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Conjunctiva Pathologies Flashcards

(90 cards)

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1
Q

Pinguecula: Aetiology (5)

A

Benign degenerative lesion on the conjunctiva

Horizontally situated at the limbus

Degeneration of collagen fibres in the stroma of the conjunctiva

Overlying epithelium thins

Can occasionally calcify

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2
Q

Pinguecula: Predisposing Factors (4)

A

Age - especially 70+

Long term UV exposure (surfers eye, outdoor work & occupational exposure)

Male

Chronic irritation from wind and dust

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3
Q

Pinguecula: Signs (7)

A

Off-white raised area of conjunctival thickening

Adjacent to limbus

Limited to palpebral aperture at 3&9 o’clock positions

Usually bilateral

Can become inflamed - surrounding conjunctiva can be more hyperaemic

Lid vaulting can cause dellen at adjacent corneal margin

Reduced TBUT

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4
Q

Pinguecula: Symptoms (4)

A

Asymptomatic

Cosmetically concerning

Foreign body sensation

CL intolerance

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5
Q

Pinguecula: Grading (3)

A

Grade 0 = no pinguecula

Grade 1 = mild/moderate - yellow/white flat or slightly raised and no bigger than 5mm

Grade 2 = severe - highly vascularised & elevated or larger than 5mm

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6
Q

Pinguecula: Differential diagnosis (3)

A

Pterygium

Squamous neoplasia

Epithelial inclusion cyst

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7
Q

Pinguecula: Management (3)

A

UV protection - close fit sunnies & wide brim hat

Reassurance

Cold compress if inflamed (IP optoms can prescribe topical steroids to reduce this short term)

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8
Q

Pinguecula: Referral (2)

A

Routine

Removal rarely required - mostly cosmetic reasons

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9
Q

Pinguecula: Contact Lens Implications (2)

A

Ensure CL edge does not aggravate lesion (consider smaller or larger diameter)

Consider ocular lubricants

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10
Q

Pterygia: Aetiology (2)

A

Thick fibrovascular growth from bulbar conjunctiva

Likely from chronic irritation

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11
Q

Pterygia: Predisposing factors (4)

A

Advancing age

Male

Prolonged UV exposure

Dry environment

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12
Q

Pterygia: Signs (8)

A

Bilateral

Usually located nasally

Slow growth onto cornea (can cease progression)

Disruption of Bowman’s and stromal layers

Neovascularisation overlying

Corneal flattening along horizontal meridian

May intrude visual axis and cover pupil

In advance cases, iron deposits can be seen

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13
Q

Pterygia: Symptoms (6)

A

Asymptomatic

Cosmetically concerning

Mild irritation

With the rule astigmatism changes

Visual blur as it encroaches visual axis

Contact lens intolerance

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14
Q

Pterygia: Grading (3)

A

Measure lesion encroaching cornea in mm

Always note changes

Use Efron grading 0-4 to show any inflammation

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15
Q

Pterygia: Differential diagnosis (2)

A

Squamous neoplasia

Pannus - flat focal opacification caused by superficial vascular invasion of the cornea

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16
Q

Pterygia: Management (4)

A

UV protection; Close fitting sunglasses & wide brim hat

UV protection cL may offer some protection

Cold compress if inflamed (IP can offer topical steroids to reduce inflammation short term)

Ocular lubricants (day drops & night gel)

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17
Q

Pterygia: Referral (5)

A

Routine

If threatens visual axis

Induced irregular astigmatism (not 90 to one another)

Regular incidence of inflammation

Cosmetically concerning

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18
Q

Pterygia: Contact Lens Implications (2)

A

Comsider smaller or larger diameter to ensure edge does not aggravate

Ocular lubricants to support wear

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19
Q

Sub Conjunctival Haemorrhage: Aetiology (3)

A

Usually spontaneous

Valsalva manoeuvre causing sudden increase in blood pressure. Eg sneezing, straining and child birth

Following eye surgery or trauma

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20
Q

Sub Conjunctival Haemorrhage: Predisposing Factors (7)

A

Hypertension

Advance age

Medication such as blood thinners or topical steroids

Excessive eye rubbing

Recent trauma

Blood clotting issues

Previous history of subconj haems

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21
Q

Sub Conjunctival Haemorrhage: Signs (5)

A

Bright red eye

Usually sectoral and inferior

Blood beneath conjunctiva

Limited to fornix border (able to see white around fornix if patient looks up/down and lid is moved) IF NOT consider retrobulbar haemorrhage

Usually unilateral

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22
Q

Sub Conjunctival Haemorrhage: Symptoms (3)

A

Asymptomatic

Cosmetically concerning

Can experience bruised sensation but no pain

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23
Q

Sub Conjunctival Haemorrhage: Grading (4)

A

Record position and extent (diagram is good)

Specifically note is white posterior border at fornix can be seen

Record timeline of incident and previous occurrences

Any verbal advise given MUST be noted

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24
Q

Sub Conjunctival Haemorrhage: Differential Diagnosis (3)

A

Retrobulbar/intra cranial haemorrhage

Conjunctival squamous neoplasms

Trauma

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25
Sub Conjunctival Haemorrhage: Management (3)
Reassurance - usually clears in a week like a bruise Cold compress Patient to return is reoccurs or does not resolve
26
Sub Conjunctival Haemorrhage: Referral (3)
Routine GP to measure blood pressure if reoccurs GP to review medication if on blood thinners
27
Sub Conjunctival Haemorrhage: Contact Lens Implications (2)
None Poor removal technique could cause haemorrhage
28
Allergic Seasonal Conjunctiva: Aetiology (3)
Allergens cause hypersensitivity - mast cells release histamines causing inflammatory reaction Conjunctival injection Oedema caused by increased permeability of blood vessels
29
Allergic Seasonal Conjunctiva: Predisposing Factors (5)
Allergy to seasonal allergens (grass pollen, trees and flowers) - more severe Allergy to perennial allergens (house dust, mites and animal hair) - less severe 1/3 of population have atopic disposition Family history of allergy Known exposure to allergens
30
Allergic Seasonal Conjunctiva: Signs (8)
Bilateral red injected eyes Papillae in palpebral conjunctiva with lid eversion Watery Mild to moderate oedema of lids Oedema of bulbar conjunctiva Sneezing and watery eyes may present Time course will suggest if seasonal, perennial or acute No corneal involvement
31
Allergic Seasonal Conjunctiva: Symptoms (3)
Itchy Gritty Strand-like watery discharge
32
Allergic Seasonal Conjunctiva: Grading (1)
Use Efron grading scale for redness and papillary conjunctivitis
33
Allergic Seasonal Conjunctiva: Differential Diagnosis (2)
Acute allergic reactions Contact lens associated papillary conjunctivitis (CLAPC)
34
Allergic Seasonal Conjunctiva: Management (3)
Advice on allergens and avoidance Cold compress for comfort Do not rub eyes as more histamine releases
35
Allergic Seasonal Conjunctiva: Referral (3)
Routine Pharmacist can advise on systemic antihistamines Written prescription for topical mast cell stabilisers (sodium cromoglicate)
36
Bacterial Conjunctiva: Aetiology (1)
Bacterial infection of conjunctiva - self limiting (resolves in 5-7 days without treatment)
37
Bacterial Conjunctiva: Common Pathogens (4)
Straphylococcus Streptococcus Haemophilus influenza Moraxella catarrhalis
38
Bacterial Conjunctiva: Predisposing Factors (6)
Poor hygiene & close contact environments Contact lens wear Diabetics Steroid use Blepharitis Contamination of eye products
39
Bacterial Conjunctiva: Signs (5)
Mucopurulent discharge - if absent look in fornix under slit lamp Crusted lids especially on waking Conjunctiva hyperaemia Mild papillary response on palpebral conjunctiva Unlikely to involve cornea
40
Bacterial Conjunctiva: Symptoms (3)
Gritty sensation Sometimes burning feeling but not painful Discharge can blur vision
41
Bacterial Conjunctiva: Grading (4)
Use Efron to grade conjunctival injection Note type and quantity of discharge Note onset and duration Note corneal clarity
42
Bacterial Conjunctiva: Differential Diagnosis (2)
Exclude other forms of conjunctivitis - No follicles (viral) - No corneal involvement (viral) - Not particularly itchy (allergic) - Excessive discharge and very acute onset (gonococcal) Exclude other red eye challenges: - Not photophobia (uveitis) - No pain (keratitis) - Normal IOPs (angle closure glaucoma)
43
Bacterial Conjunctiva: Management (4)
Clean cotton pads to clean lids (separate wipes each eye, dispose of carefully and wash hands) Advise contagious, no sharing towels but kids can attend school Advise usually resolves in 5-7 days Cease contact lens wear
44
Bacterial Conjunctiva: Referral (2)
Reviewed in 1 weeks, if not improved then refer for topical antibiotics Infants under 1 month should be an emergency referral
45
Bacterial Conjunctiva: Contact Lens Implications (4)
Cease contact lens wear Dispose of lenses, storage cases and any cosmetics Wait until resolves before wearing lenses Return at 1 week if not better, should be reviewed at 1 week
46
Viral Conjunctivitis: Aetiology (4)
Viral infection of conjunctiva Self limiting Often resolves between 7-21 days without treatment Adenovirus is the most common pathogen
47
Viral Conjunctivitis: Predisposing Factors (3)
Preceding flu-like/respiratory symptoms Hygiene Crowded. close contact environments
48
Viral Conjunctivitis: Signs (6)
Serous discharge Conjunctival injection and hyperaemia Dot subconjunctival haemorrhages Follicles on palpebral conjunctiva Sometimes corneal involvement: - diffuse punctate lesions - sub-epithelial infiltrative lesions Dendritic ulcer if herpetic - urgent referral for anti-viral (usually unilateral)
49
Viral Conjunctivitis: Symptoms (3)
Discomfort - burning or grittiness Watery eyes Photophobia if corneal involvement
50
Viral Conjunctivitis: Grading (4)
Grade conjunctival injection using Efron Type and quantity of discharge Note onset and duration Note corneal clarity - painful lesions should be observed again 24hrs later
51
Viral Conjunctivitis: Differential Diagnosis (5)
Exclude other forms of conjunctivitis - No follicles (viral) - No corneal involvement (viral) - Not particularly itchy (allergic) - Excessive discharge and very acute onset (gonococcal) Exclude other red eye challenges: - Not photophobia (uveitis) - No pain (keratitis) - Normal IOPs (angle closure glaucoma) Main exclusion is corneal involvement and dendritic ulcer
52
Viral Conjunctivitis: Management (6)
Thorough hygiene before and after appointment Self limiting over 1-2 weeks High contagious - do not share towels Cold compress for comfort Discontinue contact lens wear Review again soon if corneal involvement, pain and photophobia
53
Viral Conjunctivitis: Referral (3)
Very little can be done antibiotics and antivirals ineffective Steroids can be offered in special cases
54
Viral Conjunctivitis: Contact Lens Implications (4)
Cease contact lens wear Dispose of contact lenses, storage and eye products Wait until resolves before continuing contact lens wear Return if no improvement in 1 week
55
Fungal Conjunctivitis: Aetiology (4)
Aggressive infection Slow onset Unlikely to self resolve Commonly affects cornea
56
Fungal Conjunctivitis: Common Pathogens (3)
Candida (yeast) Fusarium (rapid onset) Aspergillus
57
Fungal Conjunctivitis: Predisposing Factors (6)
Contact lens wear Ineffective solutions Poor hygiene Trauma involving organic material (gardeners/grounds keepers) Immunocompromised patients Complications with ocular surface
58
Fungal Conjunctivitis: Signs (5)
Mucus discharge Epiphora Intense conjunctival injection and hyperaemia Corneal lesions Anterior chamber involvement, flare and in severe cases hypopyon
59
Fungal Conjunctivitis: Symptoms (4)
Pain - moderate to severe Intense photophobia Unilateral Blurred vision
60
Fungal Conjunctivitis: Grading (4)
Use Efron to grade conjunctival injection Note type and quantity of discharge Note onset and duration Note any trauma prior
61
Fungal Conjunctivitis: Differential Diagnosis (2)
Any history of organic matter - treat as fungal Corneal involvement more likely to be fungal than bacterial
62
Fungal Conjunctivitis: Referral (4)
Emergency - same day Call HES ahead to inform Take contact lenses and case with to hospital (not wearing) Emphasis importance of attending appointment (sight threatening)
63
Fungal Conjunctivitis: Contact Lens Implications (2)
Cease contact lens wear Return for contact lens reassessment after hospital treatment complete
64
CL Associated Papillary Conjunctivitis (CLAPC): Aetiology (5)
Papillary inflammation response from contact lenses Multifactorial aetiology: - proteins on lens - exotoxins of bacteria on lens - Aggravation and release of histamine
65
CL Associated Papillary Conjunctivitis (CLAPC): Predisposing Factors (6)
Soft contact lenses (esp silicon hydrogel) Lens deposits Poor lens edge design High modulus Atopic history MGD
66
CL Associated Papillary Conjunctivitis (CLAPC): Signs (8)
Papillae on tarsal conjunctiva (location where lens would be) Giant papillae GPC .1mm String like mucus Poor lens position Discharge on lens causing blurred vision Superior limbic keratoconjunctivitis SLK may be present Superior epithelial arcuate lesion SEAL may be present Diffuse bulbar conjunctival hyperaemia
67
CL Associated Papillary Conjunctivitis (CLAPC): Symptoms (5)
Itching and irritation Lens intolerance Decreased comfort and wear time Symptoms can worsen on kens removal (acts like a bandage) Visual blur
68
CL Associated Papillary Conjunctivitis (CLAPC): Grading (3)
Grade conjunctival redness and papillary conjunctivitis using Efron Neovascularisation Staining, especially superior corneo-limbal
69
CL Associated Papillary Conjunctivitis (CLAPC): Differential Diagnosis (3)
Contact lens induced allergy responses (removal/break from lenses will cause improvement) Other allergic conjunctivitis Likely to occur following a change to lens or solution
70
CL Associated Papillary Conjunctivitis (CLAPC): Management (5)
Consider ceasing contact lens wear and reviewing in 1 week Discomfort will get worse initially and then improve - reassure Refit to a new lens - lower modulus - More frequent replacement - Rub and rinse solutions - Review lens hygiene Lubricants Sodium cromoglicate (mast cell stabiliser) can be recommended to reduce response
70
CL Associated Papillary Conjunctivitis (CLAPC): Referral (1)
Routine referral for cases that do not resolve for steroid treatment
71
CL Associated Papillary Conjunctivitis (CLAPC): Contact Lens Implications (1)
Refit and management is necessary due to the lenses being the cause
72
Conjunctival Lithiasis (concretions): Aetiology (3)
Build up of keratin type debris Associated with conjunctival inclusion cysts May push through epithelium leading to foreign body sensation
73
Conjunctival Lithiasis (concretions): Predisposing Factors. (4)
Age - especially 60+ Prevalence is about 40% Reoccurring or long standing conjunctivitis Historical chalazion causing lipid accumulation
74
Conjunctival Lithiasis (concretions): Signs (3)
Off white/yellow granular deposits with defined edges in palpebral/tarsal conjunctiva Can be one single deposit (small or large in size) Can be several less than 1mm in size
75
Conjunctival Lithiasis (concretions): Symptoms (3)
Usually asymptomatic Cosmetically noticed In severe cases. foreign body sensation
76
Conjunctival Lithiasis (concretions): Differential Diagnosis (1)
Follicles
77
Conjunctival Lithiasis (concretions): Referral (1)
Refer only for removal
78
Conjunctival Lithiasis (concretions): Contact Lens Implications (1)
None *predisposing factor is longstanding conjunctivitis - implications there*
79
Conjunctival Pigmented Lesion: Aetiology (5)
Can be malignant or benign Hypermelanosis (benign) is common in those with darker skin Naevi (benign) usually congenital but can be acquired Melanoma - feeder vessels - raised - uneven borders - necrosis
80
Conjunctival Pigmented Lesion: Predisposing Factors (4)
Darker skin ethnicity Caucasian and older age (acquired melanosis) Melanoma most likely with fair skin and blue eyes Melanoma presents 50+
81
Conjunctival Pigmented Lesion (Ethnic Hypermelanosis): Signs (5)
Flat Moves over sclera freely Patchy brown Commonly near limbus Likely bilateral but asymmetric
82
Conjunctival Pigmented Lesion (Naevus): Signs (6)
Single lesion with well marked borders Can be raised Moves freely over sclera Close to limbus but never over cornea Not vascularised or inflamed Brown to pink in colour (can be faint)
83
Conjunctival Pigmented Lesion (Melanoma): Signs (5)
Any raised pigment lesion should be considered melanoma Vascularised mass with feeder vessels Fixed to sclera and unmoving About 20% of cases can be unpigmented Grows in size
84
Conjunctival Pigmented Lesion: Symptoms (2)
Asymptomatic Cosmetic concern
85
Conjunctival Pigmented Lesion: Management (2)
Reassure if confident in diagnosis Monitor - take photos - review in 3-6 months if unsure
86
Conjunctival Pigmented Lesion: Referral (1)
Urgent if meets criteria of melanoma (within 1-2 weeks)
87
Conjunctival Pigmented Lesion: Contact Lens Implications (1)
None
88
Papillae (7)
Allergy response Inflammatory cells under epithelium Almost always bilateral Central vascular tufts see at centre of swellings Found in tarsal area Flat top elevations Variable in size depending on severity
89
Follicles (5)
Due to viral response Lymphocytes and plasma cells are present Commonly unilateral at first Swellings 0.5-2mm encircled with vessels Common in fornices and palpebral areas

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