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Dr.s.veni priya 18.2.16 deg cyst tumors
- 1. CONJUNCTIVA- DEGENERATIONS , CYSTS & TUMOURS DR. S.VENI PRIYA , M.S
- 2. PLAN Degenerations : concretion , pingecula , pterygium Cysts Tumours – benign & malignant CONJUNCTIVAL DEGENERATIONS
- 3. Pinguela Pterygium Concretions Conjunctivochalasis DEGENERATIONS
- 4. CONCRETIONS Eldery patients Due to accumulation of epithelial cells & mucous in Crypts of Henle . Small,multiple, chalky, yellow- white deposits palpebral conjunctiva Treatment Removal with needle
- 5. Elastotic degeneration & hyaline infiltration in the submucous tissue. Yellow white raised lesion at the limbus in the palpberal aperture. (Pinguis – fat ) Treatment : not needed Inflammed – weak steroid – fluromethalone PINGUECULA
- 6. DEFINITION: A degenerative condition of the subconjunctival tissue Proliferates as vascularised granulation tissue to invade the cornea The word ‘pterygia’ – wing PTERYGIUM
- 7. ETIOLOGY Associated with prolonged UV exposure UV-B limbal stem cell p53 mutation apoptosis / TGF- growth • Dryness • Inflammation • Exposure to wind, dust or other irritants PTERYGIUM
- 8. PTERYGIUM – pathogenesis Elastotic degeneration – fragmentation and breakdown of stromal collagen Destruction of epithelium & Bowman’s layer by advancing fibrovascular tissue resulting in corneal scarring
- 9. PTERYGIUM – symptoms Fleshy growth in the palpebral aperture Visual acuity – reduced Astigmatism ,↑ glare, pupillary involvement Diplopia
- 10. Triangular fold of fleshy growth from conjunctiva seen encroaching on the cornea PTERYGIUM - SIGNS
- 11. PTERYGIUM – parts Cap Head - cornea Neck – limbus Body fleshy sheet ,superior and inferior folds Stocker’s line ?????????????
- 12. Types – on growth PROGRESSIVE PTERYGIUM Thick & Fleshy highly vascularised Cap present STATIONARY/ATRO PHIC PTERYGIUM Thin & pale No vascularisation No cap
- 13. Nasal Temporal DOUBLE (headed) PTERYGIUM TYPES – ON THE SITE
- 14. PTERYGIUM TYPES Type I –extends ≤ 2 mm onto cornea Type 2 – involve >2 - 4 mm of the cornea Type 3 – invade ≥ 4 mm of cornea & involve visual axis
- 15. CHANGES IN PTERYGIUM Inflammation Cyst formation Calcareous degeneration Malignancy – rarely PTERYGIUM
- 16. Surgical excision with conjunctival autograft / amniotic membrane INDICATION S: Type 2 / 3 pterygium Significant cosmetic blemish PTERYGIUM – treatment
- 17.
- 18. WHAT IS THE MOST COMMON DISADVANTAGE OF SURGICAL EXCISION ? recurrence HOW WILL YOU TREAT A RECURRENT PTERYGIUM? Surgical excision with amniotic membrane with MMC 0.02% TREATMENT
- 19. symblepharon – adhesion between palpebral & bulbar conjunctiva secondary to raw areas created by any inflammation ( membranous conjunctivitis ) or chemical injuries Which resembles a pterygium by appearance WHAT IS PSEUDOPTERYGIUM ?
- 21. TRUE PTERYGIUM PSEUDOPTERYGIUM Age - ≥ 40 yrs Any age Palpebral fissure region Anywhere Organisation into head,body and tail No such organisation Firm adhesion at limbus No such adhesion Probe test : cannot be passed under pterygium probe can be passed Always progressive initially Always stationary No such history History of severe conjunctivitis / chemical burns PTERYGIUM
- 22. What type of astigmatism is expected in Pterygium? What is Stocker’s line ? What is amniotic membrane ? From where will you harvest that ? What are the various modalities to prevent the recurrence of pterygium? Assignment
- 23. RETENTION CYST Asymptomatic Thin walled lesion with clear fluid Single / multiple TREATMENT Simple puncture
- 25. BENIGN Congenital – dermoid , dermolipoma Nevus Papilloma Pyogenic granuloma MALIGNANT Ocular surface squamous neoplasia Melanoma Lymphoma Kaposi sarcoma CLASSIFICATION
- 26. Choristomas – normal tissue in abmormal place DERMOID : Mass of collagenous tissue with dermal elements covered by stratified squamous epithelium DERMOLIPOMA : dermoid + fatty tissue Treatment : surgical excision Dermoid & dermolipoma
- 28. The most commom melanocytic conjunctival tumour Risk of malignant transformation is < 1% Signs of potential malignancy Prominent feeder vessels Sudden growth or increase in pigmentation NEVUS
- 29. TUMOURS –BENIGN PAPILLOMA HPV infection , type 6&11 Pink fibrovascular frond Sessile or pedunculated TREATMENT Large pedunculated lesion – EXCISION
- 30. PYOGENIC GRANULOMA Misnomer Proliferative fibrovascular response to prior tissue insult - inflammation, surgery, or nonsurgical trauma Elevated red mass, often with a florid blood supply
- 32. OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN) GELATINOUS LIMBAL SCC NODULAR SCC FLAT DIFFUSE SCC TREATMENT – wide surgical excision
- 33. MALIGNANT MELANOMA Limbus Usually pigmented Recurrences & metastasis are more common TREATMENT : Enucleation orbital exenteration
- 34. VASCULAR TUMOURS KAPOSI’S SARCOMA Elderly , immunocompromised person, HIV One or more reddish vascular masses that resemble a hemorrhagic conjunctivitis Chemotherapy / low dose radiotherapy
- 35. QUESTIONS PTERYGIUM CAUSE OF DEFECTIVE VISION IN PTERYGIUM HOW TO PREVENT RECURRENCES Types of pterygium Draw the pterygium & mark the parts
Editor's Notes
- Erodes through conjunctiva
- MECHANICAL stress on conj precipitated by dry eye
- Collagen shows basophilia , affinity for elastic tissue stains , but not digested by elastase
- Diplopia – symblepharon and decreased ocular motility
- Cap – grayish white avascular zone of variable size . superior and inferior folds separate it from normal conjunctiva
- Scc – limbus – transition zone. Low chances of penetration .
- Pigmented melanoma that arose de novo. B. Pigmented melanoma that arose from primary acquired melanosis. Note the flat extension of the melanoma into the cornea. C. Nonpigmented melanoma, recurrent following previous excisions.