Eq conjunctival and lacrimal disorders

Question 1

Conjunctiva anatomy/morph (4)

Answer 1

1. Analogous to a mucous membrane
2. Non-keratinized stratified columnar cells
3. Extremely vascular
4. May be pigmented

Question 2

Three regions of conjunctiva

Answer 2

1. Bulbar (on globe)
2. Palpebral (on lids)
3. Fornix (where bulbar and palpebral meet)

Question 3

Nictitating membrane/haw/third eyelid (3)

Answer 3

1. Semilunar fold of conjunctiva in front of globe ventromedially
2. T-shaped cartilage is support structure
3. Gland at base does tear production

Question 4

Nasolacrimal Apparatus

Answer 4

1. Secretory-orbital lacrimal gland, gland of the TE
2. Drainage system for tears
   - upper and lower eyelid puncta meed at lacrimal sac
   - NL duct in nasal vestibule

Question 5

3 layers of tear film

Answer 5

1. Meibomian glands: lipid layer
2. Lacrimal glands: aqueous tears
3. Epithelial goblet cells: mucin layer

Question 6

Normal STT

Answer 6

15-30 mm/min

Question 7

Fluoroscein

Answer 7

1. Hydrophilic dye
2. Stain for ulcers
3. TBUT-qualitative
4. Jone’s test-patency of NLD

Question 8

Jone’s test

Answer 8

Patency of NLD, Normal is like less than 10 min

Question 9

TBUT

Answer 9

1. fluroscein tests quality of tear film

2. abnormal < 10s

Question 10

Rose Bengal

Answer 10

1. Tests tear film integrity
2. qualitative tear test, stains if mucin deficient
3. Fungal keratitis?!?!

Question 11

Lymphoid follicles in conjunctivitis

Answer 11

Indicate chronicity

Question 12

Conjunctivitis

Answer 12

1. NONSPECIFIC

2. ALWAYS LOOK FOR PRIMARY CAUSE

Question 13

Bacterial conjunctivitis (7)

Answer 13

1. primary is rare
2. Look for FB, lid dz, KCS
3. Purulent d/c
4. Neutrophils and bacterial on cytology
5. Usually staph or strep
6. Broad spectrum topical abx
7. Culture and sensitivity

Question 14

Viral conjunctivitis

Answer 14

1. Serous discharge
2. Keratitis
3. Mononuclear cells on cytology
4. HERPES MOST COMMON
5. At risk populations
6. Recurrent
7. Antivirals, anti-inflammatories

Question 15

Allergic conjunctivitis (5)

Answer 15

1. Frequently seasonal
2. More common than other causes
3. Rare eosinophils, basophils on cytology
   - acute: neutraphils may accompany
   - chronic-lymphocytes may accompany
4. Topical anti-inflammatories
5. Avoidance

Question 16

Parasitic conjunctivitis

Answer 16

1. Habronema
2. Onchocerca
3. Thelazia

Question 17

Most common cause of bacterial conjunctivitis

Answer 17

Lack of tears

Question 18

Causes of insuff mucin/lipid

Answer 18

1. chronic conjunctival inflamm
2. meibomianitis
3. blepharitis
4. lid defects
5. inadequate blinking
   - corneal anesthesia
   - facial nerve paresis
   - general anesth

Question 19

Dacrocystitis

Answer 19

Inflammation of lacrimal sac and NL duct

Question 20

NL flush

Answer 20

1. 14 ga IVC or tomcat cath into nasal puncta
2. 20 ga IVC into medial canthal puncta
3. Saline, pulse
4. Culture exudate

Question 21

Most common conjunctival neoplasia

Answer 21

SCC

Question 22

Pseudotumors

Answer 22

Inflammatory lesions that may resemble neoplasia

Question 23

Ocular lesions in 27% of cases with systemic LSA

Answer 23

Inflammation of conjunctiva and eyelids most common

Question 24

Protrusion of TE (5)

Answer 24

1. Non-specific
2. Ocular pain
3. Decreased orbital volume-dehydration, weight loss
4. Decreased ocular size-microphthalmia, phtisis bulbi
5. Retrobulbar dz-cellulitis, abscess, mass

Question 25

TE removal most common post-op complication

Answer 25

Fat prolapse

Question 26

Lacrostimulants

Answer 26

1. Topical cyclosporine (0.2-2.0 %) 2. Tacrolimus (0.03 %) 3. Pilocarpine (0.25%)

Question 27

Insufficient mucin or lipid production results in

Answer 27

Loss of tear film stability/premature evaporation

Question 28

Treatment after removal of TE

Answer 28

1. Submit eyelid for margins 2. Systemic anti-inflammatories 3. Topical antibiotics