Disorders of the Conjunctiva: Miscellaneous & Benign Conjunctival Conditions Flashcards
what type of conjunctivitis is mechanically induced from:
- CL wear
- ocular prosthesis
- exposed sutures
- corneal surface irregularity
- filtering blebs
giant papillary conjunctivitis
what is the main cause of giant papillary conjunctivitis (GPC)
CL wear
GPC from CL wear is often seen where
superiorly
these signs are indicative of what type of conjunctivitis:
- foreign body sensation
- redness
- itching
- increased mucus production
- CL intolerance over time
giant papillary conjunctivitis
these signs are indicative of which type of conjunctivitis:
- substantial CL protein deposits
- excessive CL movement
- superior palpebral hyperemia & papillae
- papillae >1mm in diameter
giant papillary conjunctivitis
what causes excess CL movement in GPC
the papillae
what is a characteristic sign of GPC
superior palpebral hyperemia & papillae
how do you treat GPC
- discontinue CL wear & refit with daily CL modality
- topical steroid pulse
- mast cell stabilizers & antihistamines
what is an uncommon chronic disorder of the superior limbus, bulbar & palpebral conjunctiva
superior limbic keratoconjunctivitis
what is the predilection for superior limbic keratoconjunctivitis
middle-aged women
- 50% have abrnormal thyroid function (usually hyperthyroidism)
what type of conjunctivitis may be caused by blink-related trauma between upper lid & superior bulbar conjunctiva that is precipitated by tear film insufficiency & conjunctival tissue laxity
superior limbic keratoconjunctivitis
these symptoms are indicative of which type of conjunctivitis:
- usually intermittent
- foreign body sensation
- burning
- mild photophobia
- mucoid discharge
- blepharospasm
superior limbic keratoconjunctivitis
these signs are indicative of which type of conjunctivitis:
- superior palpebral papillae
- superior palpebral hyperemia
- superior bulbar conjunctival hyperemia
- superior SPK
- superior filamentary keratitis
- mild superior pannus
superior limbic keratoconjunctivitis
superior bulbar conjunctiva hyperemia in superior limbic keratoconjunctivitis will stain with what dyes
Rose Bengal & NaFl
in superior limbic keratoconjunctivitis, what do you use if filaments develop
mucomyst
if there are significant symptoms in superior limbic keratoconjunctivitis, what do you use to treat it
topical steroid pulse
these treatments are used to treat which type of conjunctivitis:
- preservative-free artificial tears
- Restasis
- bandage soft CLs
- punctal occlusion
superior limbic keratoconjunctivitis
what is a very rare disorder caused by the accumulation of fibrin
ligenous conjunctivitis
what is an inherited autosomal recessive mutation on plasminogen gene
ligenous conjunctivitis
these signs are indicative of which type of conjunctivitis:
- recurrent bilateral fibrin-rich pseudomembranous lesions of wood-like consistency that develop on palpebral conjunctiva
- episodes can be triggered by minor trauma or systemic events like fever
ligenous conjunctivitis
which type of conjunctivitis is usually caused by systemic disorder that can involve:
- periodontal tissue
- respiratory tract
- kidneys
- middle ear
- female genitalia
ligenous conjunctivitis
in ligenous conjunctivitis, when can mortality occur
when there is pulmonary involvement
this presentation is indicative of which type of conjunctivitis:
- nonspecific conjunctivitis starting in childhood (median age 5)
- gradually enlarging red-white lobular conjunctival masses covered by thick yellow mucoid discharge
ligenous conjunctivitis
what is a unilateral granulomatous conjunctivitis & regional lymphadenopathy
Parinaud Oculoglandular Syndrome
parinaud oculoglandar syndrome is most commonly caused by what organism
bartonella henselae (aka cat scratch disease)
these symptoms are indicative of which type of conjunctivitis:
- lymphadenopathy involving multiple lymph nodes
- chronic low-grade fever
- granulomatous conjunctivitis with surrounding follicles
parinaud oculoglandular syndrome
how do you treat parinaud oculoglandular syndrome
- usually self-limiting
- systemic antibiotic therapy
what is a subtype of mucus membrane pemphigoid that is a chronic autoimmune mucocutaneous blistering disease
ocular cicatricial pemphigoid
ocular cicatrical pemphigoid is what type of hypersensitivity reaction
type II (cytotoxic)
this mechanism of action causes what type of conjunctivitis:
antibodies bind to epithelial basement membrane → complement activation → recruitment of inflammatory cells → separation of epidermis from dermis → eventual scarring
ocular cicatricial pemphigoid
what does ocular cicatricial pemphigoid involve
involves conjunctiva & causes progressive scarring (cicatrization)
these systemic signs are indicative of which type of conjunctivitis:
- subepidermal blisters (usually oral)
- skin blisters
ocular cicatricial pemphigoid
these ocular symptoms are indicative of which type of conjunctivitis:
- relapsing remitting nonspecific bilateral conjunctivitis
- misdiagnosed as dry eye in early disease
ocular cicatricial pemphigoid
these ocular signs are indicative of which type of conjunctivitis:
- papillary conjunctivitis
- diffuse hyperemia
- conjunctival chemosis
- symblepharon formation
- shortening of fornix
- corneal epithelial defects caused by drying & exposure
- peripheral corneal vascularization
- corneal keratinization & conjunctivalization due to stem cell failure
ocular cicatricial pemphigoid
what is the 1st stage in ocular cicatricial pemphigoid
subconjunctival fibrosis
what is the 2nd stage in ocular cicatricial pemphigoid
forniceal shortening
what is the 3rd stage of ocular cicatricial pemphigoid
symblepharon
what is the 4th stage of ocular cicatricial pemphigoid
keratinization of ocular surface & ankyloblepharon (adhesion of lids at outer canthus)
how do you treat ocular cicatrical pemphigoid
- systemic immunosuppression required
- topical steroids can decrease symptoms but don’t stop progression
what is also known as erythema multiforme major: involves skin & mucus membranes
Stevens-Johnson syndrome
what type of hypersensitivity reaction is stevens-johnson syndrome & what is it usually from
cell-mediated (type IV) → usually to drug exposure/infection
what drugs can cause a hypersensitivity reaction in stevens-johnson syndrome
- antibiotics
- analgesics
- cold remedies
- anticonvulsants
these systemic & ocular symptoms are indicative of what conjunctival condition:
- flu-like symptoms that last up to 14 days prior to lesion appearance
- nasal pain & discharge
- pain on eating & drinking
- ocular redness, photophobia, tearing, foreign body sensation
stevens-johnson syndrome
these systemic & ocular signs are indicative of which conjunctival condition:
- blistering & hemorrhagic crusting of lips
- small, vesicular, hemorrhagic, or necrotic skin lesions of face, trunk & extremities that heal in 1-4 wks
- hemorrhagic crusting of lid margins
- papillary conjunctivitis
- conjunctival membranes & pseudomembranes
- conjunctival hyperemia, hemorrhages & blisters
- keratopathy: ranges from SPK to vascularization & keratinization
stevens-johnson syndrome
the ocular signs in stevens-johnson syndrome occuar during which phase
acute phase
late ocular signs of stevens-johnson syndrome resembles which conjunctival condition
ocular cicatricial pemphigoid
what is the mortality rate for stevens-johnson syndrome
5%
what is a elastotic degeneration of conjunctival stroma
pinguecula
what conjunctival condition is thought to be caused by actinic damage (like pterygium), dry eyes, & exposure to wind & dust
pinguecula
these presentations are indicative of which conjunctival condition:
- yellow-white mound on bulbar conjunctiva adjacent to limbus
- nasal location more frequent, but both can be present
- can become calcified
- can become inflamed
pinguecula
how do you treat a pinguecula
- topical lubrication
- UV protection
what presents as tiny cysts containing yellowish-white deposits of epithelial debris & can become calified
conjunctival concretions
what are the associations with conjunctival concretions
- usually with aging
- can form in patients with chronic conjunctival inflammation
how do you treat conjunctival concretions
- lubrication
- removal at SL with a hypodermic needle
these causes can cause what conjunctival condition:
- trauma
- ocular surgery
- idiopathic & spontaneous in the elderly
subconjunctival hemorrhage
how do you manage a subconjunctival hemorrhage
- topical lubricants QID
- cold compresses
if a younger patient presents with a subconjunctival hemorrhage without a history of trauma, what should you consider & why
consider bloodwork to rule out blood disorder
