First Aid.
Ophthalmic Examination and
Ocular Diagnostic Procedures
What is an emergency
• For owners all of problems may be like emergency
• Try to help the owner, explain
True Ocular Emergencies
• Acute onset blindness
• Acute onset red or cloudy eye
• Acute onset painful eye (squinting or excessive blinking)
• Anything dangling from the eye (including the eye itself–
proptosis/prolapse of eye)
• Trauma of the eye
Advice for the owner by phone
• The most important thing is that the animal is not allowed to cause
further damage-> Elizabethan collars help prevent trauma
• Clean the eye gently with artificial tears or special eye cleaning
solutsion, or a sterile saline solution or tap water
• No any „home “ medication!
Advice for the owner by phone
• If owner says or description seems like proptosis of eye
Owner should keep the eye moist with saline, water,
artificial tears and immediately visit the vet
Advice for the owner by phone
• If owner says or description seems like contact with
chemical solution/chemical burns
Owner should cleansing eyes with a sterile saline solution,
or tap water immediately during minimal 20 min before and
then immediately visit the vet
Prevent /prohibit the rubbing of the eye
burning with KOH solution (alkali)
• More specifically about treatment in clinic we will
talk later in next lectures
Ophthalmic Examination and
Ocular Diagnostic Procedures
The basic parts of the ophthalmic examination are:
• History taking
• Hands-off examination
• Hands-on examination
-Schirmer tear test readings
-Vision testing and neurology testing
-Ophthalmoscopy
-Ophthalmic dyes
-Tonometry
Basic Diagnostic Instruments and Supplies
• Focal light source with strong narrow beam
• Magnification: loupe 2-4 x
• Schirmer Tear Test (STT) strips
• Fluorescein strips or solution
• Topical anestheticn(Proxymethacaine, Alcaine® 0,5%)
• NaCl 0,9% sol
• Cotton-tipped applicators
• Sterile tampons
• Tropicamide eye drops 0,5 % - short acting mydriatic
• Direct (if possible undirect) ophthalmoscope
• Culture swabs and media
• Tonometer
Other factors
• A cooperative patient
• A darkened room
• Knowlege on normal anatomy and normal variations
HISTORY
Very helpful same scheme of take a
history and written form for fixations of
data -to prevent you from forgetting to
ask or examining something
• HISTORY
Breed/genetics
Age
Reason for examination
HISTORY
• When and how did the problems start
• Has the animal got other diseases
• Are there abnormal conditions in the eye region
• Is vision poor
• Is there any ocular discharge
• Does the animal squint
• Is the condition uni- or bilateral
• Has the animal got any treatment of eye disease
Examination
• Explain shortly to owner what and why you will to do with
animal
• Both eyes, not just "sick" eye
• Start from a „healthy“ eye
• Ask owner to help you
• Give some comments about findings during the examination
Examination from distance, orientation in room, general
condition. Without touching the eye and surroundings
You can get
a lot of information without touching
pigmentation on cornea, couldy eye
You can get
blepharospasm
a lot of information
without touching
cherry eye
right eyelid opening is smaller, we see third eyelid more, neurological syndrome, iris muscles, pupils are maller, innervation is
anisocoria decreased, horneh syndrome
• Examined from the front, sides and from above
• Changes in form or symmetry are noted, as well as the size
of the eyeballs (note breed differences)
• Eyelid changes, periocular alopecia and discharge form
eyes or nostrils
bibrosarcoma, deformation of the head
calici, hereps (rhinitis is her emorelikely(
Outer inspection and fixation
Outer inspection and fixation
• If you planning to take a smear or analysis
(bacteriology, PCR), take before any flushing
• SCHIRMER TEAR TEST
• The Schirmer tear test is a measure for production of the
watery part of the tears
Dog: 15-25 mm/1 min. Values between 10
and 15 mm may be caused by transitional
lowered tear production because of
stress
Cat: 12-22 mm/1 min, but the values may
min: <9mm/1min differ, and cats are difficult to measure
How to perform the STT
The strip should be folded whilst still in plastic packaging
to avoid contamination of the paper with grease and sweat from examiners
fingers, which could decrease the ability of the paper to absorb tears
https://www.youtube.com/watch?v=gYdCeLfDIAA
6 y old cocker sp with chronic mucous discharge from both eyes,
inflammation of conjunctiva and cornea
Typical signs for low production of tears – keratoconjunctivitis sicca
Sheila, 8 y, female cavalier king charles spaniel,
chronic blepharitis,
inflammation of conjunctiva and cornea, totally
pigmente, not transparent cornea
Eyelids
entropion - in maine coons common
Conjunctiva
• Eyelid conjunctiva
• Bulbar conjunctiva A thin, transparent mucous membrane that covers the sclera (the anterior part) and
continues to line the inside of the eyelids (as the palpebral conjunctiva)
Conjunctiva, normal vein in part of bulbar conjunctiva
redness related to
inflammation:
pain or irritation
discharge is
common (watery,
mucoid)
swelling (chemosis)
conjuctival vessels
are mobile
Redness of bulbar and Redness of palpebral conjunctiva, inflammation in dog
third eyelid conjunctiva, inflammation in dog
pain usually absent
discharge rare
chemosis not typical
is linked to trauma,
clotting disorders
Red and
moves? It’s
inflamed.Re self resolving in 1-2
d and stuck? weeks without any
It’s bled." specific treatment
Subconjunctival hemorrhages in dog
episcleral vessel congestion: superficial scleral vessels get more dilated and red
scleral vessel congestion: they are more deeper, become congested- darker red to purple, they are fixed , not mobile
conjuctival vessels in glaucoma - can show hyperemia due to incr. IOP but its less intense , appear bright red and mobile,
often sign of superficial eye inflammation rather than deep intraocular disease
Episcleral and scleral blood vessels congestion +/- conjunctival blood
vessels congestion/conjunctival hyperemia
Signs of intraocular diseases
There is eye with hihgh intraocular pressure - glaucoma
Focal light
Magnification
Loupe 2x
Biomicroscope , light and magnification 10 xand 16 x
Focal light for pupil examination, pupillary light reflection
pupillary reflex doesnt mean there is vision
Pupillary light reflection, PLR
• PLR
• Direct PLR
• Consensual PLR
PVR assessment-
• helps to localize changes
if problem with vision
• helps to localize changes CNS
• Direct PLR
retina
n.opticus, CN II
Afferent pathway
optic chiasm
midbrain
n.oculomotorius, CN III
Efferent pathway
m.sphincter pupillae
n.oculomotorius
Efferent pathway
m.sphincter pupillae
Anisocoria
• an unequal size of the eyes' pupils
Miosis- small size/constricted /pupil
Mydriasis- dilated pupil
Topical anesthesia, if spastic/painful eye.
For simple examinations one drop is applied.
The effect approximately one minute after application.
Topical anesthetics are not indicated as
treatment in painful conditions, due to
their tissue toxicity
proparacaine
In animal with holding/spastic eye
(blepharospasm) must be excluded:
• Foreign body in conjunctiva, cornea, under eyelids, third
eyelid
• Aberrant cilia or hair (distichia or ectopic cilia)
• Evaluated by staining with Fluorescein-Na solution for
detecting corneal ulcer
https://www.youtube.com/watch?v=O-KhHtTWAVw
Third eyelid examination
ჩავაწვეთოთ გამაყუჩებელი
თვალის ზემოდან ოდნავ დავაწვეთ, თავისით გამოჩნდება მესამე ქუთუთო, შემდეგ ბამბიანი ჩხირით გამოვევთ მესამე
ქუთუთოს
Foreign body under third eyelid
(piece of grass)
Foreign body under eyelid
Dog with chronic eye disharge Cat with acute blepharospasm
and nonresponsive inflammation , after walking outside,dry piece of wood
dry piece of tick used general anesthesia local antibiotics, pain medications
Foreign body in the cornea,
piece of plant
foreign bodies perforate
cornea rarely, mostly they are
under cornea like in this
picture
the main reason is that cornea
is so tight structure and has
ability to heal rapidly
ისეა
თიტქოს
კანქვეშაა
abnormally positioned eyelashes - they grow from areas where
eyelashes are not normally found, such as palpebral conjuctiva.
they typically emerge from meibomian gland openings
Ectopic cilia mostly in young dpgs
very rare in cats
can be congenital or
acquired due to trauma
or inflammation
trauma, inflammation- blepharitis- may predispose animal to development of ectopic cilia
FLUORESCEIN TEST
One drop of the stain is applied on the cornea and
superfluous stain is rinsed off. In areas with loss
of corneal epithelium Fluorescein-Na will penetrate
into the stroma causing a green stain. Deep ulcers
may go all the way down to the Descemet's
membrane.
1
4
Green stain in the area of corneal ulcer –
the fluorescein test is positive
observe tissue near green area
line of limbus
entropion deep ulcer but still superficial
Deep ulcers may go all the way down to the Descemet's membrane
The membrane will not stain but will present as a clear spot in the
middle of the green stained walls
black is fundus of ulcer (descement membrane) , not pupil
Fluorescein may also be added to irrigation
solution for more easy control of the tear ducts
nasolacrimal gland
test
in
brachiocephalics
we normally dont
see this
staining, because
their nasolacrimal
gland position and
lenght changed
so it comes in
mouth moslty
(swallowing)
Tonometry is the measurement of intraocular pressure
(IOP), mmHg, Indications
all animals that come with red eye, painfull eye,
blepharospasm should be checked iop, because it
• Painful eye can be first stages of glaucoma
• Red eye typical breeds: husky ს მსგავსები
• Cloudy eye american cocker spaniel
beagle
• Vision impairment chow chow
• Enlarged eye
• In breeds predisposing to glaucoma
we cant save this eye vision, only treating pain, or removing eye
Tonometry is the measurement of intraocular pressure
(IOP), mmHg
Schiøtzi
tonopen needs local anesthesia
Tonopen
https://www.youtube.com/watch?v=qhN4UOIsd5U
https://www.youtube.com/watch?v=XRRhtpahcOc
Tonovet
• Normal intraocular pressure in dogs is 15-25 mm Hg
• 15-30 mm Hg in the cat
• Normal IOP dif between eyes ≤ 8mmHG
• IOP > 30mm over some days damages the optic nerve and retina
• IOP > 40 mm is painful and causes enlargement of the globe
(buphthalmos)
• IOP > 40-50 mm paralyses the sphincter muscle of the iris and
causes
mydriasis
• Lowered IOP indicates intraocular inflammation (uveitis)
• Ellen Bjerkås DVM PhD Dipl ECVO, Professor
• Norwegian School of Veterinary Science
Please read at home
EXAMINATION TECHNIQUES
Only 15 pages
