Small Ani. Sx- Optho- Conjunctiva

drraythe's version from 2016-04-29 14:45

intro/anatomy/ clinical signs of dz

Question Answer
What is 1? 3? 4? 2? 5? (1) Palpebral conjunctiva (2) fournix- any place where the conjunctiva doubles on itself is a fournix (3) Palperbral conjunctiva of the 3rd eyelid (anterior conjunctiva of the nictitans) (4) bulbar conjunctiva of the 3rd eyelid (posterior conjunctiva of the nictitans) (5) bulbar conjunctiva
Physiology/Function of conjunctiva?Globe movement, Physical barrier, Immunologic barrier
Work-up for Conjunctival Disease Perform the MODB!--> do what things? (4) RULE OUT what things? (3)Direct examination with globe retropulsion, Schirmer tear test, Stain (fluorescein), Tonometry. RULE OUT: Tear deficiency, Corneal disease, Intraocular disease
what are some Additional Useful Diagnostics for Conjunctival Disease?Cytology, Culture, bx, Nasolacrimal flush, Rose bengal stain
what are some clinical signs of conjunctival dz? Epiphora, *Chemosis, **Hyperemia, Tissue proliferation, Mucopurulent Exudate, Emphysema, Hemorrhage, Pruritis
what is Epiphora? what are the two ways this happens?it is Tearing (serous discharge). Happens 2 ways: (1) Increased production (pain, irritation) (2) Decreased outflow (Nasolacrimal obstruction)
how does chlamydia present? how does herpes present?chlamydia chemosis, herpes hyperemia
what is Chemosis? what are the main causes?it is Conjunctival edema. Main causes are Allergic reactions, trauma, Infectious agents (***Chlamydophila felis), and tumors (rare)
****Hyperemia can be Conjunctival or Scleral. FOR THE LOVE OF GOD, KNOW THE DIFFERENCE.
*Conjunctival vs Scleral Hyperemia--> superficial or deep vessels?C: sup. S: deep
*Conjunctival vs Scleral Hyperemia--> path/shape of the vessels?C: tortuous S: straighter
*Conjunctival vs Scleral Hyperemia--> nature of the termination of the vesselsC: branching. S: less branching
*Conjunctival vs Scleral Hyperemia--> can they move?C: moves with conjunctiva. S: immobile
*Conjunctival vs Scleral Hyperemia--> do they blanch with epinephrine?C: blanch. S: blanch slowly
*Conjunctival vs Scleral Hyperemia--> superficial or deep DISEASE indicated?C: superficial. S: deep
conjunctival or scleral hyperemia?scleral
conjunctival or scleral hyperemia?conj
what is Mucopurulent Exudate? what are the three main causes?def: Excess mucus with white blood cells. Causes: Keratoconjunctivitis sicca (dry eye), Bacterial infections, viral infections
what is Emphysema? what are the 2 main causes of it?Def: Entry of air into the periorbita from surrounding tissue which causes Swelling and crepitus of conjunctiva. Causes: Trauma to sinus, Tracheostomy
***4 main causes of hemorrhage into the conjunctiva?(1) Trauma (Strangulation, CSF tap / SAH<-- subarachnoid hge) (2) Septicemia (3) Vasculitis (4) Coagulopathies (**retinal hge and retrobulbar bleeds common in warfarin poisoning )
Tissue prolif--> Follicle formation--> 2 reasons follicles form?(1) Lymphoid follicles (could be in normal or abnormal location) (2) allergies
Tissue prolif--> swelling/mass--> 5 things this could be?Neoplasia, Immune-mediated, Granuloma, Congenital, Gland prolapse
what's this mass?The answer is NOT 3rd EYELID GLAND BC THAT'S MEDIAL AND THIS IS LATERAL. It's actually a mass. get a bx. (in class she said it was an NGE, more on this later)
how does Pruritus of the conjunctiva usually present in dogs? what are some of the common 2* lesions caused by the pruritus?They itch at the eye (Rub more than squint) and end up with 2* lesions like: Alopecia, Erythema, Stained/matted hair (Metacarpal area AND periocular)


Question Answer
which sp tend to get INFECTIOUS probs with the conjunctiva? (conjunctivitis) which sp are NON-INFECTIOUS?INFECTIOUS: COW AND CAT. NON-INFECTIOUS: dog and horse
main non-infectious causes of conjunctivitis in dogs?Pannus, KCS, entropion, FB (can lead to 2* infection tho)
main non-infectious causes of conjunctivitis in horses?Immune-mediated, keratitis, uveitis (can lead to 2* infection tho)
TREATMENT GOALS of conjunctivitis (5)(1) Make a diagnosis (2) Remove all exudates / cleanse the eye (3) Maintain surface moisture (4) Control primary / secondary infections (5) Reduce inflammation
Feline Conjunctivitis due to ALLERGIC REACTIONS--> what are the main clinical signs?Chemosis, Epiphora, Anaphylaxis possible
what is the main reasons (etiology) cats get ALLERGIC conjunctivitis?Neomycin, Triple antibiotic ointment, (neo) Poly-Bac applied to cats eyes- expensive AND can cause allergic conjunctivitis
so this cat comes in with this with icky infectious conjunctivitis and your tech brings you a tube of triple antibiotic neopolybac. Shall you praise her for her good work?Although you should appreciate and acknowledge her willingness to help, this shit dont help at ALL. Usually the agents in cats causing the conjunctivitis are things like herpes, chlamydophila, mycoplasma....neopolybac and stuff like that isnt even effective for that
how do you tx feline allergic conjunctivitis?Discontinue the neopolyback/TAB (triple antibiotic ointment), and Anti-inflammatory therapy (+/-)
Chlamydophila felis causes what in cats? what are the clinical signs? how do you dx?causes infectious conjunctivitis! C/S include chemosis, sneezing, and nasal discharge. Dx with cytology or PCR
how do you tx Chlamydophila felis? (2)(1) Tetracyclines **-- Topical oxytetracycline, Oral doxycyline. (2) Azithromycin (oral)
Mycoplasma spp. causes conjunctivitis in who? what is the C/S and how do you dx?CONJUNCTIVITIS IN CATS. 90% normal cats tho. Dx with cytology
how do you tx mycoplasma?(Cats!) Tetracyclines!! Topical oxytetracycline, Oral doxycyline
**Feline Herpesvirus-1 (FHV-1)** can cause conjunctivitis-- what OTHER C/S will there maybe be?Hyperemia, Sneezing (+++), Nasal discharge (+++), keratitis
how do you dx **Feline Herpesvirus-1 (FHV-1)?Serology, Cytology, PCR, IFA, Virus isolation
**how do you tx **Feline Herpesvirus-1 (FHV-1) (2)? WHAT IS SUPER IMPORTANT YOU REMEMBER ABOUT THIS TX?(1) Oral L-lysine (2) Antiviral agents --- *****Use caution: not all antivirals are safe to use in cats (ie. Acyclovir and Valcyclovir can be toxic!)
***which antivirals CAN you use in cats, and which CANT you? (what are you trying to tx with these drugs?) (txing FHV-1) CAN: Famciclovir (which is a proddrug of penciclovir, so that works too), cidofovir.... CAN'T: Acyclovir and Valcyclovir
* what is the “Classic” FHV-1 Ocular Finding? (how do you detect this finding?)you will see Dendritic corneal lesions which look like Branching ulcers or erosions. (use rose bengal stain to see)
how do antivirals work?Inhibit viral DNA synthesis by being incorporated as “abnormal nucleotides” into replicating viral DNA
What she really emphasized was knowing about FAMCICLOVIR as a tx for FHV-1. But she gave a list of other antivirals you can it over I guess?(remember NO FREAKIN VALACYCLOVIR OR ACYCLOVIR)
(I think she breezed past this) (FHV-1) latency--> the def of latency depends on who you ask. Describe it as how a virologist, Molecular virologist and clinician would say itVIRO: the period when you can not isolate the virus. MOLVIRO:period when most of the viral replication machinery has been shut down and the latency associated transript is produced. CLINICIAN: period when the patient does not show clinical signs of viral infection
(I think she breezed past this) how does FHV-1 gain latency?The alphaherpesviruses establish latency by traveling down the sensory nerves from the site of replication. The virus will then lie dormant in the sensory ganglia. Retrograde transport of virus will also occur in the sensory nerves.
what are some things which can cause FHV-1 Reactivation?Stress, Corticosteroids, Idiopathic
what is Symblepharon? which problem can cause this?Adherence of conjunctiva to cornea or itself-- this can be caused by FHV-1!!!
Eosinophilic keratoconjunctivitis can be caused by what problem?can be caused by FHV-1!!!!
Corneal sequestrum-- what is this? What can cause this problem?it is a chunk of Necrotic cornea, can be caused by FHV-1!!!
what are the C/S of CALICIVIRUS in cats, how can you be mindful of this to make sure it isnt FHV1?you will see ocular discharge, but calici typically, only has minimal* conjunctivitis, and Usually no keratitis. In addition, it has Oral ulceration and Ptyalism which herpes doesnt have. Will see Nasal discarge and sneezing in both dzs
Canine allergic Conjunctivitis--> WHO gets this most commonly? what are the 3 possible pathogenesis which can lead to allergic conj. in a dog?usually LARGE BREED DOGS, can be from: (1) direct contact (2) inhalation (3) ingestion
what are the CS of allergic conjunctivitis in dogs? how do you dx?Follicles, Periocular erythema, Chemosis, skin/ear affected. DX WITH CYTOLOGY
4 things you can do/give to tx canine allergic conjunctivitis?(1) Flush out allergens (sterile eye wash) (2) Corticosteroids (topical or systemic) (3) Cyclosporine (4) Allergy medications (Mast cell stabilizers, Antihistamines, Eosinophil inhibitors) (ex: Zaditor (Ketotifen), Patanol (Olopatadine), Naphcon A)
Canine Conjunctivitis--> Keratoconjunctivitis Sicca (KCS)--> clinical signs? DX?CS: Conjunctivitis, keratitis, Mucopurulent discharge. DX: Schirmer tear test
common causes of Trauma/Irritation which lead to canine conjunctivitis? tx?FB, entropion, ectropion, Direct trauma (strangulation, head trauma, CSF tap), masses (dermoids, etc).... tX: Remove primary cause + Anti-inflammatory medication
Canine Conjunctivitis-->Viral Conjunctivitis--> 4 main etiological contenders?Canine Distemper - #1, Adenovirus, Herpesvirus
what are the EARLY c/s of canine distemper? Chronic? (which eye stuff is happening when with acute/early and chronic)EARLY: Serous discharge, Conjunctival hyperemia, systemic dz. CHRONIC: KCS (viral adenitis), Mucopurulent rhinitis
what are 5 Non-Neoplastic Conjunctival Masses?Dermoids, Nodular granulomatous episcleritis (NGE), Cysts, Granulation tissue, parasites
which parasite causes a non-neoplastic conjunctival mass?Oncocerca
common cause of granulation tissue causes a mass in the cats? horses?CATS: Lipogranuloma. HORSES: Habronemiasis
Conjunctival Masses--> neoplasia--> list some neoplasias of the conjunctivaMelanoma & melanocytoma, Squamous cell carcinoma, Adenoma & adenocarcinoma, Hemangiosarcoma & hemangioma, Papilloma, Lymphosarcoma