Sa Medicine Iii -- Eyelids

Front 1

What is neonatal ophthalmia?

Back 1

infection of eyes from dam's genital tract

>> can go up nasolacrimal duct

>> stophylococcus

Front 2

When do eyelids normally open in puppies and kittens?

Back 2

7-10 days

Front 3

Treatment of neonatal ophthalmia?

Back 3

-- open eyes early to allow drainage

-- lavage with LRS

-- broad spectrum topical antibiotic

Front 4

What is eyelid agenesis? Most commonly affects which part? Occurs in?

Back 4

-- congenital absence of part of palpebral fissure

(colobama) >> usually lateral aspect, upper lid

-- most common in cat

-- usually bilateral

-- exposure of globe causes irritation

Front 5

Treatment of eyelid agenesis?

Back 5

-- ophthalmic lubricants or surgical repair

>> cryosurgery to remove offending hairs

>> grafts to replace lid, lid margin, etc.

Front 6

What is entropion?

Back 6

-- inward rotation of part, or all, of the eyelid margin

-- periocular skin/fur rubs against cornea and conjunctiva leading to irritation/scarring

Front 7

Common breeds that get entropion?

Back 7

-- Shar Peis

-- Chows

Front 8

Symptoms of entropion?

Back 8

-- ocular discomfort

>> blepharospasm (squint)

>> epiphora (tearing)

>> rubbing (may be secondary to blepharitis)

-- possibly secondary corneal ulceration

-- +/- mucopurulent ocular discharge

-- eyelid margin rolled in

Front 9

Etiology of entropion?

Back 9

-- anatomical (breed)

-- spastic (painful and squinting)

-- cicatricial (secondary to scarring)

-- enophthalmos (atrophy of retrobulbar tissue)

Front 10

How can you tell if entropion is spastic?

Back 10

-- apply topical anesthesia and see if it resolves

Front 11

It is important to do what before surgically repairing entropion?

Back 11

-- correct underlying problems first!

>> spastic entropion

Front 12

Entropion repair options?

Back 12

-- eyelid tacking (staples or suture)

-- Hotz-Celsus surgery for entropion

Front 13

Eyelid tacking procedures?

Back 13

-- temporary relief or while growing

-- surgical staples or suture to evert eyelid margin

-- never go full thickness through conjunctiva

Front 14

What is the Hotz-Celsus entropion repair?

Back 14

-- pinch technique

-- remove tissue to evert margin

-- use 5-0 or 6-0 suture

-- place sutures close together

-- some dogs may need a brow lift as well

Front 15

Post-op care for entropion repair?

Back 15

-- rigid, plastic e-collar!!!

-- cool eyelid compresses (dec. swelling)

-- blot ocular discharge

-- +/- topical antibiotic, oral anti-inflammatory

Front 16

Entropion repair takes how long to resolve?

Back 16

-- 6 wks

Front 17

What is ectropion? Primary symptom?

Back 17

eyelid margins roll outwards (eversion)

>> primary symptom: conjunctivitis

Front 18

Etiology of ectropion?

Back 18

-- congenital in some breeds

-- cicatritial (scarring)

-- physiologic (occasional dec. sympathetic tone)

-- myasthenia gravis

-- facial n. paralysis

Front 19

Most cases of ectropion require surgical repair. T/F?

Back 19

-- FALSE

-- most cases do not require surgery

Front 20

Treatment of ectropion?

Back 20

-- medical management of conjunctivitis

-- wedge resection

-- V to Y blepharoplasty

Front 21

Dog breeds predisposed to ectropion?

Back 21

-- clumber spaniel

-- mastiffs

-- basset hounds

-- blood hound

Front 22

It is possible to have combined entropion and ectropion. T/F?

Back 22

-- true! e.g. St. Bernard

Front 23

What is distichia?

Back 23

-- extra cilia arising from meibomian gland

Front 24

Clinical signs of distichia?

Back 24

-- most are asymptomatic

-- may have epiphora?

Front 25

Treatment of distichia?

Back 25

-- pluck hairs

>> see if problem resolves

-- cryosurgery

-- electroepilation

-- very mild entropion repair

Front 26

Splitting techniques or laser surgery should be avoided in treatment of distichia. T/F?

Back 26

-- true!

Front 27

What are ectopic cilia?

Back 27

-- cilia erupting through bulbar conjunctiva

-- very painful

-- damages cornea (direct contact)

-- usually younger dogs

-- usually needs to be surgically addressed

>> often have distichia, too

Front 28

What is trichiasis?

Back 28

-- normal hairs rubbing on eyes

>> e.g. hair from nasal folds

>> cilia or hair from periocular fur directed toward cornea

-- common in Shih Tzus, Pekingese

Front 29

Treatment of trichiasis?

Back 29

-- trim offending hairs

-- ophthalmic ointment >> gel hair down

-- cryosurgery

-- nasal fold resection

Front 30

What is a chalazion?

Back 30

-- distended meibomian gland

>> due to blockage of duct (sm. tumor?)

>> collection of secretory products

-- painless

-- yellow/white swelling

-- common in white cats

Front 31

Treatment of chalazion?

Back 31

-- conservative: warm eyelid compress and baby shampoo wash 2-3x daily

-- surgery: open, clean, and freeze glands

Front 32

Infections at the lid margin include what?

Back 32

-- red, swollen, painful areas at lid margin

-- external hordeolum (stye): infection of eyelash follicle

-- internal hordeolum: infected chalazion

Front 33

Treatment of infections at the eyelid margin?

Back 33

-- warm compresses

-- antibiotics/anti-inflammatories

-- may need to lance and drain

-- do not manually express!

Front 34

Staphylococcus hypersensitivity can result in? How does this present?

Back 34

-- blepharitis

-- bilateral inflammation, swelling, pustules, discharge (all four eyelid margins)

Front 35

Treatment of staph blepharitis?

Back 35

-- warm eyelid compresses

-- gentle eyelid cleansing (baby shampoo)

-- cool rinse/compress

-- topical antibiotic/steroid

-- systemic antibiotic/steroid (if ulcerated)

>> rare use of abx + steroids!

-- may need long term care!

Front 36

Most common eyelid mass in middle-aged or older canines?

Back 36

-- meibomian gland adenoma/adenocarcinoma

Front 37

Treatment of meibomian gland adenoma/adenocarcinoma?

Back 37

-- clinically benign, but tend to reoccur

-- treat if corneal/conjunctival irritation

-- excision at eyelid margin is TEMPORARY

>> frequent recurrence

>> cryosurgery

>> eyelid wedge resection

Front 38

When performing eyelid wedge resection, what should you be careful of? Complications?

Back 38

-- avoid nasolacrimal puncta!

>> can result in epiphora, esp. loss of ventral puncta

-- avoid knots on the cornea w/ two layer closure

-- complications: dehisence, eyelid notching

Front 39

Squamous cell carcinoma (SCC) is most common in?

Back 39

-- horses, cattle, cats

Front 40

Where do you see SCC? Assoc. with? Success is dependent on?

Back 40

-- ear tips and nose affected on cat

-- non-pigmented tissue most problematic

-- assoc. with UV light exposure

-- post-op follow up is critical to success

>> esp. horses

Front 41

Eyelid papillomas occur in which animals?

Back 41

-- young animals

-- canine/bovine

-- generally self-limiting

Front 42

Mast cell tumors occur in? Appearance? Important to do what before FNA?

Back 42

-- common in felines

-- tend to be raised, pink, hairless

-- give antihistamine before FNA!

(mast cell degranulation)

Front 43

What is the second most common eyelid tumor in the horse?

Back 43

-- equine sarcoid

(first is SCC)

Front 44

What is an apocrine hidrocystoma?

Back 44

-- benign cystic proliferations of apocrine secretory glands

-- bluish masses on eyelid margin of Persians

Front 45

What is blepharitis?

Back 45

-- inflammation of the eyelid

Front 46

Etiology of blepharitis?

Back 46

-- self trauma

-- infectious

-- allergic

-- autoimmune

-- juvenile cellulitis

-- solar

-- Persian facial dermatitis

-- zinc deficiency

-- seborrhea, "mystery rash"

Front 47

Infectious causes of blepharitis?

Back 47

-- mites (sarcoptes, demodex), ticks, flies

-- fungal (dermatophytosis)

-- bacterial (staphylococcus)

Front 48

Allergic causes of blepharitis?

Back 48

-- atopy

-- food allergies

-- contact dermatitis

-- drugs

Front 49

Autoimmune blepharitis?

Back 49

-- uveodermatological syndrome (UDS)

>> inflammation of the uveal tract

-- usually ulcerative

-- usually see eyelid AND nasal lesions

Front 50

Diagnosis and treatment of autoimmune blepharitis?

Back 50

-- skin biopsies (special stains)

>> can be pemphigous, lupus

-- response to immunosuppressive medication

-- rule out SCC (scrape/cytology)

Front 51

Eyelid trauma/laceration repair?

Back 51

-- lavage and minimal debridement

-- cold compresses for swelling

-- assess nasolacrimal puncta

>> establish patency if possible

-- two-layer closure (no knots touching cornea!)

Front 52

Complications of eyelid laceration repair?

Back 52

-- may get scarring leading to entropion

-- lower lid repair that is not perfectly apposed may cause chronic tearing

Front 53

Eyelid hematomas may indicate?

Back 53

coagulopathy, e.g. warfarin exposure

Front 54

What is lagophthalmos?

Back 54

-- decreased/absent ability to blink

Front 55

If lagophthalmos is observed, you should?

Back 55

-- check palpebral reflex

>> CN V (sensory) and CN VII (motor)

-- observe spontaneous blinking

-- discuss observation of animal while sleeping

>> does it keep eyes shut?

Front 56

Lagophthalmos treatment?

Back 56

-- shorten palpebral fissure

-- keep eye moist?

Front 57

What is a lateral canthotomy? When is it used?

Back 57

-- cut in lateral canthus

>> subconjunctival enucleation approach

>> proptosed eye (needs to be put back)

-- +/- single tarsorrhaphy suture to dec. tension

Front 58

What is a temporary tarsorrhaphy? Types? Pros and cons?

Back 58

-- suture lid closed, can be partial or complete

-- unable to assess globe when placed

-- useful if unable to blink

-- sutures do not extend full thickness through eyelid

-- stents may be used

Front 59

Permanent partial tarsorrhaphy?

Back 59

-- shorten eyelid margins

-- permanently reduce size of palpebral fissure