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CLO > Conjunctiva Pathologies > Flashcards

Conjunctiva Pathologies Flashcards

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
Q

Sub Conjunctival Haemorrhage: Management (3)

A

Reassurance - usually clears in a week like a bruise

Cold compress

Patient to return is reoccurs or does not resolve

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26
Q

Sub Conjunctival Haemorrhage: Referral (3)

A

Routine

GP to measure blood pressure if reoccurs

GP to review medication if on blood thinners

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27
Q

Sub Conjunctival Haemorrhage: Contact Lens Implications (2)

A

None

Poor removal technique could cause haemorrhage

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28
Q

Allergic Seasonal Conjunctiva: Aetiology (3)

A

Allergens cause hypersensitivity
- mast cells release histamines causing inflammatory reaction

Conjunctival injection

Oedema caused by increased permeability of blood vessels

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29
Q

Allergic Seasonal Conjunctiva: Predisposing Factors (5)

A

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

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30
Q

Allergic Seasonal Conjunctiva: Signs (8)

A

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

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31
Q

Allergic Seasonal Conjunctiva: Symptoms (3)

A

Itchy

Gritty

Strand-like watery discharge

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32
Q

Allergic Seasonal Conjunctiva: Grading (1)

A

Use Efron grading scale for redness and papillary conjunctivitis

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33
Q

Allergic Seasonal Conjunctiva: Differential Diagnosis (2)

A

Acute allergic reactions

Contact lens associated papillary conjunctivitis (CLAPC)

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34
Q

Allergic Seasonal Conjunctiva: Management (3)

A

Advice on allergens and avoidance

Cold compress for comfort

Do not rub eyes as more histamine releases

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35
Q

Allergic Seasonal Conjunctiva: Referral (3)

A

Routine

Pharmacist can advise on systemic antihistamines

Written prescription for topical mast cell stabilisers (sodium cromoglicate)

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36
Q

Bacterial Conjunctiva: Aetiology (1)

A

Bacterial infection of conjunctiva
- self limiting (resolves in 5-7 days without treatment)

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37
Q

Bacterial Conjunctiva: Common Pathogens (4)

A

Straphylococcus

Streptococcus

Haemophilus influenza

Moraxella catarrhalis

38
Q

Bacterial Conjunctiva: Predisposing Factors (6)

A

Poor hygiene & close contact environments

Contact lens wear

Diabetics

Steroid use

Blepharitis

Contamination of eye products

39
Q

Bacterial Conjunctiva: Signs (5)

A

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
Q

Bacterial Conjunctiva: Symptoms (3)

A

Gritty sensation

Sometimes burning feeling but not painful

Discharge can blur vision

41
Q

Bacterial Conjunctiva: Grading (4)

A

Use Efron to grade conjunctival injection

Note type and quantity of discharge

Note onset and duration

Note corneal clarity

42
Q

Bacterial Conjunctiva: Differential Diagnosis (2)

A

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
Q

Bacterial Conjunctiva: Management (4)

A

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
Q

Bacterial Conjunctiva: Referral (2)

A

Reviewed in 1 weeks, if not improved then refer for topical antibiotics

Infants under 1 month should be an emergency referral

45
Q

Bacterial Conjunctiva: Contact Lens Implications (4)

A

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
Q

Viral Conjunctivitis: Aetiology (4)

A

Viral infection of conjunctiva

Self limiting

Often resolves between 7-21 days without treatment

Adenovirus is the most common pathogen

47
Q

Viral Conjunctivitis: Predisposing Factors (3)

A

Preceding flu-like/respiratory symptoms

Hygiene

Crowded. close contact environments

48
Q

Viral Conjunctivitis: Signs (6)

A

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
Q

Viral Conjunctivitis: Symptoms (3)

A

Discomfort - burning or grittiness

Watery eyes

Photophobia if corneal involvement

50
Q

Viral Conjunctivitis: Grading (4)

A

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
Q

Viral Conjunctivitis: Differential Diagnosis (5)

A

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
Q

Viral Conjunctivitis: Management (6)

A

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
Q

Viral Conjunctivitis: Referral (3)

A

Very little can be done

antibiotics and antivirals ineffective

Steroids can be offered in special cases

54
Q

Viral Conjunctivitis: Contact Lens Implications (4)

A

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
Q

Fungal Conjunctivitis: Aetiology (4)

A

Aggressive infection

Slow onset

Unlikely to self resolve

Commonly affects cornea

56
Q

Fungal Conjunctivitis: Common Pathogens (3)

A

Candida (yeast)

Fusarium (rapid onset)

Aspergillus

57
Q

Fungal Conjunctivitis: Predisposing Factors (6)

A

Contact lens wear

Ineffective solutions

Poor hygiene

Trauma involving organic material (gardeners/grounds keepers)

Immunocompromised patients

Complications with ocular surface

58
Q

Fungal Conjunctivitis: Signs (5)

A

Mucus discharge

Epiphora

Intense conjunctival injection and hyperaemia

Corneal lesions

Anterior chamber involvement, flare and in severe cases hypopyon

59
Q

Fungal Conjunctivitis: Symptoms (4)

A

Pain - moderate to severe

Intense photophobia

Unilateral

Blurred vision

60
Q

Fungal Conjunctivitis: Grading (4)

A

Use Efron to grade conjunctival injection

Note type and quantity of discharge

Note onset and duration

Note any trauma prior

61
Q

Fungal Conjunctivitis: Differential Diagnosis (2)

A

Any history of organic matter - treat as fungal

Corneal involvement more likely to be fungal than bacterial

62
Q

Fungal Conjunctivitis: Referral (4)

A

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
Q

Fungal Conjunctivitis: Contact Lens Implications (2)

A

Cease contact lens wear

Return for contact lens reassessment after hospital treatment complete

64
Q

CL Associated Papillary Conjunctivitis (CLAPC): Aetiology (5)

A

Papillary inflammation response from contact lenses

Multifactorial aetiology:
- proteins on lens
- exotoxins of bacteria on lens
- Aggravation and release of histamine

65
Q

CL Associated Papillary Conjunctivitis (CLAPC): Predisposing Factors (6)

A

Soft contact lenses (esp silicon hydrogel)

Lens deposits

Poor lens edge design

High modulus

Atopic history

MGD

66
Q

CL Associated Papillary Conjunctivitis (CLAPC): Signs (8)

A

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
Q

CL Associated Papillary Conjunctivitis (CLAPC): Symptoms (5)

A

Itching and irritation

Lens intolerance

Decreased comfort and wear time

Symptoms can worsen on kens removal (acts like a bandage)

Visual blur

68
Q

CL Associated Papillary Conjunctivitis (CLAPC): Grading (3)

A

Grade conjunctival redness and papillary conjunctivitis using Efron

Neovascularisation

Staining, especially superior corneo-limbal

69
Q

CL Associated Papillary Conjunctivitis (CLAPC): Differential Diagnosis (3)

A

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
Q

CL Associated Papillary Conjunctivitis (CLAPC): Management (5)

A

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
Q

CL Associated Papillary Conjunctivitis (CLAPC): Referral (1)

A

Routine referral for cases that do not resolve for steroid treatment

71
Q

CL Associated Papillary Conjunctivitis (CLAPC): Contact Lens Implications (1)

A

Refit and management is necessary due to the lenses being the cause

72
Q

Conjunctival Lithiasis (concretions): Aetiology (3)

A

Build up of keratin type debris

Associated with conjunctival inclusion cysts

May push through epithelium leading to foreign body sensation

73
Q

Conjunctival Lithiasis (concretions): Predisposing Factors. (4)

A

Age - especially 60+

Prevalence is about 40%

Reoccurring or long standing conjunctivitis

Historical chalazion causing lipid accumulation

74
Q

Conjunctival Lithiasis (concretions): Signs (3)

A

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
Q

Conjunctival Lithiasis (concretions): Symptoms (3)

A

Usually asymptomatic

Cosmetically noticed

In severe cases. foreign body sensation

76
Q

Conjunctival Lithiasis (concretions): Differential Diagnosis (1)

A

Follicles

77
Q

Conjunctival Lithiasis (concretions): Referral (1)

A

Refer only for removal

78
Q

Conjunctival Lithiasis (concretions): Contact Lens Implications (1)

A

None

predisposing factor is longstanding conjunctivitis - implications there

79
Q

Conjunctival Pigmented Lesion: Aetiology (5)

A

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
Q

Conjunctival Pigmented Lesion: Predisposing Factors (4)

A

Darker skin ethnicity

Caucasian and older age (acquired melanosis)

Melanoma most likely with fair skin and blue eyes

Melanoma presents 50+

81
Q

Conjunctival Pigmented Lesion (Ethnic Hypermelanosis): Signs (5)

A

Flat

Moves over sclera freely

Patchy brown

Commonly near limbus

Likely bilateral but asymmetric

82
Q

Conjunctival Pigmented Lesion (Naevus): Signs (6)

A

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
Q

Conjunctival Pigmented Lesion (Melanoma): Signs (5)

A

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
Q

Conjunctival Pigmented Lesion: Symptoms (2)

A

Asymptomatic

Cosmetic concern

85
Q

Conjunctival Pigmented Lesion: Management (2)

A

Reassure if confident in diagnosis

Monitor
- take photos
- review in 3-6 months if unsure

86
Q

Conjunctival Pigmented Lesion: Referral (1)

A

Urgent if meets criteria of melanoma (within 1-2 weeks)

87
Q

Conjunctival Pigmented Lesion: Contact Lens Implications (1)

A

None

88
Q

Papillae (7)

A

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
Q

Follicles (5)

A

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

CLO (13 decks)

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