The document summarizes diseases of the conjunctiva, including different types of conjunctivitis. It describes the anatomy of the conjunctiva and its parts. The main types of conjunctivitis discussed are bacterial, viral, allergic, and chemical conjunctivitis. Bacterial conjunctivitis commonly causes purulent discharge and is usually self-limiting. Viral conjunctivitis spreads easily and causes watery discharge. Allergic conjunctivitis like vernal catarrh causes itchiness and mucoid discharge. Chemical conjunctivitis results from exposure to irritants and causes a painful, red eye.

1. DISEASES OF THE CONJUNCTIVA

2. APPLIED ANATOMY
• The conjunctiva is a translucent mucous membrane which lines the
posterior surface of the eyelids and anterior aspect of eyeball.
• Parts of conjunctiva;
- Palpebral conjunctiva
- Bulbar conjunctiva
- Conjunctival fornix

3. PALBEBRAL CONJUCTIVA

4. CONJUNCTIVAL FORNIX

5. BULBAR CONJUCTIVA

6. DISEASE CLASSIFICATION
INFLAMMATIONS OF
CONJUNCTIVA
• Infective conjunctivitis –
- Bacterial
- Viral
- Chlamydial
• Allergic conjunctivitis
• Granulomatous conjunctivitis
DEGENERATIVE CONDITIONS
• Pinguecula
• Pterygium
• Concretions

7. SYMPTOMATIC CONDITIONS
• Hyperemia
• Xerosis
• Discoloration
• Sub conjunctival haemorrhage
• Chemosis

8. CONJUNCTIVITIS
• Conjunctivitis means inflammation of the
conjunctiva.
• Conjunctivitis is the commonest single diagnosis in
eye clinics throughout Africa.

9. ALL PATIENTS WITH CONJUNCTIVITIS HAVE SOME
SYMPTOMS AND SIGNS IN COMMON
1) Pain/Discomfort - usually described as a "foreign body
sensation"
2) Redness - The conjunctiva is red and inflamed.
3) Discharge - usually sticky, but also watery, or mucous.

10. DISCHARGE
1) Watery discharge is composed of a serous exudate and tears
and occurs in acute viral or acute allergic conjunctivitis
2) Mucoid discharge is typical of chronic allergic conjunctivitis
and dry eye
3) Mucopurulent discharge typically occurs in chlamydial or
acute bacterial infection
4) Moderately purulent discharge occurs in acute bacterial
conjunctivitis
5) Severe purulent discharge is typical of gonococcal infection

11. SIGNS OF CONJUNCTIVAL INFLAMMATION
(A) INJECTION; (B) HAEMORRHAGES; (C) CHEMOSIS; (D) PSEUDOMEMBRANE; (E) INFILTRATION; (F) SUBCONJUNCTIVAL
SCARRING

12. CONJUCTIVITIS
• It can be divided into:
1) Bacterial
2) Viral
3) Allergic
4) Chlamydial
5) Chemical
6) Granulomatous

13. BACTERIAL CONJUNCTIVITIS
• Commonly caused by Staphylococcus Aureus
• The patient has a gritty eye, with a purulent discharge
• The conjunctiva is red, particularly in the lower fornix,
where a purulent discharge may be visible
• The condition is self-limiting, but can be treated with
topical antibiotics, or regular face-washing

14. SIGNS AND SYMPTOMS

15. BACTERIAL CONJUNCTIVITIS - PURULENT DISCHARGE WITH MATTING OF EYELASHES

17. BACTERIAL CONJUNCTIVITIS. (A) EYELID EDEMA AND ERYTHEMA IN SEVERE INFECTION; (B) DIFFUSE CONJUNCTIVAL INJECTION
INVOLVING THE TARSAL AND FORNICEAL CONJUNCTIVA; (C) MUCOPURULENT DISCHARGE; (D) PROFUSE PURULENT DISCHARGE; (E)
SUPERIOR CORNEAL ULCERATION; (F) GRAM STAIN SHOWS KIDNEY-SHAPED DIPLOCOCCIC

18. GONOCOCCAL CONJUNCTIVITIS
• Rare but very serious form of bacterial conjunctivitis
caused by Neisseria Gonorrhea
• It usually affects very young babies, about 3-10 days old.
They become infected from their mother's genital tract
during birth
• The eyelids are very swollen, and there is a profuse
purulent discharge. Within 24 hours both corneas can be
totally destroyed and the child will be permanently blind
• Gonococcal conjunctivitis can also occur in adults

20. • Patients with a severe purulent conjunctivitis need an
immediate swab and gram stain of their discharge
• Treatment with half-hourly antibiotic drops, and
appropriate systemic treatment for gonorrhoea.

22. • (OPhthalmia neonatorum) can be prevented by cleaning the
eyes of babies at birth
• Additional protection may be provided by giving a drop of an
antibiotic or disinfectant (such as Silver Nitrate or Povidine
Iodine) into each eye.

23. VIRAL CONJUCTIVITIS
• Inflammation of the conjuctiva caused by the virus
• The two commonest viruses causing viral conjunctivitis outbreaks are:
-Adenovirus group
-Enterovirus 70 group
• Mainly occur in epidemics (schools work place)
• Transmitted by fingers, swimming pools
• The most common cause of viral conjunctivitis is adeno virus

24. SIGNS AND SYMPTOMS

25. ADENOVIRUS
• Adenovirus causes severe conjunctivitis, which may last for up to
four weeks
• Can be associated with small sub-epithelial corneal opacities,
which may take up to six months to disappear
• The patient will have follicles in the upper and lower fornices,
and the corneal opacities may be visible
• There is no specific treatment

26. ENTEROVIRUS70 GROUP
• Enterovirus causes acute hemorrhagic conjunctivitis
• This is a milder form of conjunctivitis, accompanied by sub-
conjunctival hemorrhages, which make the eye look worse
than it really is
• There is no specific treatment
• The condition resolves spontaneously in 1-2 weeks.

27. PRECAUTION
• Both types of viral conjunctivitis are very infectious, and
great care must be taken to avoid transmitting the disease
to other patients or to yourself!

28. ALLERGIC CONJUNCTIVITIS
• This is the most common form of conjunctivitis
• vernal catarrh is the commonest form of allergic conjuctivitis
• This is a chronic allergic condition that lasts 5-7 years before spontaneously
resolving
• It is common in young people, but rare in anyone over 20 years old
• It is found in cooler, higher areas of Kenya

29. SIGNS AND SYMPTOMS
• Itchy eyes,
• mucoid or watery discharge
• There are two types of vernal catarrh, limbal and tarsal.
• Patients with limbal vernal catarrh have large papillae around the limbus
• Those with tarsal vernal catarrh have papillae on the upper tarsal plate
• Many patients have both, but with one or other type predominating

30. TARSAL VERNAL DISEASE. (A) DIFFUSE PAPILLARY HYPERTROPHY; (B) MACROPAPILLAE; (C) GIANT PAPILLAE AND MUCUS;
(D) RELATIVELY INACTIVE DISEASE

31. LIMBAL VERNAL DISEASE. (A) SPARSE LIMBAL PAPILLAE; (B) PAPILLAE WITH HORNER–TRANTAS DOTS; (C) EXTENSIVE
PAPILLAE; (D) EXTREMELY SEVERE INVOLVEMENT

33. RX OF ALLERGIC CONJUNCTIVITIS
• Topical steroid drops make the eye feel much better, but the
disease recurs when the drops are stopped
• Long-term use of steroid drops may cause blindness
• Systemic steroids are more effective, but even more dangerous
• Unless there is corneal ulceration, oral steroids should be
avoided

34. • The patient can be reassured that the disease will get
better
• Immediate symptomatic relief can be obtained by washing
the eyes with clean cold water.
• Mast cell stabilizers drops
• Antihistamine drops
• Soothing agents

35. CHEMICAL CONJUNCTIVITIS
This is caused by exposure to an irritant chemical such as
• acids,
• tobacco
• smoke,
• snake venom, or the
• sap of certain trees- particularly Euphorbia spp.

36. PRESENTATION/RX
• There is usually hx of chemical entering the eye
• Patient has painful, watering, red eye
• If exposure took place within the preceding few hours, it
may be helpful to irrigate the conjunctival sac
• Antibiotic drops should be given to prevent secondary
infection

37. THANKS