AED - Conjunctival Degeneration - Week 4 Flashcards
Describe the SOAP mnemonic.
Subjective (symptoms
Objective (signs)
Assessment (DDx)
Plan (Mx)
Where are goblet cells located?
Just inferior to the forniceal conjunctiva on the bulbar conjunctiva
List three structures that secrete mucin.
Goblet cells
Crypts of henle
Glands of menz
List two basal lacrimal secretors.
Glands of krause
Glands of wolfring
Where are glands of krause located?
At the forniceal conjunctiva
Where are glands of manz located?
Inferior to goblet cells on the bulbar conjunctiva
Where are crpyts of henle found?
Inferior to the glands of wolfring, on the palpebral conjunctiva close to the tarsal plate
What is a sign of pingueculum? What does it look like?
A triangle with the base at the limbus, yellowish mass. Looks like a gelatinous deposit
Are pingueculae raised or flat?
Slightly raised
Are pingueculae common or rare? Are they uni- or bilateral?
Very common and generally bilateral
List 3 symptoms of pingueculae.
Usually asymptomatic
Foreign body sensation if inflammed
Cosmetically unappealing
List the three components for a pingueculum workup.
Slit lamp
Fluorescein staining
Tear workup if symptomatic
Do pingueculae affect visiond?
No
Are pingueculae vascularised? Explain (2).
Not vascular but can be hyperaemic if inflammed.
Which of the following are thought to be a possible cause of pingueculae?
Family history
Sun exposure
Age
Racial background
Family history only
The rest are not significant
What is the histopathology of pingueculae (4)?
Elastotic degeneration of collagen
Hyalinisation of the conjunctival stroma
Collection of elastotic fibres
Granular deposits
List 4 differential diagnoses for pingueculae.
Pterygium
Conjunctival intraepithelial neoplasia
Other tumours (papilloma)
Limbal dermoid
List 3 treatment options for pingueculae (no severe inflammation).
Vasoconstrictors to reduce redness [note: “vasoconstrictors useless in chronic patients” - Darryl
Ocular lubricants and cold compresses if foreign body sensation is felt
List two treatment options for pingueculae with severe inflammation.
NSAIDs or topical steroids
What should be done if dellen persists in pingueculae?
Refer for cosmetic surgery
What are two ways pingueculae can be removed?
Excision surgery - excision with the conjunctiva
Argon laser - photocoagulation
List1 3 signs of pterygium.
A vascular triangular mass ith the base to the conjunctiva
Slowly advancing to the central cornea
Increasing astigmatism
Are pterygia vascular?
Yesd
Are pterygia uni- or bilateral?
Often bilateral
Are pterygia generally nasal or temporal?
Generally nasal
What is Stocker’s line? What is it caused by?
An orange-brown line at the leading edge of pterygia caused by iron deposits
Aside from Stocker’s line, what can be seen at the leading edge of pterygia?
An opaque epithelium
List three symptoms of pterygia.
Foreign body sensation
Dryness
Reduction in vision if encroaching on the visual axes/increasing cyl
What can pterygia rarely cause?
Diplopia
List 4 differential diagnoses for pterygia.
Pingueculum
Pannus
Conjunctival intraepithelial neoplasm
Other tumours
List the 5 components for pterygia assessment.
Slit lamp
Keratometry/topography
Fluorescein staining
Tear workup if indicated
Grading scale (efron)
List 3 treatment options for pterygium (no severe inflammation).
Vasoconstrictors to reduce redness? (not if chronic)
Ocular lubricants for ocular irritation and corneal signs
List two treatment options for pterygium with severe inflammation.
NSAIDs or topical steroids
In what 5 cases would pterygia be referred for surgery?
Rapid advancement
Chronic irritation
Diplopia
Marked effect on vision
Cosmesis concern
What is the histopathology of pterygia (3)?
Activated fibroblasts in the leading edge invade and fragment bowman’s layer as well as a variable amount of the superficial corneal stroma
What does pterygium development resemble histologically?
Actinic degeneration of the skin
What does the follow-up of pterygium depend on (3)?
Rate of progression
If stable, review in 1-2 years
If progressive or new patient, review in 3-6 months
What should be advised for patients with pterygium?
UV protection
Can pterygium recur following surgical removal?
Yesd
What is the standard surgical removal for pterygia?
Bare scleral resection
What is the recurrence rate for standard surgical removal of pterygia? What about adjunctive treatments?
Bare scleral resection - up to 80%
Adjuncts - <10%
What colour are concretions?
Yellow-white
How big are concretions?
<1mm but up to 4mm
What are concretions?
Deposits in the palpebral conjunctival epithelium
In which age group are concretions common in?
The elderly
What are concretions composed of (3)?
Mucin
Necrotic cells
Eosinophilic proteins
What may concretions be associated with (2)?
Chronic conjunctivitis
Contact lens wear
What additional cyst may be seen with concretions?
A clear cyst
List 2 symptoms of concretions.
Generally asymptomatic
May have a gritty foreign body sensation
List the to components for a concretion assessment.
Slit lamp
Fluorescein staining for erosion