Professional Documents
Culture Documents
24 26 September 2009
Cardiff, UK
PLEASE NOTE:
While this presentation may be quoted from it
cannot be reprinted in full without the permission
of the author and the BVA
OPHTHALMOLOGY
Part 1
Examination of the eye and the
BVA/KC/ISDS Eye Scheme
Professor Sheila Crispin
SM Crispin 2009
1
BASIC OPHTHALMIC EQUIPMENT
1. Penlight
2. Condensing lens
e.g. 20D or 2.2 pan retinal
3. Direct ophthalmoscope
4. Magnifying device
e.g. otoscope, magnifying
loupe, slit lamp, ophthalmoscope
EXAMINATION
Careful observation of the whole patient whilst
taking the history
General physical examination
Relevant neurological examination
(incorporated in ophthalmic examination)
Routine ophthalmic examination
Additional diagnostic techniques and tests if
indicated
Careful recording of findings
Accurate diagnosis!
2
OPHTHALMIC EXAMINATION
Correct instruments
Quiet environment
Adequate facilities (light and dark)
Logical order of examination of BOTH eyes and
their adnexa (adnexa = eyelids, lacrimal
apparatus, orbit and para-orbital areas)
If the eye is red, painful, or visually impaired and
the diagnosis is in doubt seek advice do not
adopt a wait and see approach
Observe, compare,
analyse, record
3
Routine examination
in the light
Under normal lighting conditions perform
hands off examination followed by hands on
examination of orbit, eyelids, lacrimal
apparatus and internal eye, magnification may
be needed
[Basic neuro-ophthalmological tests
performed in the light if indicated:
oculovestibular reflex, menace and visual
tracking responses, palpebral and corneal
reflexes]
EXAMINATION
Initial assessment is
made by careful
observation (hands off)
4
Close examination
involves inspection,
usually with
manipulation (hands
on)
Routine examination
in the dark
Examine external eye and internal eye (to
vitreous) light source and magnification
Check for symmetry of gaze, pupil size
and shape, any opacities in the ocular
media distant direct ophthalmoscopy
Posterior segment (vitreous to fundus)
indirect and close direct ophthalmoscopy
[Basic neuro-ophthalmological tests
performed in the dark if indicated:
pupillary light reflex, swinging flashlight
test, dazzle reflex and visual tracking with
a beam of light]
5
Illumination
6
Magnification
7
Ophthalmoscopy
Normal gross
and
histological
appearance
OPHTHALMOSCOPY
Both indirect and direct ophthalmoscopy should be
used, darkness is essential, mydriasis is helpful
8
Monocular indirect ophthalmoscopy
9
Binocular indirect
ophthalmoscopy
Has the advantage of steropsis (depth perception)
DIRECT
OPHTHALMOSCOPE
Basic requirements
lens carousel
(-20 to +20)
large aperture, slit
beam and graticule
red-
red-free light
10
DISTANT DIRECT OPHTHALMOSCOPY
DISTANT DIRECT
OPHTHALMOSCOPY
11
Remember
- close orbital fit
- keep light
intensity low
- rest finger(s)
against animal
NORMAL PIGMENTATION
12
SUBALBINOTIC EYE
CLOSE DIRECT
OPHTHALMOSCOPY
13
NORMAL
NORMAL
14
Normal ageing
Senile nuclear
sclerosis of lens
with normal
pigmented eye
Fundus examination
- retinal and choroidal blood
vessels
- optic nerve head (myelinated
in most dogs)
- tapetal and non-
non-tapetal fundus
15
EYE PANEL
Currently just over 30 panellists
Existing panellists have been trained to
Certificate and /or Diploma level
All new panellists are trained to Diploma level
European and/or Royal College of Veterinary Surgeons
Aspirant panellists undertake a practical and
theoretical examination
All panellists undertake continuing professional
development and undergo annual re-
assessment
16
CERTIFICATE OF EYE EXAMINATION
AND LITTER SCREENING FORM
First section
Details of animal and owner or agent
Verification of permanent identification as from January 1st 2010
Second section
Examination technique and instruments used
Any abnormalities identified, whether or not they are inherited
Third section
The known inherited eye disease for the breed being examined
Everything other than gonioscopy is classified as affected
affected or
unaffected
unaffected
Gonioscopy is a separate examination and a grading system for
the degree of goniodysgenesis is to be introduced next year
SCHEDULE A CONDITIONS
Congenital and neonatal
Goniodysgenesis
Congenital inherited cataract
Persistent hyperplastic primary vitreous
Collie eye anomaly
Multifocal retinal dysplasia
Total retinal dysplasia
[Persistent pupillary membrane - removed]
Non-congenital (acquired)
Hereditary cataract
Primary lens luxation
Retinal pigment epithelial dystrophy
Generalised progressive retinal atrophy
17
GONIODYSGENESIS
AND PRIMARY
GLAUCOMA
normal
GONIODYSGENESIS
18
GONIODYSGENESIS AND PRIMARY
GLAUCOMA
PERSISTENT HYPERPLASTIC
PRIMARY VITREOUS (PHPV)
19
COLLIE EYE ANOMALY
Puppy with
Collie Eye Anomaly (left eye)
20
COLLIE EYE ANOMALY
TOTAL RETINAL
DYSPLASIA
21
MULTIFOCAL RETINAL DYSPLASIA
22
MULTIFOCAL RETINAL DYSPLASIA
(GEOGRAPHIC)
INHERITED
CATARACT
Congenital and
non-congenital
23
PRIMARY LENS
LUXATION
RETINAL PIGMENT
EPITHELIAL DYSTROPHY
(CENTRAL PROGRESSIVE RETINAL ATROPHY)
24
RETINAL PIGMENT EPITHELIAL DYSTROPHY
(CENTRAL PROGRESSIVE RETINAL ATROPHY)
GENERALISED
PROGRESSIVE
RETINAL ATROPHY
25
normal
GENERALISED
PROGRESSIVE
RETINAL
ATROPHY
UNDER INVESTIGATION
Multiple ocular
anomalies and
persistent
pupillary
membrane
remnants Persistent
pupillary
membrane
remnants
26
UNDER INVESTIGATION
UNDER INVESTIGATION
27
ADNEXAL ABNORMALITIES
28