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Anterior Segment > Disorders of the Conjunctiva: Miscellaneous & Benign Conjunctival Conditions > Flashcards

Disorders of the Conjunctiva: Miscellaneous & Benign Conjunctival Conditions Flashcards

1
Q

what type of conjunctivitis is mechanically induced from:

  • CL wear
  • ocular prosthesis
  • exposed sutures
  • corneal surface irregularity
  • filtering blebs
A

giant papillary conjunctivitis

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2
Q

what is the main cause of giant papillary conjunctivitis (GPC)

A

CL wear

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3
Q

GPC from CL wear is often seen where

A

superiorly

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4
Q

these signs are indicative of what type of conjunctivitis:

  • foreign body sensation
  • redness
  • itching
  • increased mucus production
  • CL intolerance over time
A

giant papillary conjunctivitis

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5
Q

these signs are indicative of which type of conjunctivitis:

  • substantial CL protein deposits
  • excessive CL movement
  • superior palpebral hyperemia & papillae
  • papillae >1mm in diameter
A

giant papillary conjunctivitis

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6
Q

what causes excess CL movement in GPC

A

the papillae

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7
Q

what is a characteristic sign of GPC

A

superior palpebral hyperemia & papillae

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8
Q

how do you treat GPC

A
  • discontinue CL wear & refit with daily CL modality
  • topical steroid pulse
  • mast cell stabilizers & antihistamines
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9
Q

what is an uncommon chronic disorder of the superior limbus, bulbar & palpebral conjunctiva

A

superior limbic keratoconjunctivitis

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10
Q

what is the predilection for superior limbic keratoconjunctivitis

A

middle-aged women

- 50% have abrnormal thyroid function (usually hyperthyroidism)

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11
Q

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

A

superior limbic keratoconjunctivitis

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12
Q

these symptoms are indicative of which type of conjunctivitis:

  • usually intermittent
  • foreign body sensation
  • burning
  • mild photophobia
  • mucoid discharge
  • blepharospasm
A

superior limbic keratoconjunctivitis

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13
Q

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
A

superior limbic keratoconjunctivitis

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14
Q

superior bulbar conjunctiva hyperemia in superior limbic keratoconjunctivitis will stain with what dyes

A

Rose Bengal & NaFl

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15
Q

in superior limbic keratoconjunctivitis, what do you use if filaments develop

A

mucomyst

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16
Q

if there are significant symptoms in superior limbic keratoconjunctivitis, what do you use to treat it

A

topical steroid pulse

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17
Q

these treatments are used to treat which type of conjunctivitis:

  • preservative-free artificial tears
  • Restasis
  • bandage soft CLs
  • punctal occlusion
A

superior limbic keratoconjunctivitis

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18
Q

what is a very rare disorder caused by the accumulation of fibrin

A

ligenous conjunctivitis

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19
Q

what is an inherited autosomal recessive mutation on plasminogen gene

A

ligenous conjunctivitis

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20
Q

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
A

ligenous conjunctivitis

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21
Q

which type of conjunctivitis is usually caused by systemic disorder that can involve:

  • periodontal tissue
  • respiratory tract
  • kidneys
  • middle ear
  • female genitalia
A

ligenous conjunctivitis

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22
Q

in ligenous conjunctivitis, when can mortality occur

A

when there is pulmonary involvement

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23
Q

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
A

ligenous conjunctivitis

24
Q

what is a unilateral granulomatous conjunctivitis & regional lymphadenopathy

A

Parinaud Oculoglandular Syndrome

25
Q

parinaud oculoglandar syndrome is most commonly caused by what organism

A

bartonella henselae (aka cat scratch disease)

26
Q

these symptoms are indicative of which type of conjunctivitis:

  • lymphadenopathy involving multiple lymph nodes
  • chronic low-grade fever
  • granulomatous conjunctivitis with surrounding follicles
A

parinaud oculoglandular syndrome

27
Q

how do you treat parinaud oculoglandular syndrome

A
  • usually self-limiting

- systemic antibiotic therapy

28
Q

what is a subtype of mucus membrane pemphigoid that is a chronic autoimmune mucocutaneous blistering disease

A

ocular cicatricial pemphigoid

29
Q

ocular cicatrical pemphigoid is what type of hypersensitivity reaction

A

type II (cytotoxic)

30
Q

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

A

ocular cicatricial pemphigoid

31
Q

what does ocular cicatricial pemphigoid involve

A

involves conjunctiva & causes progressive scarring (cicatrization)

32
Q

these systemic signs are indicative of which type of conjunctivitis:

  • subepidermal blisters (usually oral)
  • skin blisters
A

ocular cicatricial pemphigoid

33
Q

these ocular symptoms are indicative of which type of conjunctivitis:

  • relapsing remitting nonspecific bilateral conjunctivitis
  • misdiagnosed as dry eye in early disease
A

ocular cicatricial pemphigoid

34
Q

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
A

ocular cicatricial pemphigoid

35
Q

what is the 1st stage in ocular cicatricial pemphigoid

A

subconjunctival fibrosis

36
Q

what is the 2nd stage in ocular cicatricial pemphigoid

A

forniceal shortening

37
Q

what is the 3rd stage of ocular cicatricial pemphigoid

A

symblepharon

38
Q

what is the 4th stage of ocular cicatricial pemphigoid

A

keratinization of ocular surface & ankyloblepharon (adhesion of lids at outer canthus)

39
Q

how do you treat ocular cicatrical pemphigoid

A
  • systemic immunosuppression required

- topical steroids can decrease symptoms but don’t stop progression

40
Q

what is also known as erythema multiforme major: involves skin & mucus membranes

A

Stevens-Johnson syndrome

41
Q

what type of hypersensitivity reaction is stevens-johnson syndrome & what is it usually from

A

cell-mediated (type IV) → usually to drug exposure/infection

42
Q

what drugs can cause a hypersensitivity reaction in stevens-johnson syndrome

A
  • antibiotics
  • analgesics
  • cold remedies
  • anticonvulsants
43
Q

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
A

stevens-johnson syndrome

44
Q

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
A

stevens-johnson syndrome

45
Q

the ocular signs in stevens-johnson syndrome occuar during which phase

A

acute phase

46
Q

late ocular signs of stevens-johnson syndrome resembles which conjunctival condition

A

ocular cicatricial pemphigoid

47
Q

what is the mortality rate for stevens-johnson syndrome

A

5%

48
Q

what is a elastotic degeneration of conjunctival stroma

A

pinguecula

49
Q

what conjunctival condition is thought to be caused by actinic damage (like pterygium), dry eyes, & exposure to wind & dust

A

pinguecula

50
Q

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
A

pinguecula

51
Q

how do you treat a pinguecula

A
  • topical lubrication

- UV protection

52
Q

what presents as tiny cysts containing yellowish-white deposits of epithelial debris & can become calified

A

conjunctival concretions

53
Q

what are the associations with conjunctival concretions

A
  • usually with aging

- can form in patients with chronic conjunctival inflammation

54
Q

how do you treat conjunctival concretions

A
  • lubrication

- removal at SL with a hypodermic needle

55
Q

these causes can cause what conjunctival condition:

  • trauma
  • ocular surgery
  • idiopathic & spontaneous in the elderly
A

subconjunctival hemorrhage

56
Q

how do you manage a subconjunctival hemorrhage

A
  • topical lubricants QID

- cold compresses

57
Q

if a younger patient presents with a subconjunctival hemorrhage without a history of trauma, what should you consider & why

A

consider bloodwork to rule out blood disorder

Anterior Segment (37 decks)

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