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Clinical Opthalmology > Conjunctiva > Flashcards

Conjunctiva Flashcards

1
Q

Types of conjunctival tumour

A
  • epibulbar dermoid
  • dermolipoma (b)
  • conjunctival cyst
  • naevus (b)
  • papilloma (b)
  • conjunctival squamous carcinoma
  • melanosis oculi
  • malignant melanoma (m)
  • lymphoma
  • kaposi sarcoma (m)
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2
Q

Degenerative changes at conjunctiva

A
  • pinguecula
  • pterygium
  • concretions
  • conjunctivochalasis
  • retention cyst
  • trauma
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3
Q

Types of conjunctivitis

A
  • bacterial
  • viral
  • allergic
  • cicatrizing
  • other
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4
Q

Different types of lesions in conjunctiva

A
  • congenital
  • inflammation
  • degeneration
  • dystrophy
  • neoplasia
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5
Q

What is chroristoma

A
  • congenital anomaly
  • normal, mature tissue at abnormal location
  • dermoid
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6
Q

What is a hamartoma

A
  • congenital abnormality
  • exaggerated hypertrophy and hyperplasia of mature tissue at a normal location
  • haemangioma
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7
Q

What is an epithelial inclusion cyst

A
  • common finding in lower fornix
  • benign
  • form in apposition of conjunctival folds
  • large cysts following burying of epithelium following trauma/surgery/inflammation
  • clear with normal epithelium
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8
Q

What is a conjunctival papilloma, and types of growth

A
  • human papillomavirus initiates neoplastic growth
  • vascular proliferation

Pedunculated growth
- fleshy, exophytic growth from stalk, multiobulated, clear epithelium
- underlying tortuous blood vessels

Sessile growth
- flat, glistening appearance with numerous red spots
- may spread onto cornea
- rarely represents a carcinomatous lesion

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9
Q

What is conjunctival intraepithelial neoplasia, and its appearance

A
  • epithelial basement membrane is not compromised
  • mild/moderate/severe
  • carcinoma in situ when neoplasia throughout
  • Caused by HPV virus or sunlight
  • HIV in young adults

Appearance
- papilliform
- gelatinous
- leukoplakic
- mild inflammation and abnormal vascularisation
- large feeder vessels
- slow growing

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10
Q

Conjunctival intraepithelial neoplasia treatment

A

Adjunctive therapy
- mitomycin C
- interferon
Excision with clear margins
Cryotherapy

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11
Q

What is melanosis

A
  • excessive pigmentation without an elevated mass
  • congenital or acquired
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12
Q

What is benign acquired melanosis

A
  • increasing diffuse pigmentation
  • with age in dark skinned individuals
  • most apparent interpalpebral bulbar conjunctiva and perilimba area
  • possibly related to UV exposure
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13
Q

What is ocular melanocytosis

A
  • congenital melanosis of episclera
  • focal proliferation of subepithelial melanocytes
  • slate grey, non mobile, unilateral lesions
  • may be ipsilateral Naevus of Ota
  • together called oculodermal melanocytosis
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14
Q

What is a conjunctival Naevus

A
  • conjunctival hamartoma
  • junctional, compound or subepithelial
  • flat near limbus
  • elevated elsewhere
  • variable pigmentation
  • small inclusion cysts may be present leading to enlargement
  • Rapid enlargement can occur at puberty
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15
Q

What is primary acquired melanosis

A
  • similar to lentigo maligna on skin
  • abnormal melanocyte proliferation of unclear aetiology
  • unilateral, flat, brown lesions
  • more common in Caucasian population
  • usually benign but may progress to melanoma (suspect with nodularity, enlargement or increased vascularity)
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16
Q

Primary acquired melanosis treatment

A
  • small areas may be observed
  • suspicion and biopsy palpebral or forniceal conjunctiva, plica or caruncle
  • excision biopsy in large progressive lesions
  • clear margins
  • topical mitomycin C or interferon a
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17
Q

Melanoma appearance

A
  • variable pigmentation
  • vascularised
  • nodular appearance
  • invade globe or orbit to metastasise to regional lymph nodes, brain and other sites
  • excision all biopsy with 4mm borders and amniotic membrane graft
  • cryotherapy and mitomycin C
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18
Q

What are lymphoid lesions, and what do they look like

A
  • occur in young to middle age
  • range from benign reactive hyperplasia to lymphoma

Appearance
- light pink, salmon coloured lesion
- relatively flat, smooth and soft
- bulbar conjunctiva -> oval
- fornix conjunctiva -> horizontal

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19
Q

What is kaposi sarcoma, and its treatment

A
  • slow growing malignant tumour associated with aids
  • painless or discomfort
  • vascular -> red or purple
  • inferior fornix

Treatment
- investigation for HIV status
- radiotherapy
- excision

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20
Q

What are choristomas

A

Limbal dermoids
- benign
- located at limbus and can invade cornea
- firm, dome shaped, white elevations
- few mm to 1cm
- occur in isolation or as part of congenital syndrome if bilateral

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21
Q

What is dermolipoma

A
  • benign tumour
  • temporal bulbar conjunctiva
  • yellow-white solid tumour
  • softer than dermoid due to adipose
  • extend posteriorly into orbit
  • avoid treatment due to globe extension
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22
Q

What are pinguecula

A
  • small yellowish/grey nodule nasal or temporal to limbus
  • vascularised or injected
  • degeneration of collagen
  • prolonged sun exposure and increasing age
  • no treatment necessary
23
Q

What are pterygium

A
  • encroach onto cornea in wing like fashion
  • can become inflamed
  • encroach visual axis causing astigmatism and corneal scarring
  • invades bowman’s layer
24
Q

Pterygium treatment

A
  • lubrication
  • mild topical steroid
  • surgical excision
  • risk of recurrence
  • conjunctival autograft
  • fibrin glue
25
Q

What is conjunctivochalasis

A
  • age related degenerative change
  • excess folds of conjunctiva
  • noted inferior fornix
  • may be asymptomatic
  • may complain of irritation, epiphora and dry eye
  • symptomatic treatment
26
Q

What are concretions

A
  • Signs of chronic MG dysfunction
  • symptoms of blepharitis
  • multiple small yellow deposits on inferior tarsal conjunctiva
  • no treatment necessary
27
Q

Signs of acute inflammation

A
  • rapid onset of redness and irritation
  • sloughing of necrotic epithelium
  • increased inflammatory cell production
  • pseudomembrane
28
Q

Signs of chronic inflammation

A
  • slower onset
  • localised nodules and surface infolding
29
Q

Signs of acute conjunctivitis

A
  • Red eye - hyperaemia
  • discharge - type dependent on underlying cause
  • sticky in morning
  • FB sensation but rarely pain
  • usually short duration
  • follicles
  • papillae
30
Q

Signs of bacterial conjunctivitis

A
  • redness
  • pain, FB sensation/grittiness
  • less than 4 week duration
  • less itchy than other types of conjunctivitis
  • purulent discharge
  • sticky, worse in the morning
  • papillae
  • chemosis
31
Q

Bacterial conjunctivitis treatment

A
  • topical antibiotics, chloramphenicol, 4x daily for 1 week
  • lid hygiene
  • cold compress
32
Q

Signs of viral conjunctivitis - adenoviral

A
  • pain (itchy/burning/FB sensation)
  • recent upper respiratory tract infection
  • recent contact with infected person
  • both eyes involved within 1-2 days
  • follicles
  • preauricular lymph nodes
  • watery/mucus discharge
  • red and swollen eyelids
  • pinpoint subconjunctival haemorrhage
33
Q

Viral conjunctivitis treatment

A
  • artificial tears
  • antihistamine drops
  • cold compresses
  • peeling of psuedomembrane if present
  • self limiting
  • advise to possibly stay of work and avoid contact with vulnerable people
34
Q

Types of viral conjunctivitis

A
  • herpes simplex
  • varicella zoster
  • molluscum contagiosum
35
Q

Clinical presentation of herpes simplex conjunctivitis

A
  • history of HSV or cold sore
  • environmental stressors
    • fever, UV, light exposure, stress
  • FB sensation
  • unilateral follicular conjunctivitis
  • herpetic skin lesions along lid or skin
  • preauricular lymph nodes
36
Q

Herpes simplex keratitis treatment

A
  • topical antiviral therapy - aciclovir
  • cold compress
37
Q

Clinical presentation of herpes zoster (shingles)

A
  • skin rash and discomfort
  • headache, fever malaise
  • blurred vision, eye pain, red eye
  • vesicular skin rash, progressing to scarring
  • unilateral, dermatone of fifth cranial nerve
  • Hutchison sign (nose)
38
Q

Herpes zoster treatment

A
  • oral antiviral agent in presence of skin lesion
  • topical aciclovir not effective - good penetration with oral agents
  • cold compress
  • lubrication
39
Q

What is molluscum contagiosum

A
  • oncogenic virus
  • characteristic lesions of skin and mucus membranes
    • dome shaped
    • umbilicated shiny nodules
  • associated follicular conjunctivitis
  • can be associated with HIV
  • treatment - excision of lesion
40
Q

What is allergic conjunctivitis

A
  • hypersensitivity to airborne allergen that enters tear film and comes into contact with conjunctival mast cells
  • can be perennial or seasonal
  • frequently associated with nasal symptoms
  • allergens including pollen, dust, animal hair
  • perennial tends to be less severe
41
Q

Allergic conjunctivitis symptoms/signs

A

Symptoms
- itchy/red/burning
- watery or scant discharge
- symptoms usually mild
- remissions and exacerbations during season
- may be unilateral or bilateral
- nasal discharge

Signs
- mid conjunctival injection and oedema
- papillary hypertrophy possible
- mild lid oedema
- no corneal involvement

42
Q

Allergic conjunctivitis differential diagnosis

A
  • blepharitis
  • contact allergy
  • infectious conjunctivitis
  • other forms of allergic conjunctivitis
  • trauma
  • cellulitis
43
Q

Allergic conjunctivitis management

A
  • avoid inciting agent
  • cold compress
  • artificial tears
  • anti-allergy drops: antihistamine/mast cell stabiliser/combination drop
  • NSAIDS
  • mild topical steroid - FML
  • oral antihistamine
44
Q

Atopic keratoconjunctivitis signs/symptoms

A

Symptoms
- extreme itch
- photophobia
- altered acuity
- redness
- evidence of scratching on face
- mucus discharge causing eyes to be stuck in morning

Signs
- bulbar conjunctiva is erythematous and chemotic
- papillary hypertrophy
- conjunctival scarring
- gelatinous limbo infiltrates
- cornea
- superficial punctate keratopathy
- persistent epithelial defects
- secondary infection and eventual scarring from chronic inflammation.
- red, thickened and swollen lids as a result of atopic dermatitis with superadded infection

45
Q

Atopic keratoconjuctivitis management

A

Aims
- maintain visual acuity
- avoid allergens
- relieve symptoms

  • non pharmacological measures

Topical therapy
- NSAIDs useful in controlling itching
- topical corticosteroids may be necessary at an earlier stage if severe with corneal involvement
- should still be avoided long term

Long term maintenance often enquired
- mast cell stabiliser, sodium cromoglicate
- oral antihistimine

Blepharitis management
- lid hygiene
- topical antibiotic

46
Q

Vernal keratoconjunctivitis clinical presentation

A
  • bilateral, severe, sight threatening allergic conjunctivitis
  • commonly seen in young children and adolescent males
  • lasts up to 10 years
  • most symptomatic during summer/spring
  • some experience symptoms year round requiring maintainence therapy
47
Q

Vernal keratoconjunctivitis signs/symptoms

A

Symptoms
- extreme itching
- redness
- photophobia
- blepharospasm
- altered acuity
- mucus discharge

Signs
- giant papillae on upper tarsal pate
- cobblestone appearance
- pseudomembrane as a result of excess mucus production
- limbal conjunctiva
Corneal changes
- superficial punctate erosions
- trantas dots
- macroerosions
- shield ulcer
- corneal plaque
- corneal neovascularisation

48
Q

Vernal keratoconjunctivitis management

A
  • although severe, its self limiting
  • resolves without scarring
  • non pharmacological measures
  • topical anti-allergy and systemic antihistimine
  • corneal compromise - topical steroids
  • acute episodes - quickly tapered topical steroids usually necessary
  • admission in severe cases not responding to treatment may help with a change in the environment
  • treatment of chronic blepharitis, oral and topical antibiotics and eyelid hygiene
  • occasional bandage contact lens when severe corneal complications are present
49
Q

What is acute chlamydial conjunctivitis

A
  • sexually transmitted disease
  • chlamydia trachomatis D to K
  • young
  • other concomitant infections
  • 1 week incubation
  • follicular conjunctivitis
  • similar to adenoviral but becomes chronic
50
Q

Neonatal Chlamydial Conjunctivitis

A
  • notifiable disease
  • most common cause neonatal conjunctivitis
  • presentation 1-3 weeks after birth
  • mucopurlent discharge
  • papillary conjunctivitis - infants unable to form follicles
51
Q

What is cicatrical pemphigoid

A
  • chronic autoimmune blistering disease
  • predominantly affects mucous membrane membranes
    • mouth, throat, oesophagous, conjunctiva

Patients may present with
- red eye, tearing, dry eye, burning/foreign body sensation
- blepharospasm
- decreased vision, photophobia
- Diplopia

52
Q

What is Steven Johnson syndrome, and its symptoms and treatment

A
  • severe immune mediated hypersensitivity reaction
  • mucocutaneous blistering disease
  • can be caused by drugs, viral infections and malignancies
  • cell death causes separation of the epidermis from the dermis in skin
  • membranous conjunctivitis
  • cicatricial conjunctivitis

Symptoms
- fever
- rash
- malaise
- arthralgia
- red
- dry eyes
- mucopurlent/pseudomembranous
- episcleritis
- iritis

Treatment
- artificial tears
- iritis - topical steroid
- infection - scrape, topical steroid

53
Q

Signs/symptoms of conjunctival laceration

A
  • mild air and red eye
  • fluorescein staining
  • associated with adjacent subconjunctival haemorrhage
  • requires close inspection to exclude scleral injury - beware chemosis
  • usually resolves with lunrication

Clinical Opthalmology (7 decks)

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