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entropion
- rolling inward of the lid margin
- contact between hair and cornea
- common in dogs less in cats
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what breeds is entropion related to
- Shar Pei
- Retriver
- Pointer
- Setters
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what are entropion usually seen in
- pups or young dogs
- breed, anatomic
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what is entropion secondary to
- blepharospasm
- infection, injury
- corneal disease/changes
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what is the diagnosis for entropion
- physical exam findings
- spastic forms can be ruled out with topical anesthetics
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what is the treatment used for entropion
- Hotz-Celsus procedure
- Char Pei may only require tacking sutures
- 2 roles of tissue and suture it when taken out back to normal
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customer education of entropion
- surgical procedure requires general anesthesia
- procedure may need revision
- report any changes notes post operation like blepharospasm, haziness, redness, and discharge
- may need to be repeated
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ectropian
- rolling outwar of the lower lid margin
- normal in some breeds like blood hounds and basset
- genetic, congenital, or due to injury to others
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what does ectropion lead to
- conjunctivitis
- maybe corneal disease
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what is the diagnoses for ectropion
physical exam findings
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what is the treatment for ectropian
surgical-wedge resection
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client education on ectropion
surgery, post operation
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distichiasis and trichiasis
- both are inherited
- chronic disease can stimulate lash growth
- eyelash problems
- angles back and touch cornea
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distichiasis
lashed growing form an abnormal area of the lid margin
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trichiasis
- lashes originate from normal area but turn inwards contacting the cornea
- need split lamp
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what does distichia and trichiasis produce
- some level of cornea disease
- minimal to severe
- keratitis/ulcers
- blepharospam and epiphora
- need high level of magnification like good direct scope or slit lamp
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what treatment is used for distichia and trichiasis
- electroepilation
- cryoepilatioon
- plucking
- surgery of lid
- *all surgical in nature*
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client education for distichia and trichiasis
- can recur but revisions lower recurrences
- report recurrence of signs
- trouble with meds
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eyelid growth
- varies in species
- dog benign- MGA meibomian gland donoma
- cats malignant-SCC, FSA
- clinical signs depends on type
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treatment for eyelid growth
- past surgery depends on type
- SX resection if less than 1/3 of lid margin
- radical excision/other procedures in malignancies
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client education on eyelid growth
depends on what type they have
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what are the causes of corneal ulceration
- trauma is number 1
- chemical burn from shampoo in eyes
- infection-bacteria, virus, fungus
- tear abnormals
- cilia abnormalities and exposure
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corneal ulceration exams
may or may not reveal obvious detects if it does its blepharospam and corneal edema-focci or diffused
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what test do we use to verify corneal ulceration problems
- STT- shimmer tear test, make sure vet wants to do this causes has to be done first
- fluorescein stain
- slit lamp to get idea of depth
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treatment for corneal ulcers
- atropine for pain relief
- antimicrobial
- additional, tear and surgery to protect from 2nd infection
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client education for corneal ulcers
- EMPHASINZE RECHECKS
- let them know of recurrence of symtoms or lack of reponse
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how does dendritic corneal ulcers look
light bulb/ tree branch looking stain
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how does punctate corneal ulcers look like
- spotted usually mean herpes
- causes discomfort
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indolent ulcers
- corneal ulcer refractory to treatment
- can be breed related in boxers
- if this kind of ulcers should heal after 7 days
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what treatment can you do for indolent ulcer
- surgical "roughening" which is breaking back loose tissue to make it rough or grid
- non surgical-serum drops which is the serum from own blood put in eye
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what is the client education on indolent ulcers
EMPHASIZE RECHECK MORE
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what is descmetes membrane
deepest layer of cornea is all that's left
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deep ulcers and descemetoceles
- bulges forward
- eyes close to rupture
- peculiar staining patters vs deep ulcers
- doughnut of stain
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what is the treatment for deep ulcers and descemetoceles
- urgent to emergency situation
- surgical grafts or other stabization
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what is the client education on deep ulcers and descemetoceles
- EMPHASIZE RECHECK MORE
- severity should be emphasized
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corneal injury/trauma
- physical or chemical entities like foreign bodies or direct trauma
- signs same for corneal ulcers
- additional test to verify like good magnification and staining
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what is the treatment for corneal injury/trauma
- based on the problem but can be medical management or surgical intervention
- repair for FB removal/keratectomy
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what is the client education for corneal injury/trauma
- surgical risks and recheck
- importance of meds
- sutures/appearance if surgical sites
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corneal sequestration
- mainly a problem in cats don't know why but can be herpes
- dark plaque on or in cornea-asymptomatic to significant irritation
- use stain to refute ulceration
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what is the treatment for corneal sequestration
- treatment based on symptoms that resolve with time
- keratectomy with additional supportive graft
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what is the client education on corneal ssequestration
dependent on treatment
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keratitis
inflammation of the cornea cause by injury and irritation from other disease, immune or allergic reaction, infection, or birth defects
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what are the varies signs of severity and location with keratitis
- superficial, interstitial, deep
- ulcerative and non ulcerative
- punctate
- pigmentary
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what is the diagnostic test for keratitis
- based on suspected cause but can be thorough exam-mag, stain, STT
- cytology and C/S
- systemic testing like CBC, GHP, immune panel
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what is the treatment for keratitis
- antimicrobials
- steroids
- others like tears, chemo, ect.
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what is the client education on keratitis
dependent on the disease process
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keratoconjunctivitis sica (KCS)
- dry eye syndrome
- tear produced by several glands which is 75% from the gland of the third eyelid
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what are some reasons KCS happened
reduction mainly from the aqueous portion but can be immune mediated, chemical/toxin, neurologic disease, infections, or tumors that caused this
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what are signs of KCS
drying of the cornea and blepharospasm, keratitis-pigmentary, thick purulent looking discharge
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what is the diagnostics for KCS
- its the most underdiagnosed eye disease but can do STT and staining
- some will get ulcers because of inflammation
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what is the treatment in KCS
- basic replacement of tears but cyclosporine topically which increases tear production 80-88% of the time and is FDA approved
- pilocarpine either topical or oral
- surgical procedures from the eye to corner of the eye
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what is the client education on KCS
patience and good compliance with meds
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cherry eye
- prolapse of the third lid gland
- rotate up
- reduce of tear production
- very rarely self reduce which is goes back down
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what is the underlying cause of cherry eye
- genetic/breed related
- cartilage change with release of anchor
- brachycephalics, beagles, American cocker
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what are some clinical appearance diagnostics of cherry eye
occasional inflammation and tumor or lymphoid hyperplasia
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what is the treatment for cherry eye
- best is surgical reduction
- worst is removal
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what is the client education for cherry eye
patience, surgical intervention, and tears
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conjunctivitis-inflammation
- may be disease or just a symptom
- causes can be organisms, foreign matters- material aerosolized, allergic reaction, anatomical abnormalities, deeper eye disease
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what are some test needed when conjunctivitis is complicated
- scraping
- C/S
- systemic labs
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what is the treatment for conjunctivitis
- topical or systemic
- antimicrobials or anti-inflammatories
- correction of the anatomical or systemic defect
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client education for conjunctivitis
some problems chronic (herpes), not zoonotic
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what is epiphora caused by
- -obstructed NL system
- lack of a puncta
- acquired obstruction (dacorocystitis, FB)
- -excessive tearing sometimes no tear duct or inflammation in tear duct can be painful which is caused by lid disease (entr, distichia, trichiasis, inflammation) or third eye lid condition (prolapse, injury) or conjunctivitis or keratitis
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what is the diagnostics for epiphora
- flushing of the NL system
- c/s
- rarely rads of nasal passage
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what are some additional treatments for epiphora
- topical antimicrobials and aniinflammatories
- surgical creation of a puncta
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what is the client education on epiphora
surgical risks, recurrence of signs
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