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Opthalmology Test 1 Ward
Veterinary Optho test 1 utcvm
128
Veterinary Medicine
Graduate
01/30/2014

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Term
Three types of secondary entropion
Definition
cicatricial, involutional, spastic
Term
which type of entropion is a result of scar tissue formation
Definition
cicatricial
Term
In which eye surgery do you use vicryl?
Definition
Modified Hotz-Celsus
Term
why is vicryl beneficial in surgery for entropion?
Definition
the braided suture is softer and less likely to irritate cornea
Term
Three types of eyelash abnormalities; which one is always gonna cause a problem?
Definition
Trichiasis, Dystichia, Ectopic Cilia; Ectopic cilia
Term
What is a grid keratotomy used as a tx for?
Definition
Indolent Ulcer
Term
Are indolent ulcers usually superficial?
Definition
Yes
Term
Two main hypothetical mechanisms on why indolent ulcers occur
Definition
1. Increased protease production in tear film 2. Presence of acellular zone that prevents proper attachment of basal epithelial cells
Term
When basal epithelial cells are failing to adhere to underlying stroma... what do you get?
Definition
Indolent Ulcer
Term
Indolent Ulcers are particularly common in :
Definition
Boxers
Term
How does topical morphine affect corneal wound healing
Definition
It doesn't - trick question. my B
Term
Adequan and Grid keratotomy are two treatments for indolent ulcers.... which is better for combating overproduction of proteases?
Definition
Adequan
Term
In indolnet ulcers, what can you place on the eye to prevent any new epithelium from being wiped away by eyelids?
Definition
Soft contacts
Term
Ground glass appearance on cornea indicates:
Definition
corneal edema
Term
7 etiologies for corneal ulceration
Definition
Eyelash Abn, Eyelid Abn, Dry eye, toxins, foreign body in third eyelid, indolent ulceration, trauma
Term
Two sources of pain in corneal ulcerations
Definition
1. Cornea--> opthalmic branch trigeminal 2. Ciliary spasm (axon reflex)
Term
You need to assess four things in an ulcer and which is THE MOST IMPORTANT??? ( WILL be on test)
Definition
1. ETIOLOGY!!!! 2. Depth 3. Presence of complicators 4. Rate of progression
Term
What prevents fluorescein stain from penetrating healthy cornea? ( 2 things technically)
Definition
Lipophilic Epithelium with tight junctions between squamous cells
Term
How thick is the canine cornea?
Definition
500 um
Term
Canine cornea is 90%
Definition
stroma
Term
Three layers in corneal epithelium
Definition
Basal cells, Wing cells, Squamous cells
Term
Three Layers in cornea; what membrane separates the first two layers?
Definition
Endothelium - (Descemets Membrane)- Stroma- Epithelium
Term
Which layer of corneal epithelium has low cellularity?
Definition
stroma
Term
The cornea is avascular. Where does it get it's nourishment (Name primary then secondary source)
Definition
Mainly from aqueous humor but somewhat from tear film
Term
Both the endothelium and epithelium in cornea help keep it dehydrated. Which one does this by active pumping of fluid out?
Definition
Endothelium
Term
If you see dense, widespread corneal edema, you can safely say there is ( epithelial or endothelial) disease?
Definition
Endothelium
Term
How does atropine reduce pain in corneal ulceration?
Definition
Parasympatholytic--> calms down the axon reflex and relaxes ciliary spasm
Term
What's commonly in triple antibiotic
Definition
Neomycin/Polymixin B/Bacitracin
Term
What protein is laid down on stromal surface to begin corneal epithelium wound healing and help the basal cells ratchet across the defect?
Definition
Fibronectin
Term
During healing of stromal defect, Keratocytes convert into _______ and make collagen to fill the defect.
Definition
fibroblasts
Term
What is the normal beneficial function of MMPs
Definition
Debridement in normal wound healing
Term
when you see a corneal scar, you need to distinguish it from:
Definition
corneal edema
Term
Five reasons why cornea is clear
Definition
Dehydrated, Avascular, Apigmented, No keratin, Lamellar arrangement
Term
You see hyperemia in 'whites' of a pups eye it could be hyperemia of what two anatomic structures?
Definition
Episclera or conjuctiva
Term
If whites of eyes are hyperemic with vessels looking small, moving with conjuctiva, diffusely pink and blanch with topical phenylephrine, where is the redness coming from truely?
Definition
conjunctiva
Term
Almost all cases of keratitis will have secondary _____-itis
Definition
conjuctivitis
Term
Distichia in these two breeds will almost always be a problem
Definition
Lhasa Apsos and Shih Tzus
Term
What is a disorder of cilia where hairs grow out of meibomian gland pores?
Definition
Distichia
Term
What is a disorder of cilia where hairs grow straight through eyelids ( not meibomian glands)
Definition
Ectopic Cilia
Term
When normal lashes rub on cornea
Definition
Trichiasis
Term
Main tx from distichia
Definition
Cryoepilation
Term
what's a main complication with cryoepilation, that eventually caused skinny pimp some unexpected consequences?
Definition
transient conjuctival hyperemia
Term
Why are steroids strictly contraindicated with corneal ulceration????
Definition
Can stimulate MMPs and cause a melting ulcer resulting in possible desmetocele or worse
Term
What is a melting ulcer?
Definition
One caused by lots of MMP activity that eats away at stroma and "melts" cornea giving a "malacic" appearance
Term
Four things that can cause MMP activity ( one of them iatrogenic)
Definition
1. corneal healing(normal or abnormally high) 2. PMNs ( again normal or abnormal stimulation) 3. Topical steroids 4. Microbe secretion
Term
when targeting pseudomonas in the eye... what group of drugs are the best?
Definition
Fluoroquinolones
Term
Why not use an antibiotic OINTMENT in a desmetocele?
Definition
Ointment vehicles are irritating to intraocular tissue and there's a good chance that this baby will rupture
Term
Frequency of cipro application for desmetocele pt.
Definition
q 2hrs
Term
In a conjuctival pedicle graph, the strip of bulbar tissue provides what beneficial cells for strength?
Definition
fibroblasts
Term
In a conjuctival pedicle graph, the strip of bulbar tissue provides what beneficial proteins that inhibit MMP activity?
Definition
a2-macroglobulin and a1-antitrypsin
Term
A widely dilated pupil a few days after a conjuctival pedicle graft indicates:
Definition
good news: reduced or eliminated axon reflex and therefore secondary uveitis is controlled.
Term
When evaluating a conjuctival pedicel graft 3 days post-op, what color would you like it to be?
Definition
pink
Term
Which common infectious agent is Triple Antibiotic NOT good against
Definition
Pseudomonas
Term
What causes Fluorescein stippling?
Definition
inflammation w/o ulceration
Term
Hx of multiple antibiotics indicates the presenting ulcer is NOT due to:
Definition
infection
Term
Sagging of the lids
Definition
ptosis
Term
Temporary Tacking is a good temporary tx for:
Definition
ptosis with resulting congenital entropion
Term
Shar Peis are predisposed to superior lid ptosis which can sometime cause entropion on developing dogs... why can tacking suture sometimes be a problem in these animals?
Definition
this breed has abnormal subdermal tissue and sutures tear out easily
Term
What three syndromes encompass the brachycephalic ocular syndrome?
Definition
Lagopthalmia, medial canthal entropion, medial aberrant dermis
Term
Corneal pigmentation is strictly in:
Definition
dogs
Term
Term for accumulation of melanin in superficial cornea secondary to superficial keratitis
Definition
Corneal Pigmentation
Term
what do dogs tend to manifest with chronic superficial keratitis
Definition
Corneal Pigmentation
Term
neovascularization that is dichotomously branched and extends far into cornea is
Definition
superficial
Term
neovascularization that is brish border like and on edge of cornea
Definition
deep
Term
neovascularization is a sign of acute or chronic keratitis
Definition
chronic
Term
When the cornea is inflamed, it may recruit_____ vessels, resulting in _________.
Definition
limbal; neovasculrization
Term
deeper neovasularization may arise from these two intraocular diseases:
Definition
uveitis glaucoma
Term
This can result from facial nerve paralysis or from conformational problems in brachycephalics
Definition
lagopthalmia
Term
Failure to blink completely
Definition
lagopthalmia
Term
type of entropion common in brachycephalics
Definition
medial canthal
Term
Small piece of dermis in medial canthus of eye is called______ and can sometimes cause_________.
Definition
Medial Aberrant Dermis; Trichiasis
Term
Tx for lagopthalmia in brachycephalics
Definition
Medial canthoplasty
Term
Surgery that brings nasal superior and inferior lids together and shortening palpebral fissure
Definition
Medial canthoplasty
Term
What tx would you use for hastened retreat of corneal vessels?
Definition
topical steroid
Term
What topical would you NEVER use on a corneal ulcer
Definition
topical steroid
Term
Topical tx for mild lagopthalmia
Definition
GenTeal (artificial tear gel)
Term
what can you do to treat corneal pigmentation
Definition
nothing
Term
endothelial channels remaining after corneal vessels have retreated
Definition
Ghost Vessels
Term
Thick mucopurulent discharge indicates
Definition
bacterial conjuctivitis
Term
Ocular discharge almost always indicates
Definition
conjuctival pathology
Term
Culture and Sensitivity is hard to interpret from conjunctival swab but can assume it is usually what kind of organism?
Definition
Gram +
Term
What is the most common ocular disease seen in dogs?
Definition
Keratoconjuctivitis Sicca
Term
Tear film layer that acts as a surfactant
Definition
mucin
Term
tear film ayer that is excreted by conjunctival goblet cells and in direct contact with cornea
Definition
mucin
Term
tear film layer that is excreted bymeibomian glands and slows evaporation
Definition
lipid
Term
tear film layer that makes up majority of tears
Definition
aqueous
Term
tear film layer produced both by lacrimal gland and gland of third eyelid
Definition
aqueous
Term
KCS is almost always a deficiency in which tear film layer?
Definition
aqueous
Term
Four ways KCS can be truly iatrogenic (we cause it)
Definition
removal of lacrimal gland due to cherry eye, sulfa drugs, nasal radiation, general anesthesia
Term
Four non-iatrogenic etiologies of KCS
Definition
idiopathic (autoimmune), infectious, neurogenic, traumatic
Term
Two specific infectious etiologies of KCS
Definition
CDV in dogs, felines herpes in cats
Term
What immunosuppressive drug is sued for KCS
Definition
cyclosporin
Term
What is the main MOA of cyclosporin for dry eye?
Definition
directly increases tear film production in dogs
Term
How long do you want to give cyclosporin in dogs with dry eye to see a response
Definition
up to 12 weeks
Term
How long do you want to give pilocarpine in dogs with dry eye to see a response
Definition
only a few days
Term
last result surgery to get moisture to eye
Definition
Parotid duct transposition
Term
On examination there is an opacity made up of many tiny glittery dots which is consistent with:
Definition
Lipid Keratopathy
Term
tx/prevention for corneal bullae
Definition
thermokeratoplasty
Term
what secondary problem can arise from chronic corneal edema
Definition
corneal bullae
Term
topical tx for endothelial dystrophy with minimal efficacy
Definition
topical hyperosmotic NaCl ointment
Term
This is a beningn non painful type of corneal dystrophy and is the most common
Definition
Lipid dystrophy
Term
You have decided you see endothelial disease. Inflammation is one etiology most commonly caused by this agent:
Definition
Adenovirus
Term
What Diagnosis do you back into when all other causes of endothelial dysfunction are ruled out?
Definition
Senile corneal endothelial degenerations
Term
with suspected endotheilal dysfunction, what are you trying to rule out when looking for "flare"?
Definition
Anterior Uveitis
Term
with suspected endotheilal dysfunction, what are you trying to rule out when testing IOP?
Definition
Glaucoma
Term
How does anterior uveitis cause endothelial dysfunction and subsequent widespread corenal edema?
Definition
Decrease in aqueous humor production--> malnourished endothelial cells
Term
Superficial keratitis with granulation tissue- most likely Etiology
Definition
German Shepherd Pannus
Term
This disease has multifactorial causes/associations including Genetics, Immune mediated problems, and UV radiation
Definition
German Shepherd Pannus
Term
Should hit german shepherd pannus dogs hard initially with this treatment at up to 6X daily
Definition
Topical dexamethasone
Term
With refractory cases of this disease, can try last resort treatments like: subconjunctival steroid injection, strontium raditaion, or even lamellar keratectomy
Definition
German Shepherd Pannus
Term
You see multiple free floating spherical structures that can transillimuniate in anterior chamber. What are they?
Definition
Iris Cysts
Term
The most common lid tumor is:
Definition
Meibomian Gland Adenoma
Term
Other than adenomas, you migth see these benign tumors on lids:
Definition
Papillomas, Melanomas
Term
Pathognomonic for anterior uveitis ( there's more than one answer but this is most commonly seen)
Definition
Aqueous Flare
Term
If you can see a focused beam of light as it traverses through the anterior chamber, then you have:
Definition
Aqueous Flare
Term
With anterior uveitis, what subsatnce is released that causes miosis
Definition
Prostaglandin E2
Term
the pupillary sphincter muscle has receptors for ____ which make anterior uveitis cases unresponsive to atropine
Definition
Prostaglandin E2
Term
When you have anterior uveitis, why look at retina?
Definition
connected choroid and possible subsequent chorioretinitis
Term
Four Hallmark signs of anterior uveitis
Definition
Episcleral injection, Dec IOP, Aqueous flare, Miosis
Term
what percent of anterior uveitis cases are actually ocular manifestations of systemic disease?
Definition
25
Term
What is the most common cause of local ( affecting eye only) anterior uveitis?
Definition
Idiopathic
Term
What kind of anterior uveitis can result from progressed stages of cataracts?
Definition
lens-induced
Term
Even tough these manifestations may not always be present, what are the six pathognomonic signs of anterior uveitis?
Definition
Aqeuous Flare, Hypopion, Keratic Precipitates, Fibrin clots, Iris nodules, Synechiae
Term
Four fungi that cause systemic disease assoc anterior uveitis
Definition
Blasto, Histo, Crypto, Coccidiomycosis
Term
Name two bacteria that cause systemic disease assoc anterior uveitis
Definition
Ehrlichia sp., Rickettsia (RMSF)
Term
Name a protozoan and algae that cause systemic disease assoc anterior uveitis
Definition
Prototheca and Toxo
Term
Though usually mainfesting as a retinopathy Systemic hypertension can cause another ocular problem that looks clinically identical to :
Definition
Anterior Uveitis
Term
Weird systemic disease that affects melanocytes and will present with AU and skin problems
Definition
Uveodermatologic Syndrome
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