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Anterior Segment Disease > 2: Conjunctiva > Flashcards

2: Conjunctiva Flashcards

1
Q

viral conjunctivitis

A

viral infection of the conjunctiva

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2
Q

viral conjunctivitis etiology

A
  • adenovirus in 90% of cases: transmission is through contact with respiratory or ocular secretions and fomites (e.g., towels, pool equipment, toys)
  • rarely, mumps, measles, enterovirus, coxsackievirus, herpes simplex virus, varicella zoster virus, poxvirus
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3
Q

viral conjunctivitis demographics

A

no predilection

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4
Q

viral conjunctivitis laterality

A
  • often starts in one eye and involves the fellow eye within a few days
  • exception: herpes simplex and varicella zoster viruses typically cause a unilateral infection
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5
Q

viral conjunctivitis symptoms

A
  • red eye(s)
  • watery mucous discharge
  • ocular irritation (e.g., burning, FBS)
  • Hx of recent upper respiratory infection (URI) or contact with someone with viral conjunctivitis
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6
Q

viral conjunctivitis signs

A
  • conjunctival injection and chemosis
  • palpebral follicles*
  • tender and/or swollen preauricular lymph nodes
  • watery mucous discharge
  • eyelid edema
  • keratitis: epithelial microcysts in early stages, superficial punctate keratitis (SPK), focal white subepithelial infiltrates (SEIs) which may persist for months
  • membrane/pseudomembrane with severe inflammation
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7
Q

viral conjunctivitis management

A
  • self-limiting within 2-3 weeks- cold compresses and topical lubricant for palliative treatment
  • 5% ophthalmic betadine (povidone-iodine) wash in office- kills the adenovirus and reduces risk of transmission
  • topical steroid- highly recommend if SEIs are present; slow taper as SEIs can last for months; may extend the period during which the patient remains infectious
  • if a membrane or pseudomembrane is present, peel it with a cotton-tip applicator or smooth forceps; Rx topical steroid to reduce scarring
  • discuss hand-washing, avoidance of eye rubbing and towel sharing, and restrict work or school to reduce risk of transmission
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8
Q

viral conjunctivitis pearls:

  • viral conjunctivitis is highly contagious as long as ____
  • adenovirus particles can survive on dry surfaces for _____
  • adenoplus can be used to ____
  • spectrum of viral conjunctivitis- most common is _____
  • a similar follicular conjunctivitis can occur due to ____
A

there is tearing/discharge or if the eyes are red (assuming the pt is not using a steroid), typically 10-12 days;
up to 7 weeks;
detect adenovirus and confirm the diagnosis- 90% sensitivity and 96% specificity;
non-specific acute follicular conjunctivitis (mild form);
a toxic reaction to a wide variety of ocular meds (known as toxic conjunctivitis or conjunctivitis medicamentosa)

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9
Q

viral conjunctivitis pearls:

-epidemic keratoconjunctivitis (EKC)

A
  • caused by adenovirus serotypes 8, 19, 37
  • occurs in epidemics in workplaces (including hospitals), schools, and swimming pools
  • severe form of viral conjunctivitis with corneal involvement in 80% of cases
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10
Q

viral conjunctivitis pearls:

-pharyngoconjunctival fever (PCF)

A
  • caused by adenovirus serotypes 3, 4, 7

- pharyngitis (sore throat) and a low grade fever are present

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11
Q

viral conjunctivitis pearls:

-acute hemorrhagic conjunctivitis

A
  • caused by enterovirus and coxsackie virus
  • more common in tropical areas
  • marked subconjunctival hemorrhage is present
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12
Q

acute bacterial conjunctivitis

A

bacterial infection of the conjunctiva

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13
Q

acute bacterial conjunctivitis etiology

A
  • most commonly Staph aureus, Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis- transmission is through direct contact with ocular secretions
  • minority of cases due to Neisseria gonorrhoeae- transmission is through direct contact with genital secretions
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14
Q

acute bacterial conjunctivitis demographics

A
  • more common in children and the elderly

- gonococcal infection occurs in sexually active adults

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15
Q

acute bacterial conjunctivitis laterality

A

unilateral or bilateral

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16
Q

acute bacterial conjunctivitis symptoms

A
  • red eye(s)
  • mucous discharge with eyelids stuck together on waking
  • ocular irritation (e.g., burning, FBS)
  • systemic symptoms may occur in patients with infection from Haemophilus influenzae (otitis media) and Neisseria gonorrhoeae (pain/burning while urinating, more frequent urinating, vaginal discharge)
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17
Q

acute bacterial conjunctivitis signs

A
  • conjunctival injection and chemosis
  • palpebral papillae
  • mucopurulent/purulent discharge*
  • eyelid edema
  • superficial punctate keratitis (SPK)
  • if gonococcal, tender and/or swollen lymph nodes
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18
Q

acute bacterial conjunctivitis management

A
  • self-limiting within 1-2 weeks- broad spectrum topical antibiotic to speed recovery and prevent re-infection and transmission
  • remove discharge with saline and/or cotton-tip applicator
  • discuss hand-washing and avoidance of towel sharing to reduce risk of transmission
  • in severe cases or if no resolution, culture to determine causative organism
  • Haemophilus influenzae and Neisseria gonorrhoeae require systemic treatment in addition to a topical antibiotic- H. influenzae can be treated with Augmentin; N. gonorrhoeae should be referred out for 250 mg of IM ceftriaxone and 1 g of oral azithromycin
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19
Q

acute bacterial conjunctivitis pearls:

  • suspect gonococcal infection if _____
  • if infection occurs in newborns (most commonly N. gonorrhoeae, C. trachomatis, HSV-2), called _____
A

onset is hyperacute (classically within 12-24 hours) with significant discharge;
ophthalmia neonatorum or neonatal conjunctivitis- prophylaxis is routinely performed with 2.5% ophthalmic betadine or eryhtromycin 0.5% ung

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20
Q

(very) general rule:
- if an adult presents with a red eye, think _____
- when a child or elderly patient presents with a red eye, think _____
- if unsure if your diagnosis, you could _____
- if patient is a CL wearer, think ____

A

viral first (but could be bacterial);
bacterial first (but could be viral);
Rx a combo (ex: tobradex, zylet, maxitrol);
bacterial

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21
Q

inclusion conjunctivitis

A

(adult chlamydial conjunctivitis)

chlamydial infection of the conjunctiva

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22
Q

inclusion conjunctivitis etiology

A
  • chlamydia trachomatis serotypes D-K: transmission is through direct contact with genital secretions
  • is also a version that can be spread to humans from exotic birds
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23
Q

inclusion conjunctivitis demographics

A

sexually active adults

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24
Q

inclusion conjunctivitis laterality

A

often starts in one eye and involves the fellow eye within a few days

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25
Q

inclusion conjunctivitis symptoms

A
  • red eye(s)
  • mucous discharge
  • ocular irritation (e.g., burning, FBS)
  • systemic symptoms include pain/burning while urinating, more frequent urinating, vaginal discharge
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26
Q

inclusion conjunctivitis signs

A
  • conjunctival injection
  • palpebral papillae and follicles inferior > superior
  • tender and/or swollen preauricular lymph nodes
  • mucopurulent discharge
  • eyelid edema
  • keratitis: SPK, SEIs, pannus (vascular fibrous tissue on the corneal surface)
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27
Q

inclusion conjunctivitis management

A
  • azithromycin 1 g in a single dose or doxycycline 100 mg bid PO x 1 week and concomitant topical erythromycin ung x 2-3 weeks
  • confirmation of chlamydia through culturing of conjunctival sample or through urinalysis or genital swab
  • refer to genitourinary specialist to exclude other STIs and trace sexual partners
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28
Q

inclusion conjunctivitis pearls:

  • inclusion conjunctivitis can last ____
  • symptoms commonly take ______ and follicles and SEIs can take _____
  • chlamydia trachomatis can be a trigger for ____
A

for months (if a pt has a chronic conjunctivitis that does not resolve with topical antibiotics or steroids, consider chlamydial infection);
weeks to settle after treatment;
months to resolve;
reactive arthritis

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29
Q

trachoma

A

chlamydial infection of the conjunctiva

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30
Q

trachoma etiology

A
  • chlamydia trachomatis serotypes A-C
  • transmission is through direct contact with ocular or nasal secretions
  • flies are also a vector
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31
Q

trachoma demographics

A

children and adults in areas of poor sanitation and crowded conditions

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32
Q

trachoma laterality

A

bilateral

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33
Q

trachoma symptoms

A
  • red eye(s)
  • mucous discharge
  • ocular irritation (e.g., burning, FBS, pain)
  • blurred vision
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34
Q

trachoma signs

A
  • conjunctival injection
  • palpebral papillae and follicles superior > inferior
  • limbal follicles superior > inferior
  • tender and/or swollen preauricular lymph nodes
  • mucopurulent discharge
  • eyelid edema
  • keratitis superior: SPK, SEIs, pannus
  • scarring of the conjunctiva: Herbert’s pits (scarring of limbal follicles), Arlt’s line (scarring of superior tarsal conjunctiva)
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35
Q

trachoma complications

A
  • symblepharon
  • cicatricial entropion
  • trichiasis
  • corneal ulceration
  • corneal opacification (scarring)- secondary to cicatricial entropion with trichiasis
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36
Q

symblepharon

A

adhesion of palpebral conj to bulbar conj

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37
Q

cicatricial entropion

A

in-turning of the eyelid due to scarring of the tarsal conjunctiva

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38
Q

trichiasis

A

in-turning of the eyelashes due to entropion

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39
Q

corneal ulceration

A

stromal thinning with overlying epithelial epithelial defect

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40
Q

trachoma management

A
  • SAFE strategy by WHO: surgery for trichiasis due to entropion, antibiotic for active disease, facial hygiene, environmental protection
  • if non-healing epithelial defect or ulceration, consider bandage contact lens or amniotic membrane to relieve symptoms and facilitate healing
  • if corneal opacification affects vision, refer for keratoplasty
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41
Q

trachoma pearls:

  • leading cause of _____
  • overcrowding and poor hygiene lead to _____
A

preventable, irreversible blindness worldwide;
cycles of re-infection which leads to more severe signs of conjunctival scarring, cicatricial entropion, trichiasis, corneal ulceration and opacification

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42
Q

allergic conjunctivitis

A

inflammation of the conjunctiva due to an allergen

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43
Q

allergic conjunctivitis etiology/associations

A
  • seasonal allergic conjunctivitis (SAC)
  • perennial allergic conjunctivitis (PAC)
  • contact allergic blepharoconjunctivitis
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44
Q

seasonal allergic conjunctivitis (SAC)

A

type I hypersensitivity reaction typically caused by tree and grass pollens

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45
Q

perennial allergic conjunctivitis (PAC)

A

type I hypersensitivity reaction typically caused by dust mites, animal dander, fungal allergens

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46
Q

contact allergic blepharoconjunctivitis

A

type IV hypersensitivity reaction typically caused by contact with a substance; most commonly ophthalmic medications cosmetic products

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47
Q

allergic conjunctivitis demographics

A

no predilection

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48
Q

allergic conjunctivitis laterality

A
  • bilateral for SAC, PAC

- unilateral or bilateral for contact allergic blepharoconjunctivitis

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49
Q

allergic conjunctivitis symptoms

A
  • red eye(s)
  • ocular itching- esp at nasal canthus; if contact blepharoconjunctivitis, eyelid itching too
  • watery or ropy mucous discharge
  • sneezing and nasal discharge if SAC or PAC
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50
Q

allergic conjunctivitis signs

A
  • conjunctival injection and chemosis
  • palpebral papillae
  • watery or ropy mucous discharge
  • eyelid edema
  • if contact blepharoconjunctivitis, vesicular rash with scaling/crusting of eyelid skin- if chronic, lichenification (leathery patches of skin) may be present
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51
Q

allergic conjunctivitis management

A
  • identify allergens (consider allergy testing) and avoid them
  • palliative therapy (cool compress, topical lubricant, dual action mast cell stabilizer/antihistamine)
  • topical steroid in moderate to severe conjunctivitis in addition to above therapy
  • if eyelid involvement, steroid ung or cream
  • if systemic symptoms, consider recommending OTC systemic medication or referring to PCP
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52
Q

allergic conjunctivitis pearls:

  • SAC is typically worse _____
  • PAC is ____ and is ____ common and ____ than SAC
  • if contact blepharoconjunctivitis only involves the skin, called _____
  • patients can exarcebate a conjunctivitis (typically allergic conjunctivitis) by _____; called ____
A

during spring and summer;
throughout the year (worse in fall); less; milder;
contact dermatitis;
removing mucous from the eye;
mucus fishing syndrome- creates a cycle of inflammation and mucous production

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53
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC)

A

severe allergic conjunctivitis that also involves the cornea

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54
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) etiology/associations

A
  • type I and IV hypersensitivity reaction induced by nonspecific stimuli (e.g., wind, dust, sunlight)
  • commonly associated with other atopic conditions (e.g., allergic rhinitis, asthma, eczema)
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55
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) demographics

A
  • VKC: children, men > women

- AKC: late teenage to 50s

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56
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) laterality

A

bilateral

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57
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) symptoms

A
  • red eyes
  • intense ocular itching
  • watery or ropy mucous discharge
  • ocular irritation (e.g., burning, FBS, pain)
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58
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) signs

A

-conjunctival injection and chemosis
-palpebral papillae:
-VKC: giant, cobblestone appearance, superior >
inferior
-AKC: smaller, inferior > superior
-limbal papillae in VKC- may be associated with Horner-Trantas dots (collection of eosinophils)
-discharge:
-VKC: ropy, mucous discharge with deposition
between papillae
-AKC: watery mucous discharge
-eyelid edema
-keratitis: SPK, pannus, shield ulcer (more common in VKC vs AKC)
-atopic dermatitis (eczema) of the eyelid and elsewhere is common in AKC (erythema, scaling/crusting, lichenification)
-conjunctival and eyelid scarring occurs in severe cases of AKC

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59
Q

complications of AKC

A
  • symblepharon
  • ciciatricial ectropion
  • cicatricial entropion
  • trichiasis
  • keratoconus due to intense, chronic eye rubbing
  • anterior/posterior subcapsular cataract
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60
Q

cicatricial ectropion

A

out-turning of the eyelid due to scarring of the eyelid skin

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61
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) management

A
  • identify allergens (consider allergy testing) and remove them
  • palliative treatment (cool compress, topical lubricant, dual action mast cell stabilizer/antihistamine- start 2-3 weeks before spring starts in VKC)
  • topical steroid in moderate to severe conjunctivitis in addition to above therapy
  • if shield ulcer, topical antibiotic for prophylaxis of bacterial infection and topical steroid (shield ulcers may need to be scraped to remove superficial plaque-like material before re-epithelialization will occur, may also consider a BCL or amniotic membrane to relieve symptoms and facilitate healing)
  • if eyelid involvement, steroid ung or cream or tacrolimus ung
  • if entropion, ectropion, or symblepharon, refer for surgery
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62
Q

vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) pearls:

  • symptoms of VKC and AKC are similar, though those associated with ____ are more severe and unremitting
  • VKC Is worse in _____; typically resolves by ____; ~___% develop AKC later in life
  • AKC tends to be _____ and worse in ____; low expectation of _____
A 
AKC;
late spring and summer;
late teens;
5;
year-round;
in the winter;
resolution
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63
Q

giant papillary conjunctivitis (GPC)

A

allergic conjunctivitis due to mechanical irritation of the tarsal conjunctiva from a foreign body

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64
Q

giant papillary conjunctivitis (GPC) etiology/associations

A
  • contact lenses in 95% of cases (CLPC)- mainly due to build-up of proteinaceous deposits and cellular debris on the CL surface
  • other causes include ocular prosthesis and exposed suture
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65
Q

giant papillary conjunctivitis (GPC) demographics

A

no predilection

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66
Q

giant papillary conjunctivitis (GPC) laterality

A

unilateral or bilateral

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67
Q

giant papillary conjunctivitis (GPC) symptoms

A
  • red eye(s)
  • ocular irritation (e.g., burning, FBS)
  • ocular itching
  • watery mucous discharge
  • if contact lens related, CL intolerance due to excessive movement and FBS upon removal of CL
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68
Q

giant papillary conjunctivitis (GPC) signs

A
  • conjunctival injection and chemosis
  • giant palpebral papillae superior
  • watery mucous discharge
  • if contact lens related, deposits on CLs and excessive CL mobility due to UL capture
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69
Q

giant papillary conjunctivitis (GPC) management

A
  • remove the stimulus if possible (CL wear should be d/c for several weeks)
  • palliative therapy (cool compress, topical lubricant, dual action mast cell stabilizer/antihistamine)
  • topical steroid in moderate to severe conjunctivitis
  • refit in daily disposables (if pt declines, discuss CL hygiene and reduced wearing time)
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70
Q

giant papillary conjunctivitis (GPC) pearls:

-_____ on all CL patients

A

evert the UL

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71
Q

superior limbic keratoconjunctivitis (SLK)

A

inflammation of the superior limbus, cornea, bulbar and tarsal conjunctiva

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72
Q

superior limbic keratoconjunctivitis (SLK) etiology/associations

A
  • idiopathic (may be due to friction between superior tarsal and superior bulbar conj)
  • associated with thyroid disease (50% of cases, typically hyperthyroid), dry eye, and CL wear
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73
Q

superior limbic keratoconjunctivitis (SLK) demographics

A
  • typically occurs between the ages of 45-65 years

- women > men

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74
Q

superior limbic keratoconjunctivitis (SLK) laterality

A

bilateral > unilateral

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75
Q

superior limbic keratoconjunctivitis (SLK) symptoms

A
  • red eye(s) superior
  • ocular irritation (e.g., burning, FBS, pain)
  • ocular itching
  • symptoms worse than signs
76
Q

superior limbic keratoconjunctivitis (SLK) signs

A
  • conjunctival injection and chemosis superior
  • conjunctivochalasis superior
  • palpebral papillae superior
  • keratitis superior: SPK, SEIs, mild pannus
  • mucous filaments superior
77
Q

superior limbic keratoconjunctivitis (SLK) management

A
  • aggressive topical lubrication (drop 4-8x/day and ung qhs)- reduce friction between tarsal and bulbar conj
  • in moderate to severe cases, options include: topical steroid, autologous serum drop, tacrolimus ung, silver nitrate 0.5% soln applied to superior conj x10-20 secs
  • BCL can relieve symptoms and facilitate healing
  • acetylcysteine for dissolving mucous filaments
  • if no resolution, refer for surgery (conj thermocautery, conj resection)
  • if etiology is suggestive of thyroid disease and pt has not been diagnosed, order thyroid function tests (T3, T4, TSH)
78
Q

superior limbic keratoconjunctivitis (SLK) pearls:

-SLK is a chronic disease with _____

A

exacerbations and remissions that tend to diminish in frequency as age increases

79
Q

ocular mucous membrane pemphigoid (ocular cicatricial pemphigoid- OCP)

A

systemic disorder characterized by blistering lesions that primarily affect mucous membranes (e.g., mouth, nose, throat, genitalia, anus); in some cases, blistering lesions may also develop on the skin especially the head and neck

80
Q

ocular mucous membrane pemphigoid etiology/associations

A

autoimmune disease

81
Q

ocular mucous membrane pemphigoid demographics

A
  • typically affects patients 55 years and older

- women > men

82
Q

ocular mucous membrane pemphigoid laterality

83
Q

ocular mucous membrane pemphigoid symptoms

A
  • red eyes
  • discharge
  • ocular irritation (e.g., burning, FBS, pain)
  • blurred vision
  • blistering of mouth, nose, throat
84
Q

ocular mucous membrane pemphigoid signs

A
  • conjunctival injection
  • mucous discharge
  • keratitis (SPK, pannus)
  • membrane/pseudomembrane
  • conjunctival scarring
  • blistering of other mucous membranes (e.g., mouth, nose, throat)
85
Q

ocular mucous membrane pemphigoid complications

A
  • symblepharon
  • cicatricial entropion
  • trichiasis
  • corneal ulceration
  • corneal opacification (scarring- secondary to cicatricial entropion with trichiasis)
86
Q

ocular mucous membrane pemphigoid management

A
  • if diagnosis is in question, refer for conjunctival biopsy to detect the presence of the specific antibodies
  • palliative therapy: topical lubricant, Restasis, punctal occlusion, moisture goggles
  • topical steroid to suppress inflammation
  • if corneal epithelial defect or ulceration present, topical antibiotic for prophylaxis of bacterial infection
  • if non-healing epithelial defect or ulceration, consider BCL or amniotic membrane to relieve symptoms and facilitate healing
  • if complications occur, consider referral for surgery (e.g., entropion surgery, keratoprosthesis)
  • refer to PCP for systemic treatment (immunosuppressant, oral steroid, Dapsone)
87
Q

ocular mucous membrane pemphigoid pearls:

  • OCP is a chronic disease with ____
  • most commonly affects _____
A

exacerbations and remissions;

the eyes and mouth

88
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

A

systemic disorder of the skin and mucous membranes

89
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) etiology/associations

A

type IV hypersensitivity reaction induced by drugs (e.g., antibiotics, sulfa drugs, anti-epileptics, allopurinol, NSAIDs, acetaminophen) and infections (e.g., Mycoplasma pneumoniae, HSV, and adenovirus) most commonly

90
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) demographics

A

no predilection

91
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) laterality

92
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) symptoms

A
  • red eyes
  • discharge
  • ocular irritation (e.g., burning, FBS, pain)
  • blurred vision
  • blistering of nose, throat, genitalia
  • red or purplish rash on the body followed by blistering and peeling of the skin
  • fever and flu-like symptoms
93
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) signs

A
  • conjunctival injection
  • mucous discharge
  • keratitis (SPK, pannus)
  • membrane/pseudomembrane
  • conjunctival scarring
  • blistering of other mucous membranes (e.g., nose, throat)
  • red or purplish rash on the body followed by blistering and peeling of the skin
  • fever
94
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) complications

A
  • symblepharon
  • cicatricial entropion
  • trichiasis
  • corneal ulceration
  • corneal opacification (scarring- secondary to cicatricial entropion with trichiasis)
95
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) management

A

-refer to ED: medical emergency, similar ocular treatment as ocular pemphigoid

96
Q

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) pearls:

  • ____ is the more mild form; _____ is the severe form
  • SJS involves _____ body surface area
  • TEN involves _____ body surface area
  • can take _____ to recover, depending on severity
  • mortality rate is ____ in SJS, up to _____ in TEN (due to _____)
A 
SJS;
TEN;
<10%;
>30%;
weeks to months;
10%;
50%;
infection (through open skin sores)
97
Q

pinguecula

A
  • a benign, yellowish raised growth on the conjunctiva
  • composed of an increased amount of distorted elastin fibers (with a degeneration of collagen fibers) in the conj stroma
98
Q

pinguecula etiology/associations

A
  • environment (e.g., sun, wind, dust, sand)

- chronic ocular surface irritation

99
Q

pinguecula demographics

A
  • patients with increased exposure to sun, wind, dust, sand (e.g., construction workers, surfers)
  • patients with chronic ocular surface irritation (e.g., allergies, dry eye)
100
Q

pinguecula laterality

A

bilateral > unilateral

101
Q

pinguecula symptoms

A
  • asymptomatic
  • may notice yellow discoloration
  • ocular irritation (e.g., burning, FBS)
  • ocular itching
102
Q

pinguecula signs

A
  • yellow-white, often triangular, slightly elevated conjunctival lesion adjacent to the nasal or temporal side of the limbus
  • nasal > temporal
  • may be vascularized
  • dellen
103
Q

dellen

A

thinning of the adjacent cornea secondary to drying

104
Q

pinguecula complications

A
  • pingueculitis (inflammation of the pinguecula)

- pterygium

105
Q

pterygium

A
  • extension of fibrovascular tissue onto the corneal epithelium
  • typically extends from a pinguecula
  • can induce irregular astigmatism
  • may extend into the visual axis
106
Q

pinguecula management

A
  • UV protection
  • topical lubrication
  • if pingueculitis, topical steroid
  • if pterygium is affecting vision, refer for surgical excision (may recur after surgery)
107
Q

pinguecula pearls:

-_____ may be seen in the cornea at the leading edge of a pterygium

A

stocker line (an iron line)

108
Q

conjunctivochalasis (redundant conjunctiva)

A

fold of redundant bulbar conjunctiva caused by the breakdown of collagen and elastin

109
Q

conjunctivochalasis (redundant conjunctiva) etiology/associations

A
  • age
  • chronic conjunctivitis
  • SLK
110
Q

conjunctivochalasis (redundant conjunctiva) demographics

A

depends on etiology

111
Q

conjunctivochalasis (redundant conjunctiva) laterality

A

unilateral or bilateral

112
Q

conjunctivochalasis (redundant conjunctiva) symptoms

A
  • asymptomatic

- tearing

113
Q

conjunctivochalasis (redundant conjunctiva) signs

A
  • sagging bulbar conjunctiva
  • typically inferior
  • may extend over the lid margin
114
Q

conjunctivochalasis (redundant conjunctiva) complications

A

epiphora (excess tearing due to blockage of inferior punctum)

115
Q

conjunctivochalasis (redundant conjunctiva) management

A
  • no treatment necessary if asymptomatic

- if epiphora, refer for surgical conjunctival resection

116
Q

concretion

A
  • yellow-white deposit embedded in the palpebral and forniceal conjuntiva
  • composed of protein and degenerated conjunctival epithelial cells that often undergo calcification
117
Q

concretion etiology/associations

A
  • age

- chronic conjunctivitis

118
Q

concretion demographics

A

depends on etiology

119
Q

concretion laterality

A

unilateral or bilateral

120
Q

concretion symptoms

A
  • asymptomatic

- FBS

121
Q

concretion signs

A
  • small, yellow-white deposits in the palpebral and forniceal conj
  • inferior > superior
  • typically embedded in the stroma but may erode through the epithelium
122
Q

concretion management

A
  • no treatment necessary if asymptomatic

- if symptomatic, remove with a small gauge needle under topical anesthesia

123
Q

conjunctival retention cyst (inclusion cyst)

A

thin-walled, fluid-filled cyst of the conjunctiva

124
Q

conjunctival retention cyst (inclusion cyst) etiology/associations

A
  • typically occurs as a result of trauma (e.g., surgery, eye rubbing) or chronic ocular inflammation (e.g., dry eye, allergies)
  • conjunctival cells become reorganized forming pockets in which extracellular fluid can collect
125
Q

conjunctival retention cyst (inclusion cyst) demographics

A

depends on etiology

126
Q

conjunctival retention cyst (inclusion cyst) laterality

A

unilateral or bilateral

127
Q

conjunctival retention cyst (inclusion cyst) symptoms

A
  • asymptomatic

- FBS

128
Q

conjunctival retention cyst (inclusion cyst) signs

A
  • translucent fluid-filled cyst

- typically in the inferior fornix

129
Q

conjunctival retention cyst (inclusion cyst) management

A
  • no treatment necessary if asymptomatic
  • if symptomatic, drain cyst with simple puncture with small gauge needle under topical anesthesia; may recur if cystic wall remains intact; for larger cysts or cysts that recur, surgical excision
130
Q

conjunctival retention cyst (inclusion cyst) pearls:

-similar finding is _____

A

lymphangiectasia:

  • obstruction of bulbar conjunctiva lymphatic vessels
  • appears as a cluster of small cysts like “string of pearls”
  • often resolve spontaneously; if no resolution and symptomatic, similar treatment as retention cyst
131
Q

pyogenic granuloma (lobular capillary hemangioma)

A

vascular lesion composed of endothelial cells of budding capillaries and inflammatory cells (polymorphonuclear lymphocytes and fibroblasts)

132
Q

pyogenic granuloma (lobular capillary hemangioma) etiology/associations

A

-thought to occur as an abnormal reaction to wound healing- occurs in areas of prior trauma, chalazion, hordeolum

133
Q

pyogenic granuloma (lobular capillary hemangioma) demographics

A

no predilection

134
Q

pyogenic granuloma (lobular capillary hemangioma) laterality

A

unilateral

135
Q

pyogenic granuloma (lobular capillary hemangioma) symptoms

A
  • asymptomatic
  • rapidly growing, red growth on eye
  • ocular irritation (e.g., FBS, dryness)
136
Q

pyogenic granuloma (lobular capillary hemangioma) signs

A

vascularized, pedunculated lesion that bleeds easily

137
Q

pyogenic granuloma (lobular capillary hemangioma) management

A
  • topical steroid qid x1-2 weeks

- if no response to steroids, surgical excision; may recur after surgery

138
Q

pyogenic granuloma (lobular capillary hemangioma) pearls:

  • name of lesion is a ______
  • can also occur _____
A

misnomer- it is not pyogenic (relating to pus), it is not a granuloma (mass of chronically inflamed tissue);
on the skin

139
Q

conjunctival papilloma

A

benign tumor of the conjunctival epithelium

140
Q

conjunctival papilloma etiology/associations

A
  • proliferation of epithelial cells overlying a vascular core
  • may be a response to viral infection (most commonly HPV)
141
Q

conjunctival papilloma demographics

A
  • if associated with HPV, children and young adults are most commonly affected
  • if non-viral, most commonly occurs in the elderly
142
Q

conjunctival papilloma laterality

A

unilateral

143
Q

conjunctival papilloma symptoms

A
  • asymptomatic
  • growth on eye
  • FBS
144
Q

conjunctival papilloma signs

A
  • sessile or pedunculated lesion with a fibrovascular core

- often pink and spongy looking

145
Q

conjunctival papilloma management

A
  • may resolve spontaneously (more common with viral etiology)
  • if symptomatic or suspicion for malignancy, refer out: surgical excision often with cryotherapy, adjunctive topical interferon alpha-2b or topical mitomyucin C or 5-fluorouracil to reduce recurrence
146
Q

conjunctival papilloma pearls:

-if it occurs in the elderly, consider _____

A

squamous cell carcinoma

147
Q

limbal dermoid

A

benign tumor at the limbus

148
Q

limbal dermoid etiology

A
  • choristoma (normal tissue in an abnormal location) consisting of skin elements (stratified squamous epithelium, dense connective tissue, pilosebaceous units)
  • congenital
  • may be associated with Goldenhar syndrome (very rare developmental problem that affects half the face)
149
Q

limbal dermoid laterality

A

unilateral or bilateral

150
Q

limbal dermoid symptoms

A
  • asymptomatic
  • growth on eye
  • FBS
151
Q

limbal dermoid signs

A
  • smooth, white, solid lesion at the limbus (typically IT limbus)
  • irregular astigmatism
  • egg type appearance
152
Q

limbal dermoid complications

A
  • refractive amblyopia

- dellen

153
Q

limbal dermoid management

A
  • topical lubricant
  • periodic removal of cilia
  • correct the refractive error
  • if symptomatic, refer out for surgical excision
154
Q

limbal dermoid pearls:

-may enlarge, especially during _____

155
Q

conjunctival epithelial melanosis (racial melanosis)

A

excess pigmentation within the conjunctival epithelium

156
Q

conjunctival epithelial melanosis (racial melanosis) etiology/associations

A

excess melanin related to race

157
Q

conjunctival epithelial melanosis (racial melanosis) demographics

A
  • apparent during 1st few years of life; may become more pronounced during puberty
  • more common in dark-skinned individuals
158
Q

conjunctival epithelial melanosis (racial melanosis) laterality

A

bilateral > unilateral

159
Q

conjunctival epithelial melanosis (racial melanosis) symptoms

A
  • asymptomatic

- visible discoloration of the conjunctiva

160
Q

conjunctival epithelial melanosis (racial melanosis) sigsn

A
  • brown, flat, patchy, pigmentation scattered diffusely over the conj
  • often concentrated around the limbus and Axenfeld loops
161
Q

conjunctival epithelial melanosis (racial melanosis) management

162
Q

conjunctival epithelial melanosis (racial melanosis) pearls:

-similar finding is _____

A

primary acquired melanosis (PAM):

  • typically occurs between 45-65 yoa
  • flat brown patches of pigmentation w/o cysts
  • more common in Caucasians
  • unilateral
  • may extend onto cornea
  • ~10-30% develop into melanoma; suspect malignant transformation with elevation, increase in vascularity, size of > 2 clock hours
163
Q

conjunctival nevus

A

benign tumor of the conjunctival epithelium

164
Q

conjunctival nevus etiology/associations

A

proliferation of melanocytes

165
Q

conjunctival nevus demographics

A
  • often appear during puberty

- more common in Caucasians

166
Q

conjunctival nevus laterality

A

unilateral or bilateral

167
Q

conjunctival nevus symptoms

A
  • asymptomatic

- visible discoloration of the conjunctiva

168
Q

conjunctival nevus signs

A
  • yellow to brown, flat or slightly elevated, circumscribed lesion; may be amelanotic
  • typically in the interpalpebral region near the limbus
  • often contains small cysts within the lesion
169
Q

conjunctival nevus complications

A

malignant potential:

  • most important sign is documented growth (however, may increase in size during puberty)
  • risk is <1%
170
Q

conjunctival nevus management

A
  • monitor for melanoma: SL exam, ASeg photos

- if change occurs, refer out

171
Q

conjunctival melanoma

A

malignant tumor of the conjunctiva

172
Q

conjunctival melanoma etiology

A
  • proliferation of atypical melanocytes

- arise from PAM (70%), nevus (20%), de novo (10%)

173
Q

conjunctival melanoma demographics

A
  • typically occurs between the ages of 45-65

- more common in Caucasians

174
Q

conjunctival melanoma laterality

A

unilateral

175
Q

conjunctival melanoma symptoms

A
  • asymptomatic

- visible spot or discoloration of the conjunctiva or enlargement of a preexisting conjunctival lesion

176
Q

conjunctival melanoma signs

A
  • yellow to brown, elevated lesion with indistinct margins and irregular pigmentation; may be amelanotic
  • well vascularized
  • may extend onto the cornea
177
Q

conjunctival melanoma complications

A
  • intraocular and orbital invasion

- metastasis; risk is 25%; mortality rate is 12% at 5 years and 25% at 10 years

178
Q

conjunctival melanoma management

A

-refer out: surgical excision often with cryotherapy

179
Q

ocular surface squamous neoplasia (OSSN)

A
  • conjunctival-corneal intraepithelial neoplasia (CIN): pre-malignant tumor of the conjunctival and/or corneal epithelium
  • carcinoma in situ: pre-malignant tumor of the conjunctival and/or corneal epithelium
  • squamous cell carcinoma (SCC): malignant tumor of the conjunctiva and/or cornea
180
Q

ocular surface squamous neoplasia (OSSN) etiology/associations

A
  • proliferation of atypical epithelial cells of the conjunctiva and/or cornea
  • CIN: confined to basal epithelial layers
  • carcinoma in situ: involving the entire epithelial layer
  • SCC: involving the entire epithelial layer and extending into stroma
181
Q

ocular surface squamous neoplasia (OSSN) demographics

A
  • typically occurs between ages of 50-70; suspect immunosuppression in patients <50
  • more common in Caucasians
  • men > women
182
Q

ocular surface squamous neoplasia (OSSN) laterality

A

unilateral

183
Q

ocular surface squamous neoplasia (OSSN) symptoms

A
  • asymptomatic
  • growth on eye
  • ocular irritation (e.g., FBS, dryness)
184
Q

ocular surface squamous neoplasia (OSSN) signs

A
  • elevated lesion that appears gelatinous, leukoplakic, or papillomatous
  • varies in color from pearly gray to reddish brown
  • typically begins at the limbus in the interpalpebral region
  • may extend onto the cornea; appears waxy and scalloped
  • well vascularized
185
Q

ocular surface squamous neoplasia (OSSN) complications

A
  • CIN and carcinoma in situ: malignant potential

- SCC: intraocular and orbital invasion; metastasis (risk is <1%)

186
Q

ocular surface squamous neoplasia (OSSN) management

A

-refer out: surgical excision often with cryotherapy; adjunctive topical interferon alpha-2b or topical mitomycin C or 5-fluorouracil to reduce recurrence

187
Q

ocular surface squamous neoplasia (OSSN) pearls:

-_____ is the most common conjunctival malignancy

Anterior Segment Disease (22 decks)

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