The conjunctiva is a mucous membrane that lines the eyelids and eyeball. It has three parts and specialized folds. Conjunctivitis is inflammation of the conjunctiva that can be infectious, caused by bacteria, viruses, or chlamydia, or non-infectious, such as allergic, neoplastic, or immune-mediated. Signs of conjunctivitis include redness, discharge, and swelling. Different types of conjunctivitis produce different inflammatory reactions involving papillae or follicles. Vernal keratoconjunctivitis is a recurrent, seasonal allergic inflammation seen mainly in boys, characterized by papillae on the conjunctiva and other signs like

1. CONJUNCTIVA
Defn:- Conjunctiva is a translucent/transparent mucous membrane
which lines the posterior aspect of the eyelids and anterior aspect of the
eyeball.
Parts of conjunctiva:-
1) Bulbar Conjunctiva
2) Palpebral Conjunctiva
3) Conjunctival Fornix
Specialized folds:-
1) Caruncle
2) Plica semilunaris

2. Structure of Conjunctiva:-
Epithelium
Adenoid layer
Fibrous layer

3. Conjunctivitis
Defn:- Inflammation of conjunctiva
Types :-
1) Infectious:- Bacterial, Viral, Chlamydial
2) Non infectious:- Allergic, Neoplastic, Mechanical, immune
mediated

4. Signs of Conjunctivits
1) Hyperaemia /Congestion
2) Subconjuctival Haemorrhage
3) Chemosis
4) discharge

5. Inflammatory reactions of Conjunctiva
1) Papillae (hypertrophied vessel)
2) Follicles (lymphatic aggregates)
Note:-
1) Papillary reaction with MP discharge:- Bacterial
2) Papillary reaction with watery discharge:- Allergic
3) Follicular reaction with MP discharge:- Chlamydial
4) Follicular reaction with watery discharge:- Viral

6. Vernal Keratoconjunctivitis
- VKC is a recurrent, bilateral, interstitial, self-limiting, allergic inflammation of the
conjunctiva haaving a periodic seasonal incidence.
Etiopathogenesis:-
- VKC is found in individuals with predisposed atopic background, mainly associated with
Type 1 Hypersensitivity reaction(IgE mediated)
Predisposing Factors:-
- Age:- 5-20 yrs
- gender:- boys>girls
- Season:- spring and summer
- Other atopic conditions like eczema, asthama ,etc.

7. Pathology:-
1) Conjunctival epithelium in papillary region contains large number of mast cells, eosinophils and
undergoes hyperplasia
2) adenoid layer shows marked cellular infiltration by mast cells, eosinophils, plasma cells,
lymphocytes and Histiocytes
3) Fibrous layer shows proliferation which later on undergo hyaline change
4) conjunctival vessels also show proliferation, increased permeability and vasodilation
All these pathological changes lead to formation of multiple papillae in upper tarsal conjunctiva.

8. Symptoms:-
1) Marked burning and itching sensation
2) lacrimation
3) ropy discharge
4) heaviness of leads
5) Mild photophobia
Signs:-
1) Papillary Hypertrophy – “cobblestone appearance”
2) Horner Trantas Dots – collection of eosinophils and epithelial debris on the limbus
3) Pseudogerantoxin – it is a paralimbal grey white band of lipid deposition seen in
children
4) Shield ulcer- presents as a shallow transverse ulcer on upper part of cornea, ulceration
is due to enlargement of epitheial macroerosions
5) Maxwell lyon sign – ropy discharge
The excessive itching leads to greater incidence of keratoconus

9. Treatment:-
- Topical anti-histamines
- Topical mast cell stabilizers(sodium chromoglycate)
- Cold compression
- DOC:- dual action antihistamines and mast cell
stabilisers(olopatadine,azelastine,bepotastine)
- Topical Steroids ( for moderate to severe ) ( fluoro metholone,loteprednol)
- Topical immunomodulators ( cyclosporine,tacrolimus)
- toical lubricants and mucolytics should be used as adjuvants
- Surgical removal for extraordinary large papillae
- If keratopathy involved Surgical treatment is required.