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)
2
Q
Degenerative changes at conjunctiva
A
- pinguecula
- pterygium
- concretions
- conjunctivochalasis
- retention cyst
- trauma
3
Q
Types of conjunctivitis
A
- bacterial
- viral
- allergic
- cicatrizing
- other
4
Q
Different types of lesions in conjunctiva
A
- congenital
- inflammation
- degeneration
- dystrophy
- neoplasia
5
Q
What is chroristoma
A
- congenital anomaly
- normal, mature tissue at abnormal location
- dermoid
6
Q
What is a hamartoma
A
- congenital abnormality
- exaggerated hypertrophy and hyperplasia of mature tissue at a normal location
- haemangioma
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
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
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
10
Q
Conjunctival intraepithelial neoplasia treatment
A
Adjunctive therapy
- mitomycin C
- interferon
Excision with clear margins
Cryotherapy
11
Q
What is melanosis
A
- excessive pigmentation without an elevated mass
- congenital or acquired
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
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
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
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)
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
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
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
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
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
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
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
What is conjunctivochalasis
- 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
What are concretions
- Signs of chronic MG dysfunction
- symptoms of blepharitis
- multiple small yellow deposits on inferior tarsal conjunctiva
- no treatment necessary
27
Signs of acute inflammation
- rapid onset of redness and irritation
- sloughing of necrotic epithelium
- increased inflammatory cell production
- pseudomembrane
28
Signs of chronic inflammation
- slower onset
- localised nodules and surface infolding
29
Signs of acute conjunctivitis
- Red eye - hyperaemia
- discharge - type dependent on underlying cause
- sticky in morning
- FB sensation but rarely pain
- usually short duration
- follicles
- papillae
30
Signs of bacterial conjunctivitis
- 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
Bacterial conjunctivitis treatment
- topical antibiotics, chloramphenicol, 4x daily for 1 week
- lid hygiene
- cold compress
32
Signs of viral conjunctivitis - adenoviral
- 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
Viral conjunctivitis treatment
- 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
Types of viral conjunctivitis
- herpes simplex
- varicella zoster
- molluscum contagiosum
35
Clinical presentation of herpes simplex conjunctivitis
- 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
Herpes simplex keratitis treatment
- topical antiviral therapy - aciclovir
- cold compress
37
Clinical presentation of herpes zoster (shingles)
- 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
Herpes zoster treatment
- oral antiviral agent in presence of skin lesion
- topical aciclovir not effective - good penetration with oral agents
- cold compress
- lubrication
39
What is molluscum contagiosum
- 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
What is allergic conjunctivitis
- 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
Allergic conjunctivitis symptoms/signs
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
Allergic conjunctivitis differential diagnosis
- blepharitis
- contact allergy
- infectious conjunctivitis
- other forms of allergic conjunctivitis
- trauma
- cellulitis
43
Allergic conjunctivitis management
- avoid inciting agent
- cold compress
- artificial tears
- anti-allergy drops: antihistamine/mast cell stabiliser/combination drop
- NSAIDS
- mild topical steroid - FML
- oral antihistamine
44
Atopic keratoconjunctivitis signs/symptoms
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
Atopic keratoconjuctivitis management
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
Vernal keratoconjunctivitis clinical presentation
- 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
Vernal keratoconjunctivitis signs/symptoms
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
Vernal keratoconjunctivitis management
- 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
What is acute chlamydial conjunctivitis
- sexually transmitted disease
- chlamydia trachomatis D to K
- young
- other concomitant infections
- 1 week incubation
- follicular conjunctivitis
- similar to adenoviral but becomes chronic
50
Neonatal Chlamydial Conjunctivitis
- notifiable disease
- most common cause neonatal conjunctivitis
- presentation 1-3 weeks after birth
- mucopurlent discharge
- papillary conjunctivitis - infants unable to form follicles
51
What is cicatrical pemphigoid
- 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
What is Steven Johnson syndrome, and its symptoms and treatment
- 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
Signs/symptoms of conjunctival laceration
- 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
