The document discusses various diseases of the conjunctiva. It begins by describing inflammatory conditions of the conjunctiva including infective conjunctivitis caused by bacteria, viruses, or fungi. It then discusses specific types of bacterial conjunctivitis like acute mucopurulent conjunctivitis. It also covers viral conjunctivitis, allergic conjunctivitis, trachoma caused by Chlamydia trachomatis, and other conditions like giant papillary conjunctivitis. Treatment options focus on antibiotics, antivirals, and eliminating allergens depending on the underlying cause.

1. DISEASES OF CONJUNCTIVA
BY – MS. MEGHNA VERMA
ASSISTANT PROFESSOR

2. CONTENTS
• INFLAMMATIONS OF CONJUNCTIVA
• DEGENERATIVE CONDITIONS
• SYMPTOMATIC CONDITIONS
• CYSTS OF CONJUNCTIVA
• TUMOURS OF CONJUNCTIVA

3. INFLAMMATORY CONDITIONS
OF CONJUNCTVA
• Inflammation of the conjunctiva is also known as conjunctivitis.
• It is defined as conjunctival hyperaemia associated with a
discharge which may be watery, mucoid, purulent (pus).

4. INFLAMMATORY CONDITIONS OF
CONJUNCTIVA
• Infective conjunctivitis
• Allergic conjunctivitis
• Irritative conjunctivitis
• Traumatic conjunctivitis
• Keratoconjunctivitis associated with skin
disease
ETIOLOGICAL
CLASSIFICATION
• Follicular conjunctivitis
• Granulomatous conjunctivitis
• Ulcerative conjunctivitis
• Purulent conjunctivitis
• Papillary conjunctivitis
• Angular conjunctivitis
CLINICAL
CLASSIFICATION

5. INFECTIVE CONJUNCTIVITIS
Bacterial, chlamydial, viral, fungal, protozoal, parasitic.
Inflammation of the conjunctiva caused by microorganisms.
Natural protective mechanisms in the form of :
Low temperature due to exposure to air, Physical protection by lids, Flushing action
of tears, Antibacterial activity of lysozymes and protection by the tear
immunoglobulins.
BACTERIAL CONJUNCTIVITIS
It caused by gonococcus and corynebacterium diphtheriae. These are frequent
during monsoon season.
ETIOLOGY
Predisposing factors - are flies, poor hygienic conditions, hot dry climate, poor
sanitation and dirty habits.
Causative organisms - Staphylococcus aureus, Staphylococcus epidermidis,
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella lacunate, Neisseria
gonorrhoeae.

6. Mode of infection
It may get infected from three sources,
1. Exogenous infections either directly through close contact, (e.g., flies) or through material
transfer such as infected fingers of doctors, nurses, common towels, handkerchiefs, and infected
tonometer.
2. Local spread may occur from neighbouring structures such as infected lacrimal sac, lids, &
nasopharynx.
3. Endogenous infections may occur very rarely through blood.
CLINICAL TYPES OF BACTERIAL CONJUNCTIVITIS
Depending upon the severity of infection:
• Acute catarrhal or mucopurulent conjunctivitis
• Acute purulent conjunctivitis
• Acute membranous conjunctivitis
• Acute pseudomembranous conjunctivitis
• Chronic bacterial conjunctivitis
• Chronic angular conjunctivitis

7. ACUTE MUCOPURULENT CONJUNCTIVITIS
It is the most common type of bacterial conjunctivitis.
It is characterised by marked conjunctival hyperaemia and mucopurulent discharge
from the eye.
Common causative bacteria are: Staphylococcus aureus, Pneumococcus and
Streptococcus.
Symptoms- Discomfort and foreign body sensation, mild photophobia.
Mucopurulent discharge during sleep & blurring due to mucous flakes & coloured
halos in front of the cornea.
Signs - Conjunctival congestion, which is more marked in palpebral conjunctiva,
fornices in peripheral part of bulbar conjunctiva. swelling of conjunctiva.
Complications- It may be complicated by corneal ulcer, keratitis, blepharitis or
dacryocystitis.
Treatment - Topical antibiotics, dark goggles, anti-inflammatory and analgesic
drugs, no steroids should be applied,

8. ACUTE MEMBRANOUS CONJUNCTIVITIS
It is an acute inflammation of the conjunctiva, characterized by formation of a true
membrane on the conjunctiva. It is very rare, because of decreased incidence of
diphtheria.
Etiology - The disease is typically caused by Corynebacterium diphtheriae.
Pathology - It produce a inflammation of the conjunctiva, associated with
deposition of fibrinous surface on the conjunctiva resulting in formation of a
membrane.
Clinical feature - The disease usually affects children between 2-8 years of age who
are not immunized against diphtheria.
Conjunctival discharge & severe pain in the eye. Lids are swollen and hard, trichiasis
and conjunctival xerosis.
Complications- Corneal ulcer, symblepharon, trichiasis, entropion & conjunctival
xerosis.
Treatment - Topical therapy [Penicillin eye drops, anti-diphtheric serum (ADS),
Atropine ointment if cornea is ulcerated and antibiotic ointment should be applied
at bed time.]
Systemic therapy [Penicillin should be injected intramuscularly and Anti-diphtheric
serum also should be given intramuscularly.]

9. PSEUDO-MEMBRANOUS CONJUNCTIVITIS
It is a type of acute conjunctivitis, formation of a pseudo-membrane on the
conjunctiva.
Etiology - Bacterial infection by staphylococci, streptococci, H. influenzae and N.
gonorrhoea And Viral infections by herpes simplex and Chemical irritants such
as acids, ammonia, lime, silver nitrate and copper sulfate are formation of
pseudo membrane.
Pathology -The above agents produce inflammation of conjunctiva associated
with pouring of fibrinous surface which leads to formation of a pseudo-
membrane.
Clinical picture - A thin yellowish-white membrane seen in the fornices on the
palpebral conjunctiva. Pseudo-membrane can be peeled off easily and does not
bleed.
Treatment - Topical antibiotics.

10. ANGULAR CONJUNCTIVITIS
It is a type of chronic conjunctivitis by inflammation of conjunctiva and lid margins
near the angles.
Etiology –
Moraxella is the commonest causative organism.
Rarely, staphylococci may also cause angular conjunctivitis.
Source of infection is usually nasal cavity.
Infection is transmitted from nasal cavity to the eyes by contaminated fingers or
handkerchief.
Symptoms - Irritation, sensation & discomfort in the eyes and dirty-white foamy
discharge at the angles and Redness in the angles of eyes.
Signs - Hyperaemia of bulbar conjunctiva near the canthi. Hyperaemia of lid
margins near the angles. Presence of foamy mucopurulent discharge at the angles
Treatment – Personal hygiene.

11. VIRAL CONJUNCTIVITIS
Most of viral infections tend to affect the epithelium of conjunctiva and
cornea, so, 'keratoconjunctivitis’.
Viral infections of conjunctiva include: Adenovirus conjunctivitis, Herpes
simplex keratoconjunctivitis, Herpes zoster conjunctivitis, Pox virus
conjunctivitis, Myxovirus conjunctivitis, Paramyxovirus conjunctivitis.
Clinical presentations - Acute viral conjunctivitis may present in three clinical
forms:
1. Acute serous conjunctivitis
2. Acute haemorrhagic conjunctivitis
3. Acute follicular conjunctivitis

12. ACUTE SEROUS CONJUNCTIVITIS
Etiology - It is caused by a mild viral infection which does not give rise to follicular
response.
Clinical features – It is characterized by a minimal degree of congestion, a watery
discharge and a boggy swelling of the conjunctival mucosa.
Treatment - It is self-limiting & does not need any treatment, antibiotic eye drops
may be used.
ACUTE HAEMORRHAGIC CONJUNCTIVITIS
It is characterised by multiple conjunctival haemorrhages, conjunctival hyperaemia
and mild follicular hyperplasia.
Etiology - The disease is caused by picornaviruses which are RNA viruses. The
disease is transmitted by direct hand-to-eye contact.
Symptoms - Pain, redness, watering, mild photophobia, blurring of vision and lid
swelling. Signs - conjunctival congestion, chemosis, multiple haemorrhages in
bulbar conjunctiva, mild follicular hyperplasia, lid oedema.
Treatment - Antibiotic eye drops may be used to prevent secondary bacterial
infections.

13. FOLLICULAR CONJUNCTIVITIS
It is the inflammation of conjunctiva & formation of follicles, conjunctival hyperaemia and
discharge from the eyes.
Follicles are formed due to localised aggregation of lymphocytes in the adenoid layer of
conjunctiva. Follicles appear as tiny, greyish white translucent, rounded swellings, 1-2 mm
in diameter.
CLINICAL TYPES
1. Acute follicular conjunctivitis
2. Chronic follicular conjunctivitis
3. Specific type of conjunctivitis with follicle formation e.g., trachoma
ACUTE FOLLICULAR CONJUNCTIVITIS
It is an acute type associated with follicular hyperplasia especially of the lower fornix and
lower palpebral conjunctiva.
Symptoms - redness, watering, mucoid discharge, photophobia, discomfort & foreign
body sensation.
Signs - Conjunctival hyperaemia, associated with multiple follicles, more prominent in
lower lid than the upper lid.

14. Etiological types
Etiologically, acute follicular conjunctivitis is of the following types:
I. Adult inclusion conjunctivitis
II. Epidemic keratoconjunctivitis
III. Pharyngoconjunctival fever
IV. Newcastle conjunctivitis
V. Acute herpetic conjunctivitis.
Epidemic Keratoconjunctivitis (EKC)
It is a type of acute follicular conjunctivitis mostly associated with superficial
punctate keratitis. EKC is caused by adenoviruses type 8 and 19. The condition is
markedly contagious and spreads through contact with contaminated fingers,
solutions and tonometer.
Newcastle conjunctivitis
It is a rare type of acute follicular conjunctivitis caused by Newcastle virus. The
infection is derived from contact with diseased owls; and mainly affects poultry
workers.
Clinically the condition is similar to pharyngoconjunctival fever.

15. Pharyngoconjunctival fever (PCF)
It is an adenoviral infection commonly associated with subtypes 3 and 7.
It is characterized by an acute follicular conjunctivitis, associated with pharyngitis,
fever and preauricular lymphadenopathy. The disease primarily affects children.
Acute herpetic conjunctivitis
Acute herpetic follicular conjunctivitis is mainly occurs in small children and
adolescents.
The disease is caused by - herpes simplex virus type 1 and spreads by kissing or
other close personal contacts. HSV type 2 associated with genital infections, may
also involve the eyes in adults as well as children, though rarely.

16. CHRONIC FOLLICULAR CONJUNCTIVITIS
It is a mild type of chronic catarrhal conjunctivitis associated with follicular hyperplasia,
predominantly involving the lower lid.
Etiological types –
• Infective type of chronic follicular conjunctivitis is essentially a condition of mild
infection.
• Toxic type of chronic follicular conjunctivitis is seen in patients suffering from
molluscum
• Chemical type of chronic follicular conjunctivitis is a prolonged administration of
topical medication.
• Allergic type of chronic follicular conjunctivitis [allergic response is usually papillary].

17. CHLAMYDIAL CONJUNCTIVITIS
Chlamydia situated between bacteria and viruses, sharing some of the properties of
both.
Like viruses, they are obligate intracellular and filterable and like bacteria they contain
both DNA and RNA, divide by binary fission and are sensitive to antibiotics.
TRACHOMA
Trachoma is a chronic keratoconjunctivitis, primarily affecting the superficial epithelium
of conjunctiva and cornea.
It is characterized by a mixed follicular and papillary response of conjunctival tissue.
It is one of the leading causes of preventable blindness in the world.
Etiology - Trachoma is caused by a Bedsonian organism, the Chlamydia trachomatis
belonging to the Psittacosis-lymphogranulomatrachoma (PLT) group.
The infection is usually during infancy and early childhood most of females. Trachoma is
more common in areas with dry and dusty weather.
The disease is more common in unhygienic living conditions, overcrowding, unsanitary
conditions, abundant fly population, paucity of water, lack of materials like separate
towels and lack of education and understanding about spread of contagious diseases.
Environmental factors like exposure to dust, smoke, irritants, sunlight.

18. Main source of infection is the conjunctival discharge of the affected person.
Symptoms – It includes mild foreign body sensation in the eyes, occasional lacrimation,
slight stickiness of the lids and scanty mucoid discharge.
Signs –
Conjunctival signs
Congestion of upper tarsal and fornix conjunctiva.
Conjunctival follicles - like boiled sagograins and are seen on upper tarsal conjunctiva and
fornix.
Papillary hyperplasia - reddish, flat topped raised areas which give red appearance to the
tarsal part.
Conjunctival scarring, which may be irregular, star-shaped or linear.
Concretions may be formed due to accumulation of dead epithelial cells.
Corneal signs
Superficial keratitis may be present in the upper part.
Corneal opacity may be present in the upper part.
Pannus, infiltration of the cornea associated with vascularization is seen in upper part. The
vessels are superficial and lie between epithelium and Bowman's membrane.
Corneal ulcer may sometime develop at the advancing edge of pannus.

19. Complications - The only complication of trachoma is corneal ulcer which may
occur due to rubbing by concretions, or trichiasis with superimposed bacterial
infection.
Management
Management of trachoma should involve curative as well as control measures.
Firstly, treat the cause.
Antibiotics for treatment of active trachoma may be given locally or systemically.

20. ALLERGIC CONJUNCTIVITIS
It is the inflammation of conjunctiva due to allergic or hypersensitivity reactions.
CLINICAL TYPES -
1. Simple allergic conjunctivitis [Hay fever conjunctivitis & Seasonal allergic
conjunctivitis (SAC) & Perennial allergic conjunctivitis (PAC) ]
2. Vernal keratoconjunctivitis (VKC)
3. Atopic keratoconjunctivitis (AKC)
4. Giant papillary conjunctivitis (GPC)
5. Phlyctenular keratoconjunctivitis (PKC)
6. Contact dermoconjunctivitis (CDC)

21. Simple Allergic Conjunctivitis
It is a mild, allergic conjunctivitis by itching, hyperaemia and mild papillary response.
Etiology –
1. Hay fever conjunctivitis - It is associated with hay fever (allergic rhinitis). The common
allergens are pollens, grass and animal dandruff.
2. Seasonal allergic conjunctivitis – associated with seasonal allergens such as grass
pollens.
3. Perennial allergic conjunctivitis- is a response to perennial allergens such as house
dust and mite.
Pathology – It comprises vascular, cellular and conjunctival responses.
Symptoms - Itching and burning sensation with watery discharge and mild photophobia.
Signs. - Hyperaemia & chemosis and Oedema of lids.
Treatment - Elimination of allergens if possible and Systemic antihistaminic drugs.

22. Vernal Keratoconjunctivitis (VKC)
It is a recurrent, bilateral, allergic inflammation of the conjunctiva having a periodic seasonal
incidence. More common in summer.
Atopic keratoconjunctivitis (AKC)
It is associated with atopic dermatitis.
Symptoms - Itching, soreness, dry sensation, discharge, Photophobia or blurred vision.
Signs - Tarsal conjunctiva [milky appearance], & are very fine papillae, hyperaemia and scarring
with shrinkage. Cornea may show punctate epithelial keratitis, corneal vascularization, thinning.
Associations - may be keratoconus and atopic cataract.
Treatment – Firstly treat of lid margin disease.
Giant Papillary Conjunctivitis (GPC)
Inflammation of conjunctiva with formation of very large sized papillae.
Etiology - It is a allergic response to a physically rough or deposited surface (contact lens,
prosthesis, left out nylon sutures).
Symptoms - Itching, stringy discharge and hyperaemia are the main sign.
Treatment - The offending cause should be removed.

23. Phlyctenular Keratoconjunctivitis
It is a nodular affection occurring as an allergic response of the conjunctival and corneal
epithelium to some endogenous allergens.
Etiology Peak age group is 3-15 years and Incidence is higher in girls than boys & Disease
is more common in undernourished children and Overcrowded & unhygienic Living
condititions [in spring and summer seasons]
Symptoms - mild discomfort in the eye, irritation and reflex watering.
Signs -The phlyctenular conjunctivitis can present in three forms: simple, necrotizing and
miliary.
Presence of one or more whitish raised nodules on the bulbar conjunctiva near the limbus,
with hyperaemia usually of the surrounding conjunctiva, in a child living in bad hygienic
conditions.
Management - It includes by local therapy, investigations and specific therapy aimed at
eliminating the causative allergen and general measures to improve the health of the child.

24. Contact Dermatoconjunctivitis
This type of Keratoconjunctivitis associated with skin disease.
It is an allergic disorder, involving conjunctiva and skin of lids along with surrounding area of
face.
Etiology - It is a hypersensitivity response to prolonged contact with chemicals and drugs.
Clinical picture -1. Cutaneous involvement is in the form of weeping eczematous reaction,
involving all areas with which medication comes in contact. 2. Conjunctival response is
hyperaemia with a generalized papillary response affecting the lower fornix and lower
palpebral conjunctiva.
Treatment – It consists of:
1. Discontinuation of the causative medication,
2. Topical steroid eye drops to relieve symptoms,
3. Application of steroid ointment on the involved skin.

25. GRANULOMATOUS CONJUNCTIVITIS
It is the chronic inflammations of the conjunctiva, characterised by
proliferative lesions which usually tend to remain localized to one eye and
are mostly associated with regional lymphadenitis.
Common granulomatous conjunctival inflammations are:
1. Tuberculosis of conjunctiva
2. Sarcoidosis of conjunctiva
3. Syphilitic conjunctivitis
4. Leprotic conjunctivitis
5. Conjunctivitis in tularaemia
6. Ophthalmia nodos

26. DEGENERATIVE CONDITIONS OF
CONJUNCTIVA
PTERYGIUM
CONCRETIONS
PINGUECULA

27. PINGUECULA
Pinguecula is an common degenerative condition of the conjunctiva.
It occurs due to formation of a yellowish white patch on the bulbar conjunctiva near
the limbus.
ETIOLOGY
It occurs to those persons exposed to strong sunlight, dust and wind.
PATHOLOGY
There is an elastotic degeneration of collagen fibers of the substantia propria of
conjunctiva, coupled with deposition of amorphous hyaline material in the substance
of conjunctiva.
CLINICAL FEATURES
It is a bilateral, yellowish white triangular patch near the limbus. Apex of the triangle
is away from the cornea. It affects the nasal side first and then the temporal side.
COMPLICATIONS Inflammation, abscess formation.
TREATMENT In routine no treatment is required for pinguecula.

28. PTERYGIUM
Pterygium is a wing-shaped fold of conjunctiva encroaching upon the cornea.
ETIOLOGY
This disease is more common in people living in hot climates. It occurs due to
prolonged effect of environmental factors such as exposure to sun (UV rays), dry heat,
high wind and dust.
PATHOLOGY
The subconjunctival tissue undergoes elastotic degeneration & proliferates as
vascularized granulation tissue under the epithelium. The corneal epithelium,
Bowman's layer and superficial stroma are destroyed.
CLINICAL FEATURES
It may be unilateral or bilateral. It presents as a triangular fold of conjunctiva
encroaching the cornea in the area of palpebral aperture, usually on the nasal side
but may also occur on the temporal side. Deposition of iron seen sometimes in
corneal epithelium.

29. PARTS
A fully developed pterygium consists of three parts.
i. Head (apical part present on the cornea)
ii. Neck (limbal part)
iii. Body (scleral part) extending between limbus and the canthus
SYMPTOMS
It is an asymptomatic condition in early stages, except for cosmetic
apperance. Visual disturbances occur when it encroaches the pupillary
area.
Diplopia may occur due to limitation of ocular movements.
COMPLICATIONS
Cystic degeneration and infection, rarely, malignant melanoma, may occur.
TREATMENT
Surgical excision is the only satisfactory treatment

30. CONCRETIONS
ETIOLOGY
Concretions are formed due to accumulation of mucus & dead epithelial cell debris
into the conjunctival depressions called loops of Henle.
They are commonly seen in elderly people as a degenerative condition and also in
patients with scarring stage of trachoma.
CLINICAL FEATURES
Concretions are seen on palpebral conjunctiva, more commonly on upper than the
lower.
These are yellowish white, hard looking, raised areas, varying in size from pin point
to pin head. Being hard, they may produce foreign body sensations and lacrimation
by rubbing the corneal surface. Occasionally they may even cause corneal abrasions.
TREATMENT
Removal with the help of a hypodermic needle under topical anaesthesia.

31. SYMPTOMATIC CONDITION OF
CONJUNCTIVA
Hyperaemia of conjunctiva
Chemosis of conjunctiva
ECCHYMOSIS OF CONJUNCTIVA (SUBCONJUNCTIVAL HAEMORRHAGE)
Xerosis of conjunctiva
Discoloration of conjunctiva

32. ECCHYMOSIS OF CONJUNCTIVA (SUBCONJUNCTIVAL
HAEMORRHAGE)
It is of very common. It may vary in from small patches to whole of the bulbar
conjunctiva and thus making the white sclera of the eye invisible.
ETIOLOGY
It may be associated with following conditions:
Trauma
It is the most common cause. It may be in the form of-
# local trauma to the conjunctiva, due to surgery and subconjunctival injections.
# retrobulbar haemorrhage, spreads below the bulbar conjunctiva.
Inflammation
It usually associated with acute conjunctivitis caused by picornaviruses.
Sudden venous congestion of head
It may occur rupture of conjunctival capillaries due to sudden rise in pressure.
Common conditions are whooping cough, epileptic fits, strangulation.

33. Spontaneous rupture of fragile capillaries
Vascular diseases such as arteriosclerosis, hypertension & diabetes mellitus.
Local vascular anomalies - like telengiectasia, varicosities, aneurysm.
Blood dyscrasias - like anaemias, leukaemia and dysproteinaemias.
Bleeding disorders - like purpura, haemophilia and scurvy.
Acute febrile systemic infections - such as malaria, typhoid, diphtheria, measles.
CLINICAL FEATURES
There may be symptoms of associated causative disease. On examination, looks
as a flat sheet of bright red color with well defined limits. Most of the time it is
absorbed completely within 7 to 21 days. During absorption color changes are
noted from bright red to orange and then yellow.
TREATMENT
Treat the cause when discovered.

34. CYSTS OF CONJUNCTIVA
Congenital cystic lesions
These are of rare occurrence and include congenital corneoscleral cyst.
Lymphatic cysts of conjunctiva
These are common and usually occur due to dilatation of lymph spaces in
the bulbar conjunctiva.
Retention cysts
These occur occasionally due to blockage of ducts of accessory lacrimal
glands of Krause in chronic inflammatory conditions.
Epithelial implantation cyst (traumatic cyst)
It may develop implantation of conjunctival epithelium in the deeper
layers, due to surgical or non-surgical injuries of conjunctiva.

35. Epithelial cysts
It occurs due to down growth of epithelium are rarely seen in chronic
inflammatory or degenerative conditions, e.g. pterygium.
Aqueous cyst
It may be due to healing by cystoid formation, following surgical or
nonsurgical perforating limbal wounds.
Pigmented epithelial cyst
It may be formed sometimes prolonged topical use of cocaine or
epinephrine.
Parasitic cysts
Such as subconjunctival cyst.
Treatment
Conjunctival cysts need a careful surgical excision.

36. TUMORS OF CONJUNCTIVA
There are main two types of tumours -
1] Non-pigmented tumours
I. Congenital - dermoid and lipo-dermoid
II. Benign - simple granuloma, papilloma, adenoma, fibroma and
angiomas.
III. Premalignant - intraepithelial epithelioma (Bowen's disease).
IV. Malignant - epithelioma or squamous cell carcinoma, basal cell
carcinoma.
2] Pigmented tumours
I. Benign - naevi or congenital moles.
II. Precancerous melanosis - superficial melanoma
III. Malignant - primary melanoma (malignant melanoma)

37. NON- PIGMENTED TUMORS
CONGENITAL TUMOURS
Dermoid
These are common congenital tumor which usually occur at the limbus.
They appear as solid white masses, fixed to the cornea. Dermoid consists of collagenous
connective tissue, sebaceous glands. Treatment is simple excision.
Lipo-dermoid
It is a congenital tumor, usually found at the limbus or outer canthus.
It appears as soft, yellowish white, movable subconjunctival mass.
It consists of fatty tissue and surrounding dermis-like connective tissue, (the name lipo-
dermoid).
BENIGN TUMORS
Simple granuloma
It is a cauliflower-like growth of granulation tissue & associated with squint surgery &
chalazion. Treatment consists of complete surgical removal.

38. Papilloma
It is a benign polypoid tumor usually occurring at inner canthus or limbus.
It has a tendency to undergo malignant change and needs complete excision.
Fibroma
It is a rare soft or hard polypoid growth usually occurring in lower fornix.
PRE-MALIGNANT TUMOURS
Intraepithelial epithelioma
It is a rare, precancerous condition, usually occurring at the limbus as a flat,
reddish grey, vascularized plaque and treated by complete local excision.
MALIGNANT TUMOURS
Squamous cell carcinoma (epithelioma)
It usually occurs at the transitional zones i.e. at limbus and the lid margin. The
tumor invades the stroma deeply & treated by complete local excision.
Basal cell carcinoma
It may invade the conjunctiva from the lids or may arise from the plica semilunaris
and the complete surgical excision.

39. PIGMENTED TUMORS
Benign (Naevi or congenital moles)
These are common pigmented lesions, usually presenting as brown or black,
flat or slightly raised nodules on the bulbar conjunctiva, mostly near the
limbus.
It is indicated by sudden increase in size or increase in pigmentation or
inflammation so, excision is usually indicated for cosmetic reasons and rarely
for medical reasons.
Precancerous melanosis (superficial melanoma)
It develops at any site on the bulbar or palpebral conjunctiva, which spreads
as a diffuse, flat patch. It should be treated as local incision.
Malignant melanoma (primary melanoma)
It usually near the limbus. The condition usually occurs in elderly patients.
It spreads over the surface of the globe and rarely penetrates it.
Treatment, Once suspected, enucleation is the treatment of choice, depending
upon the extent of growth.

40. PIGMENTATION OF
CONJUNCTIVA
The conjunctiva sometimes develops brown discoloration.
It is primarily caused by hyper-melanosis [over production of melanocytes].
It is secondary caused by irradiation, hormonal changes, chemical
irritation, chronic inflammatory disorders.
It is found in children & adults and typically occurs only in one eye.
It leads to life threatening malignant melanoma.
Is should be treated with surgery, cryotherapy or sometime chemotherapy
eye drops.

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