Conjunctiva

Question 1

Type of epithelium in conjunctiva?

Answer 1

nonkeratinized stratified squamous, with goblet cells

Question 2

Where are conjunctival goblet cells most prevalent?

Answer 2

fornices and plica semilunaris

Question 3

Conjunctival tissue that contains sebaceous gland and hair follicles?

Answer 3

caruncle

Question 4

Examples of choristomas

Answer 4

limbal dermoid, dermatolipoma, ectopic lacrimal gland

Question 5

Dome-shaped, white-yellow papule straddling limbus? Most common location?

Answer 5

demoid. inferotemporal

Question 6

Hallmarks of Goldenhar syndrome?

Answer 6

(oculoauriculovertebral dysgenesis): epibulbar dermoid, upper eyelid coloboma, preauricular skin tags, vertebral anomalies

Question 7

Infoldings of conjunctiva with abundant goblet cells?

Answer 7

pseudoglands of Henle

Question 8

Soft, yellow conjunctival lesion found commonly in superotemporal quadrant?

Answer 8

liopdermoid (dermatolipoma)

Question 9

Most common type of conjunctival hamartoma?

Answer 9

capillary hemangioma

Question 10

Causes, clinical appearance, and histology of papillae v follicles

Answer 10

Papillae: allergic, bacterial, foreign body. Cobblestone arrangement of red-topped, clear-based flattened nodules on the tarsal surface of upper eyelid. Closely-packed, flat-topped projections with a central vascular core

Follicles: viruses, atypical bacteria, toxic (esp brimonidine). Small, dome-shaped nodules with clear top and red base, without central vessel, often at inferior palpebral conj and fornices. Subepithelial germinal centers of lympoid aggregates.

Question 11

Causes of preauricular lymphadenopathy and granulomatous conjunctivitis?

Answer 11

(Parinaud oculoglandular syndrome) bartonella (cat scratch), tularemia, mycobacteria, treponemes

Question 12

Most common causes of infectious conjunctivitis in children? In adults?

Answer 12

bacteria (H. flu, S. pneumo)

viruses (adenovirus, HSV, VZV)

Question 13

conjunctival biopsy showing multinucleated giant cells as well as scattered material highlighted by polarized light?

Answer 13

foreign body conjunctivitis

Question 14

Serotypes of Chlamydia trachomatis associated w/ trachoma? With inlcusion conjunctivitis?

Answer 14

A, B, C

D-K

Question 15

Biopsy of chronically scarred-appearing conjunctival tissue shows bullae of the epithelium and subepithelial cells. What two media should the specimen have been sent in? What is the diagnosis? What will tissue analysis show?

Answer 15

Formalin for routine histology and Michel medium for immunohistochemistry. Ocular cicatricial pemphigoid. immunoglobulin and/or C3 in epithelial basement membrane.

Question 16

Histology, patient population, and viral causes of pedunculated v sessile papilloma?

Answer 16

Pedunculated: exophytic, red, papillary growths consisting of fibrovascualr fronds covered by hyperplastic epithelium. Occur more commonly in kids and are associated with HPV subtypes 6 and 11. Exhibit benign behavior

Sessile: arise from bulbar conj (esp limbus), broad-based papilloma without fingerlike projections. Possibly malignant signs are leukoplakia and inflammation. More common in adults and associated with HPV subtypes 16 and 18

Question 17

Where do ocular seurface squamous neoplasias usually occur?

Answer 17

Over areas of solar elastosis (near limbus, maybe over pre-existing pinguecula)

Question 18

Limbal lesion in 50 year-old farmer with prominent corkscrew vascular pattern, feeder vessels, and leukoplakia? What will pathology look like?

Answer 18

OSSN. Hyperplastic epithelium with surface keratinization and loss of goblet cells; varying degrees of nuclear changes and varying depths of involvement; chronic inflammation in substantia propria. If invades past basement membrane, considered invasive SCC

Question 19

Conjunctival lesion with epithelial inclusion cysts and melanocytes exhibiting a nested pattern? Location and clinical course?

Answer 19

Melanocytic nevus. Appear in youth, grow in puberty, occur on bulbar conj.

Question 20

Unilateral slate gray subconjunctival lesion with iris heterochromia in dark skinned individual? At risk for what additional pathology?

Answer 20

Ocular melanocytosis. Called nevus of Ota, or oculodermal melanocytosis, when periocular skin is involved.
Uveal melanoma and secondary glaucoma.

Question 21

Indications for biopsy of PAM?

Answer 21

3 or more clock hours of size or location in fornix, caruncle, or palpebral conj

Question 22

Percentage of conjunctival melanomas that arrive from PAM?

Answer 22

50-70% (rest from nevus or de novo)

Question 23

Unfavorable prognostic factors in conjunctival melanoma?

Answer 23

non epibulbar location, greater thickness, scleral invasion, positive margins after excision

Question 24

Type of metastatic spread of conj. melanoma?

Answer 24

lymphatics: preauricular, submandibular, or cervical

Question 25

50 yo light-skinned patient with new unilateral pigmented conjunctival lesion?

Answer 25

PAM

Question 26

Salmon patch on bulbar conj, histology reveals normal appearing lympoid follicles with well-defined germinal centers

Answer 26

benign lymphoid hyperplasia

Question 27

Salmon patch on forniceal conj, histology reveals sheets of lymphocytes without well-defined follicles

Answer 27

conjunctival lymphoma

Question 28

Most common type of conjunctival lymphoma?

Answer 28

extranodal marginal zone lymphoma

Question 29

Percentage of patients with conjunctival lymphoma that have systemic lymphoma? Percentage in lymphoma of preseptal skin?

Answer 29

33%

67%

Question 30

Treatment if conjunctival lymphoma with and without systemic involvement?

Answer 30

With: chemo
Without: orbital radiation

Question 31

Benign proliferation of apocrine or accessory lacrimal gland epithelium in caruncle?

Answer 31

oncocytoma