This document summarizes common ear, eye, and skin disorders. It describes otitis media (inflammation of the middle ear), its types including acute suppurative and chronic suppurative otitis media. It also describes conjunctivitis, its causes and types including bacterial, viral, and trachoma. Finally, it discusses various skin conditions like infections (bacterial, viral, fungal), dermatitis, and malignant tumors (squamous cell carcinoma, basal cell carcinoma, melanoma).

1. Ear and eye disorders
• Otitis media
• Conjunctivitis

3. Otitis media
 Inflammation of the middle ear
 Common in children
 types
 Acute suppurative otitis media
 Serous otitis media
 Chronic suppurative otitis media

4. Acute suppurative otitis media
 Etiology
 Streptococcus pneumoniae
 Haemophilus influenzae

5. Acute suppurative otitis media
 Predisposing factors
 Recurrent upper respiratory tract infection
 Tonsillitis
 Cleft palate
 Route of infection
 Via eustachian tube
 Via external ear
 Haematogenous route (uncommon)

6. ASOM: Pathogenesis
 URTI- usually viral origin
 Edema of the nasopharyngeal end of ET
 ET blockage
 Negative pressure in the middle ear
 Promotes invasion of pyogenic organism
 Acute suppurative inflammation
 Tympanic membrane bulges outward and perforates
 Release of pus in the external ear
 Followed by resolution
 If persistence of infection spread of infection with
various complications

7. ASOM: Complications
 Acute mastoiditis
 Facial paralysis
 Labyrinthitis
 Extradural abscess
 Meningitis
 Brain abscess

8. Acute suppurative otitis media:
morphology
 Gross:
 Edematous and congested middle ear mucosa
 Haemorrhage
 Middle ear cavity may be filled with pus
 Microscopy:
 Neutrophilic infiltration in the mucosa
 Osteoclastic destruction of the mastoid bone
 Fibrosis

9. Serous otitis media
 Insidious onset
 Accumulation of non-purulent effusion in
the middle ear cleft

10. Chronic suppurative otitis media
 Chronic infection of the middle ear cleft
 Common in developing countries

11. Types of CSOM
 Tubotympanic- safe or benign type
 Atticoantral- unsafe or dangerous type

12. CSOM- tubotympanic type
 Involves anteroinferior part of middle ear
cleft
 Central perforation
 No risk of serious complications

13. CSOM- atticoantral type
 Involves posterosuperior part of middle ear
cleft (attic, antrum, posterior tympanum,
mastoid
 Attic perforation of tympanic membrane
 Associated with cholesteatoma
 Risk of serious complications

15. CSOM
 Etiology
 Sequelae of acute otitis media
 Causative organisms
 Gram negative bacilli
 proteus species
 pseudomaonas aeruginosa

16. CSOM- tubotympanic type:
Morphology
 Involvement of anteroinferior part of the middle
ear cleft with central perforation of tympanic
membrane
 Aural polyp (granulation tissue) protuding out
thru’ perforation
 Loss of ossicular bone

17. CSOM- atticoantral type:
morphology
 Involvement of posteriosuperior part of
middle ear with attic perforation of
tympanic membrane
 Osteitis
 Ossicular necrosis
 Cholesterol granulomas
 Cholesteatoma- stratified squamous
epithelium with underlying thin fibrous
stroma and central keratin debris- tendency
to erode bone and surrounding structures

18. Clinical features
‘TT’type
Ear discharge- mucoid or mucopurulent
Hearing loss- conductive type
Central Perforation
‘AA’ type
Ear discharge- foul smelly
Hearing loss- mostly conductive type
Bleeding
Attic perforation

20. ConjunctivitisConjunctivitis
 Inflammation of conjunctiva
RED EYE

21. Types of ConjunctivitisTypes of Conjunctivitis
 Based on duration
 Acute
 subacute
 Chronic

22. Conjunctivitis: etiologyConjunctivitis: etiology
 Infectious causes
 Bacterial
 Viral
 Fungal
 Chlamydial
 parasites
 Non-infectious
 Allergic
 Irritants
 Autoimmune
 Toxic
 Idiopathic

23. Bacterial conjunctivitisBacterial conjunctivitis
 Causative agents:
 Staphylococcus aureus (common)
 Haemophilius aegyptius
 H. influenzae
 clinically manifest as acute purulent or
mucopurulent conjunctivitis
 Conjunctiva
 Hyperemia, edema (chemosis)
 mucopurulent or purulent discharge

24. Viral conjunctivitisViral conjunctivitis
 Common causative agents
 Adenoviruses
 Paramyxoviruses
 Herpes simplex
 Watery clear or serous discharge

25. TrachomaTrachoma
 Form of chronic conjunctivitis (>4wks
duration)
 caused by chlamydia trochomatis serotypes
A,B,C
 Endemic in many parts of the world
 Contagious in the acute stages
 Common in unhygienic and crowded
surroundings
 One of the leading cause of blindness

26. TrachomaTrachoma
 WHO classification (FISTO)
 Trachomatous Follicles – active disease
 Trachoma Intense- severe disease requiring
urgent treatment
 Trachomatous Scarring- old inactive
disease
 Trachomatous Opacities- corneal opacities
with visual loss

27. Trachoma

28. Tumors of eye: classification
Eye lid tumor-
 Basal cell carcinoma,
 Sebaceous carcinoma

29. Contd.
Tumors of conjunctiva
 Benign: Squamous papilloma
Conjunctival nevi
 Malignant: Squamous cell carcinoma
Melanoma

30. Tumors of uvea(choroid, iris,
ciliary body)
 Benign-uveal nevi
 Malignant- melanoma

31. Tumors of retina
 Retinoblastoma
 Retinal lymphoma

32. Tumours of optic nerve
 Pilocytic astrocytoma
 Meningioma

33. Tumours of orbit:
Mesenchymal tumours
Benign
 Lipoma
 Haemangioma
 Schwannoma
 Neurofibroma
 Osteoma
 Chondroma
Malignant tumours
 Angiosarcoma
 Chondrosarcoma
 Malignant nerve
sheath tumours

34. Tumours of lacrimal gland
 Pleomorphic adenoma

35. Retinoblastoma
 Commonest intraocular malignancy
 Children
 Hereditary
 sporadic

36. Retinoblastoma: morphology
 Gross:
 exophytic or endophytic retinal growth
 Creamy whitish in colour with areas of
calcification
and necrosis

37. Retinoblastoma : microscopy
Sheets of small round cells with scant
cytoplasm and hyperchromatic nuclei
Flexner-Wintersteiner rosettes
Necrosis

38. Well differentiated retinoblastomaWell differentiated retinoblastoma

39. metastasis
 Brain
 Bone marrow
 Prognosis poor

41. Skin

42. Macroscopic terms
 Macule- flat circumscribed, 0.5cm
 Papule- raised, 0.5cm
 Vesicle-raised, fluid filled, 0.5cm
 Pustule- pus filled raised lesion
 Nodule- raised, >0.5cm

43. Skin diseases
 Infections
 Dermatitis
 Tumors

44. Skin infections
 Bacterial
 Viral
 fungal

45. Bacterial infections
 Furuncle, boil, carbuncle
 Impetigo

46. Furuncle/boil/carbuncle
 Causative organism- staphyoloccoci
 Hairy areas- face, axilla
 Furuncle- Focal suppurative inflammation
of the hair follicle
 Boil - abscess point
 Carbuncle- Deep suppuration beneath the
subcutaneous fascia and superficial
multiple sinuses

47. Boil and carbuncle

48. Impetigo
 Organisms:
 Group A beta hemolytic streptococci
 Staphylococcus aureus
 Common infection in children
 Site: Face, hands
 Gross examination- Erythematous macule to small
multiple pustules that ruptures and appears as honey
coloured crusted lesion
 Microscopic examination- subcorneal pustule

49. Viral infections
 Verrucae(warts)
 Cold sores(herpes simplex)

50. Verrucae (Wart)
 Caused by Human papilloma virus (HPV)
 Direct contact or autoinoculation
 Any age group
 Self limiting disease
 Verrucae vulgaris – common type – hands
 Flat to raised papules with rough surface
 Microscopy: Papillomatous hyperplasia

51. Herpes simplex virus infection
 Commonly known as Cold sores- mucocutaneous
junction
 Lip, nose
 Causative agent: HSV1 & HSV2
 Acute primary infection- replication of viruses in
the epidermis-> vesicular eruptions
 Latent infection-Via sensory nerve spread to the
sensory ganglion and remain in dormant phase
( no replication)
 Recurrent infection- reactivation of latent viruses-
spread to the skin and mucous membrane from
the affected ganglion

52. Superficial fungal infections
 Dermatophytes
 Candidiasis

53. Superficial dermatophytoses
 Limited to the stratum corneum
 Reservoirs- soil, animals

54. Types of dermatophytoses
 Tinea capitis- Scalp
 Tinea corporis-Body
 Tinea cruris- Inguinal region
 Tinea pedis- foot web space
 Tinea versicolor- Upper trunk
 Microscopic feature- Hyphae and yeast in
the stratum corneum

55. Tinea corporis (ring worm)
Appears as a circular scaly raised area
with clearing in the centre

56. Cutaneous candidiasis
 Yeast- candida albicans
 Nail, nail folds, webs of fingers and toes,
perineum of infants- diaper rash
 Microscopic features-Yeast like forms and
pseudohyphae

57. Cutaneous candidiasis

58. Dermatitis
 Inflammation of the skin secondary to
immune reaction
 Acute
 chronic

59. Acute eczematous dermatitis
 Acute immune mediated inflammatory
lesion
 Red papulovesicular oozing lesion

60. Pathogenesis
Delayed type of hypersensitivity reaction
 Exposure to antigen in the epidermis
 Sensitization of T lymphocytes and production of
T memory cells
 On repeated exposure to same antigen, T cells
recruitment at the site of antigenic exposure
 Release of cytokines
 Recruitment of inflammatory cells
 Inflammatory response
 Occurs within 24 hrs

61. Chronic dermatitis: Seborrheic
dermatitis
 Chronic inflammatory disease
 Region with high sebaceous glands- scalp,
forehead
 Fungal infection- malassezia furfur

62. Clinical appearnance
 Macules and papules with greasy base
 Scaling and crusting
 Dandruff of the scalp

63. Psoriasis
 Common chronic inflammatory disease
 All ages affected
 Association with- arthritis, myopathy,
enteropathy
 T cell mediated inflammation
 Results in proliferation of keratinocytes,
angiogenesis and inflammation

64. Clinical features
 Site of affection- elbows, knees, scalp,
lumbosacral areas, intergluteal cleft
 Scaly plaque- silver white in colour
 Nail changes-yellow brown discolouration
with pitting

65. Lichen planus
 Chronic inflammatory disorder
 Self limiting disease
 Cell mediated immune reaction
 Malignant transformation in chronic
mucosal lesions

66. Clinical features
 Itchy lesions
 Flat topped papule – coalesce – plaque
 Dark brown color in dark skinned
individual due to loss of melanin pigment
 Multiple lesions, symmetrical distribution-
extremities- wrist, elbows

68. Malignant Tumors of skin
 Squamous cell carcinoma
 Basal cell carcinoma
 Melanoma

69. Squamous cell carcinoma
 It is the 2nd
most common skin malignancy
 Sun exposed area
 Men>females
 Elderly age group

70. Predisposing factors
 Sun exposure
 Chronic ulcers
 Old burn scars
 Ionizing radiation
 Industrial exposure to carcinogens- tar

71. UV light – DNA damage- cancer
development

72. Squamous cell carcinoma
Cauliflower like growth or
Ulcerated lesion

73. Morphology
 Tumor arising from epidermal epithelium
 Invades basement membrane and infiltrates
underlying dermis
 Nests of malignant tumor cells
 Stratification
 Keratin pearls in well differentiated tumors
 Necrosis- poorly differentiated tumors

74. Squamous cell carcinoma

75. Basal cell carcinoma
 Most common skin tumors
 Sun exposed areas- face
 Slowly growing tumors
 Rarely metastasize
 Locally invasive- rodent ulcers

76. morphology
 Ulcerated lesion with pearly white border
Microscopic examination-
 Arises from the basal layer of the epidermis or
follicular epithelium
 Nest of tumor cells resembling basal layer of the
epidermis
 Peripheral palisading
 Retraction artifact
 Cells- small, scant cytoplasm, round to oval
hyperchromatic nuclei


77. Basal cell carcinoma

78. Basal cell carcinoma

79. Malignant melanoma