Conjunctiva

Question 1

Conjunctiva parts

Answer 1

1. Palpebral - adhered to tarsal plate
2. Forniceal - conjunctiva fold, covering posterior eyelid and anterior eyeball
3. Bulbar - thinnest. fused with sclera and Tenon’s capsule at limbus

Question 2

Conjunctiva nerve supply

Answer 2

Mostly CNV1 (via long ciliary nerve, a branch of nasociliary nerve)
But inferior part is CNV2 (via infraorbital nerve)

Question 3

Bacterial conjunctivitis presentation

Answer 3

• unilateral then bilateral
• red, lid oedema, sticky eyes, purulent discharge
  If neisseria gonorrhoea -> lymphadenopathy!

Question 4

Bacterial conjunctivits pathogens

Answer 4

Strep pneumoniea
Staph aureus
Haemophilus influenza
Neisseria gonorrhoea (hyperacute and lymphadenopathy)

Question 5

Bacterial conjunctivits mx

Answer 5

self limiting
topical chloramphenicol/ fusidic acid

Question 6

Chlamydial conjunctivitis

Answer 6

Serological variants of D-K
subacute but can become chronic
- red eye, mucopurulent discharge, periauricular lymphadenopathy, follicles in inferior fornix
epithelial keratitis
Reiter syndrome (cant see, cant pee, cant climb a tree)
1. conjunctivitis
2. reactive arthritis
3. urethritis

Question 7

Chlamydial conjunctiivitis Ix and Mx

Answer 7

Ix: Giemsa stain, swabs
Mx: doxycycline, or azithromycin

Question 8

Trachoma

Answer 8

Caused by chlamydia trachomatis serology A-C
leading cause of infectious blindness in the world
Transmission - musca sorbens fly

Question 9

Trachoma stages

Answer 9

1. Follicular (TF) - follicles in upper tarsal plat
2. Follicular intense (TI) - upper conjunctiva thickened and obscured blood vessels
3. Scarring (TS) - conjunctival scarring and cicatrical
4. Trichiasis (TT)
5. corneal opacification

Question 10

Trachoma inflammatory phase

Answer 10

Follicular conjunctivitis (follicles in upper eyelid)
Conjunctival vascularisation
Corneal pannus (vessels on cornea)

Question 11

Trachoma chronic cicatricial phase

Answer 11

• Herbert pits (depressions in upper limbus due to folliculitis)
• Conjunctival scarring (Arlt’s line)
• trichiasis

Question 12

Trachoma WHO management

Answer 12

SAFE
- Surgery for trichiasis
- Abx - azithromycin single dose
- Facial cleanliness
- Environmental improvement

Question 13

Ophthalmia neonatorum most common

Answer 13

Chlamydia
mucopurulent discharge, give erythromycin

Question 13

Viran conjunctivitis most common

Answer 13

Adenovirus

Question 14

Pterygium

Answer 14

Bulbar conjunctival degeneration
Starts nasally and invades laterally into the cornea!
RF: UV and ageing
Surgery

Question 14

Allergic conjunctivitis subtypes

Answer 14

1. Seasonal and perennial allergic conjunctivitis
2. Vernal keratoconjunctivitis (VKC)
3. Atopic keratoconjunctivitis (AKC)
4. Giant papillary conjunctivitis

Question 15

Pinguecula

Answer 15

Bulbar conjunctival degeneration
Starts nasally
Risk factors: UV and ageing
NEVER GROWS OVER THE CORNEA

Question 15

Ocular pemphigoid

Answer 15

Type II hypersensitivity reaction
Ig against hemidesmosomes in basement membrane

mx:
mild - dapsone
moderate - mycophenolate, methotrexate, azathioprine
severe - IV methylprednisolone