?

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

    What should be avoided for use of glycerin in patients with which condition?

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

    Which surgical procedure aims to increase aqueous humor outflow?

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

    What is a significant risk associated with diode laser cyclophotocoagulation?

    <p>Severe intraocular pressure increase (D)</p> Signup and view all the answers

    When is enucleation recommended as a procedure for glaucoma intervention?

    <p>In end-stage glaucoma cases (B)</p> Signup and view all the answers

    What is the primary effect of chemical ablation using gentamicin?

    <p>It causes the globe to shrink (C)</p> Signup and view all the answers

    Which medication should be given immediately to a patient with potential for regaining vision affected by glaucoma?

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

    What is the expected outcome when spastic entropion is treated with proparacaine?

    <p>It should resolve the entropion. (D)</p> Signup and view all the answers

    Which layer of the cornea is involved in maintaining corneal clarity through fluid regulation?

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

    What is the predominant treatment method for superficial, non-infected corneal ulcers?

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

    In cases of reflex uveitis in dogs, which is a common trigger?

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

    What characterizes rhegmatogenous retinal detachment?

    <p>Presence of a tear in the retina (B)</p> Signup and view all the answers

    What is a contraindication for using topical NSAIDs in cases of corneal ulcers?

    <p>Corneal edema from glaucoma (A)</p> Signup and view all the answers

    What systemic condition in dogs can lead to uveitis?

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

    Which clinical sign is NOT typically associated with glaucoma?

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

    Flashcards

    Trichiasis

    Abnormal hair growth from the eyelid, directed towards the cornea.

    Distichiasis

    Double row of eyelashes, arising from a meibomian gland opening.

    Ectopic Cilia

    Hair grows from meibomian gland but emerges from palpebral conjunctiva.

    Entropion

    Eyelid rolls inward, causing irritation and ulcers.

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    Ectropion

    Eyelid rolls outward.

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    Blepharitis

    Inflammation of the eyelids.

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    Nictitating Membrane

    Third eyelid; part of ocular surface protection.

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    Canine Eyelid Neoplasia

    Tumors of the eyelids in dogs.

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    Keratoconjunctivitis sicca (KCS)

    A dry eye disease in dogs, characterized by decreased tear production.

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    Clinical signs of KCS

    Include conjunctivitis, mucopurulent discharge, dull cornea, keratitis (inflammation of cornea), and blepharospasm (eyelid twitching).

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    Schirmer Tear Test

    A diagnostic test used to measure tear production in dogs.

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    Treatment of Immune-mediated KCS

    Often includes cyclosporine or tacrolimus, immunosuppressants stimulating tear production.

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    Nasolacrimal drainage system

    A pathway for tears to drain from the eye to the nose (lacrimal puncta, canaliculi, lacrimal sac, nasolacrimal duct).

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    Lacrimal puncta

    Small openings at the corner of the eye that collect tears.

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    Fluorescein stain

    Used to diagnose dry eye; detects corneal ulcers and assesses tear film.

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    Nasolacrimal duct obstruction

    Blockage in the pathway of tear drainage from eye to nasal passages.

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    Secondary Glaucoma

    Glaucoma caused by underlying conditions that affect the flow of aqueous humor, such as lens luxation, tumors, uveitis, or hyphema.

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    Anterior Lens Luxation

    A condition where the lens of the eye moves forward, blocking the flow of aqueous humor through the pupil, leading to secondary glaucoma.

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    Uveitis

    Inflammation of the middle layer of the eye (uvea), which can lead to secondary glaucoma due to blockage of drainage pathways.

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    Hyphema

    Blood in the anterior chamber of the eye, causing a blockage of drainage pathways and leading to secondary glaucoma.

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    Treatment for Secondary Glaucoma

    Treatment options for secondary glaucoma focus on addressing the underlying cause, such as surgery for lens luxation, enucleation for tumors, and medications for uveitis or hyphema.

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    Aqueous Humor Production

    The ciliary body produces aqueous humor, providing nourishment to the intraocular structures.

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    Aqueous Humor Outflow

    Aqueous humor exits the eye through the iridocorneal angle, conventionally through the trabecular meshwork and scleral veins.

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    Glaucoma (in dogs)

    Impaired aqueous humor outflow leads to increased intraocular pressure (IOP), damaging the optic nerve, retina, cornea, and iris.

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    Normal IOP (dogs)

    Intraocular pressure in a healthy dog is typically between 10-20 mmHg.

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    Primary Glaucoma in Dogs

    Commonly seen in middle-aged dogs (6-8 years), often bilateral but not necessarily at the same time.

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    Clinical Signs of Glaucoma

    Clinical signs of glaucoma include blindness (visual impairment), blepharospasm, redness in the eye (episcleral injection), and changes in pupil size (mydriasis).

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    Breed Predisposition (Glaucoma)

    Certain dog breeds, such as American Cocker Spaniels, Bassets, Chow Chows, Shar-Peis, Boston Terriers, Fox Terriers, and Siberian Huskies, have a higher risk of glaucoma.

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    Intraocular Pressure (IOP)

    Intraocular pressure is the pressure inside the eye; it result from balance between aqueous humor production and outflow

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    Hyperosmotic Agents

    Substances that draw fluid out of the eye, lowering intraocular pressure (IOP). Used for acute glaucoma.

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    Mannitol

    A hyperosmotic agent given intravenously to quickly reduce IOP in acute glaucoma. Effects last about 6-10 hours.

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    Glycerin

    A hyperosmotic agent taken orally to lower IOP. Effects last around 6-10 hours.

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    Diode Laser Cyclophotocoagulation

    A procedure that uses laser to damage the ciliary body, reducing production of aqueous humor and lowering IOP.

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    Gonioimplant

    A surgically implanted device that provides a new pathway for aqueous humor drainage, increasing outflow.

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    Enucleation

    Removal of the entire eyeball. Used as an end-stage procedure for chronic glaucoma.

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    Evisceration

    Removal of the intraocular contents, leaving the sclera. An intrascleral prosthesis is then placed. Not appropriate for tumors.

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    Chemical Ablation

    Injection of gentamicin into the vitreous, damaging the eye tissue and ultimately shrinking the globe. 85% effective but not safe in cats or with tumors.

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    Corneal Ulcer

    A wound on the cornea caused by trauma, foreign bodies, or infection. It can be superficial (minor) or deep (severe).

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    Superficial Corneal Ulcer Treatment

    Topical antibiotics (to fight infection), atropine (to dilate the pupil and reduce pain), systemic pain medication, and an Elizabethan collar (to prevent scratching).

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    Uveal Tract

    The vascular tunic of the eye, consisting of the iris, ciliary body, and choroid. It supplies nutrients and helps maintain the eye's internal pressure.

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    Reflex Uveitis

    Inflammation of the uveal tract caused by an injury or infection in the eye, often triggered by a corneal ulcer.

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    Retinal Detachment

    Separation of the retina from the choroid, usually caused by a tear in the retina. It can be rhegmatogenous (tear present) or non-rhegmatogenous (no tear).

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    Cataract

    Clouding of the lens in the eye, causing impaired vision. Common causes include genetics, diabetes, and uveitis.

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    Glaucoma

    Increased pressure within the eye, potentially leading to damage to the optic nerve and blindness. Can be acute (sudden onset) or chronic (gradual).

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    Study Notes

    VMED 7502: Ophthalmic Exam

    • A detailed ophthalmic examination includes examining the adnexa, globe, orbit, and reflexes. Findings are interpreted within a clinical context.
    • Globe size assessment includes large buphthalmos and small microphtalmos or phthsis bulbi.
    • Globe position includes exophthalmos vs enophthalmos and retropulsion.
    • Menace response assessment includes vision, blink, afferent (vision-retina, optic nerve, visual cortex), and efferent (blink-facial nerve; motor to eyelids).
    • Palpebral reflex assesses eyelid sensation and blink, with afferent (eyelid sensation- trigeminal nerve) and efferent (motor to eyelids- facial nerve) components.
    • Pupillary light reflex (PLR) assessments include the direct, indirect (consensual), afferent (retina and CN2), and efferent (CN3 and iris sphincter m.) aspects.
    • Ophthalmic diagnostic tests are selected based on the patient's history, signalment, and clinical signs.
    • Basic ophthalmic exam procedures include accurate technique and identification of incorrect technique.

    Ophthalmic Diagnostic Tests

    • Indirect ophthalmoscopy has advantages: larger field of view, better view through opacities, viewer depth perception, and distance from the patient. Disadvantages include an upside-down and reversed image and the need for learned technique.
    • Direct ophthalmoscopy has advantages: easy to perform, upright image, and a magnified image. Disadvantages include a small field of view, and opacities interfering with the view.

    Contraindications and Specific Tests

    • Recall contraindications for specific ophthalmic diagnostics, including the use of proparacaine and tropicamide.
    • Schirmer Tear test assesses basal and reflex tears. Afferent is corneal sensation and efferent is parasympathetic fibers of CN7 to the lacrimal gland
    • Tonometry (requires topical anesthesia) measures pressure in dogs (10-25 mmHg), cats (10-30 mmHg), and horses (15-30mmHg), ideally with less than or equal to 5mmHg difference in a healthy animal.
    • Hallmark of inflammation in the eye is uveitis.

    Neuro-ophthalmology

    • Assess vision using techniques and differentiate vision loss from abnormal mentation.
    • Interpret pupillary light reflex (PLR) abnormalities and localize lesions (afferent: sensory, going toward CNS; efferent: motor, going away from CNS).
    • Diagnose anisocoria (unequal pupil size) using pupillary light reflex, increasing or decreasing room lighting to assess for lack of parasympathetic or sympathetic innervation in the abnormal pupil.

    Ocular Pharmacology

    • Topical drugs do not penetrate beyond the lens. This must be considered when choosing the appropriate route of administration for different ocular regions.
    • Ointments provide longer lubrication compared to solutions.
    • Ointments are easier to administer in large animals and solutions are easier in smaller animals.
    • Solutions are contraindicated with deep corneal ulcers, perforation, or laceration.
    • Use of topical medications includes ophthalmic solutions, ointments, and subconjunctival injections, tailored to the patient's condition.

    Ophthalmic Drugs and Diseases

    • Topical, systemic antibiotics, antifungals, and other ophthalmic treatments are important in treating various ocular diseases (e.g., keratitis, scleritis, anterior uveitis, uveitis, etc.).
    • These different classes of drugs target different pathogens or inflammatory responses and are used in conjunction with local ophthalmic treatments in a variety of situations.

    Orbital Disease

    • Clinical signs of enophthalmos include globe sunken into the orbit, elevated nictitating membrane, and decreased palpebral fissure size.
    • Clinical signs of exophthalmos may include globe protruding anteriorly, increased palpebral fissure size, and elevated nictitating membrane.
    • Differentiate between inflammatory and neoplastic etiologies of orbital disease based on clinical signs, medical history, and signalment.

    Corneal Disease

    • Relate basic corneal anatomy and physiology to corneal disease pathology.
    • Systematically rule out etiologies for corneal disease based on animal signalment, history, and examination findings.
    • Identify ophthalmic diagnostic tests and evaluate and interpret findings.
    • Recognize clinical signs of corneal disease, including pain, chronicity, and severity, and predict prognosis of vision.
    • Formulate an appropriate treatment plan for corneal disease, considering ideal to palliative care, potential referrals, and justification.

    Lens Disease

    • Relate lens anatomy and physiology to nuclear sclerosis, cataract formation, and lens luxation.
    • Diagnose cataracts by performing a complete ophthalmic exam and identify etiology and stage.
    • Formulate a treatment plan that accounts for referral and pharmacological aspects.
    • Differentiate between phacolytic and phacoclastic uveitis.

    Uvea Conditions

    • Recognize the common non-inflammatory conditions of the uvea (iris atrophy, iris cyst, persistent pupillary membranes) based on history, signalment, and clinical signs (e.g. iris atrophy, uveal cysts).
    • Formulate a treatment plan for a patient with lens luxation, considering the signalment, chronicity, and the potential for vision restoration.
    • Differentiate between characteristic clinical signs of inflammatory versus neoplastic etiologies of orbital disease.

    Fundus

    • Recognize normal variations in the ocular fundus of common domestic species (e.g., tapetum).
    • Relate retinal and choroidal anatomy and physiology to appearance of normal variations in the fundus, and to the pathogenesis of chorioretinitis, hemorrhage, and retinal detachment.

    Retinal Detachment

    • Recognize the clinical signs of retinal detachment and conclude the most likely etiology.
    • Formulate an appropriate treatment plan for retinal detachment that considers signalment, severity, and potential for vision restoration.
    • Understanding of the appropriate referrals for further management.

    Feline Ophthalmology

    • Develop a differential list for feline conjunctivitis and/or keratitis, including diagnostic tests, therapeutic recommendations, and follow-up considerations.
    • Differential diagnoses of ocular conditions in feline patients (e.g, herpesvirus, chlamydophila, mycoplasma).

    Equine Ophthalmology

    • Identify ophthalmic clinical signs that can be manifestations of systemic disease.
    • Describe the pathogenesis of feline diffuse iris melanoma.
    • Evaluate the difference between uveal melanoma in canines vs that found in felines when performing differential diagnosis.
    • Recommend appropriate diagnostic tests, therapeutic recommendations, and follow-up considerations.

    Food-Animal Ophthalmology

    • Develop an accurate differential diagnosis list for an animal presenting with corneal opacity.
    • Recommend management strategies to help prevent and/or manage outbreaks of IBK.
    • Recognize various stages of Bovine Ocular Squamous Cell Carcinoma (BOSCC).

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    VMED 7502: Ophthalmic Exam PDF

    Description

    Test your knowledge on the comprehensive ophthalmic examination processes. This quiz covers key assessment techniques such as globe size evaluation, menace response, and reflex tests, all within a clinical context. Prepare to enhance your understanding of veterinary ophthalmology.

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