Conjunctiva And Sclera Flashcards by m f

What is midnit used for? What does it stand for?

-to find origin 
Metabolic 
Inflammation 
Degenerative 
Neoplasm 
Infection 
Trauma

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Conjunctiva is in the inner surfaces of the eyelids and the front surface of the eyeball except

Cornea

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Palpebral conjunctiva

Posterior surface of the eyelids: thicker

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Bulbar conjunctiva

Anterior portion of the eyeball: thinner , goblet cells, palisades of Vogt

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Fornix

Junction of the palpebral and bulbar. The plica takes the place of a fornix nasally. Also included are the caruncle, and plica semilunaris at the medial canthus

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Bulbar conjunctiva is ___ attached to ___ and can become swollen or chemotic

Loosely attached to tenons capsule

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Chemosis is

The swelling of the tissue that lines the eyelids and surface of the eye

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Chemosis can lead to

Poor lid eye contact, desiccation (dryness) of the conjunctiva and dweller

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Dellen is

Thinning of cornea that occurs from dehydration looks like blood or clear fluid build up in conjunctiva

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Palpebral conjunctiva shares blood supply with

Lids

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Bulbar conjunctiva’s blood supply is from

anterior ciliary arteries

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Sensory innervation of conjunctiva

V1 (ophthalmic branch)

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Barrier mechanism of conjunctiva

Microbiologic (pathogens), physical (curl-de-sac)

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What helps protect conjunctiva

Lymphatic tissue, extra tissue and curl-de-sac

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Extensive scarring an contraction of the conjunctiva may lead to

Motility restriction and diplopia

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Pemphigoid

Progressive scarring and shrinkage of the conjunctiva with opacification of the cornea

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Mechanical functions of the conjunctiva

Barrier, lubrication, facilitates eye movement

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The conjunctiva is nutritional metabolic support to adjacent tissues like ___. Because it is __.

The sclera, cornea, iris, and ciliary body.

It is highly vascular and helps non vascularized areas

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When there’s inflammation in the conjunctiva, you will see

VD of superficial vessels, mostly in periphery, away from the limbus

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Inflammation of cornea, iris, and CB: will VD

Deeper vessels, towards the limbus: ciliary flush at the limbus

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What contributes to the episcleral arterial circle

Both the anterior ciliary and long posterior ciliary arteries (anastomosis)

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Blood flow of the conjunctiva

Oscillates rather than flows between rectus muscle insertion sites (stagnation of flow)

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Stagnation of flow of the conjunctiva leads to

Greater risk of inflammatory disease in this region in the patients with autoimmune disease

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Conjunctiva has the small role of maintenance of IOP

Aqueous veins drains from anterior chamber

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Conjunctiva discharge is made of

Exudate, debris, mucus and tears

Serous

Allergic conjunctivitis

Mucoid

VKC and KCS (dry eyes )

Purulent

Severe acute bacterial conjunctivitis

Mucopurulent

Mild bacterial conjunctivitis and chlamydial conjunctivitis

Acute conjunctivitis

Pus and mucus

Exudate

Protein and cells

Inflammation papillae

Dilates, telangiectatic vessels: dot- like changes to enlarged tufts surrounded by edema and cells

Mild papillae

Smooth, velvety appearance

Chronic/progressive papillae

Elevates POLYGONAL, hyperemic mounds, with a central red dot (dilated capillary)

Papillae are associated with

- bacterial/ allergic reactions - chronic blepharitis - floppy eyelid syndrome (sleep apnea) - SLKC ( superior limbic keratoconjunctivitis) - contact lens wear

What are follicles

Focal lymphoid nodule with accessory vascularization, round, or oval clusters of lymphocytes like grains of rice

Small follicles are often visible where

Normal lower fornix

Clusters of enlarged, non inflammed follicles in the inf. Fornix of children and adolescents

Benign lymphoid folliculosis

What is follicular conjunctivitis: Redness and new or enlarged follicles is caused by

CHAT: chlamydia, herpes, adenovirus, toxic Viral & toxic/irritive

Focal or diffuse dilation of the sub-epithelial plexus of conjunctival vessels

Hyperemia

Conjunctival edema caused by transudate from conjunctival capillaries. Often associated with acute allergic conjunctivitis

Chemosis

Laxity of conjunctiva, sometimes with prolapse over the inferior eyelid margin. Often associated with chronic inflammation, blepharitis and dry eye

Chalasis

The 2 mechanisms of chronic epiphora are

- interference with inferior tear meniscus | - occlusion of inferior punctum

Coagulated exudate adhered to inflamed epithelium

Pseudomembrane (inflammation of conjunctiva) Easily peeled off (Adenovirus infection, Steven Johnson syndrome, gonococcal conjunctivitis)

Infiltrate superficial layers of conjunctival epithelium

Membrane (inflammation of conjunctiva) (Diphtheria, beta hemolytic streptococcus) -cannot remove

Conjunctival scarring severity ranges from

Subepithelial fibrosis to symblepharon with eyelid distortion

Chronic inflammation in ocular surface epithelium

Keratinization

Yellow-white, amorphous subepithelial deposits in the inter palpebral zone adjacent to the limbus

Pinguecula

Pinguecula may have recurrent ___.

Inflammation and ocular irritation

Pinguecula treatment

Lubrications therapy or surgical excision

Common degenerative lesion as a result of the effects of UV radiation

Pinguecula

Strongly associated with UV exposure, dryness, inflammation, exposure to wind, dust, or other irritants

Pterygium

Upregulation of cytokines (VEGF), cellular migration and angiogenesis

Petrygium

Wing shaped fold of conjunctival and fibrovascular tissue invades the superficial cornea with destruction of bowmans layer

Pterygium

What is stocker’s line

Iron line at the head if a pterygium seen by cobalt blue light

A connective tissue composed of fibroblasts embedded in an extra cellular matrix (ECM) of collagen and elastics fibers interspersed with several types of peptidoglycans

Sclera

Opaqueness of the sclera is due to

It’s water constant and the less uniform orientation of the collagen fibers

Function of the sclera

Maintains the shape and size of the eye

Sclera is a vascular except for

The superficial vessels of the episclera and the intrascleral vascular plexus

Although the sclera is devoid of innervation it

Allows for the passage of nerves (optic and ciliary nerves )

Episclera vessels attachment to sclera

Firmly attached

A layer of dense vascular connective tissue, superimposed on the sclera and merges with the scleral stroma below

Episclera

Mechanisms of emmetropization include regulation of axial elongation via active control of

- The scleral extracellular matrix | - choroidal thickness

Jaundice is

Yellow conjunctiva and sclera secondary to accumulation of bilirubin

Jaundice can be due to

- liver, gallbladder, or pancreas disease | - infections, drugs, cancer, blood disorders, birth defects

Age elated scleral degeneration

- scleral rigidity increases - scleral hydration decreases + mucopolysaccharide content - subconjunctival deposition of fat gives the sclera a yellow color - calcium plaques are visible as ovoid or rectangular zones of grayish transluncency surface

Scleritis is caused by

Immune mediated vasculitis - frequently leads to destruction of the sclera.

Treatment of scleritis

Systemic corticosteroids and immunosuppressants

Episclera this treatment

Resolves spontaneously. Topical or oral nonsteroidal anti inflammatory drugs (NSAIDS) may be prescribed for pain

Chieftain complain of Episcleritis

Ocular redness and mild tenderness, typically in only one sector of the globe. Pain worsens by palpating of the globe

Episcleritis is

Common, self limited, generally benign inflammation of the episcleral tissues. It can be diffuse or nodular