Ophthalmology

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XQWCat
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301980
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Ophthalmology
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2015-05-03 09:35:06
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ophthalmology
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  1. study of the medical and surgical diseases of the eyes (with spelling)
    ophthalmology
  2. OD
    right eye
  3. OS
    left eye
  4. OU
    both eyes
  5. o.s
    ophthalmic solution (drops)
  6. o.o.
    ophthalmic ointment
  7. gt
    one drop
  8. gtt
    multiple drops
  9. blepharo-
    lid
  10. tarso-
    lid
  11. cantho-
    corners
  12. lacrimo-
    tear system
  13. conjunctivo-
    conjunctiva
  14. kerato-
    cornea
  15. irido-
    iris
  16. uveo-
    uvea = iris, ciliary body, choroid
  17. ACVx
    American college of Veterinary (specialty x)
  18. DACVx
    Diplomate of the American College of (specialty x) = board certified specialist
  19. 3 tunics (layers) of the wall of the eye, external to internal
    • fibrous tunic (outer) - cornea and sclera
    • vascular tunic (middle) - uvea - iris, ciliary body, choroid (front to back)
    • neuroretinal tunic (inner) - retina
  20. eyelids
    • palpebrae, tarsae
    • skin and hair, muscles, tarsal plate, meibomian glands, cilia/lashes above margin, lined posteriorly by palpebral conjunctiva
    • medial/lateral canthus
    • protect from external environment, distribute tear film, contribute to oily layer, open at 3-15 days old.
  21. blepharospasm
    squinting
  22. meiomian glands
    provides oily layer to tear film, part of eyelid
  23. nictitans
    • third eyelid
    • medial canthus. Conjunctiva covering T-shaped cartilage with accessory lacrimal gland at base.  Passively elevates when eye recessed, elevated by pressing on dorsolateral aspect of globe.  
    • protection, aqueous tear film from lacrimal gland
  24. lacrimal gland
    part of nictitans, provides aqueous layer of tear film
  25. tear film
    • three components: mucus from goblet cells of conjunctiva, aqueous from lacrimal glands, oily from meibomian glands.  Mostly aqueous.  
    • flushes physical contaminants from ocular surface
    • provides for optical clarity of cornea
    • contains enzymes, immunoglobulins for protection
    • O2 to cornea
    • drains into nasolacrimal, onto face
    • dries at medial canthus as rust-colored discharge
  26. nasolacrimal system
    • drainage of tears.  
    • Upper and lower punctum at medial canthus, connect to canaliculi, meet to form lacrimal sac to nasolacrimal duct to nose/pharynx
    • blinking pushes tears toward puncta
    • overflow causes tear stains, skin issues
  27. conjunctiva
    • mucosal membrane covering the sclera and inner eyelids, composed of palpebral, bulbar, fornix, nictitans portions, goblet cells.  Highly vascular
    • flexible and elastic so globe moves
    • immunologically functional mucous membrane
    • goblet cells contribute mucus layer to tear film
  28. lacrimal glands
    • for secretion of tears
    • 2 glands, orbital (most aqueous tears) and gland of third eyelid
    • secrete aqueous portion of tears
  29. lacrimation
    tearing
  30. cornea
    • clear windshield of eye
    • 4 layers: epithelium (several cell layers), stroma (thickest, collagen), Descemet's membrane (acellular, very thin basement), endothelium (1 cell layer thick).  
    • 1mm thick in c/d
    • cornea clear due to arrangement of collagen layers, clarity due to dehydration by corneal epithelium
    • nerves in stroma bare and sensitive
    • normally avascular
    • nutrition from tear film
  31. anterior chamber
    • chamber delineated by cornea and iris/pupil/iridocorneal angle/lens
    • filled with aqueous humor (saline-like fluid made in posterior chamber, clear)
    • aqueous humor flows from ciliary body in posterior chamber through pupil to anterior chamber, then drains out iridocorneal angle
  32. sclera
    • fibrous white portion of eye wall, continuous with cornea.  Relatively spherical in d/c
    • has attachments to extraocular mm
    • somewhat rigid and helps give globe shape
  33. iris/pupil
    anterior portion of uveal tract (middle of 3 layers of eyeball).  Vascular and pigmented.  colored portion of eye.
  34. pupil
    • hole in the iris, different shape for different species
    • constricts and dilates using pupillar mm under autonomic control
    • high vascularity supplies nutrients to adjacent portions of eye
  35. heterochromia iridis
    irides of different colors, can be normal or abnormal, congenital or acquired
  36. mydriasis
    large, dilated pupil
  37. miosis
    small, constricted pupil
  38. ciliary body
    • middle portion of uveal tract, posterior continuation of iris.  Small ridge of circumferential tissue behind iris, arranged in finger-like ridges called ciliary processes.  Peripheral attachement for lens zonules (strings).  Ciliary muscle located outside ciliary body.
    • mucle makes accommodation, changing lens focal point.  
    • ciliary body makes aqueous humor.
  39. zonules
    thin clear acellular strings attaching circumferentially to lens equator
  40. posterior chamber
    chamber delinated by back of iris and front of lens
  41. accommodation
    changing focal point of the lens (near and far vision) by pulling or relaxing equator of lens
  42. lens
    • lens capsule envelops lens fibers which are arranged to be optically calear.  Suspended in center of visual axis by zonules
    • focuses incoming light via accommodation
    • vascular, needs fluid for metabolism, clear when healthy (alive). 
    • Always making new fibers, push toward center of lens. Makes center hard (nuclear sclerosis) but still clear
  43. nuclear sclerosis
    normal aging change, hardening of center of lens as fibers move to center.  Light still passes through, clear.
  44. cataract
    opacity of lens
  45. vitreous
    • clear gel filling the back of the eye, composed of mostly water and collagen
    • helps maintain eye shape and position of retina against choroid
    • avascular, slow metabolism
    • opacities (floaters)
  46. choroid
    • posterior portion of uveal tract behind ciliary body
    • contains tapetum lucidum (better night vision)
    • high vascularity (= nutrition for retina)
    • pigmentation = "black box" = less light scattering and clearer vision
  47. tapetum lucidum
    colored (yellow, green, orange) reflective surface on half back of eye, in choroid.  allows for improved night vision and "deer in the headlights" shine
  48. retina
    • innermost light-sensitive layer of eye
    • 10 histologic cellular layers
    • has neurons that gather at back to form optic nerve
    • photoreceptor cells turn light into electrical impulses, transmitted to brain with optic nerve
    • rods for night, cones for day
    • must be attached to choroid to be functional, atrophies if detached
    • very sensitive to pressure, does not heal well.
  49. fundus
    back half of eye visualized when examining from the front of eye
  50. fundic exam
    • examination of the back half of the eye (ophthalmoscope or lenses and focal light)
    • uses indirect or direct ophthalmoscopy.  Could use ocular ultrasound, electroretinogram
  51. proptosis
    • protrusion of globe from orbit/socket
    • trauma, HBC, dog fight, blow to head, excessive restraint
    • replace or remove (eval whole pet and tx, replace eye if recent, 3 or less EOMm ruptured, optic nerve attached and globe in good shape. ASAP, don't refer.  
    • remove otherwise.
    • unlikely to save vision, guarded to save eye
  52. retroillumination
    • examination of the eyes from a distance using the reflection from the back of the eye.
    • Highlights minor opacities in the clear ocular media
  53. ocular reflexes and how to test them (4)
    • menace: cover one eye, move hand towards other eye without touching hair or moving air.  Animal should blink unless very young
    • pupillary light reflex (PLR): shine light into eye, note constriction.  Direct is when pupil that received light constricts, indirect other pupil constricts.  DOES NOT MEAN VISION IS INTACT
    • palpebral reflex: touch medial or lateral canthus, eye should blink
    • dazzle reflex: shine bright light in eye, should blink (+/- globe retraction or turning away)
  54. Schirmer Tear Test (STT)
    • diagnostic test to measure quantitative tear production
    • Fold strip at notch, place in lower eyelid pocket and keep for 60s.  Measure length of wetness
    • blue dye with markings.  Remove mucus first without touching eye.  NO GOOD POST-TOPICAL
    • normal >15mm/60s.  Low/KCS is <10, high >30
  55. Fluroescein stain
    • test for corneal ulcers, nasolacrimal patency and corneal leakage
    • 1-2drops saline on tip of strip, touch to bulbar conjunctiva, flush, examine with cobalt light or Wood's lamp
    • 1 strip/P or /eye if infected.  No uptake for normal, ulcer takes stain (stroma hydrophilic).  If stain moves on eye, just mucus/hair. Descemetocele won't take stain.  
    • Should appear at nostrils/throat, patent duct.  Not blocked if doesn't appear
    • Leak in cornea shows stream of clear, WEAK CORNEA, WILL RUPTURE
  56. tonometry
    • measurement of intraocular pressure (IOP), glaucoma test
    • red eye, pain, dilated pupil, corneal edema, vision loss, globe enlargement indicators (Schiotz, tonoPen, TonoVet), normal <20mmHg.  25 borderline, >30mmHg high
    • DIGITAL TONOMETRY NO GOOD
  57. Schiotz tonometry
    • glaucoma test
    • assemble tonometer
    • apply topical anesthesia to eye (proparacaine, tetracaine etc in fridge)
    • confirm calibration on test block (reads 0)
    • nose to ceiling
    • footplate onto cornea until weight rests, VERTICAL, not on sclera or nictitating
    • repeat, average, use chart to convert to meaningful number
    • clean, disassemble
    • NOT WITH ULCERATIONS, PERFORATION, RECENT SURGERY (use tonopen or tonovet)
    • edema, poor position, anterior lens luxation make unreliable (use TonoPen)
  58. TonoPen tonometry
    • apply clean finger cot, calbrate (hold facing down, then up)
    • topical anesthesia
    • press button, double dashed lines
    • tap cornea PERPENDICULARLY
    • chirps with each reading, beeps final reading
    • <5% variance okay
    • best for corneal edema, anterior lens luxation, okay (ish) after sx, ulceration, perforation
  59. TonoVet tonometry
    • Press large button to turn on, set for species
    • insert tip
    • press button (00 = ready)
    • hold tip away from cornea as far as end piece
    • press button repeatedly for readings
    • beeps for final reading
    • okay for corneal ulceration, perforation, edema
  60. Rose bengal staining
    • similar to fluorescein, vital dye that adheres to devitalized tissues
    • good for cats to ID early herpes ulcers
    • branching dendritic ulcers
  61. slit lamp biomicroscopy
    casts a slit beam of light onto eye to magnify for viewer, detailed view and depth differentiation of front of eye
  62. indirect ophthalmoscopy
    handheld lens and light source, image is upside down and backwards, see MUCH wider portion of fundus at one time, can stay away from P
  63. direct ophthalmoscopy
    uses ophthalmoscope, image upright but only small portion seen at one time, constant refocusing, must be close to P
  64. ocular ultrasound
    images interior and retrobulbar anatomy, esp when back of eye can't be visualized directly
  65. electroretinogram (ERG)
    eval electrical impulses generated by functioning retina when stimulated by flashes of light
  66. cherry eye
    • prolapse of the gland of the third eyelid
    • caused by weka attachments, breed predisposition.  Replace gland. Sometimes manual, usually surgery.  DON'T REMOVE
  67. corneal ulcerations
    • loss of corneal epithelium
    • trauma, infection, predisposition, KCS, poor health
    • squinting, redness, rubbing, discharge, visible defect, photophobia
    • treat primary problem, topical abx to prevent infection, secondary issues if present, NO STEROIDS, NO ANALGESIA, e-collar, sx (conjunctival graft, debridement, keratotomy)
    • recheck 1-3 days
  68. KCS = keratoconjunctivitis sicca
    • dry eye
    • caused by immune-mediated destruction of lacrimal gland, neuro, excision of third eyelid, drugs
    • redness, sticky d/c, squinting, dull cornea, corneal disease
    • tx with tear replacements, tear stimulants, ocular hygiene, secondary infection tx.  LIFELONG TX
    • sx - parotid duct transposition
  69. conjunctivitis
    • inflammation of the conjunctiva
    • caused by infection (herpes), allergy, trauma, inflammation
    • redness, puffy conjunctiva and lids, watery/mucoid/mucopurulent ocular d/c. 
    • tx primary problem (eye redness not primary conjuntivitis)
    • topical abx/antiviral, systemic antiviral, topical inflammatories (MAYBE)
  70. entropion
    • inrolled eyelid margin, hairs rub on eye
    • caused by anatomic/breed, squinting, corneal ulceration
    • inrolled eyelid (1 to 4), squinting, tearing, rubbing, secondary corneal disease, often in young to young adult.  DIFFERENT that spastic entropion
    • sx required
  71. glaucoma
    • increased intraocular pressure (IOP) and vision loss
    • 1° caused by anatomic/breed, 2° caused by uveitis, lens luxation, iris adhesion, blood or tumor in eye etc.
    • drainage of aqueous humor ceases but production continues, pressure causes pain and damages retina
    • acute = cloudy eye, redness, dilated pupil, vision loss within hours
    • chronic = enlarged globe, large pupil, blind eye
    • IOP >25-30mmHg
    • tx acute = ER!  topical +/- IV mannitol (dehydrant).  Oral and topical meds available.  Lensectomy if includes anterior lens luxation (terriers)
    • shunting and cycloablation sx or salvage (prosthesis, enucleation)
    • 2nd EYE ALWAYS AT RISK
  72. cataract
    • opacities within lens
    • incipient, immature, mature (can't visualize), hypermature (lens shrinks).
    • breed disposition, diabetes (75%), uveitis, lens trama, retinal disease
    • you see white opacity in pupil, vision loss, NOT PAINFUL.  Not nuclear sclerosis (pearliness in >7yo)
    • elective cataract sx for healthy eye (shatter lens with ultrasound, aspirate from eye, prosthetic)
    • cataract may cause uveitis or glaucoma
  73. cap color for: 
    steroids
    mydriatics
    • steroids: pink cap
    • mydriatics: red cap
  74. microsurgery
    sx done under an operating microscope (light and magnification
  75. prep eye with
    betadine solution (NOT nolvasan), then rinse with saline
  76. canaliculi
    tubes
  77. part of speech for mucous
    adjective
  78. part of speech for mucus
    noun
  79. bulbar conjuctiva
    loose on surface of eye
  80. symblepharon
    constant irritation, cornea heals down onto eyeball, becomes opaque
  81. layers of the eyeball
    epithelium (surface), stroma (strength), descemets membrane (basement), endothelium (inner layer)
  82. hyphema
    blood in anterior chamber of eye
  83. hypopyon
    pus in anterior chamber of eye
  84. shape of cat pupil
    fusiform
  85. synechia
    abnormal iris adhesion.  Posterior (adhesion to lens) or anterior (adhesion to cornea)
  86. dyschoria
    abnormal shape of pupil
  87. iris atrophy
    motheaten appearance, older dogs, hard to constrict pupil.
  88. strabismus
    eyes point in different directions due to torn muscles
  89. lagophthalmos
    incomplete blinking
  90. ectropion
    eyelid rolling out so palpebra exposed
  91. spastic entropion
    caused by painful eye, P gives themselves entropion by squinting
  92. aqueous humor is made by
    ciliary body
  93. How to give eye drops
    • Position the animal so he can’t squirm backwards or resist with the front feet – use
    • towel/blanket if needed
    • Point the animals’ nose up to the ceiling
    • Hold the upper lid open from the top of the head
    • Let the drop fall from a distance
    • Do not suck back material back into the bottle
    • Hold the animal a moment to reduce the urge to rub or shake
    • One drop only is usually necessary, but can give another if not sure it went in
    • If give more than one drop, it’s usually not harmful, only wasteful
    • Wash hands before and after
  94. How to give eye ointments
    - ointments: Only a small amount of ointment is usually needed - 1⁄4 to 1/8 “ stripMake a pocket by pulling the lid away from the eye (upper or lower)Usually only have to barely squeeze the tube - let it come out on its ownWatch to make sure the ointment melts onto the eye - let the lids blinkHold the animal for a moment to reduce the urge to rub or shakeIf more ointment is used, it’s usually not harmful, only wastefulWash hands before and after- always wait at least 5 min between topicals given at the same time- give drops before ointments

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