Conjunctiva Flashcards
What are the different types of discharge in conjunctival inflammation and its causes
Watery discharge: acute viral/ acute allergic conjunctivitis
Mucoid discharge:
chronic allergic conjunctivitis and dry eyes
Mucopurulent discharge:
Acute bacteria or chlamydial infections
Severe Purulent discharge:
Gonococcal infections
Name the types of bacterial conjunctivitis
acute bacterial conjunctivitis
adult chlamydial conjunctivities
Trachoma
Ophthalmia neonatorum
What are the symptoms of acute bacterial conjunctivitis
- acute onset of redness, grittiness, burning, and discharge
- involvement usually bilateral, one eye 1-2D earlier
- on waking, eyelids frequently stuck tgt n difficult to open
What are the signs of acute bacterial conjunctivitis
- diffuse conjunctival redness and intense papillary reaction over tarsal plates
- mucopurulent discharge
- corneal staining is common
What is the management of acute bacterial conjunctivitis
- usually self-limiting, resolve within 5d w/o treatment
- refer to Gp for antibiotics (eye drops/ ointment) to speed up recovery
What is the cause of adult chlamydial conjunctivitis
oculogenital infection caused by C.trachomatis (serotype D-K)
transmission is by autoinoculation frm gential secretions, eye-eye spread for 10% of cases
What are the signs of adult chlamydial conjunctivitis
- watery or mucopurulent discharge
- prominent large fllicles in inferior fornix
- tender preauricular lymphadenopathy
- peripheral subepithelia corneal infiltrates may appear 2-3 weeks after onset of conjunctivitis
What is the mangament for adult chlamydial conjunctivitis
- refer to opthalmologist for topical antibiotics therapy
- patient will be referred to genitourinary clinic for STD investigation and treatment
What is the cause of trachoma
- Serotypes A-C of C. trachomatic
- Intial infection is self-limitng and resolves without scarring, but repeated infection can lead to blindness (leading cause of preventable irreversible blindness)
- Fly is a common vector of transmission (associated with poverty, overcrowding, poor hygiene)
What is the mangament for trachoma
- prevention by regular face washing and control of flies by spraying
- systemic antibiotic treatment
What is the cause of ophthalmia neonatorum
develops wiithin 2wk of birth as the result of infection transmitted frm mother to infant during delivery
What is the prophylaxis ( treatment given to prevent this) of ophthalmia neonatorum
Povidone- iodine 2.5%, single application at birth
What the mangaement of ophthalmia neonatorum
- oral, intravenous and topical ointment antibiotic
- if chlamydial/ gonorrhoea is confirmed, parents n partners must be investigated n treated by genitourinary specialist
What are the two causes of viral conjunctivitis
Adenoviral conjunctivitis
Molluscum contagiosum conjunctivitis
Why is adenoviral keratoconjunctivitis occur in epidemics in hospitals, schools and factories?
As the spread of infection is by the ability of virus to survive on dry surfaces, and the fact that viral shedding occurs 4-10 days before the clinical disease is apparent
What are the signs of adenoviral keratoconjunctivitis
- Watery discharge, redness. and photophobia
- becomes bilateral 1-2 days later
- eyelid oedema
- tedner pre-auricular lymphadenopathy
- Keratitis is characterised by epithelial microcysts, punctate epithelial keratitis and subepithelial/ anterior stromal infiltrates
What is the mangament for adenoviral keratoconjunctivitis
- refer to ophthalmologist/ GP
- treat conjunctivitis symptomatically w artifical tears and cold compresses until spontaneous resolution in 3wks
- For keratitis, refer to ophthalmologist fortopical steroidal traetment (supresses corneal inflammation only)
What is the cause of molluscum contagiosum conjunctivitis
Molluscum contagiosum conjunctivitis at lid margin shed poxvirus to cause conjunctivitis
What are the signs of molluscum contagiosum conjunctivitis
- presence of molluscum contagiosum
- follicular conjunctivitis and mild musucs discharge
What is the mangament of molluscum contagiosum conjunctivitis
- lesions are self-limiting and removal of lesion only necessary for cosmetic reasons or secondary conjunctivitis
What are the types of allergic conjunctivitis
- acute allergic conjunctivitis
Seasonal/ perennial allergic conjunctivitis
Atopic conjunctivitis
vernal conjunctivitis
Giant papillary conjunctivitis
What is atopy
genetically determined predisposition to hypersensitivity reactions upon exposure to specfic environmental antigens
What is the presentation of acute allergic conjunctivitis
- acute itchin, watering and sever chemosis (swelling of eyelid tissue)
What is the cause of acute allergic conjunctivitis
reaction to environmental allergen
What is the mangement of acute allergic conjunctivitis
- treatment usually not required
- resolves within hours
- Cool compress and 0.1% adrenaline may reduce severe chemosis
What is the cause of seasonal allergic conjunctivitis (hay fever eyes)
onset during spring and summer dur to freq. allergens including trees and grass pollens
What is the cause of Perennial allergic conjunctivtis
- throughout the year, exacertbation in the autumn when exposed to house dust mites, animal dander and fungal allergens
What is the difference of perennial vs seasonal allergic conjunctivitis
timing of exacerbations due to the different stimulating allergens in each
what is the presentation of seasonal/ perennial allergic conjunctivitis
redness, watering, itching, associated with sneezing and nasal discharge
What are the signgs of seasonal/ perennial allergic conjunctivitis
- lid oedema
- chemosis and mild papillary reaction
- conjunctival hyperaemia
What is the management for seasonal/ perennial allergic conjunctivitis
- artifical tears for mild symptoms
- mast cell stabilisers
- topical antihistamines for symptomatic relief
- refer for severe symptoms (oral antihistamines that may cause drowsiness)
- steroidal therapy
What is the most common group of vernal keratoconjunctivitis
- VKC is a bilateralm recurrent disorde that primarilly affects boys from age 5 onwards, 95% remit by late teens, while remainder mainly develop atopic keratoconjunctivitis
What are the symptoms of vernal keratoconjunctivitis
- intense itching, lacrimation, photophobia, foregin body sensation, burning and thick mucoid discharge
- increased blinking is common
What is the classification of vernal keratoconjunctivitis
- palpebral disease (upper tarsal conjunctiva, significant cornea disease)
- limbal disease (affect black/ asian patients)
- Mixed (both limbal and palpebral)
What are th signs of palpebral disease in VKC
- conjunctival hyperaemia
- diffuse papillary hypertrophy of superior tarsus
- macro/ giant papillae with mucus deposition
What are the signs of limbal disease in VKC
- gelatinous papillae on limbal conjunctiva that may apically located white cellular colletions
- more sever in tropical regions
What is the keratopathy in VKC
- punctate epithelial erosions, epithelial macroerosions, ulcers
What is the cause of atopic keratoconjunctivitis
develops in young adults following a long history of ezema
What are the signs of atopic keratoconjunctivitis
eyelids: erythma, dryness, scaliness and thickening
conjunctiva: papillary conjunctivitis where giant papillae may develope with time
cornea: punctate epithelial erosions over inferior third of cornea are common
What is the mangament of atopic/ vernal keratoconjunctivitis
- avoid allergen, do compresses, lid hygiene
- refer to ophthalmologist
- mast cell stabilisers reduce freq. of exacerbations
- antihistamines for acute exacerbations, not for long term use
- steroidal therapy for severe exacerbations of conjunctivitis and significant keratopathy
- immune modulators
What is the cause of giant papillary conjunctivitis
associated w/ a variety of mechanical stimuli of the tarsal conjunctiva
What are the symptoms of giant papillary conjunctivitis
- foreign body sensation
- redness
- itching
- blurring
- loss of contact lens tolerance
What are the signs of giant papillary conjunctivitis
- excessive mobility of contact lens with upper lid attachment
- increased muscus production and coating of CL
- micropapillae and eventual macropapillae on superior tarsal conjunctiva
What is the management of giant papillary conjunctivitis
- removal of stimulus aka stopping lens wear
- ensure effective cleaning of CL or prosthesis (daily lenses/ rigid lens wear)
Treatment
- non- preserved mast cell stabilisers for soft lens users
- antihistamines, topical steroids, NSAIDs, combination drugs may be beneficial
name the types of degenerations of the conjunctiva
- pinguecula
- pterygium
- concretions
- retention cysts
What are the signs of pinguecula
yellow- white deposits on the bulbar conjunctiva adjacent to the nasal or temporal limbus
what is the managment of pinguecula
- monitor with artifical tears if patient is symptomatic due to tear film evaporation form uneven conjunctiva
- refer for steroidal treatment if it become acutely inflamed (pingueculitis)
What is pterygium and in which type of condition is it mostly seen
Triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus onto the cornea
develops in hot climates, represent response to chronic surface dryness and UV exposure
What are the clinical features of pterygium
Type 1: extends less than 2mm onto cornea
Type 2: Involve up to 4mm of the cornea
Type 3: invade more than 4mm of cornea and involve visual axis
What is the managment of pterygium
- artifical tears for symptomatic relief
- refer for topical steroid inflammation, if any
- advise sunglasses wear to decrease UV exposure and growth
- refer for surgical excision for type 2 n 3 lesions
What are the signs of concretions (associated with aging)
Small, often multiple yellow-white deposits most commonly seen in the inferior tarsal and forniceal conjunctiva
What is the managment for concretions
- treatment no necessary if asymptomatic
- refer for removal if a large concretion erodes thorugh epithelium and cuase irritation
What are retention cysts
Thin walled lesion containing clear fluid or occasionally turbid fluid
What is the management of retention cysts
Simple puncture with needle if necessary
Name the benigh lesion/ tumours
Lesion:
- epithelial melanosis
Tumours”
- conjunctival naevous
- conjunctival papilloma
What is conjunctival epithelial melanosis
benign condition due to increased melanin production often seen in dark skinnes individuals
Presentation is during first few years of life and melanosis becomes static by early childhood
What are the signs of conjunctival naevus
- solitary unilateral, discrete, slightly elevated pigmented, intraepithelial bulbar lesion, most freq in the juxtalimbal area
- children and adolescents, lesion may become pink n congested
What are the causes of conjunctival papilloma
infections with human papillomavrius (HPV)
may occur by mother to infant transmission at birth thourgh infected birth canal
What are the signs of conjunctival papilloma
sessile or predunculated lesions freq. located in the juxtalimbal area, caruncle or fornix
What is the mangement of conjunctival papilloma
- small lesions may not require treatment as often resolve spontaneously
- refer large lesions for exicision biopsy or cryotheraphy
Name the malignant/ premaglignan epibulbar tumours
Primary acquired melanosis (PAM)
Melanoma
what is the group that will usually get primary acquired melanosis
white individuals with pale skin
after 45 years of age
What are the signs of primary acquired melanosis
Irregular, unifocal or multifocal areas of flat, golden brown- dark chocolate pigmentation which may involve any part of the conjunctiva
What is the mangament of primary acquired melanosis
refer patients with suspected lesions for biopsy and investigations
What is the classification of melanoma
- Melonoma arising from PAM with atypia (75%)
- melanoma arising from pre-exisiting naevus (20%)
- Primary melanoma (least common)
What are the signs of melanoma
- melanoma arising from a pre-existing naevus: black or grey nodule containg dilated feeder vessels often at limbus, which may become fixed to episclera
- amelanotic tumours are pink and have a characteritic, smooth, fish-flesh appearance
What is the managment of melanoma
refer urgently as mortaility rate is 12% at 5 yr and 25% at 10 yrs
