Conjunctiva Flashcards
Types of discharge in different types of conjunctivitis
B – bacteria – Purulent
C – chlamydial – mucopurulent
B – viral – watery
E – allergic – watery
Main pathology of conjunctivitis
Follicular and papillary
Membranous conjunctivitis features
All common features (the 5) + inflammatory membrane formation
Cause of membranous conjunctivitis
Corynebacterium diphtheria
Characteristic of true membrane
True membrane bleeds on peeling
Pseudomembranous conjunctivitis
All features +membrane formation(Does not bleed on peeling)
Aetiology of pseudomembranous conjunctivitis
- mild diphtheria
- streptococcus haemolytic us
- severe Adenoviral infection
Other causes of pseudomembranous conjunctivitis
1.gonococcal
To.Staphylococcus aureus
3.HSV
4.chemical irritant
Causes of angular conjunctivitis
- moraxella axenfeld
- moraxella laumata
- moraxella catarrhalis
Staphylococcus aureus
Treatment of angular conjunctivitis
- antibiotic eyedrops
2. zinc oxide which is an inhibitor of proteolytic enzymes. (For excoriation )
Features of haemorrhagic conjunctivitis
All features + subconjunctival haemorrhage
Aetiology of haemorrhagic conjunctivitis
Bacteria – pneumococcal us, haemophilus Viral 1.enterovirus – 70 2.adenovirus 3.coxsackievirus-24 4.echo virus – 34
Causes of subconjunctival haemorrhage
- trauma
- hypertension
- bleeding diatheses
- haemorrhage and conjunctivitis
- pertusis(whooping cough)
- passive venous congestion
What is strains cause trachoma
Chlamydia trachomatis
A, B, Ba,C
What do you strains D to K cause
Adult inclusion conjunctivitis
Swimming pool conjunctivitis
Clinical features of trachoma
Intense itching and watering
Characteristic features on examination in trachoma
On palpable conjunctiva – Sago Grain like follicles, arlt’s line
Around the cornea – Herbert follicles, Herbert pits
WHO classification Of trachoma
F – I – follicles I – II – inflammatory S –III– scarring T – IV-Trichiasis O– V– corneal opacity
Complication of trachoma
Corneal ulcer
Two main pathologies or off trachoma
Follicular + papillary reaction
Intra cytoplasmic inclusion body– Halbertsteiater prowasele
SAFE strategy
WHO programme to control trachoma S – surgery A – antibiotics F – facial hygiene E – environmental cleanliness
Indication of starting SAFE strategy
Prevalence of trachoma Follicles In 1 to 9 years of age is more than 10%
What is the strategy when the prevalence is 5 to 10% among children
Just FE
What is the strategy if the prevalence of trachoma in children is less than 5%
Nothing under the programme
What is the drug of choice for blanket therapy
Azithromycin
What are the diseases covered by a vision 2020 India
4+3
- cataract
- trachoma
- childhood blindness
- refractive error
- diabetic retinopathy
- glaucoma
- corneal blindness
Drug of choice for trachoma
Azithromycin
Treatment of trachoma
As it through Meissen
- Tetracycline
- Sulphacetamide Eyedrops
- Broad-spectrum antibiotics
Causes of phlyctenular conjunctivitis
Staphylococcus aureus
Tuberculosis
Pathology of phlyctenular keratoconjunctivitus
Type 4 hypersensitivity
Examination feature of phlyctenular keratoconjunctivitis
Fascicular ulcer
Phlycten
Ring ulcer
Conjunctival congestion
Treatment of phlyctenular keratoconjunctivitis
Anti allergic- olopatadine,epimastine
^^ dual action of
Antihistamine
Mast cell stabiliser
Mild steroid - fluoromethalone
Vernon keratoconjunctivitis AKA
Spring Catarrh
Aetiology of vernal keratoconjunctivitis
- Allergy to exogenous- dust,pollen
- in summers
- male children
- no follicles
Discharge in vernal keratoconjunctivitis
Ropy discharge
Examinational feature of vernal keratoconjunctivitis
Epithelial hyperplasia- cobblestone
Cupid’s bow/pseudogerontoxon
Horner trantas spots-aggregation of eosinophils
Maxwell lyon sign
Presence of eosinophils in ropy discharge
What is shield ulcer
Epithelial micro erosion which
Macro erosion
Fibrin and mucus gets deposited on this
Pathology of vernal keratoconjunctivitis
Type 1 hypersensitivity
Ophthalmia neonatorum
What age
Less than 1 months
MC aetiology of ophthalmia neonatorum
Chlamydia
Most dangerous etiologyof ophthalmia neonatorum
Gonorrhoea
Why? Leads to corneal perforation
Crede’s method of prevention
1 % AgNO3 to prevent gonorrhoeal conjunctivitis
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Trachoma
Burns
Steven Johnson syndrome
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Which is more dangerous
acid or alkali type of burn?
Alkali is more dangerous as it can penetrate the cornea and go inside whereas the acid coagulates the protein forming a layer
Causes of epithelial conjunctivital xerosis
Xerophthalmia (vit A deficiency)
Causes of parenchymatous conjunctival xerosis
Steven Johnson syndrome
Burns
Trachoma
Xerophthalmia stages
XN- night blindness (earliest)
XIa- conjunctival xerosis
XIb- bitots spot
XII- corneal xerosis
XIIIa- keratomalacia (less than 1/3rd)
XIIIb- keratomalacia (more than 1/3rd)
XS- xerophthalmic scarring
XF- fundus (white spotted fundus)
Dose of vitamin A
Above 1 yr - 1 lakh unit (0,1,14th day)
Less than 1 yr - half the dose
What is pterygium
Subconjunctival fibrovascular tissue encroaching the cornea
NOT inflammatory
To prevent recurrence of pterygium what to do
Mitomycin C
Autografting
PERFECT surgery
Pterygium extended resection followed by extended conjunctival transplantation
What is pseudopterygium
Any scar tissue that resembles pterygium
How to differentiate between pterygium and pseudopterygium
Glass rod test
Passes under the tissue in pseudopterygium
Does not for pterygium
What are the different iron deposition in the eye called
Stockers line
Ferry’s line
Hudson stahli line
Flescher’s ring
Know where they are found 🙈
What is pinguecula
Elastotic degeneration of conjunctiva and hyaline infiltration
Consist of fat,protein and calcium
Most common site of pterygium
Nasal part of eye
What eye conditions do UV-B rays cause
Pterygium
Pinguecula
Snow-blindness/photophthalmia
What is photoretinitis
Injury by infrared rays
Directly looking at the solar eclipse with unaided eye
C/F- macular burn—> macular scar
Layers of tear film
Secreted by
Functions
Lipid layer (meibomian gland) Prevents evaporation
Aqueous layer (lacrimal gland) Lubrication
Mucin layer (goblet cells) Helps to spread tear
Where is the maximum density of goblet cells
Inferonasal quadrant
What is dry eye
Deficiency of any three layer
What is keratoconjunctivitis sicca
Deficiency of aqueous layer
Primary Sjögren’s syndrome
keratoconjunctivitis (dry eye) + dry mouth (xerostomia)
Secondary Sjögren’s syndrome
KCS (dry eye)+ dry mouth + RA/connective tissue disorders
Schirmers test
Tear slip on lower lid for 5 min
Less than 5 mm wetting- severe dry eye
Phenol red thread test
Put on lower lid for 15 sec
Less than 9 mm change to red colour then dry eye
Tear break up time test
If absence of mucin layer
Time from last blink to first dry spot on cornea
Less than 10 sec - severe dry eye
What does rose Bengal stain
Stains dead cells and mucus
Medical and surgical management of dry eye
Medical-lubricating eye drops
Surgical - lacrimal punctual occlusion (silicone plug)
Causes of nyctalopia
Xerophthalmia
Retinitis pigmentosa
High myopia
Late stage of POAG
Congenital stationary night blindness causes
Find us albipunctatus
(NB+ white spotted fundus)
Oguchi’s disease
(NB+ pale fundus)
Mizous phenomenon
Choroidal dystrophy
Choroideremia
Gyrate atrophy
Cause of choroidal dystrophies
Deficiency of enzyme ornithine aminotransferase
Mizous phenomenon
Feature of oguchi’s disease
1 hr in the dark there is no Night blindness and fundus is normal
Cause: overestimation of rods
Causes of hamarlopia
Central corneal opacity
Central lenticular opacity
Congenital absence of cones
