Conjunctival, episcleral and scleral abnormalities

Question 1

conjuctival changes

Answer 1

inflammatory- hyperamia, odeama, folicles, paipllae
haemmohrages
degenerative
pigmentation
lids and bumps

Question 2

Conjunctival hyperaemia- ALL OVER REDNESS

Answer 2

occurs in all types of conjuctivtis

DD it from perilimabl injection which would just e on one side

Question 3

Conjuctival Odeama- chemosis-

Answer 3

swelling of conjunctivitis

Question 4

COnjuctival follicles

Answer 4

minute lymph follicles with vasculirisation
mostly in inferior fonix
could be viral, chlamydial or even toxic

Question 5

conuctival papillae

Answer 5

vacular structures
in upper fornix
less specific than follicles

Question 6

membranes -2 types

Answer 6

true membranes- when microorganisms excrete firinous or inflammatory exudate-
adhere really strong so u can get bleeding when removed

pseudomembranes- coagulated- so no bleeding as not adherent - peel these- appear in adnoviral, vernal and gonoccal conjunctivitis

Question 7

subconjuctival heommahrage

Answer 7

trauam, 
haemorrhagic conjuctivitis, 
blood disorder, 
increased venous pressure by coughing, sneezing or straying
hypertension
or could even be idiopathic

Question 8

how do u manage a subconjuctival heommahrage

Answer 8

careful examination
reassure px- should go in a week/two
cold compress
referral if needed

Question 9

Pinguecela- benign- yellow white- grows slowly

Answer 9

conjuctival callouses that grow adjacent to cornea at 3/9 o’clock

Question 10

Pterygium- wedge shaped0 extends and covers cornea- benign

Answer 10

caused by uv exposure
adheres to underlying structures
no sx- but eye may feel irritated
TRETAMENT- lubricant, sunglassss, steroids, refer for surgery when big

Question 11

conjunctivitis types

Answer 11

viral
bacterial
chlamydial
allergic

Question 12

ACUTE bacterial conjunctivitis-

Answer 12

mucopurulent discharge
lids stick together in the am
cornela changes include ulcers and infiltrates- if ulcer- refer-
treatment with anti biotics

Question 13

CHRONIC bacterial conjunctivitis

Answer 13

intesne sx
ffew signs
management- includes identify agent, antibiotics, clinical evaluation of lacrimal system

Question 14

chlamydial conjuctvitis include;

Answer 14

Trachoma

Adult inclusions conjunctivitis

Question 15

Trachoma- caused by chlamydia trachomosis

Answer 15

bilaterlal
keraoconjuctivitis
afrixa/middleeast/south asia
15%of world blindness
transmssion- fingers/towles/ mothers to child
poor hygiene
acute sx- tearing, photophobia, pain, swelling of eyelids
can cause compilations such as dry eyes, ulcers, scars, blindness

Question 16

adult inclusion conjunctivitis

Answer 16

caused b chlamydial trachomotis
STI
first effects one eye- then both
sx- FB sensation, irritatuin, watering, mucopurulent discharge

Question 17

how do u manage adult inclusion conjunctivitis

Answer 17

detailed H+S
refer to ophthalmologist and gynecologist
conjuctival scraping
topical and sytemic antibiotics
sexual partner also needs this course

Question 18

viral conjuctivitis

Answer 18

HSV
Pharingoconjunctival fever (PCF)
Epidemic keratoconjunctivitis

Question 19

herpes simplex virus

Answer 19

acute/ recurrent follicular conjunctivitis
with/without involvement of other ocular structures
similar signs and sx as other conjunctivitis
WATERY DISCHARGE
FOLLICLES
u need to give anti-viral therapy and cold compress

Question 20

Pharingoconjunctival fever (PCF)

Answer 20

V INFECTIOUS- in children
Adenovirus
acute and highly infectious
acute follicular conjunctivitis pharyngitis + pre-auricular limphadenopathy- ENLARGED LYMPH NODES
no treatment specifically- u treat sx- treat fever, pain, inflammation with cold compresses
self limited

Question 21

epidemic keratoconjuctivties

Answer 21

No enlarged lymph nodes
no fever
serious
transmitted in hops by contaminated instruments
young adults mostly effected
no systemic sx

Question 22

allergic conjunctivitis

Answer 22

seasonal
vernal
atopic
giant papillary

Question 23

SEASONAL allergic conjuctiivtis

Answer 23

Sx- bilateral itching, burning, photophobia, pain, blurred vision, watery/mucous discharge, sneezing and nasal congestion
Signs- mild conjunctival injection, papillary hypertrophy of the tarsal conjunctiva, increased tear volume, normal lid margin
Treatment: reduce exposure, cool copresses, vasoconstrictors, antihistamines,
If quite serious then: topical steroids, mast-cell stabilizers, immunotherapy, refer if resistant

Question 24

VERNAL keratoconjunctivitis

Answer 24

Bilateral conjunctivitis associated with corneal changes
Males<-
Symptoms: intense ocular itching, tearing, mucus secretion, photophobia, pain
Signs: red eye, giant papillae bigger than seasonal
Treatment: refer. As for SAC. When cornea is involved, refer and monitor the anti-inflammatory therapy. Surgery for giant papillae

Question 25

Atopic keratoconjunctivitis

Answer 25

atopy
men
same sx as seasonal
but also have topic dermatitis
and could also cause punctual stenosis
papilae in inferior fornix

similar treatment to allergic conjuctivits

Question 26

Giant papillary conjunctivitis

Answer 26

usually in cl wearers
itching after removal of cl lens, mucoid discharge, pain
u see large apillae, mucus over the lens
rmove cl- change the lens- hygiene- no steroids

Question 27

Differential diagnosis of allergic conjunctivitis

Answer 27

Atopic blepharitis
Bacterial conjunctivitis Chlamydial conjunctivitis Corneal abrasions or ulceration Dry eye
Episcleritis
Marginal and punctate keratitis Tight lens syndrome
Viral infections