Conjunctiva Disease

Question 1

Where are conjunctiva cysts more likely seen?

Answer 1

Allergic patients

NOTE: separation btwn epithelium & substantia propria

Question 2

What is Dx for conjunctival nevus?

Answer 2

Inclusion cysts

Question 3

Where is the most common location of conjunctival nevus?

Answer 3

Juxtalimbal area, followed by the plica and caruncle

Question 4

What are 2 pre-cancerous findings on the conjunctiva?

Answer 4

1. Primary acquired melanosis

2. Conjunctival Intraepithelial Neoplasia (CIN)

Question 5

• Elderly
• Caucasian
• Flat lesion w indistinct margins
• Benign but premalignant potential (30% to melanoma)

Answer 5

Primary Acquired Melanosis (PAM)

NOTE: INC vascularity &/or INC growth are MOST suspect for malignancy

Question 6

• Secondary to uncontrolled proliferation of melanocytes
• Caucasians (50-70 years old)
• Most commonly from PAM 50-75%
• Less common from pre-existing nevus (33%)
• Most important prognostic indicator for progression is thickness
• Most common site of metastasis is LIVER

Answer 6

Conjunctival Melanoma

Question 7

What is the most common conj malignancy in the US?

Answer 7

Conjunctival Intraepithelial Neoplasia (CIN)

AKA Bowen’s disease OR conj squamous dysplasia

NOTE: progresses to SCC (low risk bc basement membrane MOST often remains intact)

Question 8

RF for CIN?

Answer 8

1. UV-B
2. Smoking
3. Petroleum derivatives
4. Fair skin
5. Xeroderma pigmentosa
6. HIV/HPV

Question 9

• Lids stuck in AM
• Mucopurulent discharge
• Subsides in 10 to 14 days
• Papillae OU

Answer 9

Bacterial Conjunctivitis

Question 10

• Hyperacute onset
• (+) Thayer-Martin Agar
• (+) PAL
• Pseudomembranes
• Papillae
• Severe purulent discharge

Answer 10

Gonococcal (Neisseria) Conjunctivitis

NOTE: check for chlamydia co-infection

Question 11

• URI
• Direct contact
• Highly contagious
• Diffuse red eye
• Follicles

Answer 11

Adenoviral Conjunctivitis

Question 12

Most common adenoviral conjunctivitis?

Answer 12

Acute non-specific (1-11, 19)

Question 13

Adenovirus 3-5, 7 causes acute follicular conjunctivitis + low grade fever + pharyngitis in what disease?

Answer 13

Pharyngealconjunctival Fever

Question 14

Adenovirus 8, 19, 37 causes pain + corneal involvement (Rule of 8’s) in which disease?

Answer 14

Epidemic keratoconjunctivitis (EKC)

Rule of 8’s: S/S occur 8 days after exposure, followed by 8 days of SEI’s (central, non-contagious)