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False, the pic shows fluroscein stain done, but the next step after visual assessment should actually be schirmer tear test (SST). The dx for this pic is a corneal ulcer Normals for SST: DOGS: 15-25 mm/min Variable in cats Horses-variable: >20mm/min in
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distichia
Hair from meibomian gland
Can cause corneal ulcer
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Spastic entropion
Eye retracts in skull d/t pain Can be secondary to painful cornea Use topical anesthetic to see if eye returns to normal position Over time scarring occurs may need corrective sx
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Practice quiz
What are reasonable differentials for this patient?
KCS Trichiasis Imperforate punctas Meibomian gland Dysfunction Normal for white Poodle
KCS- no, obviously lots of tears are being produced Triachiasis- possible, hair in normal place but going in abnormal direction cancause irritation and excessive tearing Imperforate punctas- possible since tears are draining down face instead of down punta Meibomian gl dysfunction- possible since oil component to tear film cannot be made right and thus tears wont be kept on eye Normal for white poodle- NO!
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What is your primary differential for this patient with chronic conjunctivitis?
KCS!
Chronic conjunctivitis think KCS Cant see the tear film in this patient
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This dog presented for excessive tearing and blepharospasm-what are your Differentials?
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P is 1 yr oldfollicular conjunctivitis
Diet change Tapering steriods Will resolve with age Long-term tx until older
DfDxs:
Straight blood vessels, episceral injection
Therefore origin is intraocular Think glaucoma, KCS, allergies, FB, etc
Redblood present (black=pigment, white=WBCs, protein) Diffuse hemorrhage with underlying conjunctiva epithelium in tact (since blood not oozing everywhere) Think trauma or toxin ingested This dog ate rat poison.
What is this?
Dermoid!
Dermoid normal skin growing in an abnormal location Tx: Surgical excision superficial keratectomy
What is this?
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Pannus!
See german shepherdthink pannus!
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Practice quiz
Practice quiz
Look for cause of ulcer Eyelid mass removal Sx was done 5 wks ago suspect suture rubbing or eyelids not lined up when closed. Plan:
get rid of poor sx job since tissue acts like FB Get rid of loose corneal epith (use Q-tip) Stain to see how deep Debride ulcer if not deep Tx w/topical abx
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This is flare
Diagnostic for uveitis Say flarethink uveitis
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Practice quiz
Owner and dog went out hiking. Dog had blepharospasm when she got home. What do you think is going on?
Dog got poked in eye. Need to do exam. Stain strip to sclera. Check for ulcers.
Diabetic cataracts
Acute onset ERG to see if dog is really blind Start preventative tx for LIU Refer for surgery
Nuclear sclerosis
Night vision blindness Can see fundus therefore not cataract Normal fundus therefore not PRA ***may become cataract so treat preventatively
Perform enucleation
Right eye is HUGE, edematous, and not visual DfDx: glaucoma Plan: check IOP, retropulse, look at retina Give meds if not blind and painful If blind and painful then enucleate the eye! OD=right eye, OS=left eye, OU=both eyes
Right eye is Dominant
Fresh hemorrhage d/t light red color This is likely bilateral Think systemic causehypertension
Check blood pressure
SARDS
Fixed Dilated pupils (non-responsive) No menace or cotton following Need bloodwork done
Optic neuritis
Fixed dilated pupils- non-responsive Use ERG to distinguish btw the two
Answer is E.
Suspect PRA
Hard time doing downstairs at night Night vision loss Bilateral Retinal degeneration seen in fundus:
vascular attenuation (thinning), hyperreflective tapetum (as the over lying nerve layers of the retina thin) and optic nerve atrophy
This is hereditary and progressive. Need to give supp vit A and omega FAs
Retinal degeneration
Blindness Dilated pupils R/O retinal detachment Can see floaters
What??
Herpes!
Could also be:
Trichiasis Imperforate puncta Meibomian gland dysfunction
Answer is D
Hypertension caused fresh hemorrhage
Myelination noted around ON- normal Tapetal spots are capillaries- normal