The document provides information about the conjunctiva and conjunctivitis (pink eye). It defines the conjunctiva as the thin membrane that covers the eye and inner eyelid. It has two segments: the bulbar conjunctiva covers the outer eye, while the palpebral conjunctiva covers the inner eyelid. Conjunctivitis is inflammation of the conjunctiva that can be caused by allergies, bacteria, viruses, chemicals, or trachoma. Symptoms include redness, discharge, irritation and blurred vision. Treatment depends on the cause but may include antibiotics, antivirals, or surgery. Good hygiene and sanitation can help prevent infectious types.

1. Ophthalmology
By
Dr. Laraib Jameel Rph
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2. Conjunctiva
• Definition: The conjunctiva is the clear, thin membrane that covers
part of the front surface of the eye and the inner surface of the
eyelids.
• The conjunctiva is a mucous membrane, similar to mucous
membranes elsewhere in the body.
• Anatomically It has two segments:
• Bulbar conjunctiva. This portion of the conjunctiva covers the outer
surface of the eye or sclera (the "white" of the eye). The bulbar
conjunctiva stops at the junction between the sclera and cornea;
it does not cover the cornea.
• Palpebral conjunctiva. This portion covers the inner surface of both
the upper and lower eyelids. (Another term for the palpebral
conjunctiva is tarsal conjunctiva.)
• The bulbar and palpebral conjunctiva are continuous. This feature
makes it impossible for a contact lens (or anything else) to get lost

4. Anatomy & physiology
• Besides palpebral & bulbar conjunctiva, the Third part of
conjunctiva is Fornix conjunctiva. It Forms the junction between
the bulbar and palpebral conjunctivas:
• Function: It is loose and
flexible, allowing the free
movement of the lids
and eyeball.
• It is composed of
unkeratinized, stratified
squamous epithelium
with goblet cells, and stratified
columnar epithelium.
The conjunctiva is highly vascularised, with many microvessels.

5. • Blood Supply: the circulations of the bulbar
conjunctiva and palpebral conjunctiva are linked, so
both bulbar conjunctival and palpebral conjunctival
vessels are supplied by both the ophthalmic artery and
the external carotid artery, to varying extents.
• Microanatomy:
• The epithelial layer contains blood vessels, fibrous
tissue, and lymphatic channels.
• Accessory lacrimal glands in the conjunctiva
constantly produce the aqueous portion of tears.
• Additional cells present in the conjunctival epithelium
include melanocytes, T and B cell lymphocytes

6. • Conjunctiva Function
• The primary functions of the conjunctiva are:
• Keep the front surface of the eye moist and lubricated.
• Keep the inner surface of the eyelids moist and lubricated
so they open and close easily without friction or causing
eye irritation.
• Protect the eye from dust, debris and infection-causing
microorganisms.
• The conjunctiva has many small blood vessels that provide
nutrients to the eye and lids.
• It also contains special cells that secrete a component of
the tear film to help prevent dry eye syndrome.

7. Conjunctivitis
• Definition: is inflammation of the thin, clear covering of the white of
the eye and the inside of the eyelids (conjunctiva).
• Synonym: Pink eye
• Conjunctivitis can have several causes, but many eye doctors use the term
"pink eye" to refer only to viral conjunctivitis.
• When small blood vessels in the conjunctiva become inflamed, they're
more visible. This is what causes the whites of your eyes to appear
reddish or pink.

8. Types of conjunctivitis
• Types:
• Allergic conjunctivitis
• Allergic conjunctivitis affects both eyes and is a response to an allergy-causing
substance such as pollen.
• Mechanism: In response to allergens, your body produces an antibody called
immunoglobulin E (IgE). This antibody triggers special cells called mast cells in the
mucous lining of your eyes and airways to release inflammatory substances,
including histamines. Your body's release of histamine can produce a number of
allergy signs and symptoms, including red or pink eyes.
• IgE– Mast cell production--- in mucus lining of eye--- inflammatory substance
(histamine)---- allergic signs
• Symptoms: If you have allergic conjunctivitis, you may experience intense itching,
tearing and inflammation of the eyes as well as sneezing and watery nasal
discharge.
• Treatment: Most allergic conjunctivitis can be controlled with allergy eyedrops.

9. • Infectious Conjunctivitis
• 1- Bacterial conjunctivitis is an infection most often caused by staphylococcal or
streptococcal bacteria from your own skin or respiratory system.
• Respiratory bacteria: Bacterial causes include Staphylococcus aureus,
Streptococcus pneumoniae, Haemophilus species, and, less commonly, Chlamydia
trachomatis.
• Bacterial conjunctivitis is sometimes caused by a sexually transmitted infection
(STI), such as Chlamydia. If symptoms do not disappear after a month, this may
indicate an STI. Most other types of bacterial conjunctivitis will resolve more
quickly with treatment.
• Infective conjunctivitis is extremely contagious and can easily be passed on to
another person.
• Ophthalmia neonatorum is a severe form of bacterial conjunctivitis that occurs in
newborn babies. This is a serious condition that could lead to permanent eye
damage if it is not treated immediately. Ophthalmia neonatorum occurs when an
infant is exposed to chlamydia or gonorrhea while passing through the birth
canal.

10. • 2- Viral conjunctivitis is most commonly caused by
contagious, viruses associated with the common cold. It
can develop through exposure to the coughing or sneezing
of someone with an upper respiratory tract infection.
• Viral conjunctivitis can also occur as the virus spreads
along the body's own mucous membranes, which connect
the lungs, throat, nose, tear ducts and conjunctiva.
• Since the tears drain into the nasal passageway, forceful
nose blowing can cause a virus to move from your
respiratory system to your eyes.
• Viruses that cause conjunctivitis include adenoviruses and
some types of herpes virus.

11. • The other type of conjunctivitis is chemical or
• irritant conjunctivitis:
• the eye coming into contact with things that
can irritate the conjunctiva, such as shampoo
or chlorinated water, or a loose eyelash
rubbing against the eye
• this is known as irritant conjunctivitis.

12. Difference between different strains which
cause pink eye
• Viral strains are the most common -- and may be the
most contagious -- forms. They tend to start in one eye,
where they cause lots of tears and a watery discharge.
Within a few days, the other eye gets involved.
• Symptoms: You might feel a swollen lymph node in
front of your ear or under your jawbone.
• Bacterial strains usually infect one eye but can show
up in both. Your eye will put out a lot of pus
and mucus.
• Allergic types produce tearing, itching, and redness in
both eyes. You might also have an itchy, runny nose.

13. • Symptoms:
• They depend on the cause of the inflammation, but may include:
• Redness in the white of the eye or inner eyelid
• Swollen conjunctiva
• More tears than usual
• Thick yellow discharge that crusts over the eyelashes, especially
after sleep. It can make your eyelids stick shut when you wake up.
• Green or white discharge from the eye
• Itchy eyes
• Burning eyes
• Blurred vision
• More sensitive to light
• Swollen lymph nodes (often from a viral infection)

14. • Diagnosis:
• Don’t assume that all red, irritated, or swollen eyes are pinkeye (viral
conjunctivitis). Your symptoms could also be caused by seasonal allergies, a
sty, iritis, chalazion or blepharitis . These conditions aren’t contagious.
• Your eye doctor will ask you about your symptoms, give you an eye exam, and may
use a cotton swab to take some fluid from your eyelid to test in a lab. That will
help find bacteria or viruses that may have caused conjunctivitis, including those
that can cause a sexually transmitted disease, or STD.
• Testing, with special emphasis on the conjunctiva and surrounding tissues, may
include:
• Visual sharpnes measurements to determine whether vision has been affected.
• Evaluation of the conjunctiva and external eye tissue using bright light and
magnification.
• Evaluation of the inner structures of the eye to ensure that no other tissues are
affected by the condition.

15. • Treatment:
• Allergic conjunctivitis can usually be treated with anti-
allergy medications such as antihistamines. If possible, you
should avoid the substance that triggered the allergy.
• The first step is to remove or avoid the irritant, if possible.
Cool compresses and artificial tears sometimes relieve
discomfort in mild cases.
• In more severe cases, nonsteroidal anti-inflammatory
medications and antihistamines may be prescribed.
• Antihistamines (either oral or drops) can give relief in the
meantime.
• (But remember that if you have dry eyes, taking
antihistamines by mouth can make your eyes even drier.)

16. • Treatment for Bacteria. If bacteria, including those related to STDs,
caused your pinkeye, you’ll take antibiotics in the form of eyedrops,
ointments, or pills.
• You may need to apply eyedrops or ointments to the inside of your
eyelid 3 to 4 times a day for 5 to 7 days. You would take pills for
several days. The infection should improve within a week.
• The most commonly prescribed antibiotics for infective
conjunctivitis are:
• fluoroquinolones
• tetracyclines
• sulfonamides
• chloramphenicol
• These are eye drops or ointment, administered straight onto the
eye. Dosage depends on the type

17. • Viral conjunctivitis.
• No drops or ointments can treat viral conjunctivitis.
Antibiotics will not cure a viral infection.
• Like a common cold, the virus has to run its course,
which may take up to two or three weeks.
• Symptoms can often be relieved with cool compresses
and artificial tear solutions.
• For the worst cases, topical steroid drops may be
prescribed to reduce the discomfort from
inflammation.
• However, these drops will not shorten the infection.

18. • Preventions:
• The most effective prevention is good hygiene, especially avoiding rubbing
the eyes with infected hands. Vaccination against
adenovirus, Haemophilus influenzae, pneumococcus, and Neisseria
meningitidis is also effective.
• Never share personal items such as washcloths, hand towels or tissues.
• Cover your nose and mouth when coughing or sneezing.
• When swimming, wear swim goggles to protect yourself from bacteria
and other microorganisms in the water that can cause conjunctivitis.
• If you wear contact lenses, follow your eye doctor's instructions for lens
care and replacement, and use contact lens solutions properly or consider
switching to daily disposable contact lenses.
• If you know you suffer from seasonal allergies, ask your doctor what can
be done to minimize your symptoms before they begin.

19. Trachoma
• Definition: Trachoma (truh-KOH-muh) is a bacterial infection that
affects your eyes. It's caused by the bacterium Chlamydia
trachomatis.
• Trachoma is contagious,
spreading through contact
with the eyes, eyelids, and
nose or throat secretions of
infected people.
It can also be passed on by
handling infected items.
• Trachoma is the leading preventable cause of blindness
worldwide. The World Health Organization (WHO) estimates that
nearly 2 million people have been blinded by trachoma.

20. Trachoma

21. • Causes
• Trachoma is caused by certain subtypes of Chlamydia trachomatis,
a bacterium that can also cause the sexually transmitted infection
chlamydia.
• There are different types of Chlamydia trachomatis. Types A, B, Ba,
and C cause blinding trachoma. Other types (D to K) are associated
with sexually transmitted chlamydia infection.
• Epidemiology:
• In areas where trachoma is endemic, active (inflammatory)
trachoma is common among preschool-aged children, with
prevalence rates which can be as high as 60–90%. Infection
becomes less frequent and shorter in duration with increasing age

22. • Clinical manifestation:
• In its early stages, trachoma causes conjunctivitis (pink eye). Early
symptoms begin to appear within five to 12 days of exposure to
the bacterium. These symptoms can include:
• mild itching and irritation of the eyes and eyelids, and
• a discharge from the eyes
• As the infection progresses, it causes eye pain and blurred vision.
• If the infection is untreated, scarring occurs inside the eyelid. This
leads to the eyelashes turning inward toward the eye. This
condition is called trichiasis. The eyelashes brush and scratch
against the cornea, the clear, dome-shaped window at the front of
the eye. This continual irritation turns the cornea cloudy. It can
lead to the development of corneal ulcers and vision loss.

23. • Symptoms:
• Signs and symptoms of trachoma usually affect
both eyes and may include:
• Mild itching and irritation of the eyes and eyelids
• Discharge from the eyes containing mucus or pus
• Eyelid swelling
• Light sensitivity (photophobia)
• Eye pain

24. • The WHO grading system for trachoma classifies the disease in 5 grades:
1. Trachomatous inflammation -- follicular (TF): The first sign is the presence of
follicles, which are small bumps formed by swollen lymph tissue on the back of
the upper eyelid and sometimes extending to the top part of the eye. The
presence of five or more follicles greater than 0.5 mm in size on the conjunctiva
lining the back of the upper eyelid is considered grade TF.
2. Trachomatous inflammation -- intense (TI): The next phase is swelling
(inflammation) of the conjunctiva that view the normal deeper blood vessels of
the conjunctiva.
3. Trachomatous scarring (TS): Bands of scar tissue form within the conjunctiva
lining the inside of the upper eyelid.
4. Trachomatous trichiasis (TT): The bands of scar tissue tighten, causing the lid
margins to turn inward (entropion) and the eyelashes to rub against the eye
(trichiasis). Over time, this rubbing results in abrasions of the cornea, the clear
central covering of the front of the eye.
5. Corneal opacity: Corneal abrasions can lead to infectious ulcers and ultimately
opaque scarring that blocks light from entering the eye, leading to blindness.

27. • Risk factors
• Factors that increase your risk of contracting trachoma include:
• Poverty. Trachoma is primarily a disease of extremely poor populations in
developing countries.
• Crowded living conditions. People living in close contact are at greater risk
of spreading infection.
• Poor sanitation. Poor sanitary conditions and lack of hygiene, such as
unclean faces or hands, help spread the disease.
• Age. In areas where the disease is active, it's most common in children
ages 4 to 6.
• Sex. In some areas, women's rate of contracting the disease is two to six
times higher than that of men.
• Flies. People living in areas with problems controlling the fly population
may be more susceptible to infection.
• Lack of latrines. Populations without access to working latrines — a type
of communal toilet — have a higher incidence of the disease

28. • Diagnosis:
• Your ophthalmologist can diagnose most cases
of conjunctivitis through an eye exam.
• He or she may take a sample (culture) if you visited a
country where trachoma is common. To do this, he or she
will numb your eye and swab the surface. The laboratory
test will show if trachoma is the source of the eye infection.
• In more severe cases of trachoma, an eye exam will
reveal:
• scarring on the inside of the upper eyelid
• new blood vessel growth in the cornea, and
• eyelashes turned inward

29. • Treatment:
• Medication:
• In the early stages of trachoma,
treatment with antibiotics alone may be enough to
eliminate the infection. Your doctor may prescribe
tetracycline eye ointment or oral azithromycin (Zithromax).
Azithromycin appears to be more effective than tetracycline,
but it's more expensive.
• The World Health Organization (WHO) recommends giving
antibiotics to an entire community when more than 10
percent of children have been affected by trachoma. The
goal of this guideline is to treat anyone who has been
exposed to trachoma and reduce the spread of trachoma.

30. • Surgery
• Treatment of later stages of trachoma — including painful eyelid deformities —
may require surgery.
• WHO guidelines recommend surgery for people with the advanced stage of
trachoma.
• In eyelid rotation surgery (bilamellar tarsal rotation), your doctor makes an
incision in your scarred lid and rotates your eyelashes away from your cornea.
The procedure limits the progression of corneal scarring and may help prevent
further loss of vision.
• If your cornea has become clouded enough to seriously impair your vision,
corneal transplantation may be an option that may improve vision. Frequently,
however, with trachoma, this procedure doesn't have good results.
• You may have a procedure to remove eyelashes (epilation) in some cases. This
procedure may need to be done repeatedly.
• Another temporary option, if surgery isn't an available option, is to place an
adhesive bandage over your eyelashes to keep them from touching your eye

31. • Prevention and control
• Elimination programmes in endemic countries are being
implemented using the WHO-recommended SAFE strategy.
This consists of:
• Surgery to treat the blinding stage (trachomatous
trichiasis);
• Antibiotics to clear infection, particularly mass drug
administration of the antibiotic azithromycin, which is
donated by the manufacturer to elimination programmes,
through the International Trachoma Initiative;
• Facial cleanliness; and
• Environmental improvement, particularly improving access
to water and sanitation.

32. Pinguecula
• Definition: The term “pinguecula” refers to a pyramid-like
growth that appears as a yellow discoloration on the
conjunctiva
• A pinguecula (pin-GWEK-yoo-lah) is a yellowish, slightly
raised thickening of the conjunctiva on the white part of
the eye (sclera), close to the edge of the cornea.
• Pingueculae are non-cancerous bumps on the eyeball and
typically occur on top of the middle part of the sclera, the
part that's between your eyelids and therefore is exposed
to the sun.
• Usually pingueculae affect the surface of the sclera that's
closer to the nose, but they can occur on the outer sclera
(closer to the ear) as well.

33. Pinguecula

34. • Causes:
• In fact, the word “pinguecula” comes from a Latin word that
originally means “fatty.”
• A pinguecula forms when the tissue in your conjunctiva changes
and creates a small bump. Some of these bumps contain fat,
calcium, or both.
• Risk factors:
• Ultraviolet radiation from the sun is the primary cause of the
development of pingueculae,
• frequent exposure to dust and wind also appear to be be risk
factors.
• For this reason, pinguecula is sometimes known as “surfer’s eye,”
• Dry eye disease also may be a contributing factor and can promote
the growth of pingueculae

35. • Mechanism:
• Histologically, there is degeneration of the collagen fibers of the
conjunctival stroma (beneath the epithelium, covers the tarsus) with thinning of
the overlying epithelium and occasionally calcification.
• (globular protein) actinic exposure of the thin conjunctival tissue is thought to
cause fibroblasts to produce more elastin fibers, which are more twisted than
normal elastin fibers and may lead to the degradation of the collagen fibers.
• Actin exposure of thin conjunctival tissue--- forms fibroblast----- produces more
elastin fibers (yellow color)---- causes degradation of collagen fibers
• It is thought that the high reflectivity of the solid white scleral tissue underlying
the conjunctival tissue may result in additional UV exposure to the back side of the
tissue. The side of the nose also reflects sunlight on to the conjunctiva. As a result,
pingueculae tend to occur more often on the nasal side of the eye.
• Calcification: hardening of tissue by the deposition of calcium compounds.

36. • Sign & Symptoms:
• It is seen as a yellow-white deposit on the conjunctiva adjacent to
the limbus (the junction between the cornea and sclera).
• In most people, pingueculae don't cause many symptoms. But
when they do, those symptoms usually stem from a disruption of
the tear film. Because a pinguecula is a raised bump on the eyeball,
the natural tear film may not spread evenly across the surface of
the eye around it, causing dryness. This can cause dry eye
symptoms, such as a burning sensation, stinging, itching, blurred
vision and foreign body sensation.
• Another symptom of pingueculae is the appearance of extra blood
vessels in the conjunctiva that covers the sclera, causing red eyes.
• In some cases, pingueculae can become swollen and inflamed. This
is called pingueculitis.

37. • Diagnosis:
• A pingueculum is typically diagnosed by a
careful clinical examination.

38. • Treatment:
• It usually don’t need any type of treatment for a pinguecula unless it causes
discomfort because A pingueculum does not grow on the cornea or threaten
sight.
• If eye does hurt, your doctor can give you eye ointment or eye drops to relieve
redness and irritation.
• Pingueculae also can lead to localized inflammation and swelling that is sometimes
treated with steroid eye drops or non-steroidal anti-inflammatory drugs (NSAIDs).
• You can talk to your doctor about having the pinguecula surgically removed if its
appearance bothers you. In some cases, the growth might need to be removed.
• Surgery is considered when a pinguecula:
• grows over your cornea, as this can affect your vision
• causes extreme discomfort when you try to wear contact lenses
• is constantly and severely inflamed, even after you apply eye drops or ointments

39. • wear photochromic lenses, which block out 100
percent of ultraviolet radiation. They are
designed to protect the eyes from the harmful
high-energy
blue light by
automatically
darkening when
coming into
contact with
that level of sunlight.

40. • Scleral contact lenses sometimes are prescribed to cover the growth,
protecting it from some of the effects of dryness or potentially from
further UV exposure.

41. • Complications:
• The surface of the conjunctival tissue overlying a pinguecula
interferes with the normal spreading of the tear film.
• Preventions:
• If you spend a lot of time outdoors due to work or hobbies, you’re
more likely to develop pingueculae. However, you can help prevent
these growths by wearing sunglasses when you’re outside. You
should wear sunglasses that have a coating that blocks the sun’s
ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Sunglasses also help protect your eyes from wind and other
outdoor elements, such as sand.
• Keeping your eyes moisturized with artificial tears might also help
prevent pingueculae. You should also wear protective eyewear
when working in a dry and dusty environment.

42. Pterygium
• Definition: A pterygium (tuh-RIJ-ee-uhm) is a growth of
the conjunctiva or mucous membrane that covers the
white part of your eye over the cornea.
• The cornea is the clear front transparent covering of the
eye.
• This benign or noncancerous growth is often shaped like a
wedge.
• A pterygium is a pinkish, triangular tissue growth on
the cornea of the eye. It typically starts on the cornea near
the nose.
• It may slowly grow but rarely grows so large that
the pupil is covered.
• Often both eyes are involved.

43. Pterygium

44. • Cause:
• The exact cause is unknown,
• but it is associated with excessive exposure to wind, sunlight, or sand.
• Therefore, it is more likely to occur in populations that inhabit the areas
near the equator (tropical regions), as well as windy locations.
• In addition, pterygia are twice as likely to occur in men than women.
• Some research also suggests a genetic predisposition due to an expression
of vimentin, which indicates cellular migration by the keratoblasts
• embryological development, which are the cells that give rise to the
layers of the cornea. Supporting this fact is the congenital pterygium, in
which pterygium is seen in infants.
• These cells also exhibit an increased P53 (tumor protein) expression likely
due to a deficit in the tumor suppressor gene.
• These indications give the impression of a migrating limbus because the
cellular origin of the pterygium is actually initiated by the limbal
epithelium

45. • Pathophysiology
• The large number of theories that exist to explain the pathogenesis of pterygium
growth underscores the uncertainty of the etiology.
• The increased prevalence in hot dry climates and regions nearer to the equator
suggest a role of environmental factors such as UV radiation and dryness. Actinic
changes seen on histopathology similar to actinic keratoses on the skin also
supports the role of UV radiation.
• It has been suggested that radiation activated fibroblasts may result in excessive
production of material resulting in pterygia.
• Other proposed theories include choline deficiency, (supports the development of
the retina of the eye and impacts vision throughout life)
• an inflammatory disorder, disregulation of angiogenesis, immune system
abnormalities, tear film abnormalities, as well as the possible role of a viral
stimulus.
• Angiogenesis is the formation of new blood vessels. This process involves the
migration, growth, and differentiation of endothelial cells, which line the inside
wall of blood vessels. The process of angiogenesis is controlled by chemical signals
in the body.

46. • Symptoms:
• Pterygia usually occur on the side of the eye closer to the nose, but
they can also develop on the side closer to the ear as well and can
affect one eye or both eyes.
• Many people with mild surfer's eye may not experience symptoms
or require treatment.
• But large or growing pterygia often cause a gritty, itchy or burning
sensation or the feeling something is "in" the eye (called a foreign
body sensation).
• Also, these pterygia often become inflamed, causing
unattractive red eyes.
• If a pterygium significantly invades the cornea, it can distort the
shape of the front surface of the eye, causing blurred vision
and higher-order deviations that affect vision.

47. • Diagnosis:
• Pterygium (conjunctiva) can be diagnosed without need for a specific exam,
however corneal topography is a practical test (technique) as the condition
worsens
• The diagnosis is made by slit-lamp examination of the typical limbal growth at the
characteristic location within the palpebral fissure. The diagnosis is most often
clear clinically, but histopathologic confirmation is performed routinely.
• Physical examination
• External examination (lids,
lashes, lacrimal apparatus)
• Examination of bulbar
and palpebral conjunctiva
as well as fornices
• Topography : the distribution of parts or features on the surface of or within an
organ or organism.

48. • Treatment:
• Treatment of surfer's eye depends on the size of the pterygium, whether it is
growing and the symptoms it causes. Regardless of severity, pterygia should be
monitored to prevent scarring that could lead to vision loss.
• If a pterygium is small, your eye doctor may prescribe lubricants or a mild steroid
eye drop to temporarily reduce swelling and redness. Contact lenses are
sometimes used to cover the growth, protecting it from some of the effects of
dryness or potentially from further UV exposure. Topical cyclosporine also may be
prescribed for dry eye.
• If pterygium surgery is required, several surgical techniques are available.
Pterygium excision may be performed either in a room at the doctor's office or in
an operating room. It's important to note that pterygium removal can induce
astigmatism, especially in people who already have astigmatism.
• Surgery for pterygium removal usually lasts no longer than 30 minutes, after which
you likely will need to wear an eye patch for protection for a day or two. You
should be able to return to work or normal activities the next day.

49. • Surgery
• Conjunctival Flap/Graft : this is considered the
Gold Standard of care and carries an approximate
rate of recurrence of 5-10% with minimal
complications.
• However, it is a
lengthier procedure
and technically
slightly more
complicated

51. • Complication:
• Recurrence
• Unfortunately, pterygia often return after surgical removal, possibly due to
oxidative stress and/or continued UV exposure.
• To prevent regrowth after a pterygium is surgically removed, your eye surgeon
may suture or glue a piece of surface eye tissue onto the affected area. This
method, called autologous conjunctival autografting, has been shown to safely
and effectively reduce the risk of pterygium recurrence.
• A drug that can help limit abnormal tissue growth and scarring during wound
healing, such as mitomycin C, (chemotherapeutic activity) also may be applied
topically at the time of surgery and/or afterward to reduce the risk of pterygium
recurrence.
• After removal of the pterygium, the doctor will likely prescribe steroid eye drops
for several weeks to decrease swelling and prevent regrowth.
• In addition to using your drops, it's very important to protect your eyes from the
sun with UV-blocking sunglasses or photochromic lenses after surgery, since
exposure to ultraviolet radiation may be a key factor in pterygium recurrence.

52. Difference between Pterygium &
pinguecula
Pterygium
• Pterygia have a flesh-
colored (pink) appearance
and are round, oval, or
elongated.
• Pterygia are more likely to
grow over the cornea,
• Pterygia is the growth of
fleshy tissue that can start
as a pinguecula, but it grows
large enough to cover the
cornea and affect vision
Pinguecula
• A pinguecula is yellowish in
color and typically has a
triangular shape.
• Less likely to grow on
cornea & when pinguecula
that grows onto the cornea
is known as a pterygium.
• Pinguecula do not grow, do
not cover the cornea, and
do not affect vision.

53. Similarities between
Pterygium &
Pinguecula
• Both pterygium and a
pinguecula are abnormal
growths that form on the
surface of the eye.
• Pingueculae and pterygia are
both benign and grow near
the cornea.
• They’re both linked to
exposure to the sun, wind,
and other harsh elements.
• Redness, irritation, grittiness
Abnormal growth
Benign tumor
Cause
Symptoms

54. Opthalmia neonatorum
• Definition: is defined as conjunctival
inflammation occurring within the first 30
days of life.
• Synonym: Neonatal conjunctivitis
a type of neonatal
infection contracted
by newborns during
delivery.

55. Opthalmia neonatorum

56. • Cause with respect to classification
• It may be aseptic or septic.
• Aseptic= free of disease causing microbe
• Septic= disease causing microbes.
• 1- Aseptic neonatal conjunctivitis:
• Aseptic neonatal conjunctivitis most often is a chemical conjunctivitis that
is induced by silver nitrate solution, which is used at birth as prophylaxis
of infectious conjunctivitis.
• Chemical conjunctivitis is becoming less common owing to the use of
erythromycin ointment or povidone iodide in place of silver nitrate
solution for the prophylaxis of infectious conjunctivitis.
• Silver nitrate is a surface-active chemical that facilitates agglutination
and inactivation of gonococci. Ironically, silver nitrate was later found to
be toxic to the conjunctiva, particularly in higher concentrations,
potentially causing a sterile neonatal conjunctivitis.

57. • 2- Septic neonatal conjunctivitis:
• Bacterial and viral infections are major causes of septic neonatal conjunctivitis,
with Chlamydia being the most common infectious agent. Infants may acquire
these infective agents as they pass through the birth canal during the birth
process.
• Many different bacteria and viruses can cause conjunctivitis in the neonate.
• The two most common bacterial causes are
• 1- Chlamydia trachomatis is an obligate intracellular parasite and has been
identified as the most common infectious cause of neonatal conjunctivitis.
• The reservoir of the organism is the maternal cervix or urethra. Infants who are
born to infected mothers are at high risk (approximately 25%-50%) of developing
an infection.
• 2- Neisseria gonorrhoeae is a gram-negative diplococcus and is potentially the
most dangerous and virulent infectious cause of neonatal conjunctivitis. As with
chlamydia, maternal cervical and urethral mucosa provide a reservoir for N
gonorrhoeae, which is acquired during birth. Gonococci can penetrate intact
epithelial cells and divide rapidly inside them.

58. • Other bacteria
• The most commonly identified gram-positive organisms include Staphylococcus
aureus,Streptococcus pneumoniae,Streptococcus viridans, and Staphylococcus
epidermidis. These bacteria make up 30-50% of all cases of infectious neonatal conjunctivitis.
• Gram-negative organisms, such as Escherichia coli, Klebsiella pneumoniae, Serratia
marcescens, and Proteus, Enterobacter, and Pseudomonas species, also have been
implicated. There has been one reported case of Eikenella corrodens neonatal conjunctivitis.
• Infants of low birth weight and low gestational age with clinical signs of conjunctivitis in
the neonatal intensive care unit (NICU) should be evaluated and treated for a gram-
negative etiology.
• Herpes simplex virus
• Herpes simplex virus (HSV) is a rare cause of neonatal keratoconjunctivitis, found in less than
1% of cases, and can be associated with a generalized herpes simplex infection.
• Most infants with such an infection acquire the disease during the birth process. Caesarean
delivery is strongly considered when active maternal genital disease is recognized at term
since the risk of transmitting HSV to the neonate during vaginal delivery is 25-60%.

59. • Sign & Symptoms:
• Chemical conjunctivitis secondary to topical prophylaxis usually
appears within 6 to 8 h after instillation and disappears
spontaneously within 48 to 96 h. (2-3 days)
• Chlamydial ophthalmia usually occurs 5 to 14 days after birth. It
may range from mild conjunctivitis with minimal mucopurulent
discharge to severe eyelid edema with copious drainage and
pseudomembrane formation. Follicles are not present in the
conjunctiva, as they are in older children and adults.
• Gonococcal ophthalmia causes an acute purulent conjunctivitis
that appears 2 to 5 days after birth or earlier with premature
rupture of membranes. The neonate has severe eyelid edema
followed by chemosis and a profuse purulent exudate that may be
under pressure. If untreated, corneal ulcerations and blindness
may occur.

60. • Conjunctivitis caused by other bacteria has a
variable onset, ranging from 4 days to several
weeks after birth.
• Herpetic keratoconjunctivitis can occur as an
isolated infection or with disseminated or CNS
infection. It can be mistaken for bacterial or
chemical conjunctivitis, but the presence of
dendritic keratitis is pathognomonic.

61. • Diagnosis:
• Diagnostic Gram stain or Giemsa stain smears obtained from
genitourinary or ocular mucosal scrapings reveal characteristic
gram-negative intracellular diplococci.
• Conjunctival material is Gram stained, cultured for gonorrhea (eg,
on modified Thayer-Martin medium) and other bacteria, and tested
for chlamydia (eg, by culture, direct immunofluorescence, or
enzyme-linked immunosorbent assay [samples must contain cells]).
• Conjunctival scrapings can also be examined with Giemsa stain; if
blue intracytoplasmic inclusions are identified, chlamydial
ophthalmia is confirmed.
• Viral culture is done only if viral infection is suspected because of
skin lesions or maternal infection.

62. • Treatment:
• Systemic, topical, or combined antimicrobial therapy
• Neonates with conjunctivitis and known maternal gonococcal infection or
with gram-negative intracellular diplococci identified in conjunctival
exudates should be treated with ceftriaxone or cefotaxime.
• In chlamydial ophthalmia, systemic therapy is the treatment of choice,
because at least half of affected neonates also have nasopharyngeal
infection and some develop chlamydial
pneumonia. Erythromycin ethylsuccinate 12.5 mg/kg po q 6 h for 2 wk
or azithromycin 20 mg/kg po once/day for 3 days is recommended.
• A neonate with gonococcal ophthalmia is hospitalized for evaluation of
possible systemic gonococcal infection and given a single dose
of ceftriaxone 25 to 50 mg/kg IM or IV to a maximum dose of 125 mg.
Infants with hyperbilirubinemia or those receiving calcium-containing
fluids should not receive ceftriaxone and may be given a single dose
of cefotaxime 100 mg/kg IV or IM. Frequent saline irrigation of the eye
prevents secretions from adhering.

63. • Conjunctivitis due to other bacteria usually
responds to topical ointments containing
polymyxin plus bacitracin, erythromycin,
or tetracycline.
• Herpetic keratoconjunctivitis should be
treated (with an ophthalmologist’s
consultation) with systemic acyclovir 20 mg/kg
q 8 h for 14 to 21 days and topical
1% trifluridine ophthalmic drops or ointment

64. • Complications:
• If untreated, peripheral corneal ulceration may occur in N
gonorrhoeae infection and rapidly progress to corneal
perforation.
• When unrecognized and not immediately
treated, Pseudomonas infection may lead to
endophthalmitis and subsequent death.
• Pneumonia has been reported in 10-20% of infants with
chlamydial conjunctivitis.
• HSV keratoconjunctivitis can cause corneal scarring and
ulceration.
• Additionally, disseminated HSV infection often includes
central nervous system involvement.