Conjunctival, episcleral and scleral abnormalities Flashcards
conjuctival changes
inflammatory- hyperamia, odeama, folicles, paipllae haemmohrages degenerative pigmentation lids and bumps
Conjunctival hyperaemia- ALL OVER REDNESS
occurs in all types of conjuctivtis
DD it from perilimabl injection which would just e on one side
Conjuctival Odeama- chemosis-
swelling of conjunctivitis
COnjuctival follicles
minute lymph follicles with vasculirisation
mostly in inferior fonix
could be viral, chlamydial or even toxic
conuctival papillae
vacular structures
in upper fornix
less specific than follicles
membranes -2 types
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
subconjuctival heommahrage
trauam, haemorrhagic conjuctivitis, blood disorder, increased venous pressure by coughing, sneezing or straying hypertension or could even be idiopathic
how do u manage a subconjuctival heommahrage
careful examination
reassure px- should go in a week/two
cold compress
referral if needed
Pinguecela- benign- yellow white- grows slowly
conjuctival callouses that grow adjacent to cornea at 3/9 o’clock
Pterygium- wedge shaped0 extends and covers cornea- benign
caused by uv exposure
adheres to underlying structures
no sx- but eye may feel irritated
TRETAMENT- lubricant, sunglassss, steroids, refer for surgery when big
conjunctivitis types
viral
bacterial
chlamydial
allergic
ACUTE bacterial conjunctivitis-
mucopurulent discharge
lids stick together in the am
cornela changes include ulcers and infiltrates- if ulcer- refer-
treatment with anti biotics
CHRONIC bacterial conjunctivitis
intesne sx
ffew signs
management- includes identify agent, antibiotics, clinical evaluation of lacrimal system
chlamydial conjuctvitis include;
Trachoma
Adult inclusions conjunctivitis
Trachoma- caused by chlamydia trachomosis
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
adult inclusion conjunctivitis
caused b chlamydial trachomotis
STI
first effects one eye- then both
sx- FB sensation, irritatuin, watering, mucopurulent discharge
how do u manage adult inclusion conjunctivitis
detailed H+S refer to ophthalmologist and gynecologist conjuctival scraping topical and sytemic antibiotics sexual partner also needs this course
viral conjuctivitis
HSV
Pharingoconjunctival fever (PCF)
Epidemic keratoconjunctivitis
herpes simplex virus
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
Pharingoconjunctival fever (PCF)
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
epidemic keratoconjuctivties
No enlarged lymph nodes no fever serious transmitted in hops by contaminated instruments young adults mostly effected no systemic sx
allergic conjunctivitis
seasonal
vernal
atopic
giant papillary
SEASONAL allergic conjuctiivtis
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
VERNAL keratoconjunctivitis
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
Atopic keratoconjunctivitis
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
Giant papillary conjunctivitis
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
Differential diagnosis of allergic conjunctivitis
Atopic blepharitis
Bacterial conjunctivitis Chlamydial conjunctivitis Corneal abrasions or ulceration Dry eye
Episcleritis
Marginal and punctate keratitis Tight lens syndrome
Viral infections
