conjunctiva

2. The lymphatic drainage is to
the^submandibular nodes)
which drain the medial one-third of the
superior conjunctiva
and the medial two-thirds of the
inferior conjunctiva;
and the preauricular nodes which drain
the lateral twothirds
of the superior conjunctiva and lateral
one-third of
the inferior conjunctiva.
The conjunctival nerve supply consists
of branches of
the ophthalmic division and branches of
the maxillary
division of the fifth cranial nerve.

3. The functions of the conjunctiva include tear production
(mucin by the goblet cells and aqueous by the
accessory lacrimal glands),
tear film
mucinous layer lining the conjunctival
cells and corneal epithelium secreted by the goblet cells,
aqueous layer secreted by the lacrimal and accessory
conjunctival glands, and a superficial
lipid layer which is
secreted by the meibomian glands and limits the
evaporation
of tears.
This triple-layered sandwich maintains a
smooth ocular surface and the oxygen dissolved in it from
the atmosphere nourishes the corneal epithelium.

4. CLINICAL FEATURES OF CONJUNCTIVAL
DISORDERS
redness, stickiness, foreign body sensation or grittiness,
lacrimation and sometimes photophobia.
Vision is generally
normal but a slight blurring may occur if excess
secretions form a film over the cornea.
burning sensation
and dryness of the eyes.
Hyperaemia of the conjunctiva
Conjunctival discharge
1- watery or mucoid discharge occurs in viral and allergic
2-mucopurulent, or frankly
Purulent discharge is seen in bacterial conjunctivitis.
3-Itching with a 'ropy! or 'stringy' mucoid discharge
is characteristic of allergic conjunctivitis.

5. Foreivn body sensation or grittiness may be a manifestation
of dry eye, eye strain, trachoma, contact lens induced
papillary conjunctivitis, trichiasis
Follicles - Appear as
yellowish-white, round elevations, 1-2 mm in diameter, and
are due to localized aggregations of lymphocytes in the subepithelial
adenoid layer
Papillae - are a hyperplasia of the normal vascular system
with glomerulus-like bunches of capillaries growing into
the epithelium in inflammatory conditions
Subconjunctival haemorrhage

7. CONJUNCTIVITIS
Inflammation of the conjunctiva manifests usually of an
infective or allergic origin.
Hyperaemia and increased
secretion always accompany it.
The hyperaemia varies
in degree and in distribution, and the
secretion varies in
nature and amount.
The nature of the secretion is of diagnostic
importance.
Acute conjunctivitis
(resolving in less than 4 weeks) further classified
type of discharge, conjunctival reaction or aetiology.
Neonatal conjunctivitis includes a limited spectrum of
acute conjunctivitis
. Subacute / chronic conjunctivitis (of more than 4 weeks' duration)
i non-specific conjunctivitis, angular conjunctivitis,

8. Epidemic Keratoconjunctivitis: This disease is usually
Caused by adeno virus of serotypes 8 and 19, but also 3 and
7 and is characterized by a rapidly developing follicular
conjunctivitis with marked inflammatory symptoms and
scanty exudate, associated with a preauricular adenopathy.
pharyngoconjunctival fever; caused by adenovirus serotypes
3;_4,and^7 and is characterized by an acute follicnlar
conjunctivitis in association with pharyngitis, fever
and occasionally preauricular adenopathy, seen chiefly
in children in the epidemic form. Corneal involvement
as a superficial, fine, punctate keratitis manifesting as
epitheliopathy can occur but is rare

9. Newcastle conjunctivitis is clinically indistinguishable from
the conjunctivitis of pharyngoconjunctival fever; the Newcastle
virus is derived from contact with diseased jfowDD
Haemorrhagic conjunctivitis is due to picornavi ruses,
namely, coxsackie virus and emerovirus . It is also known
asApcfflgronjunctivitis and occurs in a pandemic
form producing a violent inflammatory conjunctivitis
with lacrimation and photophobia. Subconjunctival
haemorrhages and enlarged preauricular lymph nodes
are common. The cornea is usually unaffected

10. Chlamydial conjunctivitis
Acute inclusion conjunctivitis
The disease is caused by chlamydial infection (serotypes
D-K) and produces inclusion bodies morphologicallv
identical with those occurring in trachoma.
QChlamydia inclusion conjunctivitis is generally spread by
sexual transmission from a genital reservoir of infection. The
primary source of infection is a benign subclinical venereal
disease producing a mild urethritis in the male and cervicitis
in the female. In adults the organism may be transferred
from the genitals by the fingers, but a common mode of
infection is through the water in swimming pools; thus the
disease may occur in local epidemics (sivimmim-pool
conjunctivitis.).
It is also commonly transmitted from the mother
to the newborn.

11. Ophthalmia neonatorum
Neonatal conjunctivitis is defined as a mucoid, mucopurulent,
or purulent discharge from one or both eyes in the
first month of life. It is a preventable disease occurring
in a newborn child due to maternal infection acquired at
the time of birth, and used to be responsible for 50% of
blindness among children. The recent decline in the incidence
of gonorrhoea as well as effective methods of prophylaxis
and treatment have almost eliminated its occurrence
and the seriousness of its sequelae. However, the
disease is still prevalent and is a public health problem
in communities with poor hygiene and limited access to
proper health care. It may be due to Chlamydia oculogenitalis,
Streptococcus pneumoniae or other organisms.

12. Acute conjunctivitis
This is usually bacterial, viral or due to Chlamydia trachomatis
serotypes D-K.
Bacterial conjunctivitis - 1
Acute purulent and mucopurulent conjunctivitis 1 -1
Aetiology: Mucopurulent and purulent conjunctivitis may
be caused by a number of bacteria and is
contagious, being transmitted directly by the discharge.

13. Table 14.1 Classification of conjunctivitis
I Based on onset
• Acute
• Subacute
• Chronic
II Based on type of exudate
• Serous* (viral, allergic, toxic)
• Catarrhal* (allergic)
• Purulent (bacterial)
• Mucopurulent (bacterial, chlamydial)
• Membranous (bacterial)
• Pseudomembranous (bacterial)
III Based on conjunctival response
• Follicular (viral, chlamydial)
• Papillary (allergic)
• granulomatous (fungal, Parinaud oculoqlandular syndrome,
tuberculosis, syphilis, sarcoidosis, tularaemia, actinomycosis,
sporotrichosis,

14. Non-infectious
- Allergic
- Irritants (physical, foreign bodies, contact lens use, radiation)
- Endogenous or autoimmune
- Dry eye
- Toxic (chemical or drug-induced)
- Factitious or self-inflicted,
-Idiopathic

15. severe form of acute purulent conjunctivitis
'pseudomembrane' in pneumococcal conjunctivitis.
Iritis is a rare except in pneumococcal conjunctivitis
Neisseria gononhoeae
presents as ophthalmia neonatorum in newborn babies
and as severe purulent conjunctivitis in adults. It is associated
with moderate to severe pain and lid swelling with copious
purulent
discharge and tender, sometimes suppurative, preauricular
lymphadenopathy.

16. Membranous and pseudomembranous
conjunctivitis
Corynebacterium diphtheriae, beta-haemolytic
streptococci, Streptococcus pneumoniae,
HaemopMus aegyptius,
Neisseiia gononhoeae, Staphylococcus aureus, and
Escheiichia
Coli
palpebral conjunctiva is seen to be covered with a
white membrane which peels off easily without
much bleeding this form is often referred to as
pseudomembranous.

17. severe cases the conjunctiva
is permeated with semisolid exudates, which tend to necrotize both
the conjunctiva and cornea.
In these cases the membrane
separates less readily, with bleeding from the underlying
surface, which is often described as membranous and is
more common with diphtheritic infection
danger of adhesions forming between the palpebral and
bulbar parts of the conjunctiva symblepharon

18. Angular conjunctivitis (diplobacillarv conjunctivitis)
Aetiology: Such a condition may be caused by staphylococci
but is typically due to Moraxella lacunata, a diplobacillus
consisting of pairs of large, thick rods, placed end
to end which stain well with basic stains, are Gram negativejmd
easily recognized in films. They produce a proteolytic
ferment, which acts by macerating the epithelium.

19. Viral conjunctivitis
Viral infections usually cause a serous)or clear watery
discharge and are further characterized byThe type of
conjunctival inflammatory reaction they produce. In
addition, many systemic viral illnesses such as influenza,
mumps, measles and chickenpox can be accompanied
by a non-specific conjunctivitis.

20. Follicular conjunctivitis
This conjunctival reaction is most commonly caused by
viruses
Isolated follicles, however, may occur particularly in the
lower conjunctiva in any conjunctivitis of long standing
and with the prolonged topical use of some medications.
Follicular conjunctivitis can be (i) acute, or (ii) subacute
and chronic. Acute follicular conjunctivitis is due to different
causes, namely, chlamydial inclusion conjunctivitis, epidemic
keratoconjunctivitis, pharvngoconjunctival fever,
Newcastle conjunctivitis, haemorrhagic conjunctivitis, primary
herpetic conjunctivitis and recurrent hejpes simplex
conjunctivitis.