Corrected 2011 Ophtho Review Slides

8/2/2019 Corrected 2011 Ophtho Review Slides

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2011 Review slides


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False, the pic shows fluroscein stain done,but the next step after visual assessmentshould actually be schirmer tear test

(SST).

The dx for this pic is a corneal ulcer

Normals for SST:

DOGS: 15-25 mm/min

Variable in cats

Horses-variable: >20mm/min in


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Practice quiz


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distichia

Hair from meibomian gland

Can cause corneal ulcer

This can also be ectopic cilia


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Practice quiz


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Spastic entropion

Eye retracts in skull d/t pain

Can be secondary to painful cornea

Use topical anesthetic to see if eye returnsto normal position

Over time scarring occurs may need

corrective sx


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Practice quiz


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Eyelid masses in dogs areusually benign

Dogs- benign *always send in for histo*

Meibomian adenoma

Benign melanoma / melanocytomaSquamous papilloma

Cats-malignant (SqCCa, Mast cell tumor,

fibrosarcoma) Horses and cattle-malignant (SqCCa)


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Practice quiz

What are reasonable differentials for thispatient?

KCS

Trichiasis

Imperforate punctas

Meibomian gland

Dysfunction

Normal for white Poodle


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KCS- no, obviously lots of tears are beingproduced

Triachiasis- possible, hair in normal place but

going in abnormal direction cancauseirritation and excessive tearing

Imperforate punctas- possible since tears aredraining down face instead of down punta

Meibomian gl dysfunction- possible since oilcomponent to tear film cannot be made rightand thus tears wont be kept on eye

Normal for white poodle- NO!


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Practice quiz

What is your primary differential for thispatient with chronic conjunctivitis?


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KCS!

Chronic conjunctivitis think KCS

Cant see the tear film in this patient


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Practice quiz

This dog presented for excessive tearingand blepharospasm-what are yourDifferentials?


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Distichia- hair from meibomian gland

This will irritate the cornea

Meibomian gland should be oily- theyreinspissated in this patient


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Practice quiz


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P is 1 yr oldfollicular conjunctivitis

Diet change

Tapering steriods

Will resolve with age Long-term tx until older


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Practice quiz: DfDxs?


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DfDxs:

Straight blood vessels, episceral injection

Therefore origin is intraocular

Think glaucoma, KCS, allergies, FB, etc


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Clin findings and DfDxs?


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Redblood present (black=pigment,white=WBCs, protein)

Diffuse hemorrhage with underlyingconjunctiva epithelium in tact (since bloodnot oozing everywhere)

Think trauma or toxin ingestedThis dog ate rat poison.


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What do you see? What are youthinking?


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White and swollen

Think systemic dz

Anemic with hyperproteinemia


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What is this?


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Dermoid!

Dermoidnormal skin growing in anabnormal location

Tx: Surgical excisionsuperficialkeratectomy


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What is this?

Looks like lipid in cornea, occurs in purebreds (espSiberians)


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Corneal subepithelial dystrophy

Hereditary

Bilateral

Non-painful Progressive

Cholesterol-Crystal deposits

Tx: Feed low-Fat diet


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Practice quiz


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Pannus!

See german shepherdthink pannus!


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Practice quiz


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This german shepherd has pannus

Plan:

Get dogglesavoid the sun

Start special diet (z/d)

Topical steroids (Pred AC)

Oral doxy (d/t immune modulating)

Dz will never go away so tx is for life


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Practice quiz


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Answer is c)look for distichia orFB

Should have healed within 3-5 days (or 5-7 days of older patient)

Do NOT change abx

Look for other cause, ie FB or distichia


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Practice quiz


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Look for cause of ulcer

Eyelid mass removal Sx was done 5 wks agosuspect suture rubbing or eyelids not lined

up when closed. Plan:

get rid of poor sx job since tissue acts like FB

Get rid of loose corneal epith (use Q-tip)

Stain to see how deep

Debride ulcer if not deep

Tx w/topical abx


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Practice quiz


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This is flare

Diagnostic for uveitis

Say flarethink uveitis


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Practice quiz


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Iris sphincter degeneration/atrophy (agingmuscle)


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What do you see?What causes it?


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Hyphema=blood in the anterior chamber

Caused by trauma, neoplasia,coagulopathy, or hypertension

Wh t i l b t


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Whats so special about

cougars?

they have a round pupils NOT normal for cats


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Practice quiz

Owner and dog went out hiking. Dog hadblepharospasm when she got home. Whatdo you think is going on?

Dog got poked in eye. Need to do exam.Stain strip to sclera. Check for ulcers.


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Diabetic cataracts

Acute onset

ERG to see if dog is really blind

Start preventative tx for LIU

Refer for surgery


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Nuclear sclerosis

Night vision blindness

Can see fundus therefore not cataract

Normal fundus therefore not PRA

***may become cataract so treatpreventatively


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Check IOP

Retropulse to R/O tumor

Can also ultrasound

Perform enucleation


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Glaucoma treatment chart


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Right eye is HUGE, edematous, and notvisual

DfDx: glaucoma Plan: check IOP, retropulse, look at retina Give meds if not blind and painful

If blind and painful then enucleate the eye!

OD=right eye, OS=left eye, OU=both eyes Right eye is Dominant


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Fresh hemorrhage d/t light red color

This is likely bilateral

Think systemic causehypertension

Check blood pressure


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SARDS

Fixed Dilated pupils (non-responsive)

No menace or cotton following

Need bloodwork done

Optic neuritis

Fixed dilated pupils- non-responsive

Use ERG to distinguish btw the two


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Answer is E.

Suspect PRA Hard time doing downstairs at night Night

vision loss

Bilateral

Retinal degeneration seen in fundus: vascular attenuation (thinning), hyperreflective tapetum

(as the over lying nerve layers of the retina thin) andoptic nerve atrophy

Patient otherwise normal No PUPDPP

SST and IOP normal

This is hereditary and progressive. Need to give

supp vit A and omega FAs


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This cat has?


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Retinal degeneration

Blindness

Dilated pupils

R/O retinal detachment

Can see floaters

Whats wrong w/this cat?


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What s wrong w/this cat?

(hint:OS)


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Feline hypertensive retinopathy

causes of hypertension:

Hyperthyroid

Renal failure

Cardiac

primary


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What??


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Herpes!

Could also be:

Trichiasis

Imperforate puncta

Meibomian gland dysfunction


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Answer is D

Hypertension caused fresh hemorrhage

Bulging eye but normal shape-


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Bulging eye but normal shapeDfDx?

Sinus masscauses


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Sinus masscausesexopthalmus


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ERU- active uveitis

See pigment om anterior lens capsule

See flare

See posterior synechia

Think past and present uveitis

Prognosis:

never going to go awaycan progress to blindness


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A i C l f d


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Answer is C- normal fundus

Myelination noted around ON- normal

Tapetal spots are capillaries- normal


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T i i l i


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Trigeminal nerve- sensory input


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What is the tx?


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Doxycycline (oral systemic) andterramycin (topical)

Corrected 2011 Ophtho Review Slides

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