eyelid/conjunctival disorder 2

Question 1

what is the classification of conjunctival disorders?

Answer 1

. infections ( bacterial , viral and chlamydial )
. allergic/inflammatory disorders
. subconjunctival haemorrhage
. degenerations
. mucu-cutaneous disorders
. pigmented and non-pigmented lesions

Question 2

why is conjunctiva vulnerable to microbial infection?

Answer 2

. due to its exposed position

Question 3

what are the infections of the conjunctiva ?

Answer 3

. bacterial conjunctivitis
. viral conjunctivitis
. chlamydial conjunctivitis

Question 4

what is bacterial conjunctivitis ?

Answer 4

. very common condition
. can occur at any age but occurs most frequent in children
. contagious
. mostly likely to occur in patients that are taking topical/systemic steroids or immunosuppressed and patients in poor general health
. usually bilateral ( one eye may precede the other )

Question 5

what are the symptoms of bacterial conjunctivitis ?

Answer 5

. grittiness- like sand in the eye
. burning
. eyelids stuck together in the morning- due to dry pus
. blurred vision

Question 6

why is bacterial conjunctivitis usually bilateral?

Answer 6

. in the early stages of the condition , before the symptoms become manifest, it’s common that patients would touch the other eye and will cross the infection to second eye

Question 7

what are the clinical signs of bacterial conjunctivitis ?

Answer 7

. purulent( pus like discharge ) or mucopurulent( pus mixed with mucous ) discharge

. conjunctival hyperaemia maximal at the fornices

. lid crusting

. mild papillary reaction

. usually no corneal involvement

. usually no pre-auricular lymphadenopathy

Question 8

what is a way to distinct between viral and bacterial conjunctivitis ?

Answer 8

.viral conjunctivitis have pre-auricular lymphadenopathy which means swollen lymph nodes
. swollen lymph node is an indication of viral infection

Question 9

where are the regional lymph nodes for the ocular surface?

Answer 9

. in front of the ear- which are referred to as pre-auricular lymph nodes

Question 10

what is the management for bacterial conjunctivitis?

Answer 10

. antibiotic drops: chloramphenicol or fusidic acid

. self-limiting condition: ( means gets better by itself, 80% gets better by it self ) consider no treatment or delayed treatment

. advise as to the contagious nature of the condition

. refer if the condition does not respond to treatment within 5-7 days if condition worsens

Question 11

what is the aetiology/cause of viral conjunctivitis ?

Answer 11

1. adenovirus( viruses that cause upper respiratory tract infections, colds and flu ) most common cause
2. adenoviruses cause two ocular syndromes:
   - PCF (pharyngoconjunctival fever)- inflammation of both the conjunctiva as well as the nasal pharynx (no cornea)
   - EKC (epidemic keratoconjuncitivits) - occurs when people are in crowded spaces - contagious - associated with corneal involvement (cornea involved)
3. caused by airborne respiratory droplets or direct transfer of ocular secretions
4. conjunctivitis is a rare manifestation of COVID 19 ( 3%)

Question 12

what are the symptoms of viral conjunctivitis ?

Answer 12

. epiphora - watering of the eye
. discomfort ( burning and stinging )
. photophobia ( indicates corneal involvement )
. reduced acuity ( with corneal involvement )
. bilateral in 60% cases-

Question 13

what are the sign of viral conjunctivitis ?

Answer 13

. conjunctival injection
. swollen lids
. serous discharge
. conjunctival follicles
. pre-auricular lymphadenopathy
. pseudomembrane - accumulation of fibrin 
. keratitis ( more common in EKC 80% )
. epithelial lesion with or without subepithelial infiltrate -

Question 14

what are the epithelial lesion found as a sign of viral conjunctivitis ?

Answer 14

. this is an inflammatory response of the cornea to the presence of the virus
. these are accumulation of inflammatory cells

Question 15

what is the management of viral conjunctivitis ?

Answer 15

. self-limiting 1-3 weeks
. artificial tears may improve comfort
. antibiotics in children due to difficulty in distinguishing between bacterial and viral conjunctivitis
. refer if significant corneal involvement
. warn of highly contagious nature of condition

Question 16

what is chlamydial conjunctivitis ?

Answer 16

. sexually transmitted disease

. caused by chlamydia
trachomatis

. patients usually young with concomitant genital infection

. follicular conjunctivitis with mucopurulent discharge

Question 17

what is the classification of allergic eye disease?

Answer 17

. classified by wether the cornea is involved or not 
1. atopic keratoconjunctivitis 
( cornea is involved) - CHRONIC
- AKC - atopic keratoconjunctivitis 
- VKC - vernal keratoconjunctivitis 
kerato(meaning viral too)

2. allergic conjunctivitis
   ( cornea isn’t involved )
   - seasonal allergic conjunctivitis (SAC)

• perennial allergic conjunctivitis ( PAC )- happens all year round
• acute allergic conjunctivitis (AAC)- sudden reaction of ocular surface to certain allergen
• giant papillary conjunctivitis ( GPC)
• contact dermatoconjunctivitis

Question 18

what is the aetiology/cause of seasonal/perennial allergic conjunctivitis ?

intermittent

Answer 18

. seasonal: seasonal allergens
e.g. pollen

. perennial: allergens such as house dust mite symptoms throughout the year

Question 19

what are the symptoms of seasonal/perennial allergic conjunctivitis?

Answer 19

. itching

. epiphora

Question 20

what are the signs of seasonal/perennial allergic conjunctivitis ?

Answer 20

. hyperaemia
. chemosis- swelling conjunctiva 
. redness 
. lid oedema
. diffuse papillary reaction
. no corneal involvement

Question 21

what is the management of seasonal/perennial allergic conjunctivitis ?

Answer 21

. allergen avoidance
. cool compresses
. mast cell stabiliser e.g. sodium cromoglicate
. topical or systemic antihistamines

Question 22

what is sub-conjunctival haemorrhage?

What is the management of this ?

Answer 22

. presents as a bright red patch under the conjunctiva caused by rupture of a small conjunctival vessel

. may arise spontaneously, following slight trauma, or as a result of raised central venous pressure due to coughing or sneezing

. the condition is usually unilateral

. can usually see posterior border ( excludes intracranial source )

. recurrent or bilateral haemorrhages suggests hypertension or coagulation disorder ( patient may be taking an anticoagulant )

. consider gp referral

. typically resolves in 5-10 days

. usually no treatment required

Question 23

what are benign conjunctival degeneration?

Answer 23

. pterygium

. concretions

. pinguecula

Question 24

what are concretions?

Answer 24

. benign conjunctival degeneration
. white lesions
. usually sitting under the surface - slightly raised- when pull the bottom eyelid down
- usually px doesn’t really notice them- but could cause a little corneal discomfort

Question 25

what are pterygium?

Answer 25

. benign conjunctival degeneration

. common in px that lived in hot climate

. pterygium is an elevated superficial, external ocular mass that usually forms over the perilimbal conjunctiva and extends onto the corneal surface

. risk factor for pterygium include : increased exposure to uv light

. management : lubricants surgical excision

Question 26

what is pinguecula ?

Answer 26

. pinguecula is a benign yellowish-white conjunctival lesions
. generally does not affect vision and usually does not require treatment

Question 27

what are sight-threatening conjunctival disorders?

Answer 27

. cicatricial pemphigoid
. stevens- johnson syndrome- impacts mucous membrane
. conjunctival melanoma- pigmented cancer lesions or could be a nevus ( birthmark in eye)