CONJUNCTIVA Flashcards
1.Classify conjunctivitis
1.On the basis of etiology
MICROBIAL CONJUNCTIVITIS
bacterial
Viral
Chlamydial
Fungal
NON MICROBIAL CONJUNCTIVITIS
Chemical
Autoimmune
Allergic
Toxic
on the basis of exudate
Watery discharge…viral,acute allergic
Mucoid…chronic allergic,KC sicca
Mucopurulent discharge… bacterial Chlamydial
Purulent… gonococcal
_On the basis of conjunctival reaction _
Follicular…viral infection, Chlamydial infection,epinephrine and eserine medication
Papillary…allergic, autoimmune,chronic irritation,chronic blepharitis and atropine medication.
A 19-year-old man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were “stuck together” this morning when he awoke. Examination reveals congested pink palpebral and bulbar conjunctiva; reactive pupils; ; and purulent eye discharge on the right. This presentation is most consistent with:
A…Bacterial conjunctivitis
Treatment…
Irrigation of conjunctiva
Lid hygiene
Topical antibiotics plus polyfax ointment at night.
Note..vision is normal in conjunctivitis unless cornea is involved.
1.What are the features of gonococcal conjunctivitis?
2.What are features of membranous conjunctivitis?
- Caused by neisseria gonorrhea.
Occurs in infants during passage through infected birth canal.
In adults it is sexually transmitted.
Severe discomfort,pain,thick pus leaking from eyes, hyperemia and chemosis of conjunctiva is seen. Corneal ulceration may occur.
Treatment
Hospitalize the patient.
Conjunctival smear for culture and sensitivity.
Irrigation of eyes.
Topical and systemic antibiotics.
- Caused by corynebacterium diphtheria.
Formation of memb. On palpebral and fornix conjunctiva and its removal causes bleeding (true membrane). Also redness of eyes and preauricular lymph nodes are enlarged. Discharge is watery.
Treatment is same as in above plus diphtheria antitoxin is also given.
Qs. A 10 years old boy presents to opd with red eyes, photophobia and watery discharge from his both eyes. He had pharyngitis 1 week ago and fever. Conjunctiva is red,chemosis is present. On tarsal plates you noticed small follicles.
What is your dx?
What is the most common organism responsible?
How would you treat this patient?
2.what are features of herpes simplex conjunctivitis?
- What are features of molluscum contagiosum conjunctivitis?
Ans…dx viral conjunctivitis
Adenovirus is the most common viral cause of conjunctivitis.
Adenovirus causes two conditions
Epidemic keratoconjunctivitis caused by serotypes 8,19 and 37.
Pharyngoconjunctival fever is caused by serotypes 3,4 and 7.
Picornavirus gp member …enterovirus 70 also causes viral conjunctivitis.
Treatment
Spontaneous resolution occurs in 1 to 2 weeks.
Cold water application for soothing effect.
Antivirals are not effective.
Topical antibiotics.
Topical steroids are given if there is decreased visual acuity and discomfort.
In severe cases sub conjunctival hemorrhage and pseudomembrane formation occurs.
2.eyelids show presence of vesicles.
Punctate epithelial keratitis.
Multiple dendrites occur.
Decreased corneal sensation.
Antivirals drugs are given only if corneal involvement occurs.rest of ttt is same as above.
3.pale waxy umbilicated nodule is present.
Mucoid discharge
Follicles form on conjunctiva.
Treatment is surgical excision of lid lesions by cryotherapy,shave excision and cauterization.
1.What are Chlamydial eye diseases?
2.what are stages of trachoma?
3.treatment of trachoma?
4.which serotypes of Chlamydia causes adult inclusion conjunctivitis?
- Trachoma (serotypes A,B,Ba and C)
Adult inclusion conjunctivitis
Neonatal inclusion conjunctivitis
2.Stage 1…immature follicles with punctate epithelial keratitis and minimal symptoms.
Stage 2..watering,photophobia, follicular hyperplasia, papillary hypertrophy , subepithelial corneal vascularization (pannus),corneal ulceration.
Stage 3…stage of scarring
Arlt’s line…linear scarring on tarsal plate
Herbert’s pits…shallow depression at the limbus.
Stage 4…stage of complications opaque cornea and other complications e.g trichiasis,dry eyes, entropion,distichiasis.
Diagnosis…inclusion bodies in giemsa stain, McCoy cell culture.
3.Treatment.. improve hygiene
Topical and systemic Antibiotics(macrolides)
Surgical TTT for complications.
4.serotypes D to K.
- Which type of conjunctivitis occurs a few hours after birth?
2.which conjunctivitis is common after 2 to 4 days / in 1st week of birth?
3.which bacteria cause conjunctivitis within a week?
4.which organism causes conjunctivitis within 1 to 2 weeks after birth?
5.which bacteria causes conjunctivitis within 1 to 3 weeks?
1.silver nitrate causes conjunctivitis after birth that lasts for 24 hours. No TTT required.
- Gonococcal conjunctivitis with purulent discharge.
TTT…benzyle penicillin or gentamicin
3.staphlococcus
TTT..topical neomycin
Systemic cefotaxime.
4.HSV
Topical and systemic antivirals.
Topical antibiotics.
5.chlamydia is m.c cause of neonatal conjunctivitis. It rarely causes corneal opacity.
TTT…topical tetracycline and systemic macrolides.
A 12 year old child comes to opd with severe itching and watering of eyes that started yesterday when he was playing outside in the park. You noticed chemosis in his conjunctiva. What is your dx? How would you proceed?
- Acute allergic conjunctivitis.(Type 1 HSR)
TTT…Cold compresses
,topical antihistamines
Topical adrenaline to control chemosis
Mast cell stabilizers.
1.Seasonal allergic conjunctivitis/hay fever occurs during spring or summer and is associated with______.
2.In perennial allergic conjunctivitis symptoms occur_____.
3.vernal keratoconjunctivitis/spring catarrh is which type of HSR?
4.what are the features of vernal keratoconjunctivitis?
5.How would you treat vernal keratoconjunctivitis?
- Allergic rhinitis.
2.throughout the year. Allergens are house dust,animal dander and fungus.
3.type 4 HSR.
Lacrimation, photophobia, burning,foreign body sensation, large papillae resembling cobblestones which may coalesce to form giant papillae, ropy secretion
gelatinous papillae and trantas dots at limbus
and punctate epithelial erosions and ulceration with keratoconus occurs in vernal keratoconjunctivitis.
5.Treatment
Avoid exposure to allergens.
Cold compresses.
Mast cell stabilizers.
Antihistamines and NSAIDS
Acetyl cysteine to control the mucus.
A 25 year old girl presented with complaints of lacrimation, irritation and itching. On examination you noticed a nodule with white centre surrounded by erythema and hyperemia of conjunctiva on bulbar conjunctiva. There is pain, photophobia and blepharospasm for last 4 days. What is your dx?
How would you treat this ?
- Phlyctenular keratoconjunctivitis (Type 4 HSR).
The nodule is formed due to antigen antibody reaction due to staphylococcal or tuberculoproteins.
Treatment
Topical steroids
Topical antibiotics
- What is the Difference bw pterygium and pseudo pterygium?
2.whatvare stages of pterygium?
- Treatment of pterygium?
- What is pinguecula?
1.pterygium
Degenerative process occurs on nasal side mostly.
occurs in elderly due to hot and dry climate and UV radiation.
Can be progressive, stationary or regressive.
Probe cannot be passed underneath.
pseudo pterygium
inflammatory process.
Can Occur at any age.
Stationary
Probe can be passed underneath.
2.stages of pterygium
Stage 1…extends less than 2mm over the cornea.
Stage 2…extends upto 4mm over the cornea.
Stage 3…extends more than 4 mm of cornea.
3.artificial Tears
Topical steroids
Sunglasses
surgical…bare sclera technique
Conjunctival flap excision
4.pinguecula is yellowish white slightly elevated oval shaped mass on either side of cornea. It is non vascularized. Calcification is present.
- What are signs of vitamin A deficiency?
- What are signs of hypervitaminosis A?
- Define following gradings of xerophthalmia:
XN
X1A
X1B
X2
X3A
X3B
XS
XF
4.What is the treatment of vit A deficiency?
1.xerosis
Bitot spots (foamy keratinized epithelium… triangular patches)
Punctate epithelial erosions
Yellow white dots in peripheral fundus.
2.benign intracranial hypertension
Yellow discoloration of skin and conjunctiva.
Skeletal pain
3.night blindness
Conjunctivitis xerosis
Bitot spots
Corneal xerosis
Corneal ulcer <1/3 of cornea
Corneal ulcer> 1/3 of cornea
Corneal scarring
Xerophthalmia fundus
4.Treatment
Artificial tears
Topical retinoids
Treat corneal ulcer and perforation
Oral vitamin A is recommended.sometimes IM injection is given.
Grading of trachoma
Define the following grades of trachoma
TF
T1
TS
TT
CO
Trachoma follicles five or more
Trachomatous inflammation diffuse
Trachomatous scarring
Trachomatous trichiasis
Corneal opacity
