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Conjunctiva Flashcards

1
Q

Parts of conjunctiva

A
  1. Palpebral - Orbital, Tarsal, Marginal
  2. Bulbar
  3. Forniceal

Histo:
1.Epithelium

  1. Adenoid layer
  2. Fibrous layer
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2
Q

2 specialised membranes in conjunctiva

A
  1. Pelican semilunaris

2. Caruncle

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3
Q

Cells present in epithelium of conjunctiva

A
  1. Goblet cells
  2. Melanocytes
  3. Langerhan cells
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4
Q

Goblet cells form which part of tear film

A

Mucin layer of tear film

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5
Q

Only part of eye which has LYMPHATIC drainage

A

CONJUNCTIVA

Medial - Submandibular LN

Lateral - Preauricular nd superficial parotid LN

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6
Q

Significance of adenoid layer of conjunctiva

A

It consists of lymphoid tissue which shows follicular reaction.

It develops only after 3 months….so no rn in infants.

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7
Q

Glands seen in conjunctiva

A
  1. Mucin secreting = Goblet cells, Crypts of Henle, Glands of Manz
  2. Accessory lacrimal= Glands of Krause, Glands of Wolfring
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8
Q

Arterial supply of conjunctiva

A

1.Peripheral arterial arcade of eyelid - palpebral nd fornix

2.Marginal arterial arcade—> Post conj A.— bulbar
Anterior ciliary artery —>Ant conj A.—— “

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9
Q

Common symptoms of conjunctivitis

A
  1. Redness
  2. Discharge
  3. FBS
  4. Lacrimation
  5. Itching….mainly in allergic

***If pain nd loss of vision +nt=> corneal involved

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10
Q

Common signs of conjunctivitis

A
  1. Hyperemia
  2. Subconj Hmg
  3. Chemosis
  4. Discharge
  5. Inflammatory rn= papillae or follicles
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11
Q

Coloured halos are seen in?

A
  1. Glaucoma
  2. Cataract
  3. Mucopurulent conjunctivitis
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12
Q

Papillary Follicular

MP 1 2

Watery 3 4

A

1= Bacterial

2= Chlamydial

3= Allergic

4= Viral

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13
Q

MCC of Acute bacterial conjunctivitis

Specific symptoms

A

Staph aureus

Assoc with Mucopurulent discharge nd coloured halos

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14
Q

Epidemics of MP conjunctivitis or Red eye are caused by?

A

Hemophilus influenza or KOCH-WEEKS bacillus

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15
Q

Treatment for Acute conjunctivitis

A

1% chloramphenicol or 0.3%Tobramycin

If not respond - cipro0.3% or moxi0.5%.

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16
Q

Acute purulent or Hyperacute conjunctivitis
Cause?
Symptoms?
Signs?

A

Aka Blenorrhoea
*caused by N.gonorrhoea

Symptoms

  1. Copies purulent discharge
  2. Intense pain***
  3. Stickiness,PP

Signs

  1. Swollen eyelids
  2. Conj-chemosis nd congestion= Bright red velvety*
  3. Pseudomembrane formation freq
  4. Preauricular LA***
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17
Q

Treatment for Acute purulent conjunctivitis

A

1.Systemic - IM ceftriaxone 1g /Norfloxacin 1g for 5 days
+
Erythromycin 500mg or Doxycycline 100mg for 1 week

  1. Topical - ofl/cipro/E ointment init 2hrly later 5/day.
  2. Eye irrigation
  3. Top atropine
  4. T/t partner
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18
Q

MCC of chronic conjunctivitis

Symptoms

A

Staph aureus
Other - proteus,E coli,Klebsiella

  1. Redness
  2. Mucoid discharge @ canthi
  3. Burning sensation
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19
Q

Causes of Acute membranous conjunctivitis

A

Unimmunised child = C.diphtheriae

MCC in adults = Pneumococcus

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20
Q

MCC of Angular conjunctivitis

Other name?

A

Moraxella lacunata (or) Axenfield bacillus

Diplobacillary conjunctivitis

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21
Q

Symptoms of angular conjunctivitis

Signs “ “

A
  1. Redness @ angles
  2. Foamy white discharge @ angles
  3. Irritation
  4. Excoriation of skin @ canthi
  5. Hyperemia of bulbar C @ canthi
  6. Freq assoc with Blepharitis
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22
Q

Treatment for Angular conjunctivitis

A
  1. Tetracycline 1% ointment for 2 weeks

2. Zinc lotion @ day nd ointment @ night

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23
Q

Which Conjunctival diseases are caused by which serovars of Chlamydia?

A
  1. Trachoma by A,B,Ba,C
  2. Ophthalmia neonatorum by D-K
  3. Adult inclusion conjunctivitis by D-K serovars

***MCC of preventable blindness.

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24
Q

Which letter is important in Trachoma?

A

F

Transmission- finger,fly,fomite

Follicular nd Mucopurulent

FISTO-who classification

saFe stately for prevention

25
Q

What are the inclusion bodies associated with Chlamydia trachomatis?

A

HP bodies-Halberstaeder Prowazek

26
Q

What HSN reaction is associated with trachoma?

A

Type IV reaction

Active inflammation nd cicatrisation present together***

27
Q

What are the signs of active trachoma?

A

Conjunctival

  1. Congestion of tarsal nd forniceal C
  2. Sago grain follicles with LEBER cells
  3. Papillary hyperplasia

Corneal

  1. Superf K
  2. Herbert follicles @ limbus
  3. Progressive pannus
  4. Corneal ulcer at edge
28
Q

Difference between Trachoma and other types of follicular conjunctivitis?

A

Presence of leber cells in sago grain follicles and signs of necrosis

1.Adenoviral follicular conjunctivitis-Lower conjunctiva involved nd
No pannus nd papillae

2.Palpebral spring catarrh-cobblestone papilla nd ropy discharge

29
Q

What are the signs of cicatricial trachoma?

A

Conjunctival-scarring,concretions,xerosis,symblepharon
-ARLTs line @ palp c btw up1/3 nd lower2/3
Corneal
1.Herbert pits
2.Regressing pannus
3.Corneal opacity

Lids-Trichiasis,entropion

Lacrimal apparatus- chronic DC

30
Q

What are the 2 classifications of trachoma?

A 
McCallan
I- stage of infiltration 
II-stage of florid infiltration 
III-stage of scarring/cicatrisation 
IV-stage of healing(sequelae)

WHO classification 
TF-follicular 
TI-intense inflammation 
TS-scarring
TT-trichiasis 
TO-opacity
31
Q

Only complication of Trachoma?

A

Corneal ulcer d/t trichiasis

32
Q

Treatment for active Trachoma?(TF and TI)

A

Topical T/E 1% ointment 2/day for 6 weeks
+
Systemic Azithromycin 1g oral single dose

***In pregnancy-azithr is C/I….so use T/E 250mg qid for 3-4 weeks
Or doxy 100mg bid

33
Q

SAFE strategy and what prevention?

A

Surgery for trichiasis and entropion(3^ prevention)

Antibiotics->10% prev =mass therapy (2^)
5-10% prev =Family nd close contacts
<5%=only pt

Facial hygiene (1^)

Environment changes(primordial prevention)

34
Q

What is ophthalmia neonatorum?

A

B/L conjunctivitis in infant < less than 30 days old

35
Q

Is there a follicular response in ophthalmia neonatorum ?

A

Noooo

  1. Pain
  2. Discharge
  3. Swollen lids
  4. Conj symptoms
36
Q

Causes of ophthalmia neonatorum and differentiation based on time?

A
  1. Within 6 hrs………Chemical-AgNO3
  2. 24-48hrs……Gonococcal
  3. 2-5 days……other bact
  4. 5-7 days…….HSV type 2
  5. > 1week……..Chlamydia trachomatis D-K(MCC*)
37
Q

Treatment of neonatal inclusion conjunctivitis?

A

Topical 1%T (or) 0.5%E for 3weeks

38
Q

Treatment for gonococcal ophthalmia neonatorum?

A

1.Topical-saline lavage + penicillin 10’-20’IU every 1min,5min…hrly

2.Systemic-Cetriaxone (or)cipro (or)Benzyl Pn IM 50k for full term
20k IU for premature

39
Q

Types of viral conjunctivitis?

A
  1. Adenoviral Keratoconjunctivitis **MC
  2. Acute hemorrhagic/Apollo KC
  3. Molluscum contagiosum
40
Q

Serovars in Adenoviral KC?

A
  1. EKC- serovars 8,19,37

2. PCF-serovars 3,4,7

41
Q

Causes of acute hemorrhagic KC?

A
  1. Picorna family-EV type 70 , coxsackie A24

2. Adenovirus serotype 11

42
Q

Preauricular lymphadenopathy is seen in which type of conjunctivitis?

A
  1. Adenoviral
  2. Gonococcal
  3. Chlamydial
43
Q

Describe the lesion of molluscum contagiosum

A

U/L,painless nodule with UMBLICATED app

44
Q

Types of allergic conjunctivitis and associated HSN reaction?

A
  1. Simple allergic - type I
  2. Vernal KC aka spring catarrh - type I
  3. Atopic KC - with atopic dermatitis
  4. Giant papillary KC - type IV
  5. Phlyctenular KC - type IV
45
Q

Etiology and pathology of VKC?

A

Etio - B/L,recurrent,MC in young boys…..aka warm weather KC

Path - Multiple papillae in upper tarsal conjunctiva

46
Q

Symptoms of VKC?

A
  1. Intense itching
  2. Vigorous rubbing
  3. Ropy/stringy discharge
  4. Redness and Burning sensation
47
Q

Signs of VKC?

A

Palpebral - Cobblestone (or) pavement stone app of upper tarsal

Bulbar - HORNER TRANTA’s spots @ limbus

Corneal

  1. Punctate epithelial keratitis
  2. Shield ulcer
  3. Pseudogerontoxon with Cupid bow outline
48
Q

DOC for VKC?

A

Olopatadine/Alcaftadine(dual action of mast cell stab nd Anti H)

Other - Top anti inflam, Top lubric nd mucolytics, systemic, t/t large papillae
T/t VK

49
Q

What is the sign for discharge coagulated btw papillae of VKC?

A

Maxwell-Lyon sign

50
Q

Signs seen in Atopic KC?

A

DENNIE MORGAN sign - Extra lid folds

HERTOGHE sign - Loss of lateral eyebrows

51
Q

Size of papilla in Giant papillary C?

And cause of GPC?

A

More than 1 mm

Mechanically induced by

  1. Contact lens
  2. Ocular prosthesis
  3. Protruding sutures
52
Q

Differences between VKC and Phlyctenular KC?

A

VKC Phlyctenular KC

  1. Type I HSN Type IV HSN
  2. Exogenous Ags Endogenous Ags
  3. Bilateral Unilateral
53
Q

HSN to which endogenous proteins is seen in Phlyctenular KV?

A
  1. Staphylococcal *(MC)
  2. Tubercular
  3. Other - moraxella
54
Q

Clinical signs seen in Phlyctenular KC?

A

Phlycten which may ulcerate

  1. Scrofulous ulcer
  2. Fascicular ulcer
  3. Miliary ulcer
55
Q

What is pinguecula?

What is pterygium?

A

Elastotic degeneration of collagen fibers…..precursor

Pterygium is Wing shaped, fibrovascular growth of degenerative and hyperplastic conjunctival tissue over cornea within interpalpebral fissure.

Bowman’s membrane and superficial stroma

Mostly nasal

56
Q

Risk factors for pterygium?

A
  1. Sunlight - UV B rays
  2. Dry, hot climate
  3. Smoking
  4. Hpv infection

*All lead to LSC deficiency.

58
Q

Progressive and regressive pterygium?

A

Progressive - thick,fleshy,vasc with white spots in front of head
known as FUCH spots (or) ISLETS OF VOGT (or) CAP.

Regressive - thin,atrophic,less vasc,no cap but deposition of Fe anterior to
head known as STOCKER’s line.

59
Q

Symptoms and signs of pterygium?

A

Symptoms

  1. Cosmetic intolerance
  2. FBS
  3. Defective vision
  4. Diplopia**

Signs
1.Triangular fold of conj
2.STOCKER’s line
3.Loss of vision d/t astigmatism
Or
Encroach over visual axis

60
Q

Treatment for pterygium?

A

Surgical excision with free conjunctival limbal autograft(CLAU)
Or
Surgical excision with amniotic membrane and topical mitomycin c to prevent recurrences.

Ophtha (4 decks)

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