Conj disease Flashcards
What is a conjunctival cyst?
= inclusion/retention cyst
- fluid filled sac
potential symptoms of conjunctival cyst?
irritation
What are concretions?
mucous secretions + epithelial cells + calcium
another name for conj concretions?
ocular lithiasis
When do you treat conj concretions?
if bothersome or stain, can remove
What is a conj nevus?
proliferation of melanocytes
when does a conj nevus develop?
puberty/ early adulthood
by 20s
can increase in size during puberty
what are characteristics for a conj nevus?
What is diagnostic for conj nevus?
unilateral, usually only one
mobile
30% non-pigmented
INCLUSION CYST inside
what is the most common location for a conj cyst?
juxtalimbal > plica/caruncle
what are melanosomes?
organelle in melanocytes
- contains melanin
what type of cancer can conj nevus cause?
melanoma
What is primary acquired melanosis?
unilateral (usually flat) acquired pigment with indistinct margins
What is PAM a precursor to?
Malignant melanoma - 30% of patients (biopsy)
NOTE: usually benign
what are signs that PAM is melanoma?
nodular
increased vascularity
increased growth
*** does not have to be pigmented
Who gets conj melanomas?
50 year old white people
- hx of PAM (75%)
- nevus (30%)
What is the most important prognostic indicator for malignancy in a conj melanoma?
thickness
What is the most common site for metastasis for a conj melanoma?
liver
What is the most common conjunctival neoplasia in the US?
CIN - conjunctival intraepithelial Neoplasia
what are other names for CIN?
Bowen’s disease
conjunctival squamous dysplasia
What is CIN?
unilateral, pre-malignant condition that can progress to squamous cell carcinoma
what is the risk of CIN progressing to a cancerous lesion?
low - because the basement membrane is usually intact.
what are risk factors for developing cancer from CIN?
UV-B light
smoking
exposure to petroleum derivatives
fair skin
xanthoderma pigmentosa
HIV
HPV
How do you distinguish benign vs malignant/pre-malignant lesions?
toluidine blue 0.05%
What is Conjunctival squamous cell carcinoma? who gets it? located? cause? diagnositc?
rare, slow - growing malignant tumor.
white old males
limbus, can involve adjacent cornea
seen at limbus
CIN, UV radiation, HPV
usually has a feeder vessel
what is pyogenic granuloma
pedunculate, benign, red, vascular lesion of the conj
what causes pyogenic granuloma
trauma
sx
chalazion
CHRONIC IRRITATION
what is Conjunctival ganuloma?
inflamed area in the con storm secondary to a foreign body, surgery trauma, infection or systemic condition (sarcoid)
what infection can cause a conj granuloma?
Parinaud’s oculoglandular syndrome
How do you treat conjunctival granuloma?
steroids
Types of bacterial conjunctivitis?
- simple bacterial conjunctivitis
- gonococcal conjunctivitis
What gets simple bacterial conjunctivitis?
kids
Common causes of simple bacterial conjunctivitis
- kids
- adults
- worldwide
kids: H influenzae (gram -)
adults: S epi and S aureus
worldwide - S. aureus (b/c of high association with blepharitis)
Signs and symptoms of simple bacterial conjunctivitis
- acute onset (starts one eye then moves to the other)***contagious
- know the hour it began
- eyelids stuck together in morning
(discharge - first serous then mucopurulent) - papillae
what conditions cause papillae?
pABillae + friction
- allergic, bacterial
Treatment for simple bacterial conjunctivitis?
polytrim
- usually resolve un 10-14 days without treatment
How do you differentiate staph from other bacterias ?
staph A++
- catalase +
- coagulase +
What is chocolate agar used for?
N: nestle : N. gonorrhea - gram (-) diplococci
H: Hershey: H. influenzae - gram (-)
what bacterial can invade the epithelium?
CNHL
C- Corneum bacteria
N- N.gonorrhea
H-H. influenze
L - Listeria
who gets gonococcal conjunctivitis?
young adults - STD
- have multiple sexual partners
infants (as travel through the birth canal)
what is another name for chocolate agar?
Thayer-martin afar
Signs and symptoms of gonococcal conjunctivitis?
” gonorrhea -> diarrhea” - severe purulent discharge (wipe and back)
- sudden onset - minute it began
-hyperacute - (starts one eye, then spreads)
- swollen pre-auricular nodes
- conj chemosis, pseudomembrane , 4+ papillae, tender/swollen lids
in severe cases corneal ulcers
What are systemic signs to ask for/ look for if suspect gonococcal conjunctivitis?
purulent urethral discharge (seen in men> females)
look for associated chlamydial infection *** always do testing for both If suspect one.
How do you treat gonococcal conjunctivitis?
gram (-) Antibiotic
- ie. use Ceftriaxone (3rd gen) > cephalexin (first gen)
what bacterial infection causes conjunctivitis + pseudomembrane + pre-auricular lymphadenopathy?
gonorrhea
** note also usually seen in viral infections
What are the most common viral conjunctivitis?
Adenoviral
molluscum
HSV/ HZV
Who gets adenovirus conjunctivitis?
adults > kids (ie. 40 year old with pink eye + follicles)
- who have a hx of illness (upper respiratory trace infections or nasal mucosal infections)
- those who have been around someone with an illness (ie. transmission happens from direct contact)
***respiratory/ocular secretion contact, contaminated towels, bedsheets, pillowcases
How long is the adenoviral conjunctivitis contagious for?
12-14 days
What are the 3 adenoviral syndromes? serotypes? which is the most common? which is the most serious?
- Acute nonspecific (serotypes 1-11,19) *** most common
- EKC = epidemic keratoconjunctivits (serotypes 3-5, 7) *** most serious
- pharyngoconjunctival fever (PCF) (serotypes 8,19, 37)
what do all adenovirus syndromes present with?
- follicles
- pseudomembrane
- diffuse hyperemia
- hx of systemic viral infection (can be 3 weeks ago)
*** Note: pre-auricular nodes and pseudomembrane only seen in EKC
Acute non-specific conjunctivitis signs and symptoms, who?
pink eye + follicles + serous tearing
** usually in adults
what conditions cause follicles?
CHAT
C- chlamidiya (inclusion conjunctivitis, trachoma)
H - HSV/HSZ
A - adenoviral
T - toxic (molluscum, allergic, eye drops)
pharyngoconjunctival fever signs and symptoms, who?
kids (swimming pool conjunctivitis)
*** highly contagious, but rare (remember kids usually get bacterial conjunctivitis)
triad: follicles + mild fever + pharyngitis (mild sore throat)
3F’s (fever, follicles, phayangitis)
EKC phases
- symptoms start 8 days after exposure
Phase 1 - week 1&2 : SPK/ superficial keratitis
phase 2 - week 3- SEI (sub- epithelial infiltrates) *** means condition is no longer active ie. contagious
RULE OF 8 - serotype 8 causes, symptoms start after 8 days, SEI after 8 days of onset of symptoms
EKC signs/ symptoms
- follicles
- palpable pre-auricular nodes ** pathognomonic
- pseudomembrane (contains active virus - need to peel)
- severe pain -> due to superficial keratitis (diffuse)
- starts in 1 eye and then spreads to the other eye.
- rapid onset red eye + bearings
Molluscum - who gets it?
Rare - seen in communities with poor hygiene
- usually kids, young adults
pathophys of molluscum? how is it spread?
skin condition (located on lid/lid margin) caused by DNA pox virus
spread by direct contact
what do you worry about with molluscum?
if you see multiple nodules -> consider HIV or other autoimmune conditions
- do western bloct/ Elisa
- CD 4 count <200
if see 1 - not a big deal
signs and symptoms of molluscum?
usually asymptomatic, but may have mild mucous discharge
rupture -> chronic follicle conjuncitivits + superficial panes
HSV presentation
usually see unilateral follicular conjunctivitis + serous discharge
What are the 4 types of allergic disorders affecting the conjunctiva?
- allergic conjunctivitis
- VKC
- AKC
- GPC
What are the 2 categories of allergic conjunctivitis? what are the triggers? what hypersensitivity rxn?
- seasonal (airborne pathogens -pollen - trigger)
- perennial ( household allergens - dust, dander )
*** both are type 1 hypersensitivity rxn ** IgE = Allergy
signs/symptoms of allergic conjunctivitis?
itching, conj chemosis, papillae,
watery discharge
Who gets VKC? how long does it last?
males < 10 yo in hot dry climates, in patients with atopic systemic conditions (eczema, asthma, rhinitis, fam hx of atopy)
2-10 years before resolving by puberty
signs and symptoms of VKC
symptomatic usually during warm months, but can occur all year round
itching, photophobia, thick mucous discharge, bilateral cobblestone papillae Superior lid margin
trantas dots at the limbus
worried about forming shield ulcer
(starts with PEK-> erosion -> plaque + localized ulcer = shield ulcer)
Who gets AKC?
Teens to 40s w/ hx of atopic conditions
ie. atopic dermatitis
what is atopic dermatitis? hallmark signs? complications?
chronic eczema that starts at birth
- rash and itching - hallmark signs
- lead to cataract formation by age 30 and keratoconus, AKC (skin infection that gets into eyes)
what type of hypersensivity rxn is AKC?
type 1 and type 4
