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Diagnostic Examination of the Eye

David A. Wilkie DVM, MS, DiplomateACVO

Professor EmeritusThe Ohio State University

Wilkie.1@osu.edu

Ophthalmic Examination

“More is missed by not looking than by not knowing” [Thomas McCrae, 1870–1935]

Ophthalmic Examinationn External exam

Ophthalmic Examinationn External examn Internal exam

Oh, oh

Know Equipment & Anatomy! Know Equipment & Anatomy!

I can t see a thing?

mailto:Wilkie.1@osu.edu

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Basic Ophthalmic Exam Advanced Ophthalmic Examination

Maze Test Finoff & Magnification

Anyone over 40?

Anyone over 40?

Finoff & MagnificationAnyone over 40?

n Magnificationn Head Loupes

n Simple loupesn Galilean-type loupesn Prismatic loupes (Keplerian)

Fundamentals of Microsurgery

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n Magnificationn Loupes - styles

Fundamentals of MicrosurgeryTurn out the lights

Pupillary Light Reflex

!

Dazzle Reflex

Hey!That s Bright

Cotton Ball Menace Response

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Neuro-ophthalmic Exam

CN- 2, 3, 4, 5, 6, 7

Culture

Culture KCS

≤ 15mm/min consider Rx

This is the most underused, but indicated ophthalmic test in practice……YOU ARE MISSING THESE CASES

Do you see these breeds???

When do I treat???

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STT

051015202530

STT

STT

Time

Why do you wait to get to here??

Why not treat here??

75-82% response rate (CSA optimmune)85%-96% response rate (Tacro)36% with STT

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STT

TBUT

Tear Break-up Time (TBUT) LOOKS LIKE KCS, BUT STT IS >15MM

Tear Break-up Tear Break-up20 seconds

Tear Break-up - Human Abnormal Tear Break-up - Canine

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N-L Evaluation Seidel Test

Seidel Test Positive Seidel Test - Human

Positive Seidel Test - Canine Rose Bengaln Indications:

n Detection of dry, stressed, devitalized epithelial cellsn KCS?n Viral, fungal keratitis?

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Topical Anestheticsn Proparacaine 0.5%. n Rapid onset of action, 15-20 seconds with 15-

20 minute duration.

Topical Anesthetics n Prolonged use will:

n diminish duration of anesthesian retard wound healingn result in keratitis and corneal

epithelial erosions

Nasolacrimal Irrigation

Nasolacrimal Irrigation

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Cytology

CytologyKimura spatula

Cytology brush

www.microbrush.com

Chlamydophila felisconjunctivitis

n Potential zoonosis

http://www.microbrush.com/

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Eosinophilic keratitis

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Diabetes mellitus

Intraocular Pressure Determination

n Indications:n Any red or painful eyen Breeds that are

predisposed to glaucoman Predisposed breeds with

a history of glaucoma in the opposite eye

n Follow up in animals with medically controlled glaucoma

Intraocular Pressure Determination

n Determination of intraocular pressure (IOP) is indicated in all eyes with: n Diffuse corneal edeman Anisocorian Fixed and dilated pupilsn Episcleral congestionn Blindnessn Buphthalmosn Anterior uveitis

Tonometryn This is the only diagnostic test to

definitively determine the IOP.n You must be able to perform this in

practice in order to diagnose and manage glaucomaand to rule out other diseases

IOP – 4 mmHg

IOP – 40 mmHgWhat if the IOP is – 21 mmHg

Do I need to measure IOP?

n Diagnose Glaucoman Manage Glaucoman All Predisposed Breedsn All Red Eyesn All Cloudy Eyesn All Blind Eyesn All Painful Eyesn All Abnormal Pupils

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Intraocular Pressure Determination

n There are 3 specific ways to determine intraocular pressure: n Indentation tonometry n Applanation tonometryn Rebound tonometry

Schiotz Tonometry

Schiotz Tonometry

Should read zero

Schiotz Tonometry

Do your patients behave for this?

Trust your result?

Applanation Tonometry Applanation Tonometry

Transducer tip

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Applanation Tonometry

Tonopen-Avia

Takes 6 readings with 3 touches

Tonovet-Rebound Tonometry

No topical anesthesia

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TonoVet

IOP - What is significant? IOP - What is significant?

Weight 250 180 120

IOP - What is significant?

Weight 250 180 120

IOP 25 18 12

Intraocular Exam

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Intraocular Exam Biomicroscopyn Indications

n Examination of the anterior segment of the eye:n Adnexan Conjunctivan Cornean Aqueousn Irisn Lensn Anterior Vitreous

Heine monocular slitlamp

Kowa SL-15 slitlamp

Cornea

Aqueous

Anterior

Posterior

NucleusLENS

Posterior cataract

Aqueous flareIris melanoma

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Sclerosis

Biomicroscopy

Sclerosis

CataractEquatorial vacuoles - immature

BiomicroscopyPosterior cortical cataract

CataractMature cataract

Indirect Ophthalmoscopy

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Indirect Ophthalmoscopy Indirect Ophthalmoscopy

Indirect Ophthalmoscopy Indirect Ophthalmoscopy

Indirect Ophthalmoscopy

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Indirect Ophthalmoscopy Direct ophthalmoscopy

Direct ophthalmoscopyIndirect vs Direct

PanOptic

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http://www.welchallyn.com/promotions/iExaminer/index.html

Ocular Ultrasound

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Normal Normal

Cataract Diagnosis??

Etiology?

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Uveal Cysts and Glaucoma

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Electroretinogramn Electroretinogram

n Under anesthesia vs awake

n Prior to cataract Sxn SARDSn Blind unknown

nElectroretinogramnPhotopicnScotopic

Questions?