Pathology of the conjunctiva baguio 2012

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Pathology of the conjunctiva baguio 2012

  1. 1. PATHOLOGY OF THE CONJUNCTIVA
  2. 2. CONJUNCTIVITIS• Inflammation of the Conjunctiva
  3. 3. Conjunctival sign of inflammation• Hyperemia• Injections• Papillae• Follicles• Chemosis• Membrane – true, pseudo• Keratinization• Scar• Symblepharon
  4. 4. HYPEREMIA• Increased redness of conjunctiva
  5. 5. Conjunctival INJECTIONS• Presence of dilated blood vessels at the periphery that fades towards the limbal area
  6. 6. FOLLICLES
  7. 7. PAPILLAE
  8. 8. 47- Palperal spring catarrh
  9. 9. 48- Palperal spring catarrh
  10. 10. 49- Palperal spring catarrh
  11. 11. 50- Palperal spring catarrh
  12. 12. CHEMOSIS
  13. 13. MEMBRANE
  14. 14. SCARRING
  15. 15. CLASSIFICATION• By Cause• By Type of Discharges• By age of onset• By Duration
  16. 16. By Cause• Bacterial• Viral• Chlamydial• Allergic
  17. 17. Bacterial conjunctivitis
  18. 18. Hyperacute conjunctivitis• Neisseria gonorrhoeae (GC) – Lid edema, conj injection, chemosis, purulent discharge, conjunctival memb, tender preauricular adenopathy – Keratitis 15-40% – Conjunctival swab – gram stain, C/S
  19. 19. • Neisseria gonorrhoeae (GC) – Treatment • copious irrigation • systemic ATB – ceftriaxone, cefixime, ciprofloxacin, ofloxacin • topical ATB – ciprofloxacin, erythromycin, gentamicin • concurrent chlamydial infection up to 33%  doxycycline, azithromycin
  20. 20. • Neisseria meningitidis – clinical almost identical to GC – younger, more bilateral – primary or secondary from septicemia, meningitis
  21. 21. • Neonatal GC conjunctivitis – 2-5 days after birth – Bilateral 75% – Serosanguinouspurulent discharge – No preauricular adenopathy – Rhinitis, proctitis, disseminated – Treatment-topical + systemic (cefotaxime, ceftriaxone)
  22. 22. Viral conjunctivitis– Benign, self limited, last longer than bacterial conjunctivitis– Almost all – acute follicular conjunctivitis, preauricular adenopathy
  23. 23. Epidemic keratoconjunctivitis(EKC)– Adenovirus serotype 8,11,19,37– Redness, FB sensation, tearing, photophobia– Bilateral > 50%– Lid swelling, conjunctival injection, watery discharge, follicles, preauricular adenopathy– Subconj hmg, membrane, pseudomembrane– Epithelial, subepithelial keratitis
  24. 24. EKC– Treatment • Prevent transmission • Supportive treatment – cold compress, topical artificial tear, topical vasoconstrictor – antihistamine,topical NSAID, topical steroid
  25. 25. Pharyngoconjunctival fever– Adenovirus serotype 3,4,7– Sign & symptom – same as EKC– Keratitis < EKC, mild– Pharyngitis, fever– Treatment – same as EKC
  26. 26. Acute hemorrhagic conjunctivitis – Picornavirus – enterovirus70, coxsackievirus A24 – Acute follicular conjunctivitis, subconjunctival hemorrhage – Keratitis < EKC, mild – Treatment – same as EKC
  27. 27. Chlamydial infection• Chlamydia trachomatis – obligate intracellular bacteria• Trachoma, adult inclusion conjunctivitis, neonatal inclusion conjunctivitis
  28. 28. • Trachoma – C.trachomatis serotype A-C – Poor hygiene – Repeated infection – Chronic follicular conjunctivitis  conjunctival and corneal scar – Preventable blindness
  29. 29. • MacCallan classification – Stage I incipient trachoma • Acute inflammation • Immature follicles – superior tarsal conj, fornices, limbus, semilunar fold • Minimal papillae • Epi-subepithelial keratitis, early pannus at superior cornea
  30. 30. – Stage II established trachoma IIa follicles predominant -mature follicles -keratitis and pannus more advanced IIb papillae predominant -florid inflammation -papillae at upper tarsal conj -keratitis and pannus more advanced -necrosis of follicles at limbus
  31. 31. – Stage III cicatrizing trachoma • Scar and cicatrization of conjunctiva and cornea • Limbal folliclesnecrosisscar (Herbert’s pit) • Upper tarsal conjunctivascar (Arlt’s line) • Cicatrization of lid and conjunctivatrichiasis, entropion, lid distortion, symblepharon • Pannus - grossly visible
  32. 32. – Stage IV healed trachoma • Inflammation subside • Lid complication and corneal opacity  visual impairment– Diagnosis • Conjunctival swab – Giemsa, Wright stain : intracytoplasmic inclusion body • Sign & symptom : at least 2 in 4 – Conjunctival follicles at UTC – Limbal follicles, Herbert’s pit – Typical conjunctival scar – Vascular pannus at superior cornea
  33. 33. – Treatment • Topical – tetracycline EO, erythromycin EO • Systemic – oral tetracycline, erythromycin • Surgery for lid complication
  34. 34. • Adult inclusion conjunctivitis – C.trachomatis serotype D-K – Oculogenital disease, sexual transmitted disease asso with urethritis, cervicitis – Direct, indirect contact with genital secretion, swimming pool, eye cosmetics – Subacute or acute follicular conjunctivitis – Scant mucopurulent discharge, follicles (lower>upper), preauricular adenopathy, keratitis, micropannus, no membrane, minimal scar – Treatment – topical +systemic ATB, sexual
  35. 35. • Neonatal inclusion conjunctivitis – C.trachomatis serotype D-K – 3-14 days after birth – Mucopurulent discharge, papillae, membrane, no preauricular adenopathy – Keratitis,pannus – Systemic infection- otitis media, rhinitis, vaginitis, pneumonia – Conjunctival scraping-Gram, Giemsa, Wright stain, C/S – Treatment- topical+systemic erythromycin, cotrimoxazole
  36. 36. Allergic conjunctivitis• Hay fever conjunctivitis – Type I hypersensitivity to airborne allergen, seasonal – Bilateral, itching, irritation, tearing – Lid edema, conjunctival injection, chemosis, papillae, mucoid discharge – Treatment – avoid allergen, cold compress, topical vasoconstrictor-antihistamine, topical NSAID, topical steroid, topical mast cell stabilizer, oral antihistamine
  37. 37. • Vernal keratoconjunctivitis – Type I and IV hypersensitivity – Male, children and young adult – Bilateral, 2 forms – Palpebral form – giant papillae at UTC, cobblestones – Limbal form – opalescent nodules at superior limbus – Horner-Trantas’ dots – degenerated Eo and epithelial cells – PEE, pannus, shield ulcer at superior cornea – Treatment – as hay fever, 2% cyclosporin ED, topical mucolytic, tear+CL in shield ulcer
  38. 38. • Atopic keratoconjunctivitis – Type I and IV hypersensitivity – Atopic dermatitis, infant and children – Blepharitis, smaller papillae at UTC and LTC, conjunctival scar at inferior fornix – PEE at inferior, marginal corneal ulcer, pannus, stromal opacity – Cataract – PSC, ASC – Treatment – same as VKC
  39. 39. • Contact lens induced conjunctivitis – Type IV hypersensitivity to CL, deposit on CL, repeated mechanical trauma from CL – Soft CL > RGP CL – Redness, itching, irritation, mucoid discharge, blurred vision – Papillae at UTC, limbal nodule, Trantas’ dot, keratitis, pannus, CL decentration – Treatment – resolve with off CL, improved lens hygiene, topical mast-cell stabilizer, topical steroid, refitting new CL(daily, disposable, RGP)
  40. 40. Adverse reaction to topical medication• Allergic reaction – Acute onset • Rare, type I • Within minutes  itching, lid erythema and swelling, chemosis, systemic anaphylaxis • Topical bacitracin, cephalosporin, penicillin, sulfacetamide, tetracycline, anesthetics • Treatment – withdraw medication, cold compress, lubricant, topical antihistamine or steroid
  41. 41. – Delayed onset • Type IV • Within 24-72 hrs • Contact blepharoconjunctivitis • Lid – acute eczema, erythema, scaling • Conjunctival injection, mucoid discharge, + papillae • Cornea – PEE at inferior • Topical atropine, homatropine, neomycin, penicillin, gentamicin, tobramycin, idoxuridine, trifluridine, natamycin, antazoline, epinephrine, thimerosal, EDTA • Treatment – withdraw medication, cold compress, topical antihistamine or steroid
  42. 42. • Toxic reaction (much more common than allergic reaction) – Toxic papillary conjunctivitis • Direct chemical irritation, long term use • Irritation, without itching • Conjunctival injection, papillae, mucopurulent discharge, PEE at inferior cornea • Topical aminoglycoside, antiviral, benzalkonium chloride • Treatment – withdraw medication, preservative free artificial tear
  43. 43. – Toxic follicular conjunctivitis • Long term use • Drug induced mitosis and lymphoblastic transformation of lymphocytes by nonimmunologic • Irritation without itching • Conjunctival injection, follicles at LTC, no discharge • PEE at inferior cornea • Topical atropine, homatropine, antiviral, glaucoma medication (epinephrine, dipivefrin, pilocarpine), sulfonamide • Treatment – withdraw medication, preservative free artificial tear
  44. 44. By Type of Discharges• Watery• Mucous• Purulent• Mucopurulent
  45. 45. By Age of onset• Neonatal Conjunctivitis• Adult Conjunctivitis
  46. 46. By Duration• Acute• Chronic
  47. 47. Acute conjunctivitis– Staph.aureus, H.aegyptius, H.influenzae, Strep.pneumoniae, Strep.pyogenes, P.aeruginosa, E.coli, C.piphtheriae– Duration< 3-4 wks– Conj injection, mucopurulent discharge, lid edema, FB sensation, tearing– Treatment- broad spectrum topical ATB
  48. 48. Chronic conjunctivitis– S.aureus, Branharnella catarrharis, E.coli, S.pyogenes, S.pneumoniae, Moraxella lacunata– >3-4 wks– Risk factor – lid malposition, dry eye, chronic dacryocystitis, poor hygiene, eye prosthesis, topical steroid– Mild and nonspecific symptom
  49. 49. conjunctivitis• Bacterial - most common in children• Viral - most common in adults• Allergic - bilateral, frequently c/o ‘itch’
  50. 50. bacterial conjunctivitis• Signs: – Discharge - purulent vs mucopurulent
  51. 51. Question• What type of neonatal conjunctivitis occurs on the first day?
  52. 52. Pitfalls: Adult Conjunctivitis• Adult Hyperacute Conjunctivitis – Gonococcus – Signs/symptoms of severe infection – Rapid onset• Chlamydial Conjunctivitis – Sexually active adolescents/adults – Unilateral, Follicular reaction – Chronic (>3 weeks) – Microtrak – Oral Tetracyclin
  53. 53. bacterial conjunctivitis• Usually self limited• Treatment necessary? – Limits spread – Shortens course – Patient comfort – Prevents recurrence – Prevents chronic staph conjunctivitis
  54. 54. bacterial conjunctivitis therapy• Choice of antibiotic depends on other factors: – Polysporin • no prescription required – Polytrim • Low cost • Well tolerated – Fucithalmic • BID dosing
  55. 55. Pitfalls in Treatment• Avoid – Gentamicin • Epithelial toxicity – Steroid containing solutions – Garasone – Tobradex – Blephamide • Increase IOP, Cataract • Geographic Herpes • Worsen Infection • Corneal Spread – Frequent switching of drops
  56. 56. Viral Conjunctivitis• History: Infectious Contacts, URTI, Drops/Drugs• Etiology: Adenovirus• Treatment: No specific therapy – Cool compresses, artificial tears, infectious precautions
  57. 57. Allergic Conjunctivitis• Symptoms: ITCHING• Signs: mild redness, conjunctival chemosis, watery discharge, papillary hypertrophy• Treatment: cold compress, antihistamines, non-steroidal drops, mast cell stabilizers, topical corticosteroids
  58. 58. Subconjunctival Hg• What is the appropriate management of a large subconjunctival hemorrhage – A) Stop any anticoagulation and observe for improvement – B) Observe. If no resolution in 1-2 weeks refer to ophthalmology – C) Observation only – D) If large, refer to ophthalmology
  59. 59. Subconjunctival Hemorrhage
  60. 60. 28-Typical conjunctival hyperemia
  61. 61. 29- Typical conjunctival hyperemia
  62. 62. Typical conjunctival hyperemia• C h a r a c t e r s :- 1- Vasodilatation of posterior Conjunctival vessels. 2- Bright red in color . 3- Maximum in fornices . 4- Move with movement of conjunctiva . 5- Usually associated with discharge (important)• E t io l o g y & Dif f e r e n t t y p e s o f c o n j u n c t iv it is : 1- MPC 2- PC 3- Ophtalmia neonatorum .
  63. 63. 30- Ophthalmia neonatorum
  64. 64. Ophthalmia neonatorum• C a u s a t iv e o r g a n is m : 1- Chlamydia oculogenitalis ( 80 % ) . 2- Gonococci ( 20 % ) . (1, 2 are most common & Acquired during passage in birth canal) 3- Other bacterial hospital infection e . staph , strept E.coli . 4- Viral infection ( Herpes genitalis ) . 5- Chemical kerato conjunctivitis e.g. silver nitrate .• S ig n s : 1- Marked lid edema . 2- Yellow profuse purulent discharge ( Blanorrhea ) . 3- Preauricular + submandibular lymphadenitis .• M o s t s e r io u s c o mp l ic a t io n : 1- Secondary corneal ulcer usually central with perforation . 2- Dense corneal opacity Defective macular development (amblyopia) Nystagmus  If unilateral Squint . 3- Anterior polar cataract . 4- Endophthalmitis & panophthalmitis .
  65. 65. Ophthalmia neonatorum• D.D: 1- Congenital NLD obstruction ( Congenital Dacrocystitis ). 2- ? May be Buphthalmos .• TTT: 1- prophylactic: 1- Proper antenatal care 2- Treatment of any maternal infection. 3- Anti - septic delivery . 4- Broad spectrum local eye lotion . 2- Active : 1- Hot fomentation , Boric eye lotion . 2- If Chlamydia  Local acid eye lotion  Erythromycin . 3- If gonococcal  Local penicillin  Examine parents . 4- Cycoplegic( Atropine ) If cornea is affected . 5- Systemic Broad spectrum antibiotic ( by pediatrician ) .• De f in e t h is c o n d it io n : It is any form of conjunctivitis occurring in first 10 days after birth , it is preventable & acquired during delivery .
  66. 66. 31- Mucopurulent conjunctivitis
  67. 67. Mucopurulent conjunctivitis• C a u s a t iv e o r g a n is m : 1- Koch - weeks bacilli ( Heamophillus egypticus ) . 2- Staph & Strept . 3- Pneomococci .• C / O : Redness + discharge + Burning sensation + lid swelling + Halos around light .• C o mp l ic a t io n : 1- Secondary corneal ulcer usually central with perforation . 2- Dense corneal opacity ( scar ) :defective macular development(Amblyopia) Nystagmus. If unilateral  squint . 3- Panophalmitis & Endophthalmitis . 4- Anterior polar cataract . 5- Chronicity .
  68. 68. Mucopurulent conjunctivitis• D.D: 1-Halos around light :1- Incipient stage of immature senile cortical cataract .2- ACG .3- Corneal edema . 2- Glued lashes  Ulcerative blepharitis . 3- Red eye  IC , CU , ACG , Scleritis , Episcleritis .• T T T :- 1- Boric acid lotion 2 - 4 % . 2- Hot fomentation & Dark glasses . 3- Local antibiotics : 1- Chlaramphenicol eye drops . 2- Tetracycline ointment at night . 3- Sulfonamide eye drops , if no pus . 4- Systemic antibiotics  severe cases . 5- Atropine ointment  if cornea is affected .
  69. 69. 32- Follicular conjunctivitis
  70. 70. Follicular conjunctivitis• D.D:1- Viral infectionAdenovirusEpidemic kerotoconjunctivitia- Pharyngeo - conjunctival fever Herpes simplex Herpetic conjunctivitis .2- Chlamydia oculogenitatis [ Inclusion blenorrhea[3- Acute trachoma in foreigners.4-Allergic , due to chronic medication [Drug induced e.g. + Atropine + eserine]5- Folliculosis.• C a u s a t iv e o r g a n is m:1- Adenovirus . 2-Herpes S. Virus.3- Chlamydia oculogenitatis. 4- Chronic use of drugs• TTT :1- Decongestant. 2- Removal of the cause.
  71. 71. 33- Acute trachomatous follicles & papillae
  72. 72. Acute trachomatous follicles & papillae• C a u s a t iv e o r g a n is m: 1- Chlamydia Trachomatous serotypes A.B.C.• C / O: Gritty sandy sensation, scanty MP discharge Redness + Heaviness of lids .• C o mp l ic a t io n s :Eye lid 1- Trichiasis [Multiple] 2- Ptosis. 3- Cicatricial entropion.Conj. 1- Xerosis. 2- Posterior symblepharon. 3- Corneal: Ulcers & opacities. 4- Lacrimal : Fibrosis of NLD  Dacrocystitis & Epiphora• TTT: 1- Boric acid lotion wash. 2- Local & systemic Sulfonamides[ sulphacetomide eye drops10-30%] . 3- Local & systemic Tetracycline [Ointment at night] 4- In sensitive cases  Chloromphenicot 0.4 % eye drops. 5- Atropine  If cornea affected .
  73. 73. 34- Acute trachomatous follicles & papillae + pannus
  74. 74. 35- Acute trachomatous follicles & papillae + pannus
  75. 75. 36- Acute trachomatous follicles & papillae + pannus
  76. 76. Acute trachomatous follicles & papillae + pannusSee previous comment (no. 33)
  77. 77. 37- Active trachomatous pannus
  78. 78. 38- Active trachomatous pannus
  79. 79. 39- Active trachomatous pannus
  80. 80. Active trachomatous pannus• De f in e : Sub epithelial infiltration with inflammatory cells + vasculariztion of corneal margin, usually limited to upper half of cornea .• D.D.: 1- Trachomatous. 2-Phlyctenutar. 3- Leprotic. 4- Degenerative [Atrophia bulbi & Absolute Glaucoma] 5- Mechanical [Rubbing lashes]• Fat e: 1- Complete resolution , If B.M. is intact. 2- C. opacity, if B,M. is destroyed. 3- Kertectasia [Bulging forwards of cornea]• TTT; S e e p r e v io u s s l id e
  81. 81. Active trachomatous pannus• C o a r s e o f t r a c h o ma t o u s pannus : 1- Progressive. 2- Regressive. 3- Healed• T y p e s o f t r a c h o mo t o u s pannus : 1- P. Tenius (Thin P) 2- P. Vasculosus (vascular P) 3- P. Annulosus (rounded P) 4- P. Carnosus (Fleshy P)
  82. 82. 41- Herbert’s pits (festooned cornea)
  83. 83. 42- Scarred palpebral conjunctivitis
  84. 84. Scarred palpebral conjunctivitis• M o s t c o mmo n c a u s e : Trachoma• Ca u s e s : 1- Trachoma. 2- Membranous conjunctivitis. 3- Chemical injures. 4- Steven - Johnsons syndrome.• T wo C o mp l ic a t io n s : 1- Cicatricial entropion Trichiasis. 2- Xerosis + Posterior symblepharon.
  85. 85. 43- Membranous conjunctivitis
  86. 86. Membranous conjunctivitis• C a u s a t iv e o r g . o r D.D.: 1- Diphtheria bacilli. [Diphtheria until proved other wise . 2- Viral [Severe Adenoviral infection]. 3- Chemical Burns & caustics . 4- Fungal conj. 5- Severe pneumococca! Conj.• S p e c if ic c o mp l ic a t io n : 1- General: 1- Toxic myocarditis , Nephropathy, Nephritis , Neuritis , Neuropathy. 2- Local: 1- Central & marginal C.Ulcer. 2- Xerosis . 3- Entropion Trichiasis 4- Symblepharon 5- Fibrosis of lacrimal duct 6- Optic neuritis + Squint d.t. cranial n. affection• S p e c if ic T T T : l- Anti- toxic serum . 2-Penicillin systemic & local .• I nvestigations: 1-Culture & sensitivity from membrane 2- Blood culture .
  87. 87. Membranous conjunctivitis• S p e c if ic l in e s o f T T T : 1- Prophylactic 1- Mass immunization . 2- Isolation of patient + Notify health office . 3- Prophylactic anti serum for contacts. 4- Prophylactic antibiotic in other eye. 2-Curative 1- Complete bed rest to avoid heart failure. 2- Antitoxin serum. 3- Local & systemic penicillin. 4- Guard against symblepharon (ointment).
  88. 88. 44- Posterior symblepharon
  89. 89. Posterior symblepharon• C / O: 1- Binocular diplopia [d.t. limitation of movement ] 2- Symptoms of lagophthalmos: Redness, burning sensation , dryness. 3- Cosmetic disfigurement.• Ca u s e s : 1- Healed Trachoma (post). 2- Chemical burns (ant). 3- Diphtheritic conj. {Membranous conj} (ant.) 4- Postoperative after ptregium surgery [after recurrent excision] (ant.).
  90. 90. Posterior symblepharon• C o mp l ic a t io n s :1- Binocular diplopia.2- Complications of lagophthalmos.3- Conj.: 1- Conj. Ulcers & keratinization . 2- Chronic conjunctivitis .4- Corneal: 1- C.U. & keratinization. 2- Exposure keratitis & Vasculariztion.• TTT: 1) Management of lagophthalmos. 2) Excision of fibrous tissue with gloss rod or artificial conjunctiva! Shell . 3) Mucous membrane graft . 4) TTT of the cause .
  91. 91. 45- Phlyctenular keratoconjunctivitis (limbal phlycten)
  92. 92. 46- Phlyctenular keratoconjunctivitis (V. important)
  93. 93. Phlyctenular keratoconjunctivitis• E t io l o g y : Type IV Hypersensitivity reaction [cell mediated I-R.] d.t. endogenous Toxins [Antigens]:- e.g. T.B. focus. Tonsillitis. Septic focus of Staph Intestinal parasites , Ulcerative Blepharitis• A s s o c ia t e d d is e a s e : T.B. ,Tonsillitis,.....etc• C o mp l ic a t io n s : 1- Recurrence, if the cause is not treated. 2- Limbal c.u. 3- Secondary infection by staph. MPC. 4- Phlyctenular pannus.
  94. 94. Phlyctenular keratoconjunctivitis• D .D 1- Conj. Phlycten:1- Pinguicuia .2- Episcleritis [Nodular] 2- Limbal Phlycten [in slide no. 45] 3- Limbal [bulbar] spring catarrh• TTT : l- Topical steroids. 2- TTT of septic focus [cause]. 3- Local Antibiotic, for secondary infection 4- (IN Slide no. 45) Cyctoplegic [Atropine]  if Keratoconjunctivitis .
  95. 95. 47- Palperal spring catarrh
  96. 96. 48- Palperal spring catarrh
  97. 97. 49- Palperal spring catarrh
  98. 98. 50- Palperal spring catarrh
  99. 99. Palperal spring catarrh• E t io l o g y : Atopy type I hypersensitivity reaction d.t. exogenous antigen (↑ IgE) .• Commonest presentation: Bilateral , recurrent , seasonal attacks of itching & ropy discharge + lacrimation .• Ot h e r c l in ic a l t y p e s y o u k n o w ; 1- Bulbar S.catarrh 2- Mixed type.• C o mp l ic a t io n s : 1-Corneal: 1- Keratitis superficialis vernalis of Tobgy. 2- Corneal plaques . 3- Arcus senilis like opacity (Cupids bow) . 4- Weakness of cornea  increase incidence of Keratoconus A keratectasia . 2- Comp. of prolonged use of steroids: 1- Sec. Glaucoma 2- Complicated cataract 3- Viral infection reactivation
  100. 100. Palperal spring catarrh• S a f e s t d r u g u s e d f o r l o n g t ime f o r t h is p a t ie n t : Local decongestant .• S a f e s t TTT: 1- Dark glasses & cold fomentations [ compresses] (Most effective). 2- Local decongestant & local Antihistaminics. 3- Local Disodium Cromoalycate . [DONT MENTTON STEROIDS]• T T T : 1,2,3, as before. + 4-Steroids in severe cases . 5- B-irradiation or cryo on papillae in resistant cases.• D.D. o f s p r in g c a t a r r h : 1-Trachomo. 2- MP & PC.• D.D. o f Gia n t p a p il l a r y c o n j u n c t iv it is : 1- Advanced Spring catarrh. 2- CL users. 3- Protruding stitches.
  101. 101. 51- Bulbar spring catarrh
  102. 102. Bulbar spring catarrh• See previous comment :
  103. 103. 52- Corneal plaque in spring catarrh
  104. 104. Corneal plaque in spring catarrh• Ca u s e : Corneal affection in spring catarrh .• Pat hol og y : Large micro erosions in corneal epithelium with deposition [covered with mucin]  Resistant Corneal ulcer .• TTT : As spring catarrh + Cycloplegic (Atropin) .
  105. 105. 53- Argyrosis (important)
  106. 106. Argyrosis (important)• E t io l o g y : 1- Prolonged repeated painting [using] Silver Nitrate  deposits in elastic tissue of conjunctiva [walls of B.V] 2- Occupational .
  107. 107. 54- Subconjunctival hemorrhage
  108. 108. Subconjunctival hemorrhage• M a n a g e me n t : Self limiting condition , needs no TTT [Reassurance of patient]• Ca u s e s : 1- Spontaneous. 2- Blunt trauma. 3- Excessive straining as whooping cough. 4- Hemorrhagic blood diseases. 5- Vascular diseases e.g. Diabetes A hypertension . 6- Conjunctivitis . [USUALLY THE Q IS MENTION 3 CAUSES]
  109. 109. 55- True pterygium (progressive)
  110. 110. True pterygium (progressive)• E t io l o g y : Degenerative disease of cornea & conjunctiva d.t. exposure to UV rays , heat , dust , irritative chemical fumes , dry sunny environment .• C / O : Cosmetic disfigurement Drop of vision  if irregular astigmatism .  if affecting central area of cornea.• C o mp l ic a t io n : 1- Recurrence , after excision (v. Common). 2- Repeated excisions: 1- Anterior symblepharon. 2- Cornea! thinning & opacity.• T T T : Surgical removal: 1- Excision e bare scleral technique. 2- Excision e lamellar KP. 3- Tucking. 4- Rotation island operation . Followed by Beta irradiation ( 3000-6000 rods over 3-5 days ) . 5- Conjunctival graft .
  111. 111. 56- Bitot spots in case of xerosis (important)
  112. 112. Bitot spots in case of xerosis• E t io l o g y : Abnormal activity of Meibomian gland [mucin deficiency] & gas formation by proliferation of Xerosis bacilli.• Ca u s e s : 1- Trachoma. 2- Chemical burns . 3- Repeated removal of pterygium. 4- Lagophthalmos. 5- Diphtheria.• S p e c if ic t e s t : Fluorescine break up time testTTT : 1- Scraping [removal of Bitot spots] . 2- Artificial tears [ Methyl cellulose eye drops 1% . 3- Vit A .
  113. 113. 57- Loss of corneal luster in cases of xerosis
  114. 114. Loss of corneal luster in cases of xerosis• C a u s e s : 1-Conjunctival scarring & fibrosis d.t.: 1- Healed Trachoma . 2- Chemical burns . 3- Diphtheria Membranous conj . 2- Lagophthalmos. 3- Vit A deficiency. 4- Sjorens syndrome . ( 1& 2 are common causes --- 3 is less common )• E t io l o a y : Mucin deficiency d.t. destruction of Goblet cells .• . C / 0 : Burning & gritty sensation + redness + Discharge• C o mp l ic a t io n s : l-Corneal ulcers, keratinization . 2- Conjunctival ulcers, kera+inizotion . Sp. Test: Fluorescine break up time test [ Normally l5-35sec, if less diagnostic ]• T T T o f c h o ic e : 1- Artificial tears [ Methyl cellulose eye drops 17o . 2- Therapeutic CL of high water content . 3- Ointment at night + Vit A .
  115. 115. NON-INFLAMMATORY• Pinguecula• Pterygium• Pseudopterygium• Nevus• Melanosis
  116. 116. PINGUECULA• It is a deposition of hyaline substance in the bulbar conjuctiva
  117. 117. Pinguecula• Elastotic degeneration of collagen at bulbar conjunctiva• Yellow-white conjunctival nodule at interpalpebral zone• Tearing, irritation, photophobia• Treatment –topical vasoconstrictor-antihistamine, topical steroid
  118. 118. Pterygium• Elastosis of collagen with subepithelial fibrovascular tissue at bulbar conjunctiva• Interpalpebral zone• Tearing, irritation, photophobia, blurred vision
  119. 119. Pterygium
  120. 120. Pterygium
  121. 121. Pterygium• Treatment – Medication – as pinguecula – Surgery – blurred vision, chronic inflammation, cosmetic
  122. 122. Molluscum contagiosum– DNA poxvirus– Elevated pearly umbilicated nodule near lid margin– Chronic follicular conjunctivitis– Treatment – curettage,complete excision, freezing (self limited-months, years)

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