Optho, I

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HLW
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185760
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Optho, I
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2012-11-27 20:56:59
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Optho, I
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  1. What are the components of vascular tunic/uveal tract?
    • Iris
    • Ciliary body
    • Choroid
  2. What tunic is comprised of the retina?
    Neural Tunic
  3. What cranial nerves are involved in menace response?
    • IN: 2 (optic)
    • OUT: 7 (facial)
    • determines if pt is visual
  4. What cranial nerves are involved in pupilary light reflex?
    • IN: 2 (optic)
    • OUT: 3 (oculomotor)
    • *if pt fails menace but passes PLR, must be Cr.N.7 problem
  5. What cranial nerves are involved in palpebral reflex?
    • IN: 5 (Trigeminal)
    • OUT: 7 (facial)
    • *if pt fails menace but passes palpebral, must be Cr.N2 problem
  6. what tests are done after these nerve exams? what test must be done first?
    • Schirmer tear test
    • Fluorescein stain
    • Tonometry
  7. What is defined as globe to rostral in orbit (globe is normal size)? What is globe of normal size that is too caudal in orbit?
    • rostral: exophthalmos
    • caudal: enophthalmos
  8. what is term for equator of globe rostral to palpebral fissure? What is term for globe that is too large?
    • proptosis
    • large globe = buphthalmos
  9. when is retropulsion contraindicated as part of exam? what is retropulsion helpful in detecting?
    • don't do with deep ulcers or damaged cornea
    • detects mass behind eye
  10. What are some clinical signs of orbital disease?
    • Decreased retropulsion
    • Increased/Decr. scleral show
    • Elevated Nictitans
    • Pain/discomfort when open mouth
  11. What are examples of congenital enophthalmos? what is prognosis?
    • Microphthalmos (associated w/merle coat)
    • Anophthalmos (rare!)
    • Poor for both
  12. What is phthisis bulbi?
    • globe too small for orbit
    • acquired enophthalmos as end stage to other disease of globe
  13. What are reasons for acquired enophthalmos where globe is normal size?
    • emaciation (fat loss)
    • dehydration (fluid loss)
    • soft tissue atrophy
  14. What are 2 basic reasons for exophthalmos?
    • Increased fluid (inflammation, hyperplasia, neoplasia)
    • Increased cells (blood, cyst, lipids)
  15. With eye diseases, what is difference between pain when opening mouth and non-painful?
    • Pain = likely inflammatory cause/abscess/FB
    • Not painful = slow growing mass/neoplasia
  16. What is acute recurrent episodes of facial muscle inflammation associated with bilateral exophthalmos, nictitans elevation and pain when try to open mouth? what do eyes do in chronic cases?
    • masticatory muscle myositis
    • chronic: enophthalmos and muscle atrophy
  17. What test for MMM is diagnostic if results are positive? How do you treat?
    • 2M autoantibody test (serum)
    • immunosuppresion via steroids +/-azathioprine
  18. What is another autoimmune myositis associated with bilateral exophthalmos except NO nictitans elevation and NON painful when open mouth?
    • extraocular muscle myositis --> immunosuppression therapy
    • (chronic is enophthalmos like MMM)
  19. Is orbital neoplasia rapid or gradual onset? exoph- or enophthalmos? other presenting signs? Is there usually pain when open mouth?
    • Gradual Onset
    • Exophthalmos
    • Nictitans elevation
    • Decr. retropulsion
    • No pain when open mouth
  20. Is orbital neoplasia generally benign or malignant? what is prognosis for orbital neoplasia?
    • malignant 95%
    • poor to guarded
  21. distinguish evisceration, enucleation, and exenteration.
    • Evisceration: removal of intraocular contents (then prosthesis)
    • Enucleation: removeal of globe
    • Exenteration:remove globe + ALL of orbital contents
  22. enucleation can be either subconjunctival or transpalpebral. which is better for histopath? which is indicated with infected eyes?
    • histo: subconjunctival (include nictitans +conjunctiva)
    • infected: transpalpebral
  23. with proptosis, what are some positive indicators?
    • + consensual PLR
    • voluntary movement of globe (some mm. still attached)
    • ***pupil size is NOT reliable
  24. with proptosis, what are some negative indicators?
    • hyphema = retinal detach/uveal trauma
    • corneoscleral laceration
    • rupture 3+ extraocular mm.
    • transected optic n.
    • **prog. worse in cats w/deep orbits, dolicephalic dogs, and spp. w/complete orbit like equine/bovine
  25. what are some complictions following proptosis?
    • blind
    • lagophthalmos
    • KCS
    • strabismus
    • phthisis bulbi
  26. how do you treat eyelid laceration?
    • minimal debride (no scissors!) to preserve tissue then suture and clean w/betadine or saline
    • suture w/4 or 5-O vicryl in figure 8 pattern
    • (heals fast due to blood supply)
  27. what is principle of repair for wedge resection of lid laceration?
    • can only remove up to 1/3 eyelid margin
    • use 2 layer closure; apposition critical
  28. Ankyblepheron, a congenital eyelid lesion can be due to what etiology?
    Staph/Herpes-1
  29. what is a coloboma? more in cats or dogs? what is a tx option?
    • partial abcense of palpebral fissure
    • congenital eyelid lesion leads to inability to blink --> exposure keratitis
    • cats > dogs
    • pedicle graft
  30. what is choristoma?
    • dermoid; congenital eyelid lesion
    • normal tissue in abnormal location
    • resection may be indicated
  31. distinguish trichiasis, distichiasis, and ectopic cilia. Which are associated with ulcers/+fluorescein stain?
    • T: normal hair in normal location going in wrong direction
    • D: cilia from mybomian gland
    • E:cilia from bulbar surface of (upper) eyelid; young dog
    • **D and E assoc. w/ulcers and pos. fluorescein stain
  32. List 4 features of brachycephalic ocular syndrome.
    • macropalpebral fissures
    • medial trichiasis (nasal trichiasis)
    • medial lower lid entropion
    • pigmentary/exposure keratitis

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